title: Defining treatment response and remission in child anxiety: signal detection analysis using the pediatric anxiety rating scale.
abstract: OBJECTIVE
  To determine optimal Pediatric Anxiety Rating Scale (PARS) percent reduction and raw score cut-offs for predicting treatment response and remission among children and adolescents with anxiety disorders.
  
  
  METHODS
  Data were from a subset of youth (N = 438; 7-17 years of age) who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multi-site, randomized controlled trial that examined the relative efficacy of cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline [SRT]), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The clinician-rated PARS was administered pre- and posttreatment (delivered over 12 weeks). Quality receiver operating characteristic methods assessed the performance of various PARS percent reductions and absolute cut-off scores in predicting treatment response and remission, as determined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule for DSM-IV. Corresponding change in impairment was evaluated using the Child Anxiety Impact Scale.
  
  
  RESULTS
  Reductions of 35% and 50% on the six-item PARS optimally predicted treatment response and remission, respectively. Post-treatment PARS raw scores of 8 to 10 optimally predicted remission. Anxiety improved as a function of PARS-defined treatment response and remission.
  
  
  CONCLUSIONS
  Results serve as guidelines for operationalizing treatment response and remission in future research and in making cross-study comparisons. These guidelines can facilitate translation of research findings into clinical practice.
authors.affiliation: Temple University. Electronic address: nicole.caporino@temple.edu.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Caporino
authors.forename: Douglas M
authors.initials: DM
authors.lastname: Brodman
authors.forename: Philip C
authors.initials: PC
authors.lastname: Kendall
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Albano
authors.forename: Joel
authors.initials: J
authors.lastname: Sherrill
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.forename: Dara
authors.initials: D
authors.lastname: Sakolsky
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.forename: Scott N
authors.initials: SN
authors.lastname: Compton
authors.forename: Golda
authors.initials: G
authors.lastname: Ginsburg
authors.forename: Moira
authors.initials: M
authors.lastname: Rynn
authors.forename: James
authors.initials: J
authors.lastname: McCracken
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gosch
authors.forename: Courtney
authors.initials: C
authors.lastname: Keeton
authors.forename: John
authors.initials: J
authors.lastname: March
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D017603:Signal Detection, Psychological; D011795:Surveys and Questionnaires
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline