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

Jennifer L Hudson, Robert Keers, Susanna Roberts, Jonathan R I Coleman, Gerome Breen, Kristian Arendt, Susan Bögels, Peter Cooper, Cathy Creswell, Catharina Hartman, Einar R Heiervang, Katrin Hötzel, Tina In-Albon, Kristen Lavallee, Heidi J Lyneham, Carla E Marin, Anna McKinnon, Richard Meiser-Stedman, Talia Morris, Maaike Nauta, Ronald M Rapee, Silvia Schneider, Sophie C Schneider, Wendy K Silverman, Mikael Thastum, Kerstin Thirlwall, Polly Waite, Gro Janne Wergeland, Kathryn J Lester, Thalia C Eley, Jennifer L Hudson, Robert Keers, Susanna Roberts, Jonathan R I Coleman, Gerome Breen, Kristian Arendt, Susan Bögels, Peter Cooper, Cathy Creswell, Catharina Hartman, Einar R Heiervang, Katrin Hötzel, Tina In-Albon, Kristen Lavallee, Heidi J Lyneham, Carla E Marin, Anna McKinnon, Richard Meiser-Stedman, Talia Morris, Maaike Nauta, Ronald M Rapee, Silvia Schneider, Sophie C Schneider, Wendy K Silverman, Mikael Thastum, Kerstin Thirlwall, Polly Waite, Gro Janne Wergeland, Kathryn J Lester, Thalia C Eley

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.

Keywords: anxiety disorders; cognitive-behavioral therapy; predictors; treatment.

Copyright © 2015 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Mean clinician severity rating (CSR) score by primary diagnosis at each time point. Note: Error bars represent 1 standard error of the mean; “other” includes panic disorder with and without agoraphobia and agoraphobia without panic disorder (n = 38), obsessive-compulsive disorder (OCD; n = 44), posttraumatic stress disorder (PTSD; n = 17), selective mutism (n = 4), or anxiety disorder not otherwise specified (n = 10). GAD = generalized anxiety disorder; SAD = separation anxiety disorder; SoAD = social anxiety disorder; SP = specific phobia.

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