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Rabner J, Olino TM, Albano AM, Keeton CP, Sakolsky D, Birmaher B, Piacentini J, Peris TS, Compton SN, Gosch E, Ginsburg GS, Pinney EL, Kendall PC. Substance use outcomes from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). J Child Psychol Psychiatry 2024; 65:910-920. [PMID: 38217328 DOI: 10.1111/jcpp.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3-12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use). METHODS The sample was from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), a naturalistic follow-up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7-17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11-26 years) at the time of the first CAMELS follow-up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use). RESULTS Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow-up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow-up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow-up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome. CONCLUSIONS Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Philip C Kendall
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
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Rabner JC, Ney JS, Kendall PC. Cognitive Functioning in Youth with Anxiety Disorders: A Systematic Review. Clin Child Fam Psychol Rev 2024:10.1007/s10567-024-00480-9. [PMID: 38829508 DOI: 10.1007/s10567-024-00480-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 06/05/2024]
Abstract
Anxiety disorders are disorders involving cognition. Research on cognition in youth with anxiety can focus on cognitive content (e.g., self-talk) as well cognitive functioning. The present review examines domains of cognitive functioning (i.e., episodic memory, language, attention, executive functioning, motor skills, and visual functioning) in youth diagnosed with an anxiety disorder. A database search of Embase, PsycINFO, and PubMed yielded 28 studies that met inclusion criteria of youth aged 17 years or younger, a sample diagnosed with a principal anxiety disorder and a comparison sample of controls, a comparison between those samples, and use of a behavioral measure of neuropsychological performance. Findings did not identify any cognitive functioning strengths for anxious youth. Deficits were found in two domains (i.e., receptive language and motor skills) whereas no deficits were found in attention, visuospatial skills and one domain of executive functioning (i.e., inhibition). Most domains had mixed findings. Additional analysis indicated that anxiety disorders in youth are not associated with diminished IQ. Directions for future research are identified including (a) the prioritization of studies with larger, representative samples (b) the role of cognitive functioning as a predictor of anxiety treatment outcome (c) the examination of the effect of treatment on cognitive performance, and (d) the course of anxiety and potential impairment in cognitive functioning.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
- Behavioral Psychology Department, Kennedy Krieger Institute, Baltimore, MD, USA.
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Julia S Ney
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, 1701 North 13th Street, Philadelphia, PA, 19122, USA.
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Kendall PC, Martel S, Meyer M, McKnight DS. The Fast Track Intervention: What Happens Down the River? Am J Psychiatry 2024; 181:178-179. [PMID: 38425256 DOI: 10.1176/appi.ajp.20231021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia
| | - Sophie Martel
- Department of Psychology and Neuroscience, Temple University, Philadelphia
| | - Marisa Meyer
- Department of Psychology and Neuroscience, Temple University, Philadelphia
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Rothenberg WA, Lansford JE, Godwin JW, Dodge KA, Copeland WE, Odgers CL, McMahon RJ, Rybinska A. Intergenerational Effects of the Fast Track Intervention on Next-Generation Child Outcomes: A Preregistered Randomized Clinical Trial. Am J Psychiatry 2024; 181:213-222. [PMID: 38321914 PMCID: PMC11137839 DOI: 10.1176/appi.ajp.20220927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors sought to determine whether the Fast Track mental health intervention delivered to individuals in childhood decreased mental health problems and the need for health services among the children of these individuals. METHODS The authors examined whether Fast Track assignment in one generation of children (generation 2; G2) from grades 1 through 10 reduced parent-reported mental health problems and health services use in these children's children (generation 3; G3) 18 years later relative to a control group. The Fast Track intervention blended parent behavior-management training, child social-cognitive skills tutoring, home visits, and classroom social-ecology changes across grades 1-10 to ameliorate emerging conduct problems among the G2 children. For this study, 1,057 G3 children of Fast Track participants (N=581 intervention group, N=476 control group) were evaluated. RESULTS G3 children of G2 parents who were randomized to the Fast Track intervention group used fewer general inpatient services and fewer inpatient or outpatient mental health services compared with G3 children of G2 parents randomized to the control group. Some of these effects were mediated: randomization to Fast Track predicted fewer internalizing problems and less use of corporal punishment among G2 adults at age 25, which subsequently predicted less general inpatient service use and outpatient mental health service use among the G3 children by the time the G2 parents were 34 years old. There were no significant differences between G3 children from these two groups on the use of other health services or on mental health measures. CONCLUSIONS Fast Track was associated with lower use of general inpatient services and inpatient and outpatient mental health services intergenerationally, but effects on parent-reported mental health of the children were not apparent across generations. Investing in interventions for the mental health of children could reduce service use burdens across generations.
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Affiliation(s)
- W. Andrew Rothenberg
- Duke University Center for Child and Family Policy
- University of Miami Miller School of Medicine’s Mailman Center for Child Development
| | | | | | | | - William E. Copeland
- Duke University Center for Child and Family Policy
- University of Vermont Department of Psychiatry
| | - Candice L. Odgers
- Duke University Center for Child and Family Policy
- University of California Irvine
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Brennan GM, Moffitt TE, Ambler A, Harrington H, Hogan S, Houts RM, Mani R, Poulton R, Ramrakha S, Caspi A. Tracing the origins of midlife despair: association of psychopathology during adolescence with a syndrome of despair-related maladies at midlife. Psychol Med 2023; 53:7569-7580. [PMID: 37161676 PMCID: PMC10636241 DOI: 10.1017/s0033291723001320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Midlife adults are experiencing a crisis of deaths of despair (i.e. deaths from suicide, drug overdose, and alcohol-related liver disease). We tested the hypothesis that a syndrome of despair-related maladies at midlife is preceded by psychopathology during adolescence. METHODS Participants are members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972-73 and followed to age 45 years, with 94% retention. Adolescent mental disorders were assessed in three diagnostic assessments at ages 11, 13, and 15 years. Indicators of despair-related maladies across four domains - suicidality, substance misuse, sleep problems, and pain - were assessed at age 45 using multi-modal measures including self-report, informant-report, and national register data. RESULTS We identified and validated a syndrome of despair-related maladies at midlife involving suicidality, substance misuse, sleep problems, and pain. Adults who exhibited a more severe syndrome of despair-related maladies at midlife tended to have had early-onset emotional and behavioral disorders [β = 0.23, 95% CI (0.16-0.30), p < 0.001], even after adjusting for sex, childhood SES, and childhood IQ. A more pronounced midlife despair syndrome was observed among adults who, as adolescents, were diagnosed with a greater number of mental disorders [β = 0.26, 95% CI (0.19-0.33), p < 0.001]. Tests of diagnostic specificity revealed that associations generalized across different adolescent mental disorders. CONCLUSIONS Midlife adults who exhibited a more severe syndrome of despair-related maladies tended to have had psychopathology as adolescents. Prevention and treatment of adolescent psychopathology may mitigate despair-related maladies at midlife and ultimately reduce deaths of despair.
