Defining Treatment Response and Remission in Child Anxiety: Signal Detection Analysis Using the Pediatric Anxiety Rating Scale - 27/12/12
, Douglas M. Brodman, M.A. a, Philip C. Kendall, Ph.D. a, Anne Marie Albano, Ph.D. b, Joel Sherrill, Ph.D. c, John Piacentini, Ph.D. d, Dara Sakolsky, M.D., Ph.D. e, Boris Birmaher, M.D. f, Scott N. Compton, Ph.D. 6, Golda Ginsburg, Ph.D. 7, Moira Rynn, M.D. b, James McCracken, M.D. d, Elizabeth Gosch, Ph.D. h, Courtney Keeton, Ph.D. g, John March, M.D., M.P.H. f, John T. Walkup, M.D. i
Correspondence to Nicole E. Caporino, Ph.D., Department of Psychology, Temple University, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA 19122;Abstract |
Objective |
To determine optimal Pediatric Anxiety Rating Scale (PARS) percent reduction and raw score cut-offs for predicting treatment response and remission among children and adolescents with anxiety disorders.
Method |
Data were from a subset of youth (N = 438; 7–17 years of age) who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS), a multi-site, randomized controlled trial that examined the relative efficacy of cognitive-behavioral therapy (CBT; Coping Cat), medication (sertraline [SRT]), their combination, and pill placebo for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. The clinician-rated PARS was administered pre- and posttreatment (delivered over 12 weeks). Quality receiver operating characteristic methods assessed the performance of various PARS percent reductions and absolute cut-off scores in predicting treatment response and remission, as determined by posttreatment ratings on the Clinical Global Impression scales and the Anxiety Disorders Interview Schedule for DSM-IV. Corresponding change in impairment was evaluated using the Child Anxiety Impact Scale.
Results |
Reductions of 35% and 50% on the six-item PARS optimally predicted treatment response and remission, respectively. Post-treatment PARS raw scores of 8 to 10 optimally predicted remission. Anxiety improved as a function of PARS-defined treatment response and remission.
Conclusions |
Results serve as guidelines for operationalizing treatment response and remission in future research and in making cross-study comparisons. These guidelines can facilitate translation of research findings into clinical practice.
Le texte complet de cet article est disponible en PDF.Key Words : anxiety, treatment, measurement
Plan
| Clinical trial registration information—Child and Adolescent Anxiety Disorders (CAMS); ;NCT00052078 NCT00052078. |
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| This article was reviewed under and accepted by Ad Hoc Editor Daniel S. Pine, M.D. |
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| 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.). |
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| Sertraline and matching placebo were supplied free of charge by Pfizer. |
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| 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. |
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| 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. |
Vol 52 - N° 1
P. 57-67 - janvier 2013 Retour au numéro
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