Abstract
Objective: The current study examined trajectories of anxiety during (a) acute treatment and (b) extended follow-up to better characterize the long-term symptom trajectories of youth who received evidence-based intervention for anxiety disorders using a person-centered approach. Method: Participants were 319 youth (age 7–17 years at enrollment), who participated in a multicenter randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study, and a 4-year naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study, an average of 6.5 years later. Using growth mixture modeling, the study identified distinct trajectories of anxiety across acute treatment (Weeks 0–12), posttreatment (Weeks 12–36), and the 4-year-long follow-up, and identified baseline predictors of these trajectories. Results: Three nonlinear anxiety trajectories emerged: “short-term responders” who showed rapid treatment response but had higher levels of anxiety during the extended follow-up; “durable responders” who sustained treatment gains; and “delayed remitters” who did not show an initial response to treatment, but showed low levels of anxiety during the maintenance and extended follow-up periods. Worse anxiety severity and better family functioning at baseline predicted membership in the delayed remitters group. Caregiver strain differentiated short-term responders from durable responders. Conclusions: Findings suggest that initial response to treatment does not guarantee sustained treatment gains over time for some youth. Future follow-up studies that track treated youth across key developmental transitions and in the context of changing social environments are needed to inform best practices for the long-term management of anxiety.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1336-1345 |
| Number of pages | 10 |
| Journal | Journal of Child Psychology and Psychiatry and Allied Disciplines |
| Volume | 64 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 2023 |
Funding
S.B. has received support from NIMH, Society for Research on Child Development, and the American Psychological Foundation. B.R.‐A. has received support from NIMH. J.T.W. has received research support from the Tourette Syndrome Association of America and the Hartwell Foundation. He has received honoraria and travel expenses for speaking engagements and meetings sponsored by the Tourette Association of America. He has received royalties from Guilford Press and Oxford University Press for multiauthor books published about Tourette's syndrome and from Wolters Kluwer for CME activity on childhood anxiety. He has served as an unpaid advisor to the Anxiety Disorders Association of America and the Trichotillomania Learning Center. He has served as a paid speaker for the Tourette Syndrome – Center for Disease Control and Prevention outreach educational programs, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. P.C.K. has received support from NIMH and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). He has received royalties from the sales of materials related to the treatment of anxiety disorders in youth (e.g., Guilford Press, Workbook Publishing, Gyldendal Norsk, and Gyldendal Akademisk). G.S.G. has received support from NIMH and from the US Department of Education/Institute of Education Sciences and receives royalties from Oxford University Press. C.P.K. has received support from NIMH. A.M.A. has received grant support from the NIMH and Duke University, royalties from Oxford University Press and Lynn Sonberg Books, and honoraria from the American Psychological Association and Brackett Global. S.N.C. has received support from NIMH, NC GlaxoSmithKline Foundation, Pfizer, Neurocrine Biosciences, and Mursion, Inc. He has served as a consultant for Shire and Mursion, Inc. He has received honoraria from the Nordic Long‐Term OCD Treatment Study Research Group and the Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. He has served on the scientific advisory board of the Tourette Association of America, Anxiety and Depression Association of America, and Mursion, Inc. He has presented expert testimony for Duke University. D.S. has received support from NIMH and NARSAD and honoraria from the American Academy of Child and Adolescent Psychiatry. She has served as a consultant for LEK Consulting Inc. J.P. has received support from NIMH, PCORI, and the TLC Foundation for Body‐Focused Repetitive Behaviors. He has received royalties from Guilford Press, Oxford University Press, and Elsevier. He has served on the speakers' bureau of the Tourette Association of America, the International Obsessive–Compulsive Disorder Foundation, and the TLC Foundation for Body‐Focused Repetitive Behaviors. He serves as a consultant to Spinnaker Health, Inc. T.S.P. has received support from NIMH, the Society for Clinical Child and Adolescent Psychology, and the TLC Foundation for Repetitive Behavior Disorders. She has received royalties from Oxford University Press. Key points This work was supported by the National Institute of Mental Health (R01MH064089, R01MH064003, R01MH64088, R01MH64092, R01MH64107, R01MH063747, and T32MH073517). All participants provided informed written consent and/or assent. S.B. has received support from NIMH, Society for Research on Child Development, and the American Psychological Foundation. B.R.