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Casline EP, Ogle RR, Peris TS, Kendall PC, Piacentini J, Compton S, Keeton C, Ginsburg GS. Client-rated facilitators and barriers to long-term youth anxiety disorder recovery. J Clin Psychol 2022; 78:2164-2179. [PMID: 35687807 PMCID: PMC9561069 DOI: 10.1002/jclp.23400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.
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Affiliation(s)
| | - Robert R. Ogle
- Counseling Center, Yeshiva University, New York, NY, USA
| | - Tara S. Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Cervin M, Norris LA, Ginsburg G, Gosch EA, Compton SN, Piacentini J, Albano AM, Sakolsky D, Birmaher B, Keeton C, Storch EA, Kendall PC. The p Factor Consistently Predicts Long-Term Psychiatric and Functional Outcomes in Anxiety-Disordered Youth. J Am Acad Child Adolesc Psychiatry 2021; 60:902-912.e5. [PMID: 32950650 PMCID: PMC8109237 DOI: 10.1016/j.jaac.2020.08.440] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 07/23/2020] [Accepted: 09/11/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pediatric anxiety disorders can have a chronic course and are considered gateway disorders to adult psychopathology, but no consistent predictors of long-term outcome have been identified. A single latent symptom dimension that reflects features shared by all mental health disorders, the p factor, is thought to reflect mechanisms that cut across mental disorders. Whether p predicts outcome in youth with psychiatric disorders has not been examined. We tested whether the p factor predicted long-term psychiatric and functional outcomes in a large, naturalistically followed-up cohort of anxiety-disordered youth. METHOD Children and adolescents enrolled in a randomized controlled treatment trial of pediatric anxiety were followed-up on average 6 years posttreatment and then annually for 4 years. Structural equation modeling was used to estimate p at baseline. Both p and previously established predictors were modeled as predictors of long-term outcome. RESULTS Higher levels of p at baseline were related to more mental health disorders, poorer functioning, and greater impairment across all measures at all follow-up time points. p Predicted outcome above and beyond previously identified predictors, including diagnostic comorbidity at baseline. Post hoc analyses showed that p predicted long-term anxiety outcome, but not acute treatment outcome, suggesting that p may be uniquely associated with long-term outcome. CONCLUSION Children and adolescents with anxiety disorders who present with a liability toward broad mental health problems may be at a higher risk for poor long-term outcome across mental health and functional domains. Efforts to assess and to address this broad liability may enhance long-term outcome.
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Affiliation(s)
| | - Lesley A. Norris
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Golda Ginsburg
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Elizabeth A. Gosch
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Scott N. Compton
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - John Piacentini
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Anne Marie Albano
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Dara Sakolsky
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Boris Birmaher
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Courtney Keeton
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Eric A. Storch
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
| | - Philip C. Kendall
- Dr. Cervin is with Lund University, Sweden. Ms. Norris and Dr. Kendall are with Temple University, Philadelphia, Pennsylvania. Dr. Ginsburg is with the University of Connecticut School of Medicine, West Hartford, Connecticut. Dr. Gosch is with the Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania. Dr. Compton is with Duke University Medical Center, Durham, North Carolina. Dr. Piacentini is with Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California. Dr. Albano is with Columbia University, New York, New York. Drs. Sakolsky and Birmaher are with the University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Keeton is with The Johns Hopkins University School of Medicine, Baltimore, Maryland. Dr. Storch is with Baylor College of Medicine, Houston, Texas
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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 DOI: 10.1037/ccp0000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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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Kagan ER, Frank HE, Norris LA, Palitz SA, Chiappini EA, Knepley MJ, Crane ME, Philips 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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [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, Baltimore, MD
| | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | | | - Mark J. Knepley
- Department of Psychology, Temple University, Philadelphia, PA
| | | | | | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Harford, CT
| | - Courtney Keeton
- Division of Child & Adolescent Psychiatry, Johns Hopkins, Baltimore, MD
| | | | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA, Los Angeles, CA
| | - Tara Peris
- Department of Psychiatry, UCLA, Los Angeles, CA
| | - Scott Compton
- Department of Psychiatry and Behavioral 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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Makover HB, Kendall PC, Olino T, Carper MM, Albano AM, Piacentini J, Peris T, Langley AK, Gonzalez A, Ginsburg GS, Compton S, Birmaher B, Sakolsky D, Keeton C, Walkup J. Mediators of youth anxiety outcomes 3 to 12 years after treatment. J Anxiety Disord 2020; 70:102188. [PMID: 32078966 PMCID: PMC10783175 DOI: 10.1016/j.janxdis.2020.102188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/13/2019] [Accepted: 01/07/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. METHOD Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. RESULTS Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. CONCLUSION Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.
