Golda S Ginsburg1, Emily M Becker2, Courtney P Keeton1, Dara Sakolsky3, John Piacentini4, Anne Marie Albano5, Scott N Compton6, Satish Iyengar3, Kevin Sullivan6, Nicole Caporino7, Tara Peris4, Boris Birmaher3, Moira Rynn5, John March6, Philip C Kendall7. 1. Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland. 2. Department of Psychology, University of Miami, Coral Gables, Florida. 3. Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania. 4. Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California. 5. Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York. 6. Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina. 7. Department of Psychology, Temple University, Philadelphia, Pennsylvania.
Abstract
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 (i.e., 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. DESIGN, SETTING, AND PARTICIPANTS: This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample. EXPOSURES: Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use. MAIN OUTCOMES AND MEASURES: Remission, defined as the absence of all study entry anxiety disorders. RESULTS Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified. CONCLUSIONS AND RELEVANCE: Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00052078.
RCT Entities:
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 (i.e., 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. DESIGN, SETTING, AND PARTICIPANTS: This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample. EXPOSURES: Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use. MAIN OUTCOMES AND MEASURES: Remission, defined as the absence of all study entry anxiety disorders. RESULTS Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified. CONCLUSIONS AND RELEVANCE: Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00052078.
Authors: Philip C Kendall; Scott N Compton; John T Walkup; Boris Birmaher; Anne Marie Albano; Joel Sherrill; Golda Ginsburg; Moira Rynn; James McCracken; Elizabeth Gosch; Courtney Keeton; Lindsey Bergman; Dara Sakolsky; Cindy Suveg; Satish Iyengar; John March; John Piacentini Journal: J Anxiety Disord Date: 2010-02-06
Authors: Ronald C Kessler; Shelli Avenevoli; Jennifer Green; Michael J Gruber; Margaret Guyer; Yulei He; Robert Jin; Joan Kaufman; Nancy A Sampson; Alan M Zaslavsky; Kathleen R Merikangas Journal: J Am Acad Child Adolesc Psychiatry Date: 2009-04 Impact factor: 8.829
Authors: Scott N Compton; John T Walkup; Anne Marie Albano; John C Piacentini; Boris Birmaher; Joel T Sherrill; Golda S Ginsburg; Moira A Rynn; James T McCracken; Bruce D Waslick; Satish Iyengar; Phillip C Kendall; John S March Journal: Child Adolesc Psychiatry Ment Health Date: 2010-01-05 Impact factor: 3.033
Authors: Andrea Chronis-Tuscano; Christina M Danko; Kenneth H Rubin; Robert J Coplan; Danielle R Novick Journal: J Clin Child Adolesc Psychol Date: 2018-02-06
Authors: Joseph F McGuire; Scott P Orr; Joey K-Y Essoe; James T McCracken; Eric A Storch; John Piacentini Journal: Expert Rev Neurother Date: 2016-06-27 Impact factor: 4.618
Authors: Emily M Becker-Haimes; Kelsie H Okamura; Courtney Benjamin Wolk; Ronnie Rubin; Arthur C Evans; Rinad S Beidas Journal: J Anxiety Disord Date: 2017-04-27
Authors: Anna M Wehry; Katja Beesdo-Baum; Meghann M Hennelly; Sucheta D Connolly; Jeffrey R Strawn Journal: Curr Psychiatry Rep Date: 2015-07 Impact factor: 5.285
Authors: Muhammet Emin Naldan; Ali Karayagmurlu; Elif Oral Ahıskalıoglu; Mehmet Nuri Cevizci; Pelin Aydin; Duygu Kara Journal: Pediatr Surg Int Date: 2018-05-04 Impact factor: 1.827
Authors: Matti Cervin; Lesley A Norris; Golda Ginsburg; Elizabeth A Gosch; Scott N Compton; John Piacentini; Anne Marie Albano; Dara Sakolsky; Boris Birmaher; Courtney Keeton; Eric A Storch; Philip C Kendall Journal: J Am Acad Child Adolesc Psychiatry Date: 2020-09-17 Impact factor: 8.829