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Affiliation(s)
- Grace M. Brennan
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Terrie E. Moffitt
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Population Health and Aging, Duke University Population Research Institute, Durham, NC, USA
- Institute of Psychiatry, King's College London, London, UK
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Promenta, University of Oslo, Oslo, Norway
| | - Antony Ambler
- Institute of Psychiatry, King's College London, London, UK
| | - HonaLee Harrington
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | - Sean Hogan
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Renate M. Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
| | | | - Richie Poulton
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology and Dunedin Multidisciplinary Health and Development Research Unit, University of Otago, Dunedin, New Zealand
| | - Avshalom Caspi
- Duke Aging Center, Duke University School of Medicine, Durham, NC, USA
- Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Center for the Study of Population Health and Aging, Duke University Population Research Institute, Durham, NC, USA
- Institute of Psychiatry, King's College London, London, UK
- Center for Genomic and Computational Biology, Duke University, Durham, NC, USA
- Promenta, University of Oslo, Oslo, Norway
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Etkin RG, Juel EK, Lebowitz ER, Silverman WK. Does Cognitive-Behavioral Therapy for Youth Anxiety Disorders Improve Social Functioning and Peer Relationships? Clin Child Fam Psychol Rev 2023; 26:1052-1076. [PMID: 37838627 DOI: 10.1007/s10567-023-00454-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2023] [Indexed: 10/16/2023]
Abstract
Child and adolescent anxiety disorders (ADs) contribute to impairment in social functioning and peer relationships, exacerbating anxiety and related difficulties. The extent to which the AD treatment with the strongest evidence-base, cognitive-behavioral therapy (CBT), improves social functioning and peer relationships is unclear. In this article, we report results of the first systematic narrative review of this topic. Randomized clinical trials of CBT for child and/or adolescent ADs were included if they used at least one measure of social functioning or peer relationships as a treatment outcome. Sixteen studies met our inclusion criteria. From each study, we extracted the sample characteristics, treatment arms, social and/or peer outcome measures, and statistical findings. Results show that social functioning and/or peer relationships improved over time in the majority of studies, highlighting an important aspect of treatment efficacy beyond anxiety reduction. There were also several treatment-specific effects, but considerable variability across studies' samples, methods, and findings, makes it difficult to draw firm conclusions about which specific treatments improve specific outcomes. We recommend next steps for research to reconcile these findings, including improved operationalization and standardization of social and peer outcomes, and research on treatment specificity and mechanisms.
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Affiliation(s)
- Rebecca G Etkin
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Emily K Juel
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Wendy K Silverman
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA.
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Dooley N, Kennelly B, Arseneault L, Zammit S, Whelan R, Mosley O, Cotter D, Clarke M, Cotter DR, Kelleher I, McGorry P, Healy C, Cannon M. Functional Outcomes Among Young People With Trajectories of Persistent Childhood Psychopathology. JAMA Netw Open 2023; 6:e2336520. [PMID: 37773492 PMCID: PMC10543080 DOI: 10.1001/jamanetworkopen.2023.36520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/25/2023] [Indexed: 10/01/2023] Open
Abstract
Importance Understanding which children in the general population are at greatest risk of poor functional outcomes could improve early screening and intervention strategies. Objective To investigate the odds of poor outcomes in emerging adulthood (ages 17 to 20 years) for children with different mental health trajectories at ages 9 to 13 years. Design, Setting, and Participants Growing Up in Ireland is a longitudinal, nationally representative population-based cohort study. Data collection began in August 2007 and was repeated most recently in September 2018. All results were weighted to account for sampling bias and attrition and were adjusted for socioeconomic factors. Data analysis took place from October 2022 to April 2023. Exposure Four latent classes captured variation in mental health in children aged 9 and 13 years, based on the parent-completed Strengths and Difficulties Questionnaire. Classes included no psychopathology, internalizing, externalizing, and high (comorbid) psychopathology. Those who remained in the same class from ages 9 to 13 years were included. Main Outcomes and Measures Poor functional outcomes in emerging adulthood were measured at approximate ages 17 years (range, 16 to 18 years) and 20 years (range, 19 to 21 years). Outcomes included poor mental health, poor physical health, social isolation, heavy substance use, frequent health service use, poor subjective well-being, and adverse educational/economic outcomes. Results Of 5141 included participants, 2618 (50.9%) were male. A total of 3726 (72.5%) were classed as having no childhood psychopathology, 1025 (19.9%) as having persistent externalizing psychopathology, 243 (4.7%) as having persistent internalizing psychopathology, and 147 (2.9%) as having persistent high psychopathology. Having any childhood psychopathology was associated with poorer functional outcomes in emerging adulthood. The internalizing group had elevated odds of most outcomes except for heavy substance use (range of odds ratios [ORs]: 1.38 [95% CI, 1.05-1.81] for frequent health service use to 3.08 [95% CI, 2.33-4.08] for poor mental health). The externalizing group had significantly elevated odds of all outcomes, albeit with relatively small effect sizes (range of ORs: 1.38 [95% CI, 1.19-1.60] for frequent health service use to 1.98 [95% CI, 1.67-2.35] for adverse educational/economic outcomes). The high psychopathology group had elevated odds of all outcomes (nonsignificantly for frequent health service use), though with wide confidence intervals (range of ORs: 1.53 [95% CI, 1.06-2.21] for poor physical health to 2.91 [95% CI, 2.05-4.12] for poor mental health). Female participants with any psychopathology had significantly higher odds of poor physical health and frequent health service use compared with male participants with any psychopathology. Conclusions and Relevance In this longitudinal cohort study, childhood psychopathology was associated with a widespread pattern of functional impairment in emerging adulthood. Findings point to the need for a wider range of preventive interventions in child and adolescent mental health services.
