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

TY - JOUR

T1 - Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders

T2 - The Genes for Treatment (GxT) Study

AU - Hudson, Jennifer

AU - Keers, Robert

AU - Roberts, Susanna

AU - Coleman, Jonathan

AU - Breen, Gerome

AU - Arendt, Kristian

AU - Bogels, Susan

AU - Cooper, Peter

AU - Creswell, Cathy

AU - Hartman, Catharina A.

AU - Heiervang, Einar

AU - Hotzel, Katrin

AU - In-Albon, Tina

AU - Lavallee, Kristen

AU - Lyneham, Heidi J

AU - Marin, Carla E.

AU - McKinnon, Anna

AU - Meiser-Stedman, Richard

AU - Morris, Talia

AU - Nauta, Maaike

AU - Rapee, Ronald

AU - Schneider, Silvia

AU - Schneider, Sophia

AU - Silverman, Wendy

AU - Thastum, Mikael

AU - Thirlwall, Kerstin

AU - Waite, Polly

AU - Wergeland, Gro Janne

AU - Lester, Kathryn

AU - Eley, Thalia

PY - 2015/6/1

Y1 - 2015/6/1

N2 - 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.

AB - 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.

KW - ANXIETY DISORDERS

KW - TREATMENT

KW - PREDICTORS

KW - Cognitive Behavioural Therapy (CBT)

U2 - 10.1016/j.jaac.2015.03.018

DO - 10.1016/j.jaac.2015.03.018

M3 - Article

SN - 0890-8567

VL - 54

SP - 454

EP - 463

JO - Journal of the American Academy of Child and Adolescent Psychiatry

JF - Journal of the American Academy of Child and Adolescent Psychiatry

IS - 6

ER -