Child Psychiatry & Human Development

, Volume 49, Issue 3, pp 434–442 | Cite as

Multimodal Residential Treatment for Adolescent Anxiety: Outcome and Associations with Pre-treatment Variables

  • Sophie C. Schneider
  • Valérie La Buissonnière-Ariza
  • Davíð R. M. A. Højgaard
  • Brian S. Kay
  • Bradley C. Riemann
  • Stephanie C. Eken
  • Peter Lake
  • Joshua M. Nadeau
  • Eric A. Storch
Original Article

Abstract

This study aimed to determine the effect of a multimodal residential treatment program for severe adolescent anxiety, and examine whether treatment outcome was associated with pre-treatment anxiety, comorbid disorders, or participant age or gender. Participants were 70 adolescents (61.4% female, mean age = 15.4 years) with a primary anxiety disorder who received residential treatment involving cognitive behavioral therapy and medication management. Treatment outcome was assessed both as the change in adolescent-reported anxiety symptoms, and using treatment response criteria. Results indicated a strong effect of the intervention on symptoms of anxiety, depression, and anxiety-related life interference. Most pre-treatment variables were not associated with treatment outcome. However, higher adolescent-reported pre-treatment anxiety was associated with a greater reduction in anxiety at post-treatment, and the presence of a comorbid anxiety disorder was associated with poorer odds of treatment response. Findings indicate that residential treatment is a robust intervention for adolescent anxiety.