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Affiliation(s)
- Niamh Dooley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Social, Genetic and Developmental Psychology, King’s College London, London, United Kingdom
| | - Brendan Kennelly
- School of Business and Economics, University of Galway, Galway, Ireland
| | - Louise Arseneault
- Social, Genetic and Developmental Psychology, King’s College London, London, United Kingdom
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, United Kingdom
- Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Rob Whelan
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Olivia Mosley
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Delia Cotter
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - David R. Cotter
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Ian Kelleher
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- NHS Lothian Child and Adolescent Mental Health Service, Edinburgh, United Kingdom
- School of Medicine, University College Dublin, Dublin, Ireland
- University of Oulu, Faculty of Medicine, Oulu, Finland
| | - Pat McGorry
- Centre for Youth Mental Health, Orygen, Melbourne, Australia
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
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Baumel WT, Mills JA, Schroeder HK, Neptune Z, Levine A, Strawn JR. Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and Their Relationship to Selective Serotonin Reuptake Inhibitor Treatment or Placebo. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01586-x. [PMID: 37659029 DOI: 10.1007/s10578-023-01586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Gastrointestinal symptoms are commonly reported as adverse effects of selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacologic treatment for pediatric anxiety disorders; however, the temporal course of these symptoms during treatment, although believed to be transient, has never been prospectively evaluated. Additionally, rates of gastrointestinal symptoms and functional gastrointestinal syndromes in anxious youth are poorly understood. We examined gastrointestinal symptoms in youth with anxiety disorders during a double-blind, placebo-controlled trial of escitalopram (n = 51). Then, in a separate sample of prospectively treated children and adolescents with generalized, social and/or separation anxiety disorders (n = 56), we examined the frequency of gastrointestinal symptoms based on the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) and ROME III criteria and the association of these symptoms with clinical and demographic characteristics using logistic regression. The frequency/severity of abdominal pain, diarrhea, bloating constipation or total gastrointestinal symptoms did not differ between patients receiving placebo (n = 25) or escitalopram (n = 26). However, escitalopram-treated youth had transient changes in nausea/vomiting and total upper gastrointestinal symptoms during the first two weeks of treatment. ROME III criteria for functional gastrointestinal syndromes were present in 12/56 patients (21.4%). QPGS-related functional gastrointestinal syndromes and symptoms were unrelated to treatment, treatment type, or clinical or demographic variables. Gastrointestinal symptoms are common in youth with anxiety and SSRIs produce transient-rather than sustained-gastrointestinal symptoms. Assessing gastrointestinal symptoms prior to pharmacotherapy and discussing factors that increase (or decrease) the likelihood of transient SSRI-related symptoms in youth may decrease patient uncertainty related to side effects and decrease medication-related anxiety.
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Affiliation(s)
- W Thomas Baumel
- Department of Psychiatry, University of North Carolina, 77 Vilcom Center Dr, Chapel Hill, NC, 27514, USA.
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
| | - Heidi K Schroeder
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Zoe Neptune
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Amir Levine
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, Division of Child & Adolescent Psychiatry, Divisions of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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Graff LA, Geist R, Kuenzig ME, Benchimol EI, Kaplan GG, Windsor JW, Bitton A, Coward S, Jones JL, Lee K, Murthy SK, Peña-Sánchez JN, Targownik LE, Jannati N, Jones May T, Akhtar Sheekha T, Davis T, Weinstein J, Dahlwi G, Im JHB, Amankwah Osei J, Rohatinsky N, Ghandeharian S, Goddard Q, Gorospe J, Gertsman S, Louis M, Wagner R, Brass C, Sanderson R, Bernstein CN. The 2023 Impact of Inflammatory Bowel Disease in Canada: Mental Health and Inflammatory Bowel Disease. J Can Assoc Gastroenterol 2023; 6:S64-S75. [PMID: 37674499 PMCID: PMC10478810 DOI: 10.1093/jcag/gwad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Psychiatric disorders are 1.5 to 2 times more prevalent in persons with inflammatory bowel disease (IBD) than in the general population, with pooled prevalence estimates of 21% for clinical anxiety and 15% for depression. Rates are even higher when considering mental health symptoms, as nearly one-third of persons with IBD experience elevated anxiety symptoms and one-quarter experience depression symptoms. Rates of these symptoms were much higher during periods of disease activity, more common in women than men, and more common in Crohn's disease than ulcerative colitis. There is robust evidence of the detrimental effects of comorbid depression and anxiety on the subsequent course of IBD based on longitudinal studies tracking outcomes over time. However, psychiatric disorders and IBD have bidirectional effects, with each affecting risk of the other. Elevated mental health concerns have been consistently associated with greater healthcare utilization and costs related to IBD. There is some signal that low resilience in adolescence could be a risk factor for developing IBD and that enhancing resilience may improve mental health and intestinal disease outcomes in IBD. Psychological therapies used to treat anxiety and depression occurring in the context of IBD have been shown to significantly improve the quality of life for persons with IBD and reduce anxiety and depression. There is less evidence in regard to the impact of psychotropic medications on mental health or disease outcomes in persons with IBD. There is consensus, however, that mental health must be addressed as part of comprehensive IBD care for children and adults.
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Affiliation(s)
- Lesley A Graff
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
| | - Rose Geist
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Ellen Kuenzig
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Eric I Benchimol
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Gilaad G Kaplan
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Joseph W Windsor
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Alain Bitton
- Division of Gastroenterology and Hepatology, McGill University Health Centre IBD Centre, McGill University, Montréal, Quebec, Canada
| | - Stephanie Coward
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer L Jones
- Departments of Medicine, Clinical Health, and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kate Lee
- Crohn’s and Colitis Canada, Toronto, Ontario, Canada
| | - Sanjay K Murthy
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Juan-Nicolás Peña-Sánchez
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Laura E Targownik
- Division of Gastroenterology and Hepatology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nazanin Jannati
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tyrel Jones May
- Division of Gastroenterology and Hepatology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Tasbeen Akhtar Sheekha
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tal Davis
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jake Weinstein
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Ghaida Dahlwi
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - James H B Im
- SickKids Inflammatory Bowel Disease Centre, Division of Gastroenterology, Hepatology, and Nutrition, The Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jessica Amankwah Osei
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Noelle Rohatinsky
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Quinn Goddard
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Julia Gorospe
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shira Gertsman
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Richelle Wagner
- Department of Educational Psychology, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Charles N Bernstein
- University of Manitoba IBD Clinical and Research Centre, Winnipeg, Manitoba, Canada
- Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Shapiro M. Psychodynamic Formulation and Psychodynamic Psychotherapy for Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:559-572. [PMID: 37201967 DOI: 10.1016/j.chc.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Psychodynamic psychotherapy can be an effective treatment of pediatric anxiety disorders. Psychodynamic formulation can be easily integrated with other conceptualizations of anxiety (eg, biological/genetic, developmental, and social learning theory). Psychodynamic formulation helps determine whether anxiety symptoms represent innate biological responses, learned responses from early experiences, or defensive reactions to intrapsychic conflict. Child and Adolescent Anxiety Psychodynamic Psychotherapy and Psychoanalytic Child Therapy are two evidence-based manualized psychodynamic approaches to treating pediatric anxiety disorders.
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Affiliation(s)
- Michael Shapiro
- Department of Psychiatry, University of Florida, 1149 Newell Drive, Suite L4-100, Gainesville, FL 32610, USA.
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12
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Warner EN, Ammerman RT, Glauser TA, Pestian JP, Agasthya G, Strawn JR. Developmental Epidemiology of Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:511-530. [PMID: 37201964 DOI: 10.1016/j.chc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.
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Affiliation(s)
- Emily N Warner
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Environmental and Public Health Sciences, University of Cincinnati.
| | - Robert T Ammerman
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy A Glauser
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John P Pestian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Greeshma Agasthya
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Advanced Computing for Health Sciences Section
| | - Jeffrey R Strawn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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13
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Becker-Haimes EM, Wislocki K, Schriger SH, Kratz HE, Sanchez AL, Clapp D, Frank HE. Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth. CHILD & YOUTH CARE FORUM 2023; 52:1-18. [PMID: 36711198 PMCID: PMC9854404 DOI: 10.1007/s10566-023-09732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/19/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023]
Abstract
Background Exposure therapy ("exposure") for youth anxiety is highly underutilized in clinical practice. Asynchronous, online implementation strategies such as online toolkits hold promise as pragmatic approaches for extending the sustainability of evidence-based interventions, but their long-term usage, perceived utility, and impact are rarely studied. Objective This study presents three-year preliminary implementation outcomes for a free, online toolkit to support exposure therapy use with youth: the Resource for Exposure for Anxiety Disordered Youth (READY; www.bravepracticeforkids.com). Implementation outcomes of interest included READY usage statistics, adoption, perceived utility, and clinician exposure use. Methods Web analytics characterized usage patterns. A survey of READY users (N = 49; M age = 34.2, 82.9% female, 71% White) assessed adoption, perceived utility, clinician exposure use, and persistent barriers to exposure use. Results In its first three years, READY had 13,543 page views across 1,731 unique users; 442 (25.6%) registered as a site user to access specialized content. Survey data suggested variability in usage and perceived utility across toolkit components. Qualitative analyses highlighted persistent exposure barriers that pointed to potential READY refinements. Conculsions Overall, READY has been accessed by hundreds of clinicians, but its impact was limited by low return to the site. This study highlights strengths and limitations of standalone online implementation supports and identifies additional steps needed to optimally support clinicians to deliver exposure to youth in need.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
| | - Katherine Wislocki
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Department of Psychological Science, University of California Irvine, Irvine, USA
| | | | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Amanda L. Sanchez
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, George Mason University, Fairfax, VA USA
| | - Douglas Clapp
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
- Bradley Hospital, Lifespan Health System, Providence, USA
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14
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Strawn JR, Mills JA, Poweleit EA, Ramsey LB, Croarkin PE. Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents. Pharmacotherapy 2023. [PMID: 36651686 PMCID: PMC10378577 DOI: 10.1002/phar.2767] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin-norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of pharmacotherapy for children and adolescents with anxiety and depressive disorders. These medications alleviate symptoms and restore function for many youths; however, they are associated with a distinct adverse effect profile, and their tolerability may complicate treatment or lead to discontinuation. Yet, SSRI/SNRI tolerability has received limited attention in the pediatric literature. METHODS This review examines the early- (e.g., activation, gastrointestinal symptoms, sedation) and late-emerging (e.g., weight gain) adverse effects of SSRIs and some SNRIs in pediatric patients. RESULTS We provide a framework for discussing SSRI/SNRI tolerability with patients and their families and describe the pharmacologic basis, course, and predictors of adverse events in youth. Strategies to address specific tolerability concerns are presented. For selected adverse events, using posterior simulation of mean differences over time, we describe their course based on Physical Symptom Checklist measures in a prospective, randomized trial of anxious youth aged 7-17 years who were treated with sertraline (n = 139) or placebo (n = 76) for 12 weeks in the Child/Adolescent Anxiety Multimodal Study (CAMS). MAIN RESULTS In CAMS, the relative severity/burden of total physical symptoms (p < 0.001), insomnia (p = 0.001), restlessness (p < 0.001), nausea (p = 0.002), abdominal pain (p < 0.001), and dry mouth (p = 0.024) decreased from baseline over 12 weeks of sertraline treatment, raising the possibility that these symptoms are transient. No significant changes were observed for sweating (p = 0.103), constipation (p = 0.241), or diarrhea (p = 0.489). Finally, we review the antidepressant withdrawal syndrome in children and adolescents and provide guidance for SSRI discontinuation, using pediatric pharmacokinetic models of escitalopram and sertraline-two of the most used SSRIs in youth. CONCLUSION SSRI/SNRIs are associated with both early-emerging (often transient) and late-emerging adverse effects in youth. Pharmacokinetically-informed appraoches may address some adverse effects and inform SSRI/SNRI discontinuation strategies.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ethan A Poweleit
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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15
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Bertelsen TB, Wergeland GJ, Nordgreen T, Himle JA, Håland ÅT. Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder. Psychiatry Res 2022; 313:114632. [PMID: 35597139 DOI: 10.1016/j.psychres.2022.114632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).
