Journal of the American Academy of Child & Adolescent Psychiatry
New ResearchDefining Treatment Response and Remission in Child Anxiety: Signal Detection Analysis Using the Pediatric Anxiety Rating Scale
Section snippets
Participants
Participants were CAMS youth5 who were administered all measures of interest before and after treatment. This subset of CAMS participants comprised 438 youth (51% female and 49% male) with a principal diagnosis of SAD (31%), GAD (48%), and/or SoP (49%). They ranged in age from 7 to 17 years (mean = 10.72, SD = 2.80) and were recruited with a parent across six university-based outpatient clinics. Youth were randomly assigned to one of four treatment conditions: sertraline (SRT; n = 115),
Missing Data
Data were analyzed for participants with both pre- and posttreatment measures. For these analyses, there were no data missing for the PARS, CGI scales, or ADIS-IV-C/P. For the CAIS-R/P, fewer than 10% of items were omitted for each participant and scores were calculated by averaging responses across the items that make up each scale. Analyses were repeated using the CAMS intent-to-treat sample and multiple imputation procedures for addressing missing data due to attrition, which was minimal.
Discussion
Signal detection analysis of the six-item PARS, a relatively brief, clinician-rated measure of anxiety symptoms across disorders, revealed that a 35% reduction in total scores from pre- to posttreatment best predicted treatment response. A 50% reduction in PARS best predicted remission. Posttreatment PARS absolute cut-offs of 8 and 10 showed the strongest association with the “gold standard” measures of remission used in CAMS. Furthermore, each of the percent reduction and absolute cut-offs
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Clinical trial registration information—Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov/; NCT00052078.
This article was reviewed under and accepted by Ad Hoc Editor Daniel S. Pine, M.D.
This research was supported by NIMH grants U01 MH064089 (J.T.W.), U01 MH64092 (A.M.A.), U01 MH64003 (B.B., S.N.C.), U01 MH63747 (P.C.K.), U01 MH64107 (J.M.), and U01 MH64088 (J.P.).
Sertraline and matching placebo were supplied free of charge by Pfizer.
Views expressed within this article represent those of the authors and are not intended to represent the position of NIMH, the National Institutes of Health (NIH), or the Department of Health and Human Services.
Disclosure: Dr. Kendall has received research support from NIMH. He has received honoraria from professional societies for speaking at conventions. He has received royalties from Guilford Press, Ericsson, Workbook Publishing, and Oxford University Press. Drs. Albano has received research support from NIMH. She has received honoraria from the American Psychological Association. She has served as a consultant to Brackett Global. She has received royalties from Oxford University Press. Dr. Piacentini has received grant or research support from NIMH, the Tourette Syndrome Association, and Otsuka Pharmaceuticals. He has reviewed survey materials related to the 2010 World Contraception Day media report for Bayer Schering Pharma. He has received book royalties from Guilford Press and Oxford University Press. He is a co-author of assessment tools, none of which are commercially published and therefore no royalties have been received. He has received speaking honoraria / travel support from the Tourette Syndrome Association and the International Obsessive Compulsive Disorder Foundation. Dr. Sakolsky has received research support from NIMH and the National Alliance for Research on Schizophrenia and Depression (NARSAD). She has received honoraria from the American Academy of Child and Adolescent Psychiatry for participation in the 37th Annual Review Course in Child and Adolescent Psychiatry and Training for the Oral Exams. Dr. Birmaher has received research support from NIMH. He has received royalties from Random House. Dr. Compton has received research support from NIMH. He has served as a consultant to Shire Pharmaceuticals. He has provided expert forensic testimony for mental health needs of children in high-conflict families. Dr. Rynn has received research support from NIMH, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Eli Lilly and Co., Pfizer, Merck, and Shire. She has served as a consultant to Shire. She has received royalties from American Psychiatric Publishing. Dr. McCracken has received research support from Seaside Therapeutics, Roche, and Otsuka. He has served as a consultant to BioMarin, PharmaNet, Roche, and Novartis. He has received research study drug from Shire. Dr. Gosch has received royalties from Springer Publishing Company. Dr. Keeton has received research support from NIMH and the Johns Hopkins Urban Health Institute. Dr. March has received research support from NIMH, the National Institute on Drug Abuse (NIDA), NARSAD, and Pfizer. He has served as a consultant to Atentiv, Bristol-Myers Squibb, Eli Lilly and Co., Pfizer, and Widay Pharmaceuticals. He has served on scientific advisory boards of Eli Lilly and Co., Pfizer, and Shire. He has served on the Data Safety Monitoring Boards (DSMB) of Eli Lilly and Co., NIDA, and Pfizer. He has received royalties from Guilford Press, MultiHealth Systems, and Oxford University Press. He retains equity in MedAvante. He has provided expert forensic consultation to DLA Piper. Dr. Walkup has received grant or research support from the Tourette Syndrome Association. He has served as a consultant to Shire. He has received free medication and placebo from Eli Lilly and Co., Pfizer, and Abbott for NIH-funded studies. He has served on the advisory board and speakers’ bureau of the Tourette Syndrome Association. He has received royalties from Guilford Press and Oxford University Press. He has received honorarium for an Educational Meeting from the Tourette Syndrome Association. He also has received travel support and honoraria for paid and unpaid activities from the Tourette Syndrome Association including an unpaid position on the Medical Advisory Board. Drs. Caporino, Sherrill, and Ginsburg, and Mr. Brodman report no biomedical financial interests or potential conflicts of interest.