title: 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS).
abstract: OBJECTIVE
  We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS).
  
  
  METHODS
  CAMS youth (N = 488; 74% ≤ 12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up.
  
  
  RESULTS
  The majority (>80%) of acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment.
  
  
  CONCLUSIONS
  COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials.gov. Unique identifier: NCT00052078.
authors.affiliation: University of California-Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior. Electronic address: jpiacentini@mednet.ucla.edu.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: Weill Cornell Medical College.
authors.forename: Shannon
authors.initials: S
authors.lastname: Bennett
authors.affiliation: Duke University Medical Center.
authors.forename: Scott N
authors.initials: SN
authors.lastname: Compton
authors.affiliation: Temple University.
authors.forename: Phillip C
authors.initials: PC
authors.lastname: Kendall
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: New York State Psychiatric Institute-Columbia University Medical Center.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Albano
authors.affiliation: Duke University Medical Center.
authors.forename: John
authors.initials: J
authors.lastname: March
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health (NIMH).
authors.forename: Joel
authors.initials: J
authors.lastname: Sherrill
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Dara
authors.initials: D
authors.lastname: Sakolsky
authors.affiliation: Johns Hopkins Medical Institutions.
authors.forename: Golda
authors.initials: G
authors.lastname: Ginsburg
authors.affiliation: New York State Psychiatric Institute-Columbia University Medical Center.
authors.forename: Moira
authors.initials: M
authors.lastname: Rynn
authors.affiliation: University of California-Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior.
authors.forename: R Lindsey
authors.initials: RL
authors.lastname: Bergman
authors.affiliation: Philadelphia College of Osteopathic Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gosch
authors.affiliation: Baystate Medical Center.
authors.forename: Bruce
authors.initials: B
authors.lastname: Waslick
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: University of California-Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior.
authors.forename: James
authors.initials: J
authors.lastname: McCracken
authors.affiliation: Weill Cornell Medical College.
authors.forename: John
authors.initials: J
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000188:drug therapy / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D020280:Sertraline / Q000008:administration & dosage / Q000494:pharmacology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline
keywords: Child/Adolescent Anxiety Multimodal Study (CAMS); anxiety; cognitive-behavioral therapy (CBT); follow-up; selective serotonin reuptake inhibitor (SSRI)