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Affiliation(s)
- Thomas B Bertelsen
- Department of Child and Adolescence Mental Health, Sørlandet Sykehus, Kristiansand, Norway; Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Norway.
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Global Health and primary care, Faculty of Medicine, University of Bergen, Norway
| | - Joseph A Himle
- School of Social Work and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA
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16
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Temkin AB, Beaumont R, Wkya K, Hariton JR, Flye BL, Sheridan E, Miranda A, Vela J, Zendegui E, Schild J, Gasparro S, Loubriel D, Damiandies A, Weisman J, Silvestre A, Yadegar M, Catarozoli C, Bennett SM. Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment. Res Child Adolesc Psychopathol 2022; 50:1107-1119. [PMID: 35441908 DOI: 10.1007/s10802-022-00919-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8-12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n = 47) or TAU (n = 42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs ≥ 6.79, ps ≤ 01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F = 0.41, p = 0.475) and ER (F = 0.99, p = 0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8-12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.
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Affiliation(s)
- Andrea B Temkin
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.
| | - Renae Beaumont
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Katarzyna Wkya
- CUNY Graduate School of Public Health, New York, NY, USA
| | - Jo R Hariton
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Barabra L Flye
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Elisabeth Sheridan
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Drexel University (A.J. Drexel Autism Institute), Philadelphia, PA, USA
| | - Amy Miranda
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Jamie Vela
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Elaina Zendegui
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Psychiatry, Mount Sinai Hospital, New York, NY, USA
| | - Jennifer Schild
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Clinical Psychology, Suffolk University, Boston, MA, USA
| | - Shannon Gasparro
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Daphne Loubriel
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Andreas Damiandies
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Touro College of Osteopathic Medicine, New York, NY, USA
| | - Julia Weisman
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Clinical Psychology, Hofstra University, Long Island, NY, USA
| | - Alexandra Silvestre
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Columbia School of Social Work, New York, NY, USA
| | - Mina Yadegar
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Rogers Behavioral Health, Los Angeles, CA, USA
| | - Corinne Catarozoli
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Shannon M Bennett
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
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17
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Does irritability predict attention biases toward threat among clinically anxious youth? Eur Child Adolesc Psychiatry 2022:10.1007/s00787-022-01954-3. [PMID: 35138476 DOI: 10.1007/s00787-022-01954-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 01/27/2022] [Indexed: 11/03/2022]
Abstract
Aberrant threat processing is a known cognitive characteristic of anxiety disorders and irritability. Youth with more severe symptomatology show greater allocation of attention towards threat relative to neutral stimuli. Although irritability contributes to poorer outcomes among anxious youths, irritability has not been considered as a contributing factor to threat processing in anxiety disorders. Thus, the current study examined the role of irritability in predicting attention biases for threat among clinically anxious youth. Our study included 84 clinically anxious youth (M = 9.31 years old, SD = 2.44) who completed a dot-probe task to determine attention biases. Anxiety disorders were assessed using semi-structured diagnostic interviews. Well validated measures were used to assess the severity of anxiety and irritability symptoms via child- and parent-report, respectively. Findings indicated that more severe irritability predicted greater attention biases toward threat among clinically anxious youth, covarying for age, anxiety severity, and the number of comorbid diagnoses. At a trend-level, anxiety severity also predicted attention bias for threat. Among clinically anxious youth, irritability severity was the strongest predictor of attention bias toward threat. Findings point to the salience of irritability, and to some extent anxiety severity, in relation to threat processing among youth with clinical anxiety disorders.
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18
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Friedberg RD. Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal. World J Clin Pediatr 2021; 10:112-123. [PMID: 34868888 PMCID: PMC8603637 DOI: 10.5409/wjcp.v10.i6.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, San Jose, CA 95136, United States
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19
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Norris LA, Kendall PC. A Close Look Into Coping Cat: Strategies Within an Empirically Supported Treatment for Anxiety in Youth. J Cogn Psychother 2021; 34:4-20. [PMID: 32701473 DOI: 10.1891/0889-8391.34.1.4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Coping Cat protocol has shown both efficacy and effectiveness in the treatment of youth anxiety across numerous randomized controlled trials (RCTs), leading to its designation as an empirically supported treatment. The treatment is completed in two phases. In the first phase, children are taught a series of coping skills outlined using the FEAR plan acronym. The FEAR plan is then practiced in exposure tasks during the second phase of treatment. To illustrate implementation of both phases, and highlight core treatment components (i.e., exposure, flexibility within fidelity), a case description is presented. Directions for future research are discussed.
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20
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Murphy SE, Capitão LP, Giles SLC, Cowen PJ, Stringaris A, Harmer CJ. The knowns and unknowns of SSRI treatment in young people with depression and anxiety: efficacy, predictors, and mechanisms of action. Lancet Psychiatry 2021; 8:824-835. [PMID: 34419187 DOI: 10.1016/s2215-0366(21)00154-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 01/12/2023]
Abstract
The use of SSRIs for the treatment of depression and anxiety in young people is increasing. However, the effects of SSRIs in adolescence, a time when there are substantial changes in neural, cognitive, and social functioning, are not well understood. Here, we review evidence from clinical trials about the benefits and risks of SSRIs in young people and consider their mechanisms of action, as shown through human experimental work and animal models. We emphasise key outstanding questions about the effects of SSRIs in youth, identified through gaps in the literature and in consultation with young people with lived experience. It is crucial to characterise the mechanisms underpinning risks and benefits of SSRIs in this age group to progress the field, and to narrow the chasm between the widespread use of SSRIs in youth and the science on which this use is based.
