24- and 36-week outcomes for the child/adolescent anxiety multimodal study (CAMS)

John Piacentini, Shannon Bennett, Scott N. Compton, Phillip C. Kendall, Boris Birmaher, Anne Marie Albano, John March, Joel Sherrill, Dara Sakolsky, Golda Ginsburg, Moira Rynn, R. Lindsey Bergman, Elizabeth Gosch, Bruce Waslick, Satish Iyengar, James McCracken, John Walkup

Research output: Contribution to journalArticle

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 of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral 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 The majority (>80%) of 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, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. Conclusions COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas 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. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information - Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials. gov. Unique identifier: NCT00052078.

Original languageEnglish (US)
Pages (from-to)297-310
Number of pages14
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume53
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

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Keywords

  • anxiety
  • Child/Adolescent Anxiety Multimodal Study (CAMS)
  • cognitive-behavioral therapy (CBT)
  • follow-up
  • selective serotonin reuptake inhibitor (SSRI)

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

Cite this

Piacentini, J., Bennett, S., Compton, S. N., Kendall, P. C., Birmaher, B., Albano, A. M., March, J., Sherrill, J., Sakolsky, D., Ginsburg, G., Rynn, M., Bergman, R. L., Gosch, E., Waslick, B., Iyengar, S., McCracken, J., & Walkup, J. (2014). 24- and 36-week outcomes for the child/adolescent anxiety multimodal study (CAMS). Journal of the American Academy of Child and Adolescent Psychiatry, 53(3), 297-310. https://doi.org/10.1016/j.jaac.2013.11.010