In this randomized study, children and adolescents with primary diagnoses of separation anxiety or generalized anxiety disorders or social phobia received cognitive behavioral therapy, sertraline, a ...combination of these treatments, or placebo for 12 weeks. The results indicate that both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders, and a combination of the two therapies had superior response rates.
The results of this study indicate that both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders, and a combination of the two therapies had superior response rates.
Anxiety disorders are common in children and cause substantial impairment in school, in family relationships, and in social functioning.
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Such disorders also predict adult anxiety disorders and major depression.
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Despite a high prevalence (10 to 20%
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) and substantial morbidity, anxiety disorders in childhood remain underrecognized and undertreated.
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An improvement in outcomes for children with anxiety disorders would have important public health implications.
In clinical trials, separation and generalized anxiety disorders and social phobia are often grouped together because of the high degree of overlap in symptoms and the distinction from other anxiety disorders (e.g., . . .
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.
Objective: To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy ...(CBT), both sertraline and CBT (COMB), or a pill placebo. Method: Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each candidate predictor or moderator variable were examined using a general linear model on the adjusted predicted week 12 CY-BOCS scores. Results: Youth with lower obsessive-compulsive disorder (OCD) severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had more than a sixfold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD. Conclusions: Greater attention is needed to build optimized intervention strategies for more complex youth with OCD. Youth with a family history of OCD are not likely to benefit from CBT unless offered in combination with an SSRI. (Contains 5 tables.)
Objective: Few studies have examined predictors of parental accommodation (assessed with the Family Accommodation Scale-Parent Report) among families of children with obsessive-compulsive disorder ...(OCD). No studies have examined this phenomenon using empirically derived subscales of the Family Accommodation Scale-Parent Report (i.e., Caregiver Involvement, Avoidance of Triggers). Method: Ninety-six youths (and their families) were included in the present study. Parents were asked to complete the Family Accommodation Scale-Parent Report. Families also completed several additional measurements assessing child-and parent-level variables of interest. Regression analyses were used to examine potential predictors of accommodation. Results: Results support prior research suggesting that accommodation is ubiquitous among the families of children with OCD. Analyses revealed that several child-level (i.e., compulsion severity, oppositional behavior, and frequency of washing symptoms) and one parent-level (i.e., symptoms of anxiety) predictors work jointly to provide significant predictive models of parental accommodation. Conclusions: Clinicians and researchers should be aware of the impact of specific child- and parent-level variables on family accommodation in pediatric OCD and in turn their implications for treatment compliance, adherence, and, by extension, outcome. Study limitations warrant replication and extension of these findings; in particular, researchers may seek to obtain a better understanding of how the various facets of parental accommodation may differentially affect treatment. (Contains 3 tables.)
Most major psychiatric disorders have an onset in childhood or adolescence in a sizeable proportion of patients, and earlier onset disorders often have a severe and chronic course that can seriously ...disrupt sensitive developmental periods, with lifelong adverse consequences. Accordingly, psychopharmacologic treatments have been increasingly utilized in severely ill youth. However, the increased use of psychopharmacologic treatments in pediatric patients has also raised concerns regarding a potential overdiagnosis and overtreatment of youth, without adequate data regarding the pediatric efficacy and safety of psychotropic agents. Over the past decade, a remarkable number of pediatric randomized controlled trials have been completed, especially with psychostimulants, antidepressants, and antipsychotics. For these frequently used agents, effect sizes against placebo have typically been at least moderate, with most numbers-needed-to-treat well below 10 for response, indicating clinical significance as well. Nevertheless, data also point to a greater and/or different profile of susceptibility to adverse effects in pediatric compared to adult patients, as well as to a role for nonpharmacologic treatments, given alone or combined with pharmacotherapy, for many of the youth. Taken together, these results highlight the need for a careful assessment of the risk-benefit relationship of psychopharmacologic treatments in patients who cannot be managed sufficiently with nonpharmacologic interventions and for routine, proactive adverse effect monitoring and management. Although considerable progress has been made, there is still enormous need for additional data and funding of pediatric psychopharmacology trials. It is hoped that the field will acquire the necessary resources to propel pediatric clinical psychopharmacology to new levels of insight by linking it with, but not replacing it by, pharmacoepidemiologic and biomarker approaches and advances.
Objective: To review the literature on the cognitive-behavioral treatment of children and adolescents with anxiety and depressive disorders within the conceptual framework of evidence-based medicine. ...Method: The psychiatric and psychological literature was systematically searched for controlled trials applying cognitive-behavioral treatment to pediatric anxiety and depressive disorders. Results: For both anxiety and depression, substantial evidence supports the efficacy of problem-specific cognitive-behavioral interventions. Comparisons with wait-list, inactive control, and active control conditions suggest medium to large effects for symptom reduction in primary outcome domains. Conclusions: From an evidence-based perspective, cognitive-behavioral therapy is currently the treatment of choice for anxiety and depressive disorders in children and adolescents. Future research in this area will need to focus on comparing cognitive-behavioral psychotherapy with other treatments, component analyses, and the application of exportable protocol-driven treatments to divergent settings and patient populations.
