Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study

Abstract

ObjectiveThe 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.MethodA 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.ResultsIndividuals 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.ConclusionSoAD, 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.

A Genome-Wide Test of the Differential Susceptibility Hypothesis Reveals a Genetic Predictor of Differential Response to Psychological Treatments for Child Anxiety Disorders

“…Full details of the sample are available elsewhere [29]. In brief, participants were included if they were aged 5-18 years (94% were 5-13 years old), met DSM-IV criteria for a primary diagnosis of an anxiety disorder and provided DNA.…”

Recent developments in the treatment of anxiety disorders in children and adolescents

“…Participants were 1519 children (aged 5–18 years, although the majority were preadolescent) who had a primary anxiety disorder. The most consistent finding was that individuals with social anxiety disorder, comorbid mood or externalising disorders had poorer outcomes immediately after CBT and at longer term follow-up 17. Ongoing work is now required to establish how to improve treatment outcomes in these contexts.…”

Refining Clinical Judgment of Treatment Response and Symptom Remission Identification in Childhood Anxiety Using a Signal Detection Analysis on the Pediatric Anxiety Rating Scale

“…Consistent with existing definitions (e.g., Tolin et al 2005;Lewin et al 2011;Storch et al 2011;Caporino et al 2013;Farris et al 2013;Jeon et al 2013;Johnco et al 2015), participants were classified as treatment responders if they scored ''much'' or ''very much'' improved on the CGI-I at posttreatment. Consistent with others (e.g., Caporino et al 2013;Hudson et al 2013Hudson et al , 2015Johnco et al 2015), remission was defined as loss of primary diagnosis on the ADIS-IV (CSR£3) at posttreatment. For each proposed PARS cutoff value (percent reduction of symptoms in 5% intervals, and posttreatment raw scores), we examined the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), efficiency (percentage agreement with the gold standard test), and j statistics to determine optimal cutoff values.…”