Paeds Cases · mental-behavioural-and-psychosomatic
Explain childhood anxiety and the stepped-care plan to parents — OSCE
OSCE communication station: anxiety psychoeducation, the worry cycle, multi-informant assessment, exposure-based CBT, when an SSRI such as sertraline is considered, and activation and suicidality monitoring, framed without blame.
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Target exams
MRCPCH ClinicalRACP DCE
Prompt
Parents of a 12-year-old with separation and social anxiety, partial school attendance, morning stomach aches that remit at home, and a request to understand whether the problem is real, whether they caused it, how exposure CBT works, when an SSRI such as sertraline might be added, and how to monitor for activation and suicidal thoughts.
Candidate instructions
Explain that anxiety disorders are real, common and treatable (not bad parenting or attention-seeking), outline the worry cycle and how exposure-based CBT helps the brain learn the threat is survivable, discuss reducing accommodation without blame, cover when an SSRI such as sertraline might be added and how you monitor for activation and suicidal thoughts, check understanding, and agree a shared plan. The examiner plays a parent. [1] [2] [3]
References5ShowHide
- [1]Walkup JT, Albano AM, Piacentini J, Birmaher B, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med, 2008.PMID 18974308
- [2]Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders. J Am Acad Child Adolesc Psychiatry, 2020.PMID 32439401
- [3]James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev, 2020.PMID 33196111
- [4]Bridge JA, Iyengar S, Salary CB, Barbe RP, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA, 2007.PMID 17440145
- [5]Birmaher B, Khetarpal S, Brent D, Cully M, et al. The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry, 1997.PMID 9100430