CONTEXT The empirical literature on treatment of obsessive-compulsive disorder
(OCD) in children and adolescents supports the efficacy of short-term OCD-specific
cognitive-behavior therapy (CBT) or ...medical management with selective serotonin
reuptake inhibitors. However, little is known about their relative and combined
efficacy. OBJECTIVE To evaluate the efficacy of CBT alone and medical management with the
selective serotonin reuptake inhibitor sertraline alone, or CBT and sertraline
combined, as initial treatment for children and adolescents with OCD. DESIGN, SETTING, AND PARTICIPANTS The Pediatric OCD Treatment Study, a balanced, masked randomized controlled
trial conducted in 3 academic centers in the United States and enrolling a
volunteer outpatient sample of 112 patients aged 7 through 17 years with a
primary Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition diagnosis of OCD and a Children’s Yale-Brown Obsessive-Compulsive
Scale (CY-BOCS) score of 16 or higher. Patients were recruited between September
1997 and December 2002. INTERVENTIONS Participants were randomly assigned to receive CBT alone, sertraline
alone, combined CBT and sertraline, or pill placebo for 12 weeks. MAIN OUTCOME MEASURES Change in CY-BOCS score over 12 weeks as rated by an independent evaluator
masked to treatment status; rate of clinical remission defined as a CY-BOCS
score less than or equal to 10. RESULTS Ninety-seven of 112 patients (87%) completed the full 12 weeks of treatment.
Intent-to-treat random regression analyses indicated a statistically significant
advantage for CBT alone (P = .003), sertraline
alone (P = .007), and combined treatment
(P = .001) compared with placebo. Combined
treatment also proved superior to CBT alone (P = .008)
and to sertraline alone (P = .006), which
did not differ from each other. Site differences emerged for CBT and sertraline
but not for combined treatment, suggesting that combined treatment is less
susceptible to setting-specific variations. The rate of clinical remission
for combined treatment was 53.6% (95% confidence interval CI, 36%-70%);
for CBT alone, 39.3% (95% CI, 24%-58%); for sertraline alone, 21.4% (95% CI,
10%-40%); and for placebo, 3.6% (95% CI, 0%-19%). The remission rate for combined
treatment did not differ from that for CBT alone (P = .42)
but did differ from sertraline alone (P = .03)
and from placebo (P<.001). CBT alone did not differ
from sertraline alone (P = .24) but did
differ from placebo (P = .002), whereas
sertraline alone did not (P = .10). The
3 active treatments proved acceptable and well tolerated, with no evidence
of treatment-emergent harm to self or to others. CONCLUSION Children and adolescents with OCD should begin treatment with the combination
of CBT plus a selective serotonin reuptake inhibitor or CBT alone.
Objective: To evaluate the relative efficacy of (1) individual cognitive-behavioral family-based therapy (CBFT); (2) group CBFT; and (3) a waitlist control group in the treatment of childhood ...obsessive-compulsive disorder (OCD). Method: This study, conducted at a university clinic in Brisbane, Australia, involved 77 children and adolescents with OCD who were randomized to individual CBFT, group CBFT, or a 4- to 6-week waitlist control condition. Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews, symptom severity interviews, and self-report measures. Parental distress, family functioning, sibling distress, and levels of accommodation to OCD demands were also assessed. Active treatment involved a manualized 14-week cognitive-behavioral protocol, with parental and sibling components. Results: By an evaluable patient analysis, statistically and clinically significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT, with no significant differences in improvement ratings between these conditions. There were no significant changes across measures for the waitlist condition. Treatment gains were maintained up to 6 months of follow-up. Conclusions: Contrary to previous findings and expectations, group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment. Findings support the efficacy and durability of CBFT in treating childhood OCD.
Objective:
The purpose of this report was to summarize the key clinical messages from the Treatment for Adolescents with Depression Study (TADS).
Methods:
TADS is a National Institute of Mental ...Health (NIMH)-funded randomized controlled trial designed to evaluate the relative effectiveness of fluoxetine, cognitive-behavioral therapy (CBT), and the combination of fluoxetine plus CBT across acute treatment, maintenance treatment, and naturalistic follow-up periods among adolescents with major depressive disorder.
Results:
Findings revealed that 6 to 9 months of combined fluoxetine plus CBT should be the modal treatment from a public health perspective as well as to maximize benefits and minimize harms for individual patients.
Conclusion:
The combination of fluoxetine and CBT appears to be superior to both CBT monotherapy and fluoxetine monotherapy as a treatment for moderate to severe major depressive disorder in adolescents.
The objective of this study is to evaluate the psychometrics and clinical efficiency of the Multidimensional Anxiety Scale for Children (MASC), which measures physical symptoms, harm avoidance, ...social anxiety, and separation/panic. Using a sample of 190 treatment-seeking Norwegian youth (aged 7-13 years, M
age
= 10.3 years, 62.1% male), the internal stability and ability to predict to disorder were examined for child, mother, and father reports on the MASC. Moderate to strong internal reliability was exhibited across all MASC subscales. Parent-child agreement was low, but mother-father agreement was high. MASC scores successfully distinguished between children with and without anxiety disorders and identified youth with separation anxiety disorder and social phobia, but less accurately generalized anxiety disorders. The MASC has favorable psychometric properties and is a useful screening instrument for identifying youth with anxiety disorders.
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