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Affiliation(s)
- Heather B Makover
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Philip C Kendall
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA.
| | - Thomas Olino
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Matthew M Carper
- Department of Psychology, Temple University, 1301 North 13th Street, Philadelphia, PA, 19122, USA
| | - Anne Marie Albano
- Columbia University Clinic for Anxiety and Related Disorders, 1775 Broadway, Suite 601, New York, NY, 10019, USA
| | - John Piacentini
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Tara Peris
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Audra K Langley
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Araceli Gonzalez
- UCLA Semel Institute, 760 Westwood Blvd, Rm 67-439, Los Angeles, CA, 90024, USA
| | - Golda S Ginsburg
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - Scott Compton
- Duke University Medical Center, Department of Psychiatry and Behavioral Sciences, DUMC Box 3527, Durham, NC, 27710, USA
| | - Boris Birmaher
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Dara Sakolsky
- University of Pittsburgh Medical Center, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Courtney Keeton
- The Johns Hopkins University School of Medicine, Division of Child and Adolescent Psychiatry, 550 North Broadway, Suite 202, Baltimore, MD, 21205, USA
| | - John Walkup
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine, 446 East Ontario, Suite 7-200, Chicago, IL, 60611, USA
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Correll CU, Sikich L, Reeves G, Johnson J, Keeton C, Spanos M, Kapoor S, Bussell K, Miller L, Chandrasekhar T, Sheridan EM, Pirmohamed S, Reinblatt SP, Alderman C, Scheer A, Borner I, Bethea TC, Edwards S, Hamer RM, Riddle MA. Metformin add-on vs. antipsychotic switch vs. continued antipsychotic treatment plus healthy lifestyle education in overweight or obese youth with severe mental illness: results from the IMPACT trial. World Psychiatry 2020; 19:69-80. [PMID: 31922663 PMCID: PMC6953545 DOI: 10.1002/wps.20714] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Antipsychotics are used for many psychiatric conditions in youth. Although developmentally inappropriate weight gain and metabolic abnormalities, which are risk factors for premature cardiovascular mortality, are especially frequent in youth, optimal strategies to reduce pediatric antipsychotic-induced overweight/obesity are unclear. The Improving Metabolic Parameters in Antipsychotic Child Treatment (IMPACT) was a randomized, parallel group, 24-week clinical trial which enrolled overweight/obese, psychiatrically stable youth, aged 8-19 years, with a DSM-IV diagnosis of severe mental illness (schizophrenia spectrum disorder, bipolar spectrum disorder or psychotic depression), at four US universities. All of them had developed substantial weight gain following treatment with a second-generation antipsychotic. The centralized, computer-based randomization system assigned participants to unmasked treatment groups: metformin (MET); antipsychotic switch (aripiprazole or, if already exposed to that drug, perphenazine or molindone; SWITCH); or continued baseline antipsychotic (CONTROL). All participants received healthy lifestyle education. The primary outcome was body mass index (BMI) z-score change from baseline, analyzed using estimated least squares means. Altogether, 127 participants were randomized: 49 to MET, 31 to SWITCH, and 47 to CONTROL. BMI z-score decreased significantly with MET (week 24: -0.09±0.03, p=0.002) and SWITCH (week 24: -0.11±0.04, p=0.003), while it increased non-significantly with CONTROL (week 24: +0.04±0.03). On 3-way comparison, BMI z-score changes differed significantly (p=0.001). MET and SWITCH were each superior to CONTROL (p=0.002), with effect sizes of 0.68 and 0.81 respectively, while MET and SWITCH did not differ. More gastrointestinal problems occurred in MET than in SWITCH or CONTROL. The data safety monitoring board closed the perphenazine-SWITCH arm because 35.2% of subjects discontinued treatment due to psychiatric worsening. These data suggest that pediatric antipsychotic-related overweight/obesity can be reduced by adding metformin or switching to a lower risk antipsychotic. Healthy lifestyle education is not sufficient to prevent ongoing BMI z-score increase.