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Affiliation(s)
- Susannah E Murphy
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Liliana P Capitão
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Sophie L C Giles
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Philip J Cowen
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Argyris Stringaris
- Section of Clinical and Computational Psychiatry, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Catherine J Harmer
- University Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
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21
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Peris TS, Sugar CA, Rozenman MS, Walkup JT, Albano AM, Compton S, Sakolsky D, Ginsburg G, Keeton C, Kendall PC, McCracken JT, Piacentini J. Long-term Service Use Among Youths Previously Treated for Anxiety Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:501-512. [PMID: 33301814 DOI: 10.1016/j.jaac.2020.07.911] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 07/06/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE (1) To describe rates of long-term service use among subjects previously enrolled in a landmark study of youth anxiety disorder treatment and followed into early adulthood; (2) to examine predictors of long-term service use; and (3) to examine the relationship between anxiety diagnosis and service use over time. METHOD The Child/Adolescent Anxiety Multimodal Extended Long-term Study prospectively assessed youths treated through the Child/Adolescent Anxiety Multimodal Study at ages 7-17 years into early adulthood. A total of 319 youths (mean age 17.7, 55.2% female) previously randomized to cognitive-behavioral therapy, sertraline, combination, or placebo for the treatment of anxiety participated; 318 had service use data. Four annual clinic assessments were conducted along with telephone check-ins every 6 months. RESULTS Overall, 65.1% of participants endorsed receiving some form of anxiety treatment over the course of the follow-up period, with more subjects reporting medication use than psychotherapy; 35.2% reported consistent use of services over the course of the study. Overall, service use declined over time in subjects with less severe anxiety but remained more steady in those with recurrent/chronic symptoms. Levels of life stress and depressive symptoms were associated with amount of service use over time whereas treatment-related variables (type of initial intervention, acute response, remission) were not. A subset of youths remained chronically anxious despite consistent service use. CONCLUSION These findings point to the need to develop models of care that approach anxiety disorders as chronic health conditions in need of active long-term management.
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Affiliation(s)
| | | | | | - John T Walkup
- Robert and Ann Lurie Children's Hospital, Chicago, Illinois
| | | | | | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
| | | | - Courtney Keeton
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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22
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Creswell C, Nauta MH, Hudson JL, March S, Reardon T, Arendt K, Bodden D, Cobham VE, Donovan C, Halldorsson B, In-Albon T, Ishikawa SI, Johnsen DB, Jolstedt M, de Jong R, Kreuze L, Mobach L, Rapee RM, Spence SH, Thastum M, Utens E, Vigerland S, Wergeland GJ, Essau CA, Albano AM, Chu B, Khanna M, Silverman WK, Kendall PC. Research Review: Recommendations for reporting on treatment trials for child and adolescent anxiety disorders - an international consensus statement. J Child Psychol Psychiatry 2021; 62:255-269. [PMID: 32683742 DOI: 10.1111/jcpp.13283] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/12/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continued as the field strives to improve efficacy and effectiveness, and accessibility of interventions. This increase in research brings potential to draw together data across studies to compare treatment approaches and advance understanding of what works, how, and for whom. There are challenges to these efforts due largely to variation in studies' outcome measures and variation in the way study characteristics are reported, making it difficult to compare and/or combine studies, and this is likely to lead to faulty conclusions. Studies particularly vary in their reliance on child, parent, and/or assessor-based ratings across a range of outcomes, including remission of anxiety diagnosis, symptom reduction, and other domains of functioning (e.g., family relationships, peer relationships). METHODS To address these challenges, we convened a series of international activities that brought together the views of key stakeholders (i.e., researchers, mental health professionals, young people, parents/caregivers) to develop recommendations for outcome measurement to be used in treatment trials for anxiety disorders in children and young people. RESULTS AND CONCLUSIONS This article reports the results of these activities and offers recommendations for selection and reporting of outcome measures to (a) guide future research and (b) improve communication of what has been measured and reported. We offer these recommendations to promote international consistency in trial reporting and to enable the field to take full advantage of the great opportunities that come from data sharing going forward.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Sonja March
- School of Psychology and Counselling, University of Southern Queensland, Springfield, QLD, Australia
| | - Tessa Reardon
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | | | - Denise Bodden
- Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands
| | - Vanessa E Cobham
- Children's Health QLD Child and Youth Mental Health Service, Brisbane, QLD, Australia.,School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Caroline Donovan
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia
| | - Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy Unit, University of Koblenz and Landau, Landau, Germany
| | | | | | - Maral Jolstedt
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Rachel de Jong
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Leonie Kreuze
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Lynn Mobach
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
| | - Ronald M Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Susan H Spence
- School of Applied Psychology, Griffith University, Brisbane, QLD, Australia.,Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | | | - Elisabeth Utens
- Research Institute of Child Development and Education, University of Amsterdam / The Bascule / Amsterdam UMC, Amsterdam, The Netherlands.,Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sarah Vigerland
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gro Janne Wergeland
- Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Cecilia A Essau
- Department of Psychology, University of Roehampton, London, UK
| | - Anne Marie Albano
- Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Brian Chu
- Department of Clinical Psychology, Rutgers, The State University of New Jersey, Piscataway, NJ, USA
| | - Muniya Khanna
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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23
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Kagan ER, Frank HE, Norris LA, Palitz SA, Chiappini EA, Knepley MJ, Crane ME, Phillips KE, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris T, Compton S, Sakolsky D, Birmaher B, Kendall PC. Antidepressant Use in a 3- to 12-Year Follow-up of Anxious Youth: Results from the CAMELS Trial. Child Psychiatry Hum Dev 2021; 52:41-48. [PMID: 32253545 PMCID: PMC7541463 DOI: 10.1007/s10578-020-00983-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The current study explored whether patient characteristics predicted patterns of antidepressant use (i.e., never used, single episode of use, or two or more episodes) in a naturalistic follow-up. Participants in the child/adolescent multimodal (CAMS) extended long-term study. (n = 318) indicated medication use over the course of eight follow-up visits, 3-12 years after receiving treatment in CAMS. 40.6% of participants reported never using an antidepressant during follow-up, 41.4% reported a single episode of antidepressant use, and 18.0% reported multiple episodes of antidepressant use. Greater baseline anxiety severity marginally predicted a single episode of antidepressant use; baseline depression severity predicted multiple episodes of use. Reasons for discontinuing antidepressants included perceived ineffectiveness (31.8%), side effects (25.5%), and improvement in symptoms (18.5%). Exploratory analyses examined predictors of medication use. Findings suggest that antidepressant use is common among anxious youth, as is discontinuation of antidepressant use. Clinical implications and future directions are discussed.
