Integrating evidence-based assessment into clinical practice for pediatric anxiety disorders

Joseph F. McGuire*, Nicole E. Caporino, Sophie A. Palitz, Philip C. Kendall, Anne Marie Albano, Golda S. Ginsburg, Boris Birmaher, John T. Walkup, John Piacentini

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Although evidence-based assessments are the cornerstone of evidence-based treatments, it remains unknown whether incorporating evidence-based assessments into clinical practice enhances therapists’ judgment of therapeutic improvement. This study examined whether the inclusion of youth- and parent-reported anxiety rating scales improved therapists’ judgment of treatment response and remission compared to the judgment of treatment-masked independent evaluators (IEs) after (a) weekly/biweekly acute treatment and (b) monthly follow-up care. Methods: Four hundred thirty six youth received cognitive-behavioral therapy (CBT), medication, CBT with medication, or pill placebo through the Child/Adolescent Anxiety Multimodal Study. Participants and parents completed the following anxiety scales at pretreatment, posttreatment, and follow-up: Screen for Childhood Anxiety and Related Disorders (SCARED) and Multidimensional Anxiety Scale for Children (MASC). IEs rated anxiety on the Clinical Global Impression of Severity (CGI-S) and Improvement (CGI-I) at posttreatment and follow-up. Therapists rated anxiety severity and improvement using scales that paralleled IE measures. Results: Fair-to-moderate agreement was found between therapists and IEs after acute treatment (κ = 0.38–0.48), with only slight-to-fair agreement found after follow-up care (κ = 0.07–0.33). Optimal algorithms for determining treatment response and remission included the combination of therapists’ ratings and the parent-reported SCARED after acute (κ = 0.52–0.54) and follow-up care (κ = 0.43–0.48), with significant improvement in the precision of judgments after follow-up care (p <.02–.001). Conclusion: Therapists are good at detecting treatment response and remission, but the inclusion of the parent-report SCARED optimized agreement with IE rating—especially when contact was less frequent. Findings suggest that utilizing parent-report measures of anxiety in clinical practice improves the precision of therapists’ judgment.

Original languageEnglish (US)
Pages (from-to)744-752
Number of pages9
JournalDepression and anxiety
Volume36
Issue number8
DOIs
StatePublished - Aug 1 2019

Keywords

  • adolescents
  • anxiety disorders
  • assessment
  • children
  • evidence-based assessment

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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