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Affiliation(s)
- Christoph U. Correll
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA,Department of Psychiatry and Molecular MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Linmarie Sikich
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Gloria Reeves
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | | | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Marina Spanos
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Sandeep Kapoor
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA,Department of Psychiatry and Molecular MedicineDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA,Department of Child and Adolescent PsychiatryCharité UniversitätsmedizinBerlinGermany
| | - Kristin Bussell
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Leslie Miller
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | - Tara Chandrasekhar
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Eva M. Sheridan
- Department of Science EducationDonald and Barbara Zucker School of Medicine at Hofstra/NorthwellHempsteadNYUSA
| | - Sara Pirmohamed
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Shauna P. Reinblatt
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA,Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
| | | | - Abigail Scheer
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA
| | - Irmgard Borner
- Division of Psychiatric ResearchZucker Hillside HospitalNYUSA
| | - Terrence C. Bethea
- Department of Psychiatry and Behavioral SciencesDuke University School of MedicineDurhamNCUSA,Hughes CenterDanvilleVAUSA
| | - Sarah Edwards
- Division of Child and Adolescent Psychiatry, School of MedicineUniversity of MarylandBaltimoreMDUSA
| | - Robert M. Hamer
- Department of PsychiatryUniversity of North CarolinaChapel HillNCUSA
| | - Mark A. Riddle
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreMDUSA
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Swan AJ, Kendall PC, Olino T, Ginsburg G, Keeton C, Compton S, Piacentini J, Peris T, Sakolsky D, Birmaher B, Albano AM. Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes. J Consult Clin Psychol 2018; 86:738-750. [PMID: 30138013 DOI: 10.1037/ccp0000334] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). METHOD Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. RESULTS Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. CONCLUSION Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record
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Affiliation(s)
- Anna J Swan
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone
| | | | | | - Golda Ginsburg
- Child Division of Department of Psychiatry, University of Connecticut Health
| | - Courtney Keeton
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
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9
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Ginsburg GS, Becker-Haimes EM, Keeton C, Kendall PC, Iyengar S, Sakolsky D, Albano AM, Peris T, Compton SN, Piacentini J. Results From the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes. J Am Acad Child Adolesc Psychiatry 2018; 57:471-480. [PMID: 29960692 DOI: 10.1016/j.jaac.2018.03.017] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 02/13/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive-behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events. METHOD Data were from 319 youths (age range 10.9-25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview Schedule and completed questionnaires (eg, about family functioning, life events, and mental health service use). RESULTS Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers. Acute treatment responders were less likely to be in the chronically ill group (odds ratio = 2.73; confidence interval = 1.14-6.54; p < .02); treatment type was not associated with remission status across the follow-up. Several variables (eg, male gender) predicted stable remission from anxiety disorders. CONCLUSION Findings suggest that acute positive response to anxiety treatment may reduce risk for chronic anxiety disability; identified predictors can help tailor treatments to youth at greatest risk for chronic illness. CLINICAL TRIAL REGISTRATION INFORMATION Child and Adolescent Anxiety Disorders (CAMS). http://clinicaltrials.gov/; NCT00052078.