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Affiliation(s)
- Elana R Kagan
- Department of Behavioral Psychology, Kennedy Krieger Institute/Johns Hopkins School of Medicine, 720 Aliceanna Street, Baltimore, MD, 210202, USA.
| | - Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Lesley A Norris
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Sophie A Palitz
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Erika A Chiappini
- Division of Child & Adolescent Psychiatry, Johns Hopkins, Baltimore, MD, USA
| | - Mark J Knepley
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | | | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Harford, CT, USA
| | - Courtney Keeton
- Division of Child & Adolescent Psychiatry, Johns Hopkins, Baltimore, MD, USA
| | | | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Tara Peris
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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24
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Crane ME, Norris LA, Frank HE, Klugman J, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris TS, Compton SN, Sakolsky D, Birmaher B, Kendall PC. Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS. J Consult Clin Psychol 2021; 89:126-133. [PMID: 33705168 PMCID: PMC7959050 DOI: 10.1037/ccp0000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. METHOD Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. RESULTS Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. CONCLUSIONS Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | - Joshua Klugman
- Department of Sociology, Temple University, Philadelphia, PA
| | - Golda S. Ginsburg
- Department of Psychiatry University of Connecticut of Medicine, Farmington, CT
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Scott N. Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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25
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Parent M, Albuquerque I, Tiwari A, Cassani R, Gagnon JF, Lafond D, Tremblay S, Falk TH. PASS: A Multimodal Database of Physical Activity and Stress for Mobile Passive Body/ Brain-Computer Interface Research. Front Neurosci 2020; 14:542934. [PMID: 33363449 PMCID: PMC7753022 DOI: 10.3389/fnins.2020.542934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
With the burgeoning of wearable devices and passive body/brain-computer interfaces (B/BCIs), automated stress monitoring in everyday settings has gained significant attention recently, with applications ranging from serious games to clinical monitoring. With mobile users, however, challenges arise due to other overlapping (and potentially confounding) physiological responses (e.g., due to physical activity) that may mask the effects of stress, as well as movement artifacts that can be introduced in the measured signals. For example, the classical increase in heart rate can no longer be attributed solely to stress and could be caused by the activity itself. This makes the development of mobile passive B/BCIs challenging. In this paper, we introduce PASS, a multimodal database of Physical Activity and StresS collected from 48 participants. Participants performed tasks of varying stress levels at three different activity levels and provided quantitative ratings of their perceived stress and fatigue levels. To manipulate stress, two video games (i.e., a calm exploration game and a survival game) were used. Peripheral physical activity (electrocardiography, electrodermal activity, breathing, skin temperature) as well as cerebral activity (electroencephalography) were measured throughout the experiment. A complete description of the experimental protocol is provided and preliminary analyses are performed to investigate the physiological reactions to stress in the presence of physical activity. The PASS database, including raw data and subjective ratings has been made available to the research community at http://musaelab.ca/pass-database/. It is hoped that this database will help advance mobile passive B/BCIs for use in everyday settings.
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Affiliation(s)
- Mark Parent
- INRS-EMT, Université du Québec, Montréal, QC, Canada
| | | | | | | | | | - Daniel Lafond
- Thales Research and Technology Canada, Quebec City, QC, Canada
| | | | - Tiago H Falk
- INRS-EMT, Université du Québec, Montréal, QC, Canada.,PERFORM Center, Concordia University, Montréal, QC, Canada
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26
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In-Session Involvement in Anxious Youth Receiving CBT with/without Medication. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2020. [DOI: 10.1007/s10862-020-09810-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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27
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Wood JJ, Kendall PC, Wood KS, Kerns CM, Seltzer M, Small BJ, Lewin AB, Storch EA. Cognitive Behavioral Treatments for Anxiety in Children With Autism Spectrum Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2020; 77:474-483. [PMID: 31755906 PMCID: PMC6902190 DOI: 10.1001/jamapsychiatry.2019.4160] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Anxiety is common among youth with autism spectrum disorder (ASD), often interfering with adaptive functioning. Psychological therapies are commonly used to treat school-aged youth with ASD; their efficacy has not been established. OBJECTIVE To compare the relative efficacy of 2 cognitive behavioral therapy (CBT) programs and treatment as usual (TAU) to assess treatment outcomes on maladaptive and interfering anxiety in children with ASD. The secondary objectives were to assess treatment outcomes on positive response, ASD symptom severity, and anxiety-associated adaptive functioning. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial began recruitment in April 2014 at 3 universities in US cities. A volunteer sample of children (7-13 years) with ASD and maladaptive and interfering anxiety was randomized to standard-of-practice CBT, CBT adapted for ASD, or TAU. Independent evaluators were blinded to groupings. Data were collected through January 2017 and analyzed from December 2018 to February 2019. INTERVENTIONS The main features of standard-of-practice CBT were affect recognition, reappraisal, modeling/rehearsal, in vivo exposure tasks, and reinforcement. The CBT intervention adapted for ASD was similar but also addressed social communication and self-regulation challenges with perspective-taking training and behavior-analytic techniques. MAIN OUTCOMES AND MEASURES The primary outcome measure per a priori hypotheses was the Pediatric Anxiety Rating Scale. Secondary outcomes included treatment response on the Clinical Global Impressions-Improvement scale and checklist measures. RESULTS Of 214 