Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial.

Abstract

OBJECTIVE:

We sought to examine predictors and moderators of treatment outcomes among 488 youths ages 7-17 years (50% female; 74% ≤ 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 either cognitive behavioral therapy (CBT), sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) in the Child/Adolescent Anxiety Multimodal Study (CAMS).

METHOD:

Six classes of predictor and moderator variables (22 variables) were identified from the literature and examined using continuous (Pediatric Anxiety Ratings Scale; PARS) and categorical (Clinical Global Impression Scale-Improvement; CGI-I) outcome measures.

RESULTS:

Three baseline variables predicted better outcomes (independent of treatment condition) on the PARS, including low anxiety severity (as measured by parents and independent evaluators) and caregiver strain. No baseline variables were found to predict Week 12 responder status (CGI-I). Participants' principal diagnosis moderated treatment outcomes but only on the PARS. No baseline variables were found to moderate treatment outcomes on Week 12 responder status (CGI-I).

DISCUSSION:

Overall, anxious children responded favorably to CAMS treatments. However, having more severe and impairing anxiety, greater caregiver strain, and a principal diagnosis of social phobia were associated with less favorable outcomes. Clinical implications of these findings are discussed.

• Authors: Scott N Compton, Tara S Peris, Daniel Almirall, Boris Birmaher, Joel Sherrill, Phillip C Kendall, John S March, Elizabeth A Gosch, Golda S Ginsburg, Moira A Rynn, John C Piacentini, James T McCracken, Courtney P Keeton, Cynthia M Suveg, Sasha G Aschenbrand, Dara Sakolsky, Satish Iyengar, John T Walkup, Anne Marie Albano
• Journal: Journal of consulting and clinical psychology (J Consult Clin Psychol) Vol. 82 Issue 2 Pg. 212-24 (Apr 2014) ISSN: 1939-2117 [Electronic] United States
• PMID: 24417601 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)

Chemical References

• Serotonin Uptake Inhibitors
• Sertraline

Topics

• Adolescent
• Anxiety Disorders (drug therapy, psychology, therapy)
• Child
• Cognitive Behavioral Therapy (methods)
• Combined Modality Therapy
• Female
• Humans
• Male
• Selective Serotonin Reuptake Inhibitors (therapeutic use)
• Sertraline (therapeutic use)
• Socioeconomic Factors
• Treatment Outcome