Functional Outcomes of Youths Treated for Pediatric Anxiety Disorders: A Naturalistic 3 -12 year Follow-up

Abstract

Objective: To examine the impact of treatment outcome and treatment condition (Cognitive-behavioral therapy, CBT; Sertraline, SRT; COMB, CBT and SRT; Placebo) for youth treated for anxiety disorders on global and domain-specific functioning across a 3 to 12 year, naturalistic follow-up. Method: A subset (319) of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated in an average of 3.38 assessments during the follow-up period. All youth met criteria for a principal anxiety disorder pretreatment. Growth curve modeling examined the impact of treatment outcomes (response/remission) and treatment condition on global functioning, global and domain- specific impairment, and life satisfaction across the follow-up period. Logistic regression explored the impact of treatment response and condition on low frequency events (arrests/convictions) and educational achievement (high school graduation/college enrollment). Results: Growth curve analyses revealed that treatment responders/remitters demonstrated better global functioning, increased life satisfaction, and decreased overall impairment at their first follow-up assessment (growth curve mean intercept). The positive effect of treatment response on life satisfaction, but not global functioning or overall impairment, attenuated across the follow-up period. Treatment response also predicted decreased academic impairment at first follow-up. Participants in the COMB condition demonstrated improved functional trajectories with regards to family life and academic grade-point average. CBT participants demonstrated a greater decline in overall impairment and problems with self-care/independence across the follow-up. Treatment response and condition did not predict legal outcomes, school attendance, high school graduation, college attendance, occupational outcomes, or social/peer relationships. Conclusion: Response to early intervention is associated with improved overall functioning, as well as functioning within specific domains (academics) 3 to 12 years posttreatment. Treatment type differentially predicted functional trajectories. Findings support the positive impact of pediatric anxiety treatment on functioning during adolescence and emerging adulthood.