Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study (original) (raw)
Related papers
The British journal of psychiatry : the journal of mental science, 2016
Anxiety disorders are common, and cognitive-behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980). Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. No variants passed a genome-wide significance threshold (P = 5×10(-8)) in either analysis. Four variants met criteria for suggestive significance (P<5×10(-6)) in association with response post-treatment, and t...
Journal of Consulting and Clinical Psychology, 2013
Objective-This study evaluated follow-up outcomes associated with cognitive-behavioral therapy (CBT) for childhood anxiety by comparing successfully and unsuccessfully treated participants 6.72 to 19.17 years after treatment. Method-Participants were a sample of 66 youth (ages 7 to 14 at time of treatment, ages 18 to 32 at present follow-up) who had been diagnosed with an anxiety disorder and randomized to treatment in a randomized clinical trial on average 16.24 (SD = 3.56, Range = 6.72-19.17) years prior. The present follow-up included self-report measures and a diagnostic interview to assess anxiety, depression, and substance misuse. Results-Compared to those who responded successfully to CBT for an anxiety disorder in childhood, those who were less responsive had higher rates of Panic Disorder, Alcohol Dependence, and Drug Abuse in adulthood. Relative to a normative comparison group, those who were less responsive to CBT in childhood had higher rates of several anxiety disorders and substance misuse problems in adulthood. Participants remained at particularly increased risk, relative to the normative group, for Generalized Anxiety Disorder and Nicotine Dependence regardless of initial treatment outcome. Conclusions-The present study is the first to assess the long-term follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety, depression, and substance abuse through the period of young adulthood when these disorders are often seen. Results support the presence of important long-term benefits of successful early CBT for anxiety. Keywords Cognitive-behavioral therapy; anxiety; child anxiety; treatment outcome; long-term follow-up Anxiety disorders are common in youth (e.g., Bernstein & Borchardt, 1991) and adults, based on 12-month prevalence estimates from the general population (Kessler, Chui, Demler, & Walters, 2005) and across the lifespan (28.8%; Kessler, Berglund, Demler, Jin, & Walters, 2005). Approximately 10 to 20% of children in the general population and primary care settings report distressing levels of anxiety (Chavira,
Assessment and Treatment of Anxiety Disorders in Children and Adolescents HHS Public Access
Recent advances in the developmental epidemiology, neurobiology and treatment of pediatric anxiety disorders have increased our understanding of these conditions and herald improved outcomes for affected children and adolescents. This article reviews the current epidemiology, longitudinal trajectory, and neurobiology of anxiety disorders in youth. Additionally, we summarize the current evidence for both psychotherapeutic and psychopharmacologic treatments of fear-based anxiety disorders (e.g., generalized, social and separation anxiety disorders) in children and adolescents. Current data suggest that these disorders begin in childhood and adolescence, exhibit homotypic continuity and increase the risk of secondary anxiety and mood disorders. Psychopharmacologic trials involving selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SSNRIs) are effective in pediatric patients with anxiety disorders and have generally demonstrated moderate effect sizes. Additionally, current data support cognitive-behavioral therapy (CBT) are efficacious in the treatment of these conditions in youth and that combination of CBT + an SSRI may be associated with greater improvement than would be expected with either treatment as monotherapy. Keywords antidepressant; selective serotonin reuptake inhibitor (SSRI); anxiety disorders; separation anxiety disorder (SAD); social phobia (SoP); generalized anxiety disorder (GAD)
External validation of comorbid patterns of anxiety disorders in children and adolescents
Journal of Anxiety Disorders, 2007
To evaluate the external validity of comorbid patterns of anxiety disorders among youth who presented to an anxiety disorders clinic, comorbid cases were compared to "pure" anxiety disorder cases. Children and adolescents (N = 329; mean age = 10.04 years) and parents were administered structured interviews and four groups were formed, Pure Anxiety, Anxiety + Anxiety, Anxiety + Externalizing, and Anxiety + Depressive, and compared along 4 external validation criteria: sociodemographics, clinical phenomenology, psychosocial, and family factors. All comorbid groups were more severe than the pure anxiety group on clinical phenomenology and psychosocial factors. The Anxiety + Depressive Disorders group was most severe on all criteria except sociodemographics. Results provide evidence for the external validity of comorbid diagnostic presentations among anxiety disorders, as there was differential meaningfulness in the diagnostic presentation of a pure anxiety disorder versus anxiety disorder comorbid with other disorders. Assessment and future research implications are discussed.
