title: Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study.
abstract: OBJECTIVE
  The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child's gender, type of anxiety disorder, initial severity and comorbidity, and parents' psychopathology would significantly predict outcome.
  
  
  METHODS
  A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points.
  
  
  RESULTS
  Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up.
  
  
  CONCLUSIONS
  SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, Australia.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hudson
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Medical Research Council (MRC) Social, Genetic and Developmental Psychiatry (SGDP) Centre, London.
authors.forename: Robert
authors.initials: R
authors.lastname: Keers
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Medical Research Council (MRC) Social, Genetic and Developmental Psychiatry (SGDP) Centre, London.
authors.forename: Susanna
authors.initials: S
authors.lastname: Roberts
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Medical Research Council (MRC) Social, Genetic and Developmental Psychiatry (SGDP) Centre, London.
authors.forename: Jonathan R I
authors.initials: JR
authors.lastname: Coleman
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Medical Research Council (MRC) Social, Genetic and Developmental Psychiatry (SGDP) Centre, London.
authors.forename: Gerome
authors.initials: G
authors.lastname: Breen
authors.affiliation: University of Aarhus, Denmark.
authors.forename: Kristian
authors.initials: K
authors.lastname: Arendt
authors.affiliation: Research Institute Child Development and Education, University of Amsterdam.
authors.forename: Susan
authors.initials: S
authors.lastname: Bögels
authors.affiliation: School of Psychology and Clinical Language Sciences, University of Reading, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: Cooper
authors.affiliation: School of Psychology and Clinical Language Sciences, University of Reading, UK.
authors.forename: Cathy
authors.initials: C
authors.lastname: Creswell
authors.affiliation: University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Catharina
authors.initials: C
authors.lastname: Hartman
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway and Anxiety Research Network, Haukeland University Hospital, Bergen, Norway.
authors.forename: Einar R
authors.initials: ER
authors.lastname: Heiervang
authors.affiliation: Ruhr-Universität Bochum, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Hötzel
authors.affiliation: University Koblenz-Landau, Landau, Germany.
authors.forename: Tina
authors.initials: T
authors.lastname: In-Albon
authors.affiliation: University of Basel, Switzerland.
authors.forename: Kristen
authors.initials: K
authors.lastname: Lavallee
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, Australia.
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Lyneham
authors.affiliation: Yale University, New Haven, CT.
authors.forename: Carla E
authors.initials: CE
authors.lastname: Marin
authors.affiliation: MRC Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: McKinnon
authors.affiliation: MRC Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Meiser-Stedman
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, Australia.
authors.forename: Talia
authors.initials: T
authors.lastname: Morris
authors.affiliation: University Medical Center Groningen, University of Groningen, The Netherlands.
authors.forename: Maaike
authors.initials: M
authors.lastname: Nauta
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, Australia.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Rapee
authors.affiliation: Ruhr-Universität Bochum, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Centre for Emotional Health, Macquarie University, Sydney, Australia.
authors.forename: Sophie C
authors.initials: SC
authors.lastname: Schneider
authors.affiliation: Yale University, New Haven, CT.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Silverman
authors.affiliation: University of Aarhus, Denmark.
authors.forename: Mikael
authors.initials: M
authors.lastname: Thastum
authors.affiliation: School of Psychology and Clinical Language Sciences, University of Reading, UK.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Thirlwall
authors.affiliation: School of Psychology and Clinical Language Sciences, University of Reading, UK.
authors.forename: Polly
authors.initials: P
authors.lastname: Waite
authors.affiliation: Anxiety Research Network, Haukeland University Hospital.
authors.forename: Gro Janne
authors.initials: GJ
authors.lastname: Wergeland
authors.affiliation: School of Psychology, University of Sussex, UK. Electronic address: k.lester@sussex.ac.uk.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Lester
authors.affiliation: King's College London, Institute of Psychiatry, Psychology and Neuroscience, Medical Research Council (MRC) Social, Genetic and Developmental Psychiatry (SGDP) Centre, London. Electronic address: thalia.eley@kcl.ac.uk.
authors.forename: Thalia C
authors.initials: TC
authors.lastname: Eley
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D010290:Parents / Q000523:psychology*; D010698:Phobic Disorders; D011379:Prognosis; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: anxiety disorders; cognitive-behavioral therapy; predictors; treatment