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10
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Albano AM, Comer JS, Compton SN, Piacentini J, Kendall PC, Birmaher B, Walkup JT, Ginsburg GS, Rynn MA, McCracken J, Keeton C, Sakolsky DJ, Sherrill JT. Secondary Outcomes From the Child/Adolescent Anxiety Multimodal Study: Implications for Clinical Practice. ACTA ACUST UNITED AC 2017; 3:30-41. [PMID: 30906874 DOI: 10.1080/23794925.2017.1399485] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Controlled evaluations comparing medication, cognitive-behavioral therapy (CBT), and their combination in the treatment of youth anxiety have predominantly focused on global ratings by independent evaluators. Such ratings are resource-intensive, may be of limited generalizability, and do not directly inform our understanding of treatment responses from the perspective of treated families. We examined outcomes from the perspective of treated youth and parents in the Child/Adolescent Anxiety Multimodal Study (CAMS). Methods Participants (N=488; ages 7-17 years) who had a primary diagnosis of separation, social, and/or generalized anxiety disorder were randomly assigned to a treatment condition in the CAMS trial. Linear mixed-effects and ANCOVA models examined parent- and youth-reported anxiety symptoms, impact of anxiety, broader internalizing and externalizing psychopathology, depressive symptoms, and family burden throughout the 12-week acute treatment phase and 6-month follow-up. Results At week 12, combination treatment showed superiority over placebo, sertraline, and CBT with regard to parent-reported youth anxiety symptoms, and sertraline and CBT as monotherapies showed superiority over placebo with regard to parent-reported youth anxiety. Combination therapy and sertraline also showed week 12 superiority over placebo with regard to parent-reported internalizing psychopathology, and superiority over placebo and CBT with regard to parent-reported impact of anxiety, family burden, and youth depressive symptoms. By week 36, parent reports of many youth outcomes were comparable across active conditions. Youth measures tracked parent measures on many outcomes. Conclusions Findings were drawn on brief, readily available questionnaires that in conjunction with clinician measures can inform patient-centered care and collaborative decision-making.Trial Registry Name: Child and Adolescent Anxiety Disorders (CAMS)Registry identification number: NCT00052078Registry URL: https://www.clinicaltrials.gov/ct2/show/NCT00052078.
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Affiliation(s)
- Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - Jonathan S Comer
- Departments of Psychology and Psychiatry, Center for Children and Families, Florida International University, Miami, FL
| | - Scott N Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College and New York Presbyterian Hospital, New York, NY
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT
| | - Moira A Rynn
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
| | - James McCracken
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Courtney Keeton
- Department of Psychiatry, Johns Hopkins Medical Institutions
| | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Joel T Sherrill
- Division of Services and Interventions Research, National Institute of Mental Health, Bethesda, MD
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11
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Lee P, Zehgeer A, Ginsburg GS, McCracken J, Keeton C, Kendall PC, Birmaher B, Sakolsky D, Walkup J, Peris T, Albano AM, Compton S. Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes. J Clin Child Adolesc Psychol 2017; 48:S215-S226. [PMID: 28448176 DOI: 10.1080/15374416.2017.1310046] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.
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Affiliation(s)
- Phyllis Lee
- a Department of Psychiatry, University of Connecticut Health
| | - Asima Zehgeer
- a Department of Psychiatry, University of Connecticut Health
| | | | - James McCracken
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Courtney Keeton
- c Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine
| | | | | | - Dara Sakolsky
- e Department of Psychiatry, University of Pittsburgh
| | - John Walkup
- f Department of Child and Adolescent Psychiatry, Weill Cornell Medical College
| | - Tara Peris
- b Division of Child and Adolescent Psychiatry,UCLA Semel Institute of Neuroscience and Human Behavior
| | - Anne Marie Albano
- g Department of Child and Adolescent Psychiatry, Columbia University
| | - Scott Compton
- h Department of Psychiatry and Behavioral Sciences, Duke University
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12
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Hoff AL, Kendall PC, Langley A, Ginsburg G, Keeton C, Compton S, Sherrill J, Walkup J, Birmaher B, Albano AM, Suveg C, Piacentini J. Developmental Differences in Functioning in Youth With Social Phobia. J Clin Child Adolesc Psychol 2015; 46:686-694. [PMID: 26630122 DOI: 10.1080/15374416.2015.1079779] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Social phobia (SoP) in youth may manifest differently across development as parent involvement in their social lives changes and social and academic expectations increase. This cross-sectional study investigated whether self-reported and parent-reported functioning in youth with SoP changes with age in social, academic, and home/family domains. Baseline anxiety impairment data from 488 treatment-seeking anxiety-disordered youth (ages 7-17, N = 400 with a SoP diagnosis) and their parents were gathered using the Child Anxiety Impact Scale and were analyzed using generalized estimating equations. According to youth with SoP and their parents, overall difficulties, social difficulties, and academic difficulties increased with age, even when controlling for SoP severity. These effects significantly differed for youth with anxiety disorders other than SoP. Adolescents may avoid social situations as parental involvement in their social lives decreases, and their withdrawn behavior may result in increasing difficulty in the social domain. Their avoidance of class participation and oral presentations may increasingly impact their academic performance as school becomes more demanding. Implications are discussed for the early detection and intervention of SoP to prevent increased impairment over the course of development.
