title: Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale.
abstract: OBJECTIVE
  The purpose of this study was to determine guidelines for delineating treatment response and symptom remission for children with anxiety disorder based on the five item and Pediatric Anxiety Rating Scale (PARS5), and replicate guidelines using the six item PARS (PARS6).
  
  
  METHODS
  Participants were 73 children 7-13 years of age with a primary anxiety disorder who received computer-assisted cognitive behavioral therapy for anxiety. Signal detection analyses utilizing receiver operating curve procedures were used to determine optimal guidelines for defining treatment response and symptom remission for youth with anxiety disorders on the PARS5 and PARS6. The percent reduction in anxiety severity was used to predict treatment responder status. The percent reduction in symptoms and posttreatment raw score were used to predict remission status.
  
  
  RESULTS
  Optimal prediction of treatment response based on gold standard criteria was achieved at 15-20% reduction in symptoms on the PARS5 (with 20% reduction achieving marginally higher accuracy), and 20% reduction on the PARS6. A 25% reduction in symptoms on the PARS5 or a posttreatment raw score cutoff of 9 optimally predicted remission status. For the PARS6, a cutoff of 35% reduction or a posttreatment score of 11, was considered optimal for determining remission in clinical settings, whereas a 30% reduction or score of 12 was considered optimal for research settings.
  
  
  CONCLUSIONS
  With different scoring options available for the PARS, these results provide guidelines for determining response and remission based on the PARS5 and PARS6 scores. Guidelines have implications for use in clinical trials, as well as for assessment of change in clinical practice.
authors.affiliation: 1 Department of Pediatrics, University of South Florida , St. Petersburg, Florida.
authors.forename: Carly J
authors.initials: CJ
authors.lastname: Johnco
authors.affiliation: 2 School of Social Work, University of South Florida , St. Petersburg, Florida.
authors.forename: Alison
authors.initials: A
authors.lastname: Salloum
authors.affiliation: 1 Department of Pediatrics, University of South Florida , St. Petersburg, Florida.|3 Department of Psychology, University of South Florida , St. Petersburg, Florida.|4 Department of Psychiatry & Behavioral Neurosciences, University of South Florida , St. Petersburg, Florida.
authors.forename: Adam B
authors.initials: AB
authors.lastname: Lewin
authors.affiliation: 1 Department of Pediatrics, University of South Florida , St. Petersburg, Florida.|3 Department of Psychology, University of South Florida , St. Petersburg, Florida.|4 Department of Psychiatry & Behavioral Neurosciences, University of South Florida , St. Petersburg, Florida.|5 Department of Health Policy and Management, University of South Florida , St. Petersburg, Florida.|6 Rogers Behavioral Health - Tampa Bay , Tampa, Florida.|7 All Children's Hospital - Johns Hopkins Medicine , Baltimore, Maryland.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D005260:Female; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012372:ROC Curve; D012074:Remission Induction; D017603:Signal Detection, Psychological; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome