Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study - 28/05/15
, Thalia C. Eley, PhD b, ⁎ Abstract |
Objective |
The 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.
Method |
A 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.
Results |
Individuals 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.
Conclusion |
SoAD, 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.
Le texte complet de cet article est disponible en PDF.Key Words : anxiety disorders, treatment, predictors, cognitive-behavioral therapy
Plan
| Clinical guidance is available at the end of this article. |
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| This article was reviewed under and accepted by deputy editor John Piacentini, PhD. |
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| Combined study supported by UK MRC grant G0901874/1 (T.C.E.). Individual trials support by Australian Research Council grant DP0878609 (J.L.H., Jenny Donald, PhD, R.M.R., T.C.E.); Australian National Health and Medical Research Council grants (1027556: R.M.R., J.L.H., H.J.L., Cathy Mihalopolous, BSc[Hons], PhD), (488505: H.J.L., J.L.H., R.M.R.), and (382008: J.L.H. and R.M.R.); TrygFonden grant (7-10-1391: M.T. and Esben Hougaard, PhD); Edith og Godtfred Kirk Christiansens Fond grant (21-5675: M.T.); Swiss National Science Foundation grant (105314-116517: S.S.); Western Norway Regional Health Authority grants (911253: Odd E. Havik, PhD) and (911366: E.H.); UK MRC Clinical Fellowship (G0802821: R.M.-S.); National Institute of Mental Health R01MH079943 (W.K.S.); UK National Institute for Health Research (NIHR) grants (PB-PG-0110-21190: C.C.) and (PB-PG-0107-12042: P.C.); UK MRC grants (09-800-17: P.C. and C.C.; G0802326: K.T., P.C., and C.C.; G1002011: P.W., C.C., and P.C.; and G0601874; C.C.). Grant 09-800-17 was managed by NIHR on behalf of the MRC-NIHR partnership. Dr. Lester is supported by an MRC research grant (MR/J011762/1) and Jacobs Foundation Young Scholar Award. Dr. Keers is supported by an MRC Population Health Scientist Award (MR/K021281/1). This study presents independent research partly funded by the NIHR Biomedical Research Centre at South London and Maudsley, NHS Foundation Trust, and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR, or the Department of Health. |
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| Drs. Hudson and Keers contributed equally to the work. Drs. Lester and Eley also contributed equally to the work. |
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| Dr. Keers served as the statistical expert for this research. |
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| Disclosure: Dr. Hudson is an author of the Cool Kids program but receives no direct payment from it. Dr. Creswell is joint author of a book used in treatment within the Overcoming trial and receives royalties from sales of the book. Dr. Lyneham is an author of the Cool Kids program but receives no direct payment from it. Dr. Rapee is an author of the Cool Kids program but receives no direct payment from it. Dr. Schneider is an author of the Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter, from which she receives royalties. Dr. Silverman is an author of the Anxiety Disorders Interview Schedule for Children, from which she receives royalties. Drs. Keers, Breen, Arendt, Bogels, Cooper, Hartman, Heiervang, Hötzel, In-Albon, Lavallee, Marin, McKinnon, Meiser-Stedman, Nauta, Thastum, Thirlwall, Waite, Wergeland, Lester, Eley, Ms. Roberts, Mr. Coleman, Ms. Morris, and Ms. Schneider report no biomedical financial interests or potential conflicts of interest. |
Vol 54 - N° 6
P. 454-463 - juin 2015 Retour au numéro
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