-A. has received support from NIMH. J.T.W. has received research support from the Tourette Syndrome Association of America and the Hartwell Foundation. He has received honoraria and travel expenses for speaking engagements and meetings sponsored by the Tourette Association of America. He has received royalties from Guilford Press and Oxford University Press for multiauthor books published about Tourette's syndrome and from Wolters Kluwer for CME activity on childhood anxiety. He has served as an unpaid advisor to the Anxiety Disorders Association of America and the Trichotillomania Learning Center. He has served as a paid speaker for the Tourette Syndrome – Center for Disease Control and Prevention outreach educational programs, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. P.C.K. has received support from NIMH and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). He has received royalties from the sales of materials related to the treatment of anxiety disorders in youth (e.g., Guilford Press, Workbook Publishing, Gyldendal Norsk, and Gyldendal Akademisk). G.S.G. has received support from NIMH and from the US Department of Education/Institute of Education Sciences and receives royalties from Oxford University Press. C.P.K. has received support from NIMH. A.M.A. has received grant support from the NIMH and Duke University, royalties from Oxford University Press and Lynn Sonberg Books, and honoraria from the American Psychological Association and Brackett Global. S.N.C. has received support from NIMH, NC GlaxoSmithKline Foundation, Pfizer, Neurocrine Biosciences, and Mursion, Inc. He has served as a consultant for Shire and Mursion, Inc. He has received honoraria from the Nordic Long-Term OCD Treatment Study Research Group and the Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. He has served on the scientific advisory board of the Tourette Association of America, Anxiety and Depression Association of America, and Mursion, Inc. He has presented expert testimony for Duke University. D.S. has received support from NIMH and NARSAD and honoraria from the American Academy of Child and Adolescent Psychiatry. She has served as a consultant for LEK Consulting Inc. J.P. has received support from NIMH, PCORI, and the TLC Foundation for Body-Focused Repetitive Behaviors. He has received royalties from Guilford Press, Oxford University Press, and Elsevier. He has served on the speakers' bureau of the Tourette Association of America, the International Obsessive–Compulsive Disorder Foundation, and the TLC Foundation for Body-Focused Repetitive Behaviors. He serves as a consultant to Spinnaker Health, Inc. T.S.P. has received support from NIMH, the Society for Clinical Child and Adolescent Psychology, and the TLC Foundation for Repetitive Behavior Disorders. She has received royalties from Oxford University Press.Key points Childhood anxiety disorders can be effectively treated with cognitive behavioral therapy, SSRI, and combination treatment, but the long-term outcomes of treated youth are less well characterized. The study examined long-term outcomes of youth treated for anxiety disorders and identified three classes: short-term responders, durable responders, and delayed remitters. Two thirds of the sample showed a durable response to treatment, providing strong support for the enduring effectiveness of cognitive behavioral therapy, SSRI, and combination treatment for the majority of youth with anxiety disorders. Closely following youth over key developmental and social transitions across childhood and adolescence may inform best practices for the long-term management of anxiety for the minority of youth who did not sustain treatment gains. Childhood anxiety disorders can be effectively treated with cognitive behavioral therapy, SSRI, and combination treatment, but the long-term outcomes of treated youth are less well characterized. The study examined long-term outcomes of youth treated for anxiety disorders and identified three classes: short-term responders, durable responders, and delayed remitters. Two thirds of the sample showed a durable response to treatment, providing strong support for the enduring effectiveness of cognitive behavioral therapy, SSRI, and combination treatment for the majority of youth with anxiety disorders. Closely following youth over key developmental and social transitions across childhood and adolescence may inform best practices for the long-term management of anxiety for the minority of youth who did not sustain treatment gains. This work was supported by the National Institute of Mental Health (R01MH064089, R01MH064003, R01MH64088, R01MH64092, R01MH64107, R01MH063747, and T32MH073517).
Keywords
- Anxiety
- adolescents
- children
- growth mixture modeling
- treatment
- treatment relapse
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Developmental and Educational Psychology
- Psychiatry and Mental health