Keywords

Anxiety Adolescent Residential treatment Cognitive-behavioral therapy Predictor 

References

  1. 1.
    Merikangas KR, He J-P, Burstein M, Swanson SA, Avenevoli S, Cui L et al (2010) Lifetime prevalence of mental disorders in US adolescents: results from the national comorbidity study-adolescent supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49:980–989. doi: 10.1016/j.jaac.2010.05.017 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56:345–365. doi: 10.1111/jcpp.12381 CrossRefPubMedGoogle Scholar
  3. 3.
    Bennett K, Manassis K, Duda S, Bagnell A, Bernstein GA, Garland EJ et al (2016) Treating child and adolescent anxiety effectively: overview of systematic reviews. Clin Psychol Rev 50:80–94. doi: 10.1016/j.cpr.2016.09.006 CrossRefPubMedGoogle Scholar
  4. 4.
    Strawn JR, Welge JA, Wehry AM, Keeshin B, Rynn MA (2015) Efficacy and tolderability of antidepressant in pediatric anxiety disorders: a systematic review and meta-analysis. Depress Anxiety 32:149–157. doi: 10.1002/da.22329 CrossRefPubMedGoogle Scholar
  5. 5.
    James AC, James G, Cowdrey FA, Soler A, Choke A (2013) Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD004690.pub3 PubMedGoogle Scholar
  6. 6.
    Ipser JC, Stein DJ, Hawkridge S, Hoppe L (2009) Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. doi: 10.1002/14651858.CD005170.pub2 Google Scholar
  7. 7.
    Leonard RC, Franklin ME, Wetterneck CT, Riemann BC, Simpson HB, Kinnear K et al (2016) Residential treatment outcomes for adolescents with obsessive-compulsive disorder. Psychother Res 26:727–736. doi: 10.1080/10503307.2015.1065022 CrossRefPubMedGoogle Scholar
  8. 8.
    Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766. doi: 10.1056/NEJMoa0804633 CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Connolly SD, Bernstein GA, Work Group on Quality Issues (2007) Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 46:267–283. doi: 10.1097/01.chi.0000246070.23695.06 CrossRefPubMedGoogle Scholar
  10. 10.
    Veale D, Naismith I, Miles S, Gledhill LJ, Stewart G, Hodsoll J (2016) Outcomes for residential or inpatient intensive treatment of obsessive–compulsive disorder: a systematic review and meta-analysis. J Obsessive Compuls Relat Disord 8:38–49. doi: 10.1016/j.jocrd.2015.11.005 CrossRefGoogle Scholar
  11. 11.
    Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32:251–262. doi: 10.1016/j.cpr.2012.01.005 CrossRefPubMedGoogle Scholar
  12. 12.
    Lundkvist-Houndoumadi I, Hougaard E, Thastum M (2014) Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders. Nord J Psychiatry 68:524–535. doi: 10.3109/08039488.2014.903295 CrossRefPubMedGoogle Scholar
  13. 13.
    Knight A, McLellan L, Jones M, Hudson J (2014) Pre-treatment predictors of outcome in childhood anxiety disorders: a systematic review. Psychopathology Review 1:77–129. doi: 10.5127/pr.034613 CrossRefGoogle Scholar
  14. 14.
    Bennett K, Manassis K, Walter SD, Cheung A, Wilansky-Traynor P, Diaz-Granados N et al (2013) Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis. Depress Anxiety 30:829–841. doi: 10.1002/da.22099 CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Hudson JL, Keers R, Roberts S, Coleman JRI, Breen G, Arendt K et al (2015) Clinical predictors of response to cognitive-behavioral therapy in pediatric anxiety disorders: the genes for treatment (GxT) study. J Am Acad Child Adolesc Psychiatry 54:454–463. doi: 10.1016/j.jaac.2015.03.018 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Wergeland GJH, Fjermestad KW, Marin CE, Bjelland I, Haugland BSM, Silverman WK et al (2016) Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders. Behav Res Ther 76:1–12. doi: 10.1016/j.brat.2015.11.001 CrossRefPubMedGoogle Scholar
  17. 17.
    Compton SN, Peris TS, Almirall D, Birmaher B, Sherrill J, Kendall PC et al (2014) Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial. J Consult Clin Psychol 82:212–224. doi: 10.1037/a0035458 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Birmaher B, Brent DA, Chiappetta L, Bridge J, Monga S, Baugher M (1999) Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 38:1230–1236CrossRefPubMedGoogle Scholar
  19. 19.
    Hale WW, Crocetti E, Raaijmakers QAW, Meeus WHJ (2011) A meta-analysis of the cross-cultural psychometric properties of the screen for child anxiety related emotional disorders (SCARED). J Child Psychol Psychiatry 52:80–90. doi: 10.1111/j.1469-7610.2010.02285.x CrossRefPubMedGoogle Scholar
  20. 20.
    Muris P, Merckelbach H, Gadet B, Moulaert V, Tierney S (1999) Sensitivity for treatment effects of the screen for child anxiety related emotional disorders. J Psychopathol Behav Assess 21:323–335. doi: 10.1023/a:1022120832187 CrossRefGoogle Scholar
