This month’s issue of European Child and Adolescent Psychiatry contains a nice set of well-conducted studies involving children and adolescents as research subjects. Isolan et al. (REF) studied children and adolescents from the general population in Brazil and found that being a victim of bullying is clearly associated with more anxiety symptoms. While this being a single time point observational study made it not possible to demonstrate causality, the authors rightly argue that the relationship between being bullied and symptoms of anxiety most probably is bidirectional in nature. On one hand being bullied is a considerable source of distress, which may increase anxiety symptoms; conversely, anxiety and anxious behavior could make a child appear more nervous and uncomfortable with peers and thus more vulnerable to aggressive peers and make him a possible target of further victimization. Another study in this issue, from the Netherlands, addressed the cost-effectiveness of different screening strategies to prevent anxiety (Simon REF this issue). Screening and offering a parent-focused intervention to children of anxious parents, and a child-focused intervention to children of non-anxious parents, was found to be the most cost-effective approach. The study has clear implications for policy makers. In perhaps the most intriguing study of the current issue, Schmitz and colleagues (REF this issue) investigated a range of autonomic measurements in three different domains (cardiac, vascular, and electrodermal sympathetic activation) prior to, during, and after a social stress task in a sample of high and low socially anxious. The high socially anxious children showed blunted cardiac response to the social stress task pointing to restricted cardiac flexibility in these children. The authors conclude that this demonstrates that social anxiety cannot be considered a mere cognitive phenomenon, which has clear consequences of our understanding and best treatment of this impairing condition. When reading the article of Schmitz et al., few readers if any will pay much attention to an almost ubiquitous single sentence within the paper’s methods section: The current study was approved by the local ethics committee. The amount of work and time behind this simple sentence, however, is not to be underestimated, especially when it comes to non-commercial clinical trials. For example, Hackshaw et al. [1] demonstrated that it took more than half of the UK sites involved in a multicenter trial more than 6 months to get full ethical approval for a relatively straightforward low-risk treatment study, with delays of 12 months or more until approval being quite common. Whereas already the process of designing a study, obtaining agreement for drug supply from the pharmaceutical industry, and submitting the trial for funding can rarely be achieved in less than 12–18 months, a further delay of almost a year to recruit the first patient could clearly make Europe less attractive for the conduct of clinical trials. Hackshaw et al. [1] point out that such a delay not only extends the duration of a trial, but also increases its cost. Employing a trial coordinator for an extra year might cost about €50,000, so for every ten trials that need to be P. J. Hoekstra (&) Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands e-mail: p.hoekstra@accare.nl