title: The relation of severity and comorbidity to treatment outcome with Cognitive Behavioral Therapy for childhood anxiety disorders.
abstract: The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8-12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; "total comorbidity" which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and "non-anxiety comorbidity' which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.
authors.affiliation: Department of Child and Adolescent Psychiatry, Curium/ Leiden University Medical Center, Leiden, the Netherlands. J.M.Liber@uva.nl
authors.forename: Juliette Margo
authors.initials: JM
authors.lastname: Liber
authors.forename: Brigit M
authors.initials: BM
authors.lastname: van Widenfelt
authors.forename: Adelinde J M
authors.initials: AJ
authors.lastname: van der Leeden
authors.forename: Arnold W
authors.initials: AW
authors.lastname: Goedhart
authors.forename: Elisabeth M W J
authors.initials: EM
authors.lastname: Utens
authors.forename: Philip D A
authors.initials: PD
authors.lastname: Treffers
mesh_terms: D001008:Anxiety Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012650:Self Disclosure; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016896:Treatment Outcome