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

Research output: Contribution to journalArticlepeer-review


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
Issue number8
StatePublished - Aug 1 2019


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

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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