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Affiliation(s)
| | | | - Audra Langley
- b Department of Psychiatry , University of California , Los Angeles
| | - Golda Ginsburg
- c Department of Psychiatry , University of Connecticut School of Medicine
| | - Courtney Keeton
- d Department of Psychiatry and Behavioral Sciences , Johns Hopkins University School of Medicine
| | - Scott Compton
- e Department of Psychiatry and Behavioral Science , Duke University Medical Center
| | | | - John Walkup
- g Division of Child and Adolescent Psychiatry , Weill Cornell Medical College
| | - Boris Birmaher
- h Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | | | | | - John Piacentini
- b Department of Psychiatry , University of California , Los Angeles
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13
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Caporino NE, Read KL, Shiffrin N, Settipani C, Kendall PC, Compton SN, Sherrill J, Piacentini J, Walkup J, Ginsburg G, Keeton C, Birmaher B, Sakolsky D, Gosch E, Albano AM. Sleep-Related Problems and the Effects of Anxiety Treatment in Children and Adolescents. J Clin Child Adolesc Psychol 2015; 46:675-685. [PMID: 26467211 DOI: 10.1080/15374416.2015.1063429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined (a) demographic and clinical characteristics associated with sleep-related problems (SRPs) among youth with anxiety disorders, and (b) the impact of anxiety treatment: cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline), their combination, and pill placebo on SRPs. Youth (N = 488, ages 7-17, 50% female, 79% White) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated. SRPs were reported by parents and youth. Findings differed by informant and by type of SRP, with evidence that SRPs are associated with age, anxiety severity, externalizing problems, functional impairment, and family burden at pretreatment. Anxiety treatment reduced SRPs; effect sizes were small to medium. Reductions in parent-reported separation-related sleep difficulties were significantly greater in active treatment than in the placebo condition, with the greatest reductions reported by parents of youth whose active treatment was multimodal or included sertraline. Youth whose anxiety treatment involved CBT reported significantly greater decreases in dysregulated sleep (e.g., sleeplessness). Both CBT for anxiety and sertraline appear to be somewhat effective in reducing SRPs, and multimodal treatment may be preferable depending on the symptom presentation. To inform practice, future research should examine a broad range of SRPs, incorporate objective measures of sleep, and evaluate the impact of behavioral strategies that directly target SRPs in youth with anxiety disorders.
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Affiliation(s)
| | | | | | | | | | - Scott N Compton
- c Department of Psychiatry and Behavioral Services , Duke University Medical Center
| | - Joel Sherrill
- d Division of Services and Intervention Research , National Institute of Mental Health
| | - John Piacentini
- e Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles
| | - John Walkup
- f Division of Child and Adolescent Psychiatry , Weill Cornell Medical College
| | | | - Courtney Keeton
- h Division of Child and Adolescent Psychiatry , The Johns Hopkins University School of Medicine
| | - Boris Birmaher
- i Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | - Dara Sakolsky
- i Western Psychiatric Institute and Clinic , University of Pittsburgh Medical Center
| | - Elizabeth Gosch
- j Department of Psychology , Philadelphia College of Osteopathic Medicine
| | - Anne M Albano
- k Department of Psychiatry , Columbia Medical Center
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14
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Kendall PC, Cummings CM, Villabø MA, Narayanan MK, Treadwell K, Birmaher B, Compton S, Piacentini J, Sherrill J, Walkup J, Gosch E, Keeton C, Ginsburg G, Suveg C, Albano AM. Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study. J Consult Clin Psychol 2015; 84:1-14. [PMID: 26460572 DOI: 10.1037/a0039773] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). METHOD Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. RESULTS Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. CONCLUSIONS The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.
