Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study

Jennifer Hudson, Robert Keers, Susanna Roberts, Jonathan Coleman, Gerome Breen, Kristian Arendt, Susan Bogels, Peter Cooper, Cathy Creswell, Catharina A. Hartman, Einar Heiervang, Katrin Hotzel, Tina In-Albon, Kristen Lavallee, Heidi J Lyneham, Carla E. Marin, Anna McKinnon, Richard Meiser-Stedman, Talia Morris, Maaike NautaRonald Rapee, Silvia Schneider, Sophia Schneider, Wendy Silverman, Mikael Thastum, Kerstin Thirlwall, Polly Waite, Gro Janne Wergeland, Kathryn Lester, Thalia Eley

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Objective: The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first in a series of 3, examined demographic and clinical predictors of response to CBT. We hypothesized that the child’s gender, type of anxiety disorder, initial severity and comorbidity, and parents’ psychopathology would significantly predict outcome.

Method: A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analysed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points.

Results: Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and followup, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up.

Conclusion: SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.
Original languageEnglish
Pages (from-to)454–463
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number6
Early online date1 Apr 2015
Publication statusPublished - 1 Jun 2015


  • Cognitive Behavioural Therapy (CBT)


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