Defining Treatment Response and Remission in Child Anxiety: Signal Detection Analysis Using the Pediatric Anxiety Rating Scale

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.

Prefrontal Reactivity to Social Signals of Threat as a Predictor of Treatment Response in Anxious Youth

“…The majority of the current sample (75.6%) showed a ⩾ 35% reduction in PARS severity, which has been associated with treatment response (Caporino et al, 2013). This rate is higher than response rates observed in large randomized controlled trials of CBT and SSRI in anxious youth (Walkup et al, 2008), likely because the current study focused only on youth who completed treatment and posttreatment clinical measures.…”

“…With regard to treatment response, 75.6% of the sample responded to treatment and 58.5% showed evidence of remission, as indicated by at least a 35 and 50% decrease in PARS, respectively (Caporino et al, 2013). History of psychiatric treatment, number of sessions, and weeks between screening and posttreatment measures were not significantly related to anxiety severity change (ps40.17).…”

A Sample Size Calculator for SMART Pilot Studies

“…Here, we provide a mathematical derivation of equation (7). All the variables used here are defined in a similar way as in Section 2.…”

“…In this adaptive intervention, response is defined based on a measure of improvement, for example, based on a cut-off of five or less on the Clinical Global Impression-Improvement Scale [6]. Change in the Pediatric Anxiety Rating Scale could also be used to define response/non-response [7]. An adaptive intervention is also known as an adaptive treatment strategy [8] or a dynamic treatment regime [9].…”

Treatment Concerns and Functional Impairment in Pediatric Anxiety

“…Responses on the severity scale are provided on a scale from 0 to 5, with higher scores Child Psychiatry Hum Dev indicating greater levels of anxiety. To determine the severity of anxiety symptomology, six items from the severity scale are summed [31,32]. The PARS has high inter-rater reliability, as well as acceptable short-term stability, internal consistency, and convergent/divergent validity [22].…”