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Affiliation(s)
| | | | | | - Martina K Narayanan
- Department of Psychology, The Norwegian Center for Child Behavioral Development
| | | | | | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University
| | - John Piacentini
- Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles
| | - Joel Sherrill
- Child and Adolescent Mental Health, National Institute of Mental Health
| | - John Walkup
- Department of Child and Adolescent Psychiatry, Cornell University
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine
| | - Courtney Keeton
- Department of Child and Adolescent Psychiatry, Johns Hopkins University
| | - Golda Ginsburg
- Department of Child and Adolescent Psychiatry, Johns Hopkins University
| | - Cindy Suveg
- Department of Psychology, University of Georgia
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Gordon-Hollingsworth AT, Becker EM, Ginsburg GS, Keeton C, Compton SN, Birmaher BB, Sakolsky DJ, Piacentini J, Albano AM, Kendall PC, Suveg CM, March JS. Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes. Child Psychiatry Hum Dev 2015; 46:643-55. [PMID: 25293650 PMCID: PMC4390415 DOI: 10.1007/s10578-014-0507-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement.
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Affiliation(s)
- Arlene T. Gordon-Hollingsworth
- Department of Pediatrics, Psychology Section, Baylor College of Medicine, 6701 Fannin Street, CC1630, Houston, TX 77030, USA
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Emily M. Becker
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL 33124-0751, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, 65 Kane Street, Room 1005, West Hartford, CT 06119, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine, 550 N. Broadway, Baltimore, MD 21205, USA
| | - Scott N. Compton
- Department of Psychiatry, Duke University Medical Center, Suite 3527, Durham, NC 27710, USA
| | - Boris B. Birmaher
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - Dara J. Sakolsky
- Department of Psychiatry, University of Pittsburgh, 3811 O’Hara Street, Pittsburg, PA 15213, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, 3811 O’Hara Street, Pittsburg, PA, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90024, USA
| | - Anne M. Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Drive, New York, NY 10032, USA
| | - Philip C. Kendall
- Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA
| | - Cynthia M. Suveg
- Department of Psychology, University of Georgia, 125 Baldwin Street, Athens, GA 30602, USA
| | - John S. March
- Division of Neurosciences Medicine, Duke Research Institute, 2400 Pratt Street, Durham, NC 27710, USA
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Rynn MA, Walkup JT, Compton SN, Sakolsky DJ, Sherrill JT, Shen S, Kendall PC, McCracken J, Albano AM, Piacentini J, Riddle MA, Keeton C, Waslick B, Chrisman A, Iyengar S, March JS, Birmaher B. Child/Adolescent anxiety multimodal study: evaluating safety. J Am Acad Child Adolesc Psychiatry 2015; 54:180-90. [PMID: 25721183 PMCID: PMC4362776 DOI: 10.1016/j.jaac.2014.12.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 12/08/2014] [Accepted: 12/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the frequency of adverse events (AEs) across 4 treatment conditions in the Child/Adolescent Anxiety Multimodal Study (CAMS), and to compare the frequency of AEs between children and adolescents. METHOD Participants ages 7 to 17 years (mean = 10.7 years) meeting the DSM-IV criteria for 1 or more of the following disorders: separation anxiety disorder, generalized anxiety disorder, or social phobia were randomized (2:2:2:1) to cognitive-behavioral therapy (CBT, n = 139), sertraline (SRT, n = 133), a combination of both (COMB, n = 140), or pill placebo (PBO, n = 76). Data on AEs were collected via a standardized inquiry method plus a self-report Physical Symptom Checklist (PSC). RESULTS There were no differences between the double-blinded conditions (SRT versus PBO) for total physical and psychiatric AEs or any individual physical or psychiatric AEs. The rates of total physical AEs were greater in the SRT-alone treatment condition when compared to CBT (p < .01) and COMB (p < .01). Moreover, those who received SRT alone reported higher rates of several physical AEs when compared to COMB and CBT. The rate of total psychiatric AEs was higher in children (≤12 years) across all arms (31.7% versus 23.1%, p < .05). Total PSC scores decreased over time, with no significant differences between treatment groups. CONCLUSION The results support the tolerability/safety of selective serotonin reuptake inhibitor (SSRI) treatment for anxiety disorders even after adjusting for the number of reporting opportunities, leading to no differences in overall rates of AEs. Few differences occurred on specific items. Additional monitoring of psychiatric AEs is recommended in children (≤12 years). Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov; NCT00052078.
