Defining treatment response and remission in child anxiety: signal detection analysis using the pediatric anxiety rating scale.

Abstract

OBJECTIVE:

To determine optimal Pediatric Anxiety Rating Scale (PARS) percent reduction and raw score cut-offs for predicting treatment response and remission among children and adolescents with anxiety disorders.

METHOD:

Data were from a subset of youth (N = 438; 7-17 years of age) who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multi-site, randomized controlled trial that examined the relative efficacy of cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline [SRT]), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The clinician-rated PARS was administered pre- and posttreatment (delivered over 12 weeks). Quality receiver operating characteristic methods assessed the performance of various PARS percent reductions and absolute cut-off scores in predicting treatment response and remission, as determined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule for DSM-IV. Corresponding change in impairment was evaluated using the Child Anxiety Impact Scale.

RESULTS:

Reductions of 35% and 50% on the six-item PARS optimally predicted treatment response and remission, respectively. Post-treatment PARS raw scores of 8 to 10 optimally predicted remission. Anxiety improved as a function of PARS-defined treatment response and remission.

CONCLUSIONS:

Results serve as guidelines for operationalizing treatment response and remission in future research and in making cross-study comparisons. These guidelines can facilitate translation of research findings into clinical practice.

• Authors: Nicole E Caporino, Douglas M Brodman, Philip C Kendall, Anne Marie Albano, Joel Sherrill, John Piacentini, Dara Sakolsky, Boris Birmaher, Scott N Compton, Golda Ginsburg, Moira Rynn, James McCracken, Elizabeth Gosch, Courtney Keeton, John March, John T Walkup
• Journal: Journal of the American Academy of Child and Adolescent Psychiatry (J Am Acad Child Adolesc Psychiatry) Vol. 52 Issue 1 Pg. 57-67 (Jan 2013) ISSN: 1527-5418 [Electronic] United States
• PMID: 23265634 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2013 American Academy of Child and Adolescent Psychiatry. All rights reserved.

Chemical References

• Serotonin Uptake Inhibitors
• Sertraline

Topics

• Adolescent
• Anxiety Disorders (diagnosis, psychology, therapy)
• Child
• Cognitive Behavioral Therapy
• Combined Modality Therapy
• Female
• Humans
• Male
• Personality Inventory (statistics & numerical data)
• Psychometrics
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sertraline (therapeutic use)
• Signal Detection, Psychological
• Surveys and Questionnaires