24- and 36-Week Outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS)

Abstract

Objective We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). Method CAMS youth (N=488; 74%≤12 years) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive behavior therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (N=412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n=76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. Results Most (>80%) acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, while those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. Discussion COMB maintained advantage over CBT and SRT on some measures over follow-up, while the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. While outcomes were variable, most CAMS-treated youth enjoyed sustained treatment benefit. Clinical trial registration information— Child and Adolescent Anxiety Disorders (CAMS); http://clinicaltrials.gov; NCT00052078.

Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety

“…She graduates out of cognitive behavioral therapy and endorses depressive symptom remission in monthly then in every 3-month follow-ups. Ten months later, Emma, her parents, and Dr Smith [43][44][45][46] Only a few medications are FDA-approved for use in the pediatric population, so that much of the psychopharmacologic prescribing for pediatric depression and all of the prescribing for non-obsessive-compulsive disorder anxiety are considered off-label. Although most SSRIs are considered equivalent, paroxetine is disfavored in the pediatric population because of its efficacy and side-effect profile [47][48][49] Research does not support the use of SSRIs as first-line treatment of symptoms of posttraumatic stress disorder, although, in practice, they are commonly used as an adjunctive therapy.…”

Cognitive Behavioral Therapy for Childhood Anxiety Disorders: Effectiveness of “Fear Hunter Program”

“…2013, Wergeland ve ark. 2014, Piacentini ve ark. 2014 Toparlanacak olursa, hem BDT hem de ilaç tedavisi, çocuk-luk çağı kaygı bozukluklarının belirtileri üzerinde anlamlı bir iyiye gidiş sağlamakla beraber, bu iki tedavi birleştirilerek yaklaşıldığında, sağaltımın anlamlı biçimde daha etkili olduğu gözlenmiştir.…”

“…12 haftalık ve 36 haftalık izlemde de sonuçların değişmediği yayınlanan iki araştırma ile gösterilmiştir (Ginsburg ve ark. 2011, Piacentini ve ark. 2014).…”

Long Term Follow up in Children with Anxiety Disorders Treated with Acceptance and Commitment Therapy or Cognitive Behavioral Therapy: Outcomes and Predictors

“…Each treatment on its own is effective for young people with anxiety disorders, but a combination of SSRIs and CBT has been found to be more effective than mono-therapies, with this difference decreasing over time [3]. However, pharmacological treatment is not recommended as a first line as there is a potential risk of harm to children and young people [2].…”

“…Several studies have shown maintenance of gains one year post treatment [15][16][17]; and including youth 2-3 years [3], 3.5 years [18], 6 years [19] and 7.4 years [20] following treatment cessation. Assessing outcomes over the long term may be particularly indicated among children treated with ACT as studies of ACT for children with a spectrum of presenting problems have found that treatment gains were either not fully evident at posttreatment (or initial follow-up), or that greater improvements for ACT were obtained some months after therapy cessation [21][22][23].…”