  21. 21.
    Costello EJ, Angold A (1988) Scales to assess child and adolescent depression: checklists, screens, and nets. J Am Acad Child Adolesc Psychiatry 27:726–737. doi: 10.1097/00004583-198811000-00011 CrossRefPubMedGoogle Scholar
  22. 22.
    Orchard F, Pass L, Marshall T, Reynolds S (2017) Clinical characteristics of adolescents referred for treatment of depressive disorders. Child Adolesc Ment Health 22:61–68. doi: 10.1111/camh.12178 CrossRefGoogle Scholar
  23. 23.
    Burleson Daviss W, Birmaher B, Melhem NA, Axelson DA, Michaels SM, Brent DA (2006) Criterion validity of the mood and feelings questionnaire for depressive episodes in clinic and non-clinic subjects. J Child Psychol Psychiatry 47:927–934. doi: 10.1111/j.1469-7610.2006.01646.x CrossRefPubMedGoogle Scholar
  24. 24.
    Whiteside SP (2009) Adapting the Sheehan disability scale to assess child and parent impairment related to childhood anxiety disorders. J Clin Child Adolesc Psychol 38:721–730. doi: 10.1080/15374410903103551 CrossRefPubMedGoogle Scholar
  25. 25.
    Olivares J, Sánchez-García R, López-Pina JA (2009) The Liebowitz social anxiety scale for children and adolescents. Psicothema 21:486–491PubMedGoogle Scholar
  26. 26.
    Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19. doi: 10.1037/0022-006X.59.1.12 CrossRefPubMedGoogle Scholar
  27. 27.
    Leonard RC, Jacobi DM, Riemann BC, Lake PM, Luhn R (2014) The effect of depression symptom severity on OCD treatment outcome in an adolescent residential sample. J Obsessive Compuls Relat Disord 3:95–101. doi: 10.1016/j.jocrd.2014.02.003 CrossRefGoogle Scholar
  28. 28.
    O’Neil KA, Podell JL, Benjamin CL, Kendall PC (2010) Comorbid depressive disorders in anxiety-disordered youth: demographic, clinical, and family characteristics. Child Psychiatry Hum Dev 41:330–341. doi: 10.1007/s10578-009-0170-9 CrossRefPubMedGoogle Scholar
  29. 29.
    Gibby BA, Casline EP, Ginsburg GS (2017) Long-term outcomes of youth treated for an anxiety disorder: a critical review. Clin Child Fam Psychol Rev. doi: 10.1007/s10567-017-0222-9 PubMedGoogle Scholar
  30. 30.
    Lawrence D, Hafekost J, Johnson SE, Saw S, Buckingham WJ, Sawyer MG et al (2015) Key findings from the second Australian child and adolescent survey of mental health and wellbeing. Aust NZ J Psychiatry 50:876–886. doi: 10.1177/0004867415617836 CrossRefGoogle Scholar
  31. 31.
    Gordon-Hollingsworth AT, Becker EM, Ginsburg GS, Keeton C, Compton SN, Birmaher BB et al (2015) Anxiety disorders in caucasian and african american children: a comparison of clinical characteristics, treatment process variables, and treatment outcomes. Child Psychiatry Hum Dev 46:643–655. doi: 10.1007/s10578-014-0507-x CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Lavell CH, Farrell LJ, Waters AM, Cadman J (2016) Predictors of treatment response to group cognitive behavioural therapy for pediatric obsessive-compulsive disorder. Psychiat Res 245:186–193. doi: 10.1016/j.psychres.2016.08.033 CrossRefGoogle Scholar
  33. 33.
    Pereira AI, Muris P, Roberto MS, Marques T, Goes R, Barros L (2017) Examining the mechanisms of therapeutic change in a cognitive-behavioral intervention for anxious children: the role of interpretation bias, perceived control, and coping strategies. Child Psychiatry Hum Dev. doi: 10.1007/s10578-017-0731-2 PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sophie C. Schneider
    • 1
    • 10
  • Valérie La Buissonnière-Ariza
    • 1
  • Davíð R. M. A. Højgaard
    • 2
  • Brian S. Kay
    • 3
  • Bradley C. Riemann
    • 3
  • Stephanie C. Eken
    • 4
  • Peter Lake
    • 3
  • Joshua M. Nadeau
    • 5
  • Eric A. Storch
    • 1
    • 5
    • 6
    • 7
    • 8
    • 9
  1. 1.Department of Pediatrics, Rothman Center for Pediatric NeuropsychiatryUniversity of South FloridaSt. PetersburgUSA
  2. 2.Center for Child and Adolescent PsychiatryAarhus University HospitalAarhusDenmark
  3. 3.Rogers Memorial HospitalOconomowocUSA
  4. 4.Rogers Behavioral Health – NashvilleNashvilleUSA
  5. 5.Rogers Behavioral Health – TampaTampaUSA
  6. 6.Department of PsychologyUniversity of South FloridaTampaUSA
  7. 7.Department of Psychiatry and Behavioral NeurosciencesUniversity of South FloridaTampaUSA
  8. 8.Department of Health Management and PolicyUniversity of South FloridaTampaUSA
  9. 9.Johns Hopkins All Children’s HospitalSt. PetersburgUSA
  10. 10.Rothman Center for NeuropsychiatrySt. PetersburgUSA

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