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Affiliation(s)
- Moira A Rynn
- Columbia University Medical Center (CUMC)/New York State Psychiatric Institute, New York.
| | - John T Walkup
- Weill Cornell Medical College and New York Presbyterian Hospital, New York
| | | | - Dara J Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh
| | - Joel T Sherrill
- Division of Services and Intervention Research at the National Institute of Mental Health (NIMH), Bethesda, MD
| | - Sa Shen
- University of Illinois at Urbana-Champaign
| | | | - James McCracken
- University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
| | - Anne Marie Albano
- Columbia University Medical Center (CUMC)/New York State Psychiatric Institute, New York
| | - John Piacentini
- University of California, Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | | | | | - Satish Iyengar
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center, Pittsburgh
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Nail JE, Christofferson J, Ginsburg GS, Drake K, Kendall PC, McCracken JT, Birmaher B, Walkup JT, Compton SN, Keeton C, Sakolsky D. Academic Impairment and Impact of Treatments Among Youth with Anxiety Disorders. Child Youth Care Forum 2014. [DOI: 10.1007/s10566-014-9290-x] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Crawley SA, Caporino NE, Birmaher B, Ginsburg G, Piacentini J, Albano AM, Sherrill J, Sakolsky D, Compton SN, Rynn M, McCracken J, Gosch E, Keeton C, March J, Walkup JT, Kendall PC. Somatic complaints in anxious youth. Child Psychiatry Hum Dev 2014; 45:398-407. [PMID: 24129543 PMCID: PMC3989467 DOI: 10.1007/s10578-013-0410-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study examined (a) demographic and clinical characteristics associated with physical symptoms in anxiety-disordered youth and (b) the impact of cognitive-behavioral therapy (Coping Cat), medication (sertraline), their combination, and pill placebo on physical symptoms. Youth (N = 488, ages 7-17 years) with a principal diagnosis of generalized anxiety disorder, separation anxiety disorder, or social phobia participated as part of a multi-site, randomized controlled trial and received treatment delivered over 12 weeks. Diagnostic status, symptom severity, and impairment were assessed at baseline and week 12. The total number and severity of physical symptoms was associated with age, principal diagnosis, anxiety severity, impairment, and the presence of comorbid internalizing disorders. Common somatic complaints were headaches, stomachaches, head cold or sniffles, sleeplessness, and feeling drowsy or too sleepy. Physical symptoms decreased over the course of treatment, and were unrelated to treatment condition. Clinical implications and directions for future research are discussed (ClinicalTrials.gov number, NCT00052078).
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Affiliation(s)
- Sarah A. Crawley
- Kennedy Krieger Institute/Johns Hopkins University School of Medicine,Department of Psychology, Temple University
| | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | - Golda Ginsburg
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | | | - Joel Sherrill
- Division of Services and Intervention Research, National Institute of Mental Health
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center
| | - Scott N. Compton
- Department of Psychiatry and Behavioral Services, Duke University Medical Center
| | - Moira Rynn
- Department of Psychiatry, Columbia University Medical Center
| | - James McCracken
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, The Johns Hopkins University School of Medicine
| | - John March
- Department of Psychiatry and Behavioral Services, Duke University Medical Center
| | - John T. Walkup
- Division of Child and Adolescent Psychiatry, Weill Cornell Medical College
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Read KL, Settipani CA, Peterman J, Kendall PC, Compton S, Piacentini J, McCracken J, Bergman L, Walkup J, Sakolsky D, Birmaher B, Albano AM, Rynn M, Ginsburg G, Keeton C, Gosch E, Suveg C, Sherrill J, March J. Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales? J Psychopathol Behav Assess 2014; 37:100-111. [PMID: 26257470 DOI: 10.1007/s10862-014-9439-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A's unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.
