Naturalistic follow-up of youths treated for pediatric anxiety disorders.
OBJECTIVE
Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication.


OBJECTIVE
To determine whether acute clinical improvement and treatment type (i.e., cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up.


METHODS
This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample.


METHODS
Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use.


METHODS
Remission, defined as the absence of all study entry anxiety disorders. RESULTS Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified.


CONCLUSIONS
Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00052078.
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Golda S
GS
Ginsburg
Department of Psychology, University of Miami, Coral Gables, Florida.
Emily M
EM
Becker
Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Courtney P
CP
Keeton
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
Dara
D
Sakolsky
Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.
John
J
Piacentini
Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York.
Anne Marie
AM
Albano
Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina.
Scott N
SN
Compton
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
Satish
S
Iyengar
Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina.
Kevin
K
Sullivan
Department of Psychology, Temple University, Philadelphia, Pennsylvania.
Nicole
N
Caporino
Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California.
Tara
T
Peris
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
Boris
B
Birmaher
Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York.
Moira
M
Rynn
Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina.
John
J
March
Department of Psychology, Temple University, Philadelphia, Pennsylvania.
Philip C
PC
Kendall
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010919:Placebos; D011237:Predictive Value of Tests; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012074:Remission Induction; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D014151:Anti-Anxiety Agents; D010919:Placebos