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

doi:10.1002/da.22900

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

Depress Anxiety. 2019 Aug;36(8):744-752. doi: 10.1002/da.22900. Epub 2019 Jun 24.

Authors

Joseph F McGuire^{1

2}, Nicole E Caporino³, Sophie A Palitz⁴, Philip C Kendall⁴, Anne Marie Albano⁵, Golda S Ginsburg⁶, Boris Birmaher⁷, John T Walkup⁸, John Piacentini²

Affiliations

¹ Department of Psychiatry and Behavioral Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
² Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, California.
³ Department of Psychology, American University, Washington, D.C.
⁴ Department of Psychology, Temple University, Philadelphia, Pennsylvania.
⁵ New York State Psychiatric Institute and Columbia University Medical Center, New York City, New York.
⁶ University of Connecticut Health Center, Farmington, Connecticut.
⁷ University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
⁸ Lurie Children's Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois.

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.

Keywords: adolescents; anxiety disorders; assessment; children; evidence-based assessment.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Anxiety Disorders / diagnosis*
Anxiety Disorders / psychology
Anxiety Disorders / therapy*
Child
Clinical Decision-Making / methods*
Cognitive Behavioral Therapy / methods*
Combined Modality Therapy / methods
Evidence-Based Medicine / methods*
Female
Follow-Up Studies
Humans
Male
Meditation / methods*
Meditation / psychology
Parents
Self Report
Treatment Outcome

Abstract

Publication types

MeSH terms

Grants and funding