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Cummings CM, Caporino NE, Settipani CA, Read KL, Compton SN, March J, Sherrill J, Piacentini J, McCracken J, Walkup JT, Ginsburg G, Albano AM, Rynn M, Birmaher B, Sakolsky D, Gosch E, Keeton C, Kendall PC. The therapeutic relationship in cognitive-behavioral therapy and pharmacotherapy for anxious youth. J Consult Clin Psychol 2013; 81:859-64. [PMID: 23750468 PMCID: PMC4511279 DOI: 10.1037/a0033294] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We examined the therapeutic relationship with cognitive-behavioral therapists and with pharmacotherapists for youth from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). The therapeutic relationship was examined in relation to treatment outcomes. METHOD Participants were 488 youth (ages 7-17 years; 50% male) randomized to cognitive-behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), their combination, or placebo pill. Participants met criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). The therapeutic relationship was assessed by youth report at Weeks 6 and 12 of treatment using the Child's Perception of Therapeutic Relationship scale (Kendall et al., 1997). Outcome measures (Pediatric Anxiety Rating Scale; Research Units on Pediatric Psychopharmacology Anxiety Study Group, 2002; and Clinical Global Impressions Scales; Guy, 1976) were completed by independent evaluators blind to condition. RESULTS For youth who received CBT only, a stronger therapeutic relationship predicted positive treatment outcome. In contrast, the therapeutic relationship did not predict outcome for youth receiving sertraline, combined treatment, or placebo. CONCLUSION A therapeutic relationship may be important for anxious youth who receive CBT alone.
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Wei C, Hoff A, Villabø MA, Peterman J, Kendall PC, Piacentini J, McCracken J, Walkup JT, Albano AM, Rynn M, Sherrill J, Sakolsky D, Birmaher B, Ginsburg G, Keeton C, Gosch E, Compton SN, March J. Assessing anxiety in youth with the multidimensional anxiety scale for children. J Clin Child Adolesc Psychol 2013; 43:566-78. [PMID: 23845036 DOI: 10.1080/15374416.2013.814541] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The present study examined the psychometric properties, including discriminant validity and clinical utility, of the youth self-report and parent-report forms of the Multidimensional Anxiety Scale for Children (MASC) among youth with anxiety disorders. The sample included parents and youth (N = 488, 49.6% male) ages 7 to 17 who participated in the Child/Adolescent Anxiety Multimodal Study. Although the typical low agreement between parent and youth self-reports was found, the MASC evidenced good internal reliability across MASC subscales and informants. The main MASC subscales (i.e., Physical Symptoms, Harm Avoidance, Social Anxiety, and Separation/Panic) were examined. The Social Anxiety and Separation/Panic subscales were found to be significantly predictive of the presence and severity of social phobia and separation anxiety disorder, respectively. Using multiple informants improved the accuracy of prediction. The MASC subscales demonstrated good psychometric properties and clinical utilities in identifying youth with anxiety disorders.
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Kendall PC, Compton SN, Walkup JT, Birmaher B, Albano AM, Sherrill J, Ginsburg G, Rynn M, McCracken J, Gosch E, Keeton C, Bergman L, Sakolsky D, Suveg C, Iyengar S, March J, Piacentini J. Clinical characteristics of anxiety disordered youth. J Anxiety Disord 2010; 24:360-5. [PMID: 20206470 PMCID: PMC2838990 DOI: 10.1016/j.janxdis.2010.01.009] [Citation(s) in RCA: 254] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Revised: 01/26/2010] [Accepted: 01/29/2010] [Indexed: 11/28/2022]
Abstract
Reports the characteristics of a large, representative sample of treatment-seeking anxious youth (N=488). Participants, aged 7-17 years (mean 10.7 years), had a principal DSM-IV diagnosis of separation anxiety disorder (SAD), generalized anxiety disorder (GAD), or social phobia (SP). Although youth with a co-primary diagnosis for which a different disorder-specific treatment would be indicated (e.g., major depressive disorder, substance abuse) were not included, there were few other exclusion criteria. Participants and their parent/guardian underwent an extensive baseline assessment using a broad array of measures capturing diagnostic status, anxiety symptoms and severity, and areas of functional impairment. Means and standard deviations of the measures of psychopathology and data on diagnostic status are provided. The sample had moderate to severe anxiety disorder and was highly comorbid, with 55.3% of participants meeting criteria for at least one non-targeted DSM-IV disorder. Anxiety disorders in youth often do not present as a single/focused disorder: such disorders in youth overlap in symptoms and are highly comorbid among themselves.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, 1701 North 13th Street, Philadelphia, PA 19122, USA.
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