children initially enrolled, 167 were randomized, 145 completed treatment, and 22 discontinued participation. Those who were not randomized failed to meet eligibility criteria (eg, confirmed ASD). There was no significant difference in discontinuation rates across conditions. Randomized children had a mean (SD) age of 9.9 (1.8) years; 34 were female (20.5%). The CBT program adapted for ASD outperformed standard-of-practice CBT (mean [SD] Pediatric Anxiety Rating Scale score, 2.13 [0.91] [95% CI, 1.91-2.36] vs 2.43 [0.70] [95% CI, 2.25-2.62]; P = .04) and TAU (2.93 [0.59] [95% CI, 2.63-3.22]; P < .001). The CBT adapted for ASD also outperformed standard-of-practice CBT and TAU on parent-reported scales of internalizing symptoms (estimated group mean differences: adapted vs standard-of-practice CBT, -0.097 [95% CI, -0.172 to -0.023], P = .01; adapted CBT vs TAU, -0.126 [95% CI, -0.243 to -0.010]; P = .04), ASD-associated social-communication symptoms (estimated group mean difference: adapted vs standard-of-practice CBT, -0.115 [95% CI, -0223 to -0.007]; P = .04; adapted CBT vs TAU: -0.235 [95% CI,-0.406 to -0.065]; P = .01); and anxiety-associated social functioning (estimated group mean difference: adapted vs standard-of-practice CBT, -0.160 [95% CI, -0.307 to -0.013]; P = .04; adapted CBT vs TAU: -0.284 [95% CI, -0.515 to -0.053]; P = .02). Both CBT conditions achieved higher rates of positive treatment response than TAU (BIACA, 61 of 66 [92.4%]; Coping Cat, 47 of 58 [81.0%]; TAU, 2 of 18 [11.1%]; P < .001 for each comparison). CONCLUSIONS AND RELEVANCE In this study, CBT was efficacious for children with ASD and interfering anxiety, and an adapted CBT approach showed additional advantages. It is recommended that clinicians providing psychological treatments to school-aged children with ASD consider developing CBT expertise. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02028247.
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Affiliation(s)
- Jeffrey J. Wood
- Department of Education, University of California, Los Angeles, Los Angeles,Department of Psychiatry, University of California, Los Angeles, Los Angeles
| | - Philip C. Kendall
- Department of Psychology, Temple University, Philadelphia, Pennsylvania
| | - Karen S. Wood
- Department of Psychiatry, University of California, Los Angeles, Los Angeles
| | - Connor M. Kerns
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael Seltzer
- Department of Education, University of California, Los Angeles, Los Angeles
| | - Brent J. Small
- University of South Florida School of Aging Studies, Tampa
| | - Adam B. Lewin
- Departments of Pediatrics and Psychiatry, University of South Florida, Tampa
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28
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Storch EA, Schneider SC, De Nadai AS, Selles RR, McBride NM, Grebe SC, Bergez KC, Ramirez A, Viana AG, Lewin AB. A Pilot Study of Family-Based Exposure-Focused Treatment for Youth with Autism Spectrum Disorder and Anxiety. Child Psychiatry Hum Dev 2020; 51:209-219. [PMID: 31493105 DOI: 10.1007/s10578-019-00923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6-17 years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45-55 min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA.
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | | | - Robert R Selles
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Nicole M McBride
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stacey C Grebe
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Katherine C Bergez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Ana Ramirez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - Adam B Lewin
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, Saint Petersburg, FL, USA
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30
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Ginsburg GS, Drake KL, Muggeo MA, Stewart CE, Pikulski PJ, Zheng D, Harel O. A pilot RCT of a school nurse delivered intervention to reduce student anxiety. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 50:177-186. [PMID: 31373524 DOI: 10.1080/15374416.2019.1630833] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The goal of this study was to evaluate the feasibility and impact of brief school-nurse-administered interventions for reducing anxiety. Thirty school nurses in Connecticut and Maryland were randomly assigned to deliver the Child Anxiety Learning Modules (CALM; n = 14) or CALM-Relaxation only (CALM-R; n = 16). Students (N = 54) were ages 5-12 (M age = 8; 84.9% White; 68.5% female) with elevated anxiety symptoms and/or anxiety disorders. Feasibility was assessed based on recruitment, retention, attendance, training and intervention satisfaction, and intervention adherence. Multiple informants, including independent evaluators (IEs), completed measures of clinical improvement at postintervention and at a 3-month follow-up. Of nurses in CALM and CALM-R, 62% and 81%, respectively, enrolled a student and completed an average of 6 sessions. Youth retention was 85% and 94% in CALM and CALM-R, respectively. Training and intervention satisfaction were high. At postintervention and follow-up, youth in both groups showed significant reductions in anxiety and related symptoms and improvements in functioning. Within-group effect sizes were medium to large, and between-group effect sizes were small. Task shifting responsibility for delivering brief mental health interventions to school nurses is feasible and shows promise for reducing anxiety and related impairment. This approach may also be integrated within a response to intervention model used in schools.Public Health Significance: Brief school-nurse-administered anxiety reduction interventions were shown to be feasible and had a positive impact on student anxiety and related impairment highlighting that school nurses can be an important school resource.
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Affiliation(s)
- Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Kelly L Drake
- The Johns Hopkins University School of Medicine, c/o Anxiety Treatment Center of Maryland
| | - Michela A Muggeo
- Department of Psychiatry, University of Connecticut School of Medicine
| | | | - Paige J Pikulski
- Department of Psychiatry, University of Connecticut School of Medicine
| | - Di Zheng
- Department of Statistics, University of Connecticut
| | - Ofer Harel
- Department of Statistics, University of Connecticut
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31
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Truong A, Hashmi A, Banu S, Williams L. Anxiety Disorders in Adolescents. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190507-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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