Development and Psychopathology, 2002
With advancements in the technology of prevention and treatment of childhood anxiety disorders, information regarding our understanding of normal and abnormal child development can be enriched. Typically, research has focused on developing efficacious and effective interventions with less attention devoted to the impact this information may have on the field of developmental psychopathology. By reviewing the results of both treatment and prevention studies, several potential contributions of intervention research to the field can be explored. Results from wait-list or monitoring control groups will be reviewed, providing valuable information regarding the normal trajectory of the anxious child. Outcomes of children receiving the intervention prove that this pathway can be altered and is not impermeable. Furthermore, a review of long-term follow-up studies addresses the question of whether intervention can change the long-term trajectory of an anxiety-disordered child and prevent disorders in later life. Contributions to the etiological understanding of the anxiety disorders will also be reviewed: changes in variables considered important in the etiology and maintenance of disorder can be examined in synchronicity with changes in symptomatology following intervention. An examination of potential developmental predictors of treatment outcome will also contribute to this review, with a focus on the limitations of the current research in gaining a complete understanding of the relationship between developmental level and outcome. Directions regarding future research in the study of interventions for child and adolescent anxiety disorders will be discussed with the aim of promoting further communication between intervention research and the field of developmental psychopathology.
Incidence, recurrence and comorbidity of anxiety disorders in four major developmental stages
Journal of affective disorders, 2018
Anxiety disorders are common in childhood, adolescence, and adulthood, and frequently comorbid with other mental disorders. The main aim of the present study was to examine the incidence, recurrence and comorbidity rates of anxiety disorders across four developmental periods, namely, during childhood (5 - 12.9 years), adolescence (13 - 17.9 years), emerging adulthood (18 - 23.9 years), and adulthood (24 - 30 years). Eight hundred and sixteen participants from a large community sample were interviewed twice during adolescence, at age 24, and at age 30. They completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and adulthood. The result showed first incidence of anxiety disorders to be significantly higher in childhood and adulthood than in adolescence and emerging adulthood. Female gender was associated with first incidence, but not with recurrence. Significant comorbidity was found between anxiety disorders and major ...
Naturalistic Follow-up of Youths Treated for Pediatric Anxiety Disorders
JAMA Psychiatry, 2014
IMPORTANCE Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication. OBJECTIVE To determine whether acute clinical improvement and treatment type (ie, cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up.
Journal of Consulting and Clinical Psychology, 2014
We sought to examine predictors and moderators of treatment outcomes among 488 youths ages 7-17 years (50% female; 74% Յ 12 years) meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) criteria for diagnoses of separation anxiety disorder, social phobia, or generalized anxiety disorder who were randomly assigned to receive
Journal of the American Academy of Child and Adolescent Psychiatry, 2017
Objective-To determine optimal percent reduction and raw score cutoffs on the parent-and child-report Screen for Child Anxiety Related Emotional Disorders (SCARED) for predicting treatment response and remission among youth with anxiety disorders. Method-Data were from youth (N = 438; ages 7-17 years) who completed treatment in the Child/Adolescent Anxiety Multimodal Study, a multi-site, randomized clinical trial that examined the relative efficacy of medication (sertraline), cognitive-behavioral therapy (Coping Cat), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The parent-and youth-report SCARED were administered at pre-and posttreatment. Quality receiver operating characteristic methods evaluated the performance of various SCARED percent reductions and absolute cutoff scores in predicting treatment response and remission, as defined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule. Results-Reductions of 55% on the SCARED-Parent and 50% on the SCARED-Youth optimally predicted treatment response. Posttreatment absolute raw scores of 10 (SCARED-Parent) and 12 (SCARED-Youth) optimally predicted remission in the total sample, though separate SCARED-Parent cutoffs for children (12-13) and adolescents (9) showed greatest quality of efficiency. Each cutoff significantly predicted response and remission at 6-month follow-up. Conclusion-Results serve as guidelines for operationalizing treatment response and remission on the SCARED, which may help clinicians systematically monitor treatment outcomes of youth with anxiety disorders in a cost-and time-efficient manner. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov/; NCT00052078.