With point prevalence estimates ranging from 12 percent to 20 percent, anxiety disorders are among the most common conditions affecting children and adolescents. The three most commonly impairing childhood-onset anxiety disorders are separation anxiety disorder, social phobia and generalized anxiety disorder. As a group, these disorders routinely co-occur and cause clinically significant distress and impairment affecting school, social, and family functioning. Left untreated, these disorders leave children at risk for anxiety disorders, major depression and, in some cases, substance abuse extending into late adolescence and adulthood. Hence, effective treatments for childhood-onset anxiety disorders promise to alleviate and perhaps to prevent long-term morbidity and even mortality. In randomized controlled trials, we have shown that two monotherapies, cognitive-behavioral therapy (CBT) and the selective serotonin reuptake inhibitor (SSRI), fluvoxamine (FLV), are effective treatments for separation anxiety, social phobia, and generalized anxiety disorders in children and adolescents. Even though the monotherapies are effective a substantial number of patients remain symptomatic following treatment and, might have benefited from combined treatment. There are as yet no systematic, controlled studies comparing CBT and an SSRI, alone or in combination, against a control condition in the same patient population. This revised application proposes a four-year, six site, randomized controlled efficacy trial comparing cognitive-behavioral (CBT) and pharmacological treatment for youth ages 7 to 16 years with anxiety disorders. Phase 1 is a 12-week, random assignment acute efficacy study comparing CBT, FLV, their combination (n=90, each condition), and pill placebo control (n=48) in 318 (53/site) youth with DSM-IV primary diagnoses of separation anxiety, social phobia, and/or generalized anxiety disorder. Phase II involves a 6-month treatment maintenance period for Phase I responders. All subjects regardless of response status will be evaluated at all scheduled assessment points. In addition to comprehensive parent, child, clinician, and teacher reports, the primary outcome variables will be assessed by blind independent evaluators. Manualized intervention and assessment protocols plus state-of-the-art quality assurance and adverse event monitoring procedures insure uniform cross-site administration of the study protocol.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project--Cooperative Agreements (U01)
Project #
1U01MH064107-01A1
Application #
6473560
Study Section
Special Emphasis Panel (ZMH1-NRB-G (03))
Program Officer
Menvielle, Edgardo
Project Start
2002-09-21
Project End
2006-05-31
Budget Start
2002-09-21
Budget End
2003-05-31
Support Year
1
Fiscal Year
2002
Total Cost
$346,498
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
071723621
City
Durham
State
NC
Country
United States
Zip Code
27705
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Caporino, Nicole E; Sakolsky, Dara; Brodman, Douglas M et al. (2017) Establishing Clinical Cutoffs for Response and Remission on the Screen for Child Anxiety Related Emotional Disorders (SCARED). J Am Acad Child Adolesc Psychiatry 56:696-702
Lee, Phyllis; Zehgeer, Asima; Ginsburg, Golda S et al. (2017) Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes. J Clin Child Adolesc Psychol :1-12
Becker, Emily M; Jensen-Doss, Amanda; Kendall, Philip C et al. (2016) All anxiety is not created equal: Correlates of parent/youth agreement vary across subtypes of anxiety. J Psychopathol Behav Assess 38:528-537
Rynn, Moira A; Walkup, John T; Compton, Scott N et al. (2015) Child/Adolescent anxiety multimodal study: evaluating safety. J Am Acad Child Adolesc Psychiatry 54:180-90
White, Susan W; Lerner, Matthew D; McLeod, Bryce D et al. (2015) Anxiety in youth with and without autism spectrum disorder: examination of factorial equivalence. Behav Ther 46:40-53
Gonzalez, Araceli; Peris, Tara S; Vreeland, Allison et al. (2015) Parental anxiety as a predictor of medication and CBT response for anxious youth. Child Psychiatry Hum Dev 46:84-93

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