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Original Investigation |

Naturalistic Follow-up of Youths Treated for Pediatric Anxiety Disorders

Golda S. Ginsburg, PhD1; Emily M. Becker, MS2; Courtney P. Keeton, PhD1; Dara Sakolsky, MD, PhD3; John Piacentini, PhD4; Anne Marie Albano, PhD5; Scott N. Compton, PhD6; Satish Iyengar, PhD3; Kevin Sullivan, BS6; Nicole Caporino, PhD7; Tara Peris, PhD4; Boris Birmaher, MD3; Moira Rynn, MD5; John March, MD, MPH6; Philip C. Kendall, PhD7
[+] Author Affiliations
1Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
2Department of Psychology, University of Miami, Coral Gables, Florida
3Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
4Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
5Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, New York
6Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, North Carolina
7Department of Psychology, Temple University, Philadelphia, Pennsylvania
JAMA Psychiatry. 2014;71(3):310-318. doi:10.1001/jamapsychiatry.2013.4186.
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Importance  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 (ie, 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.

Design, Setting, and Participants  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.

Exposures  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.

Main Outcomes and Measures  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 and Relevance  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

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Figure.
Flowchart for Child/Adolescent Anxiety Multimodal Study (CAMS) and Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS)

Flowchart shows treatment assignments and breakdown between CAMELS participants and nonparticipants among the original 488 CAMS participants. CBT indicates cognitive behavioral therapy.

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