title: Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis.
abstract: BACKGROUND
  Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap.
  
  
  OBJECTIVE
  Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure?
  
  
  METHODS
  All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects.
  
  
  RESULTS
  Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust.
  
  
  CONCLUSIONS
  Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.
authors: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. kbennett@mcmaster.ca
authors: Kathryn
authors: K
authors: Bennett
authors: Katharina
authors: K
authors: Manassis
authors: Stephen D
authors: SD
authors: Walter
authors: Amy
authors: A
authors: Cheung
authors: Pamela
authors: P
authors: Wilansky-Traynor
authors: Natalia
authors: N
authors: Diaz-Granados
authors: Stephanie
authors: S
authors: Duda
authors: Maureen
authors: M
authors: Rice
authors: Susan
authors: S
authors: Baer
authors: Paula
authors: P
authors: Barrett
authors: Denise
authors: D
authors: Bodden
authors: Vanessa E
authors: VE
authors: Cobham
authors: Mark R
authors: MR
authors: Dadds
authors: Ellen
authors: E
authors: Flannery-Schroeder
authors: Golda
authors: G
authors: Ginsburg
authors: David
authors: D
authors: Heyne
authors: Jennifer L
authors: JL
authors: Hudson
authors: Philip C
authors: PC
authors: Kendall
authors: Juliette
authors: J
authors: Liber
authors: Carrie Masia
authors: CM
authors: Warner
authors: Sandra
authors: S
authors: Mendlowitz
authors: Maaike H
authors: MH
authors: Nauta
authors: Ronald M
authors: RM
authors: Rapee
authors: Wendy
authors: W
authors: Silverman
authors: Lynne
authors: L
authors: Siqueland
authors: Susan H
authors: SH
authors: Spence
authors: Elisabeth
authors: E
authors: Utens
authors: Jeffrey J
authors: JJ
authors: Wood
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001008:Anxiety Disorders / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D016896:Treatment Outcome; D055815:Young Adult
keywords: anxiety disorders; child/adolescent; cognitive behavior therapy; empirical supported treatment; treatment
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