Zaburzenia lękowe u dzieci – Rokowania, prognozy i postęp choroby

Zaburzenia lękowe u dzieci
Rokowania, prognozy i postęp choroby

Zaburzenia lękowe u dzieci stanowią istotny problem zdrowia psychicznego, z częstością występowania około 25,1% w populacji 13-18 lat, z czego 5,9% to ciężkie postaci. Charakteryzują się przewlekłym przebiegiem, wpływając negatywnie na rozwój społeczny, emocjonalny i akademicki. Rokowanie zależy od wielu czynników, w tym nasilenia objawów, współwystępowania innych zaburzeń (depresji, zaburzeń eksternalizacyjnych), diagnozy fobii społecznej oraz funkcjonowania rodziny i zdrowia psychicznego rodziców. Wczesna interwencja jest kluczowa, gdyż tylko około 46,5% dzieci osiąga remisję w ciągu 6 lat, a nieleczone zaburzenia często utrzymują się i prowadzą do dalszych problemów psychopatologicznych. Czynniki takie jak płeć męska, wyższe funkcjonowanie rodziny oraz lepsze umiejętności społeczne sprzyjają lepszemu rokowaniu, podczas gdy wysoka intensywność objawów i współwystępowanie wielu zaburzeń lękowych predysponują do gorszych wyników terapii.

Prognoza zaburzeń lękowych u dzieci (Prognosis of anxiety disorders in children)

Zaburzenia lękowe u dzieci (anxiety disorders) należą do najczęstszych problemów zdrowia psychicznego w populacji pediatrycznej. Jak wskazują dane Narodowego Instytutu Zdrowia Psychicznego (NIMH), częstość występowania tych zaburzeń w ciągu życia między 13 a 18 rokiem życia wynosi około 25,1%, z czego 5,9% stanowią „ciężkie” zaburzenia lękowe¹. Zaburzenia te mają często przewlekły przebieg i mogą prowadzić do dodatkowych problemów psychopatologicznych, a także zaburzać rozwój społeczny, emocjonalny i akademicki dziecka. Rokowanie w zaburzeniach lękowych u dzieci zależy od wielu czynników, które mogą wpływać na przebieg choroby oraz odpowiedź na leczenie.

Naturalny przebieg zaburzeń lękowych

Zaburzenia lękowe u dzieci generalnie charakteryzują się uporczywym przebiegiem, prowadzącym do dodatkowych problemów psychopatologicznych i często zaburzają rozwój społeczny, emocjonalny i akademicki². Nieleczone zaburzenia lękowe mogą utrzymywać się przez długi czas. Wczesna interwencja jest szczególnie ważna ze względu na wczesny początek i nieustępujący charakter tych zaburzeń³.

Badania długoterminowe wskazują, że jedynie około 46,5% dzieci z zaburzeniami lękowymi osiąga remisję w okresie 6 lat, niezależnie od rodzaju zastosowanego leczenia⁴. Rokowanie zależy od nasilenia objawów, dostępności kompetentnego leczenia oraz odporności psychicznej dziecka. Chociaż wiele dzieci zmaga się z objawami lęku w dorosłości, wczesne leczenie może pomóc im nauczyć się kontrolować swój lęk⁵.

Predyktory odpowiedzi na leczenie

Identyfikacja czynników prognostycznych odpowiedzi na leczenie ma kluczowe znaczenie dla poprawy wyników terapii u dzieci z zaburzeniami lękowymi⁶. Czynniki te można podzielić na predyktory (baseline characteristics związane z wynikami po leczeniu niezależnie od rodzaju terapii) oraz moderatory (czynniki, których wpływ różni się w zależności od konkretnego leczenia)⁷.

Czynniki demograficzne

Wiek i płeć pacjenta mogą mieć wpływ na rokowanie w zaburzeniach lękowych:

Wiek – dzieci starsze są bardziej narażone na utrzymywanie się zaburzeń lękowych po zakończeniu terapii⁸
Płeć męska – została zidentyfikowana jako czynnik predykcyjny lepszej remisji w badaniach długoterminowych⁹

Czynniki kliniczne

Najważniejsze czynniki kliniczne wpływające na rokowanie w zaburzeniach lękowych u dzieci to:

Nasilenie objawów lękowych – wyższe wyjściowe nasilenie objawów lękowych jest najczęściej identyfikowanym predyktorem gorszej odpowiedzi na leczenie¹⁰¹¹
Współwystępowanie wielu zaburzeń lękowych – większa liczba diagnozowanych zaburzeń lękowych przewiduje mniejsze prawdopodobieństwo remisji¹²
Diagnoza fobii społecznej – jest jednym z najbardziej konsekwentnie identyfikowanych predyktorów gorszych wyników terapii CBT¹³¹⁴
Współwystępowanie depresji – obecność zaburzeń nastroju przewiduje niższe prawdopodobieństwo remisji¹⁵¹⁶
Współwystępowanie zaburzeń eksternalizacyjnych – wskazuje na niższe prawdopodobieństwo remisji¹⁷
Umiejętności społeczne – wyższy poziom umiejętności społecznych, w tym asertywności, samokontroli i odpowiedzialności, zwiększa prawdopodobieństwo powodzenia leczenia¹⁸

Czynniki rodzinne

Funkcjonowanie rodziny i zdrowie psychiczne rodziców odgrywają istotną rolę w rokowaniu zaburzeń lękowych u dzieci:

Wyższe funkcjonowanie rodziny – znacząco przewiduje remisję¹⁹
Psychopatologia rodziców – wyższy poziom depresji, lęku i stresu u matki przyczynia się do przewidywania niższego prawdopodobieństwa remisji²⁰

Czynniki związane z leczeniem

Rodzaj i sposób prowadzenia terapii również wpływają na rokowanie:

Modalność leczenia – grupowe terapie CBT (zarówno dla dzieci, jak i rodzin) mogą wiązać się z niższym prawdopodobieństwem remisji w porównaniu z terapią indywidualną²¹
Intensywność leczenia – niska intensywność terapii przewiduje mniejsze prawdopodobieństwo remisji²²
Doświadczenie terapeuty – interesująco, niższe doświadczenie terapeuty jest powiązane z wyższym prawdopodobieństwem remisji w niektórych badaniach²³

Długoterminowe wyniki

Badania dotyczące długoterminowych wyników zaburzeń lękowych u dzieci wskazują, że:

Mniej niż połowa (46,5%) pacjentów osiąga remisję w okresie 6 lat po leczeniu²⁴
Pacjenci bez remisji są znacznie bardziej narażeni na współwystępowanie zaburzeń internalizacyjnych (47% vs 10%) i eksternalizacyjnych (27% vs 10%) w porównaniu z pacjentami w remisji²⁵
Długoterminowe wyniki nie różnią się znacząco w zależności od pierwotnie przypisanego leczenia lub rodzaju terapii stosowanej w okresie obserwacji²⁶

Wczesne objawy jako predyktory przyszłych zaburzeń

Objawy lękowe i depresyjne obecne we wczesnym dzieciństwie mogą przewidywać późniejsze zaburzenia:

Objawy lękowe i depresyjne zgłaszane przez rodziców gdy dzieci miały 3 lata, przewidują spełnienie kryteriów diagnostycznych dla zaburzeń lękowych i/lub depresji w wieku 8 lat²⁷
Dla każdego jednostkowego wzrostu w sumie objawów lęku i depresji w wieku 3 lat, szacowane szanse na zaburzenia lękowe/depresyjne wzrastają odpowiednio o 38% i 78%²⁸
Wśród specyficznych zaburzeń lękowych, objawy fobii społecznej w wieku 3 lat szczególnie przyczyniają się do przewidywania późniejszych zaburzeń lękowych/depresyjnych²⁹

Identyfikacja i wczesna interwencja

Wczesna identyfikacja i interwencja mają kluczowe znaczenie dla poprawy rokowania:

Zaburzenia lękowe u dzieci w wieku przedszkolnym są powszechne, upośledzające i predykcyjne dla zaburzeń lękowych i nastroju w późniejszym dzieciństwie. Jednak mniej niż 15% małych dzieci z upośledzającym zaburzeniem lękowym otrzymuje ocenę lub leczenie w zakresie zdrowia psychicznego³⁰.

Zdolność do szybkiego i niezawodnego wykrywania i interweniowania w przypadku zaburzeń lękowych, gdy mózg dziecka jest jeszcze w fazie rozwoju, może bezpośrednio zmienić trajektorię rozwojową dziecka i może zmniejszyć ryzyko chorób psychicznych w późniejszym życiu³¹.

Istnieje niezaspokojona potrzeba narzędzi przesiewowych do wykrywania lęku przedszkolnego, które można wykorzystać w warunkach podstawowej opieki pediatrycznej lub placówkach opiekuńczych, takich jak przedszkola, w celu oceny ryzyka i ustalenia, kiedy dziecko powinno zostać skierowane na specjalistyczną ocenę zdrowia psychicznego³².

Implikacje dla leczenia

Zrozumienie czynników wpływających na rokowanie ma istotne implikacje dla praktyki klinicznej:

Niskie wskaźniki remisji sugerują, że klinicyści powinni współpracować z rodzinami indywidualnie, aby zdecydować, jak często monitorować nawroty i jak długo kontynuować leczenie wdrożone po pierwszym nawrocie³³
Obecne wyniki mogą pomóc zidentyfikować dzieci, które potrzebują dodatkowego leczenia po podstawowym programie CBT³⁴
Zrozumienie kombinacji czynników determinujących idiograficzne wzorce wyników będzie kluczowe dla poprawy precyzji indywidualnej opieki nad dziećmi i ich rodzinami³⁵
Przyszłe badania nad stopniowaną opieką, leczeniem modułowym lub przepisowym mogłyby ocenić strategie ukierunkowane zarówno na lęk, jak i na współistniejące problemy u tych dzieci³⁶

Komputerowo wspomagana CBT a rokowanie

Wprowadzanie nowych form terapii, takich jak komputerowo wspomagana terapia poznawczo-behawioralna (CCBT), rodzi pytania o czynniki prognostyczne dla tych metod:

Badania wykazały, że objawy internalizacyjne oceniane przez rodziców przewidywały nasilenie lęku po leczeniu dla całej próby, a poziomy lęku przed leczeniem przewidywały wyższe globalne upośledzenie po leczeniu dla grupy otrzymującej standardową opiekę w społeczności, ale nie dla grupy CCBT³⁷.

Ponieważ jest to pierwsze badanie analizujące te predyktory i moderatory leczenia CCBT, a wcześniejsze badania tradycyjnych formatów dostarczania CBT dały wysoce niespójne wyniki, wyniki te należy interpretować jako wstępne. Potrzebne są dalsze badania, aby wyjaśnić, które cechy pacjenta, jeśli w ogóle, są konsekwentnie związane z wynikami CCBT³⁸.

Podsumowanie czynników prognostycznych

Rokowanie w zaburzeniach lękowych u dzieci zależy od złożonej interakcji wielu czynników. Do najważniejszych negatywnych czynników prognostycznych należą:

Wysokie wyjściowe nasilenie objawów lękowych
Współwystępowanie wielu zaburzeń lękowych
Diagnoza fobii społecznej
Współwystępowanie depresji i zaburzeń eksternalizacyjnych
Psychopatologia rodziców

Do pozytywnych czynników prognostycznych zaliczamy:

Płeć męska
Wyższe funkcjonowanie rodziny
Lepsze umiejętności społeczne
Wczesna interwencja terapeutyczna

Zrozumienie tych czynników może pomóc klinicystom w identyfikacji dzieci potrzebujących intensywniejszego lub zmodyfikowanego leczenia oraz w przewidywaniu długoterminowego rokowania, co pozwala na lepsze planowanie opieki i interwencji.³⁹⁴⁰

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Anxiety in Children | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/anxiety-children/research-protocol
Childhood anxiety disorders are very common, affecting one in eight children. The National Institute of Mental Health (NIMH) estimates a lifetime prevalence between the ages 13 and 18 years of 25.1% and a lifetime prevalence of 5.9% for „severe” anxiety disorder. Anxiety disorders in childhood generally follow an unremitting course leading to additional psychopathology and often interfere with social, emotional, and academic development. Early intervention is especially important given the childhood onset and unrelenting course of anxiety disorders. […] The objectives of this systematic review are: 1) to evaluate the comparative effectiveness of psychotherapy and pharmacotherapy for childhood anxiety disorders, including panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, and separation anxiety, and 2) to evaluate the harms and safety concerns associated with those treatments. […] Severity of symptoms are generally believed to be associated with worse outcomes and guidelines suggest a different treatment approach for these children. Despite many available treatments, the majority of children with anxiety disorders do not receive treatment.
#2 Anxiety in Children | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/anxiety-children/research-protocol
Childhood anxiety disorders are very common, affecting one in eight children. The National Institute of Mental Health (NIMH) estimates a lifetime prevalence between the ages 13 and 18 years of 25.1% and a lifetime prevalence of 5.9% for „severe” anxiety disorder. Anxiety disorders in childhood generally follow an unremitting course leading to additional psychopathology and often interfere with social, emotional, and academic development. Early intervention is especially important given the childhood onset and unrelenting course of anxiety disorders. […] The objectives of this systematic review are: 1) to evaluate the comparative effectiveness of psychotherapy and pharmacotherapy for childhood anxiety disorders, including panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, and separation anxiety, and 2) to evaluate the harms and safety concerns associated with those treatments. […] Severity of symptoms are generally believed to be associated with worse outcomes and guidelines suggest a different treatment approach for these children. Despite many available treatments, the majority of children with anxiety disorders do not receive treatment.
#3 Anxiety in Children | Effective Health Care (EHC) Program
https://effectivehealthcare.ahrq.gov/products/anxiety-children/research-protocol
Childhood anxiety disorders are very common, affecting one in eight children. The National Institute of Mental Health (NIMH) estimates a lifetime prevalence between the ages 13 and 18 years of 25.1% and a lifetime prevalence of 5.9% for „severe” anxiety disorder. Anxiety disorders in childhood generally follow an unremitting course leading to additional psychopathology and often interfere with social, emotional, and academic development. Early intervention is especially important given the childhood onset and unrelenting course of anxiety disorders. […] The objectives of this systematic review are: 1) to evaluate the comparative effectiveness of psychotherapy and pharmacotherapy for childhood anxiety disorders, including panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, and separation anxiety, and 2) to evaluate the harms and safety concerns associated with those treatments. […] Severity of symptoms are generally believed to be associated with worse outcomes and guidelines suggest a different treatment approach for these children. Despite many available treatments, the majority of children with anxiety disorders do not receive treatment.
#4 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#5 Overview of Anxiety Disorders in Children and Adolescents – Pediatrics – Merck Manual Professional Edition
https://www.merckmanuals.com/professional/pediatrics/psychiatric-disorders-in-children-and-adolescents/overview-of-anxiety-disorders-in-children-and-adolescents
Prognosis for anxiety disorders in children depends on severity, availability of competent treatment, and the child’s resiliency. Many children struggle with anxiety symptoms into adulthood. However, with early treatment, many children learn how to control their anxiety.
#6 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
The identification of predictors of treatment response is crucial for improving treatment outcome for children with anxiety disorders. […] A machine learning approach was applied to predict anxiety disorder remission in a large sample of 2114 anxious youth (518 years). […] Children who were older, had multiple anxiety disorders, comorbid depression, comorbid externalising disorders, received group treatment and therapy delivered by a more experienced therapist, and who had a parent with higher anxiety and depression symptoms, were more likely than other children to still meet criteria for anxiety disorders at the completion of therapy. […] These findings underscore the utility of prediction models that may indicate which children are more likely to remit or are more at risk of non-remission following CBT for childhood anxiety.
#7 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
Studies have found a nonresponse rate of up to 40% in clinical trials evaluating CBT for anxiety in youth. It is therefore important to examine demographic and clinical features that could predict who will respond to CBT treatment and, when developing a new format of delivery, identify who will be most likely to benefit. Identifying predictors and moderators of clinical outcomes not only helps with matching patients to suitable treatment but also knowing who fails treatment, and why, allows researchers and clinicians to modify, and individualize, their treatment formats more effectively. […] Predictors refer to baseline characteristics of participants that are related to posttreatment outcomes in a consistent way, regardless of which treatment the participant received. Predictors are not specific to one treatment or another, and are considered particularly useful in identifying, at baseline, refractory subgroups of individuals who might require new or refined interventions. Moderators can also be baseline characteristics of participants, which are associated with posttreatment outcomes. However, for moderators, the association differs in magnitude or direction depending on the specific treatment. That is, moderators specify for whom an assigned treatment is likely to be effective.
#8 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
The identification of predictors of treatment response is crucial for improving treatment outcome for children with anxiety disorders. […] A machine learning approach was applied to predict anxiety disorder remission in a large sample of 2114 anxious youth (518 years). […] Children who were older, had multiple anxiety disorders, comorbid depression, comorbid externalising disorders, received group treatment and therapy delivered by a more experienced therapist, and who had a parent with higher anxiety and depression symptoms, were more likely than other children to still meet criteria for anxiety disorders at the completion of therapy. […] These findings underscore the utility of prediction models that may indicate which children are more likely to remit or are more at risk of non-remission following CBT for childhood anxiety.
#9 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#10 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
Predictors of traditionally delivered CBT outcomes have been previously examined for pediatric anxiety. The most consistent predictor of treatment nonresponse is higher baseline symptom severity. Comorbid mood and externalizing disorders and a diagnosis of social anxiety disorder have also been associated with poorer treatment outcome. However, these potential predictors are not reliably identified between studies and results for their significance are mixed. Similarly, several studies have examined potential moderators of outcomes. […] Overall, a clear and replicable pattern of moderator variables for youth CBT have not emerged, with inconsistent results across informants, measures, and studies. That said, recent systematic reviews and meta-analyses suggest that, of all predictors analyzed, higher baseline anxiety severity and the presence of a social anxiety disorder diagnosis appear to be most consistently associated with poorer CBT outcomes.
#11
https://link.springer.com/article/10.1007/s10802-010-9394-1
The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. […] Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. […] Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. […] Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. […] The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved. […] In the present study, children with a higher level of pre-treatment symptom severity were less likely to have recovered at post-treatment.
#12 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#13 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
Predictors of traditionally delivered CBT outcomes have been previously examined for pediatric anxiety. The most consistent predictor of treatment nonresponse is higher baseline symptom severity. Comorbid mood and externalizing disorders and a diagnosis of social anxiety disorder have also been associated with poorer treatment outcome. However, these potential predictors are not reliably identified between studies and results for their significance are mixed. Similarly, several studies have examined potential moderators of outcomes. […] Overall, a clear and replicable pattern of moderator variables for youth CBT have not emerged, with inconsistent results across informants, measures, and studies. That said, recent systematic reviews and meta-analyses suggest that, of all predictors analyzed, higher baseline anxiety severity and the presence of a social anxiety disorder diagnosis appear to be most consistently associated with poorer CBT outcomes.
#14 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
Anxiety disorders are among the most common mental health problems in children and adolescents and have a range of adverse consequences across several developmental, familial, social, and school domains. […] At present, cognitive behavioral therapy (CBT) is the first line intervention recommended for childhood anxiety disorders, with on average 5 out of 10 children demonstrating remission at post-treatment. […] It has become crucial to identify risk factors that may indicate which children are more or less likely to respond to treatment, that is, identify factors that predict outcome regardless of the treatment received. […] Existing evidence suggests that a diagnosis of social anxiety disorder, comorbid depression, and parent psychopathology are the most robust baseline predictors of poorer treatment outcomes.
#15 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#16 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
Anxiety disorders are among the most common mental health problems in children and adolescents and have a range of adverse consequences across several developmental, familial, social, and school domains. […] At present, cognitive behavioral therapy (CBT) is the first line intervention recommended for childhood anxiety disorders, with on average 5 out of 10 children demonstrating remission at post-treatment. […] It has become crucial to identify risk factors that may indicate which children are more or less likely to respond to treatment, that is, identify factors that predict outcome regardless of the treatment received. […] Existing evidence suggests that a diagnosis of social anxiety disorder, comorbid depression, and parent psychopathology are the most robust baseline predictors of poorer treatment outcomes.
#17 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#18
https://link.springer.com/article/10.1007/s10802-021-00824-x
The overall aim of the current study was to investigate the role of parent-reported social skills performance on treatment outcome and the possible interaction with social anxiety. […] We found that parents of children with SoAD reported significantly lower levels of assertive and responsible social behavior prior to treatment in their children compared to parents of children with an anxiety disorder without SoAD. […] The results of the present study showed that higher levels of assertion, self-control and responsibility predicted a higher likelihood of Treatment-Recovery. […] Children with no SoAD who had higher levels of responsibility had a more favorable outcome as measured with the ADIS-TR than children with lower social skills, but this effect did not show for children with SoAD. […] In sum, it appears that higher social skills in general predicted Treatment-Recovery, and that SoAD only played a minor role in this relation. […] The findings in the present study indicate that higher parent reported social skills in their children predicted higher treatment-recovery.
#19 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#20 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#21 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#22 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
A greater number of diagnosed anxiety disorders predicted a greater likelihood that children would not remit all their anxiety disorders following treatment. […] The presence of a mood disorder predicted a lower likelihood of remission in both models. […] The presence of an externalizing disorder indicated a lower likelihood of remission, but only for the primary anxiety model. […] Higher mother self-reported depression, anxiety, and stress scores contributed to model predictions of lower likelihood of remission from all anxiety disorders. […] In both prediction models, treatment modality made the models more likely to predict a lower likelihood of remission when youth received group child and family CBT. […] Low treatment intensity predicted a lower likelihood of remission in both models.
#23 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
Lower therapist experience was associated with a higher likelihood of remission. […] The findings of these models have implications for clinical practice. […] Understanding the combination of factors in determining idiographic patterns of outcome will be critical to improving the precision of individualized care for children and their families.
#24 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#25 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#26 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#27 Anxiety and depression from age 3 to 8Â years in children with and without ADHD symptoms | Scientific Reports
https://www.nature.com/articles/s41598-023-42412-7
Parent-reported anxiety and depressive symptoms when children were 3 years old predicted the fulfilment of diagnostic criteria for anxiety disorder and/or depression (i.e., Anx/Dep) at 8 years of age. […] For each one-unit increase in the symptom sum score of anxiety and depression at 3 years, the estimated odds for Anx/Dep increased by 38% and 78%, respectively. […] Anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep in the multivariable analysis, even after including co-occurring ADHD at 8 years in the model. […] Parent-reported ADHD symptoms at 3 years was a significant predictor of Anx/Dep in the univariable analysis, though the estimate was attenuated when adjusted for the effects of anxiety and depressive symptoms at 3 years. […] Teacher-reported anxiety symptoms at 3 years also predicted Anx/Dep but did not contribute significantly when including the parent-reported symptoms. […] Symptoms of all the specific anxiety disorders at 3 years predicted Anx/Dep at 8 years in the univariable analysis. […] Among these, only symptoms of social phobia contributed to Anx/Dep when controlling for symptoms of other anxiety disorders as well as depression and ADHD at 3 years.
#28 Anxiety and depression from age 3 to 8Â years in children with and without ADHD symptoms | Scientific Reports
https://www.nature.com/articles/s41598-023-42412-7
Parent-reported anxiety and depressive symptoms when children were 3 years old predicted the fulfilment of diagnostic criteria for anxiety disorder and/or depression (i.e., Anx/Dep) at 8 years of age. […] For each one-unit increase in the symptom sum score of anxiety and depression at 3 years, the estimated odds for Anx/Dep increased by 38% and 78%, respectively. […] Anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep in the multivariable analysis, even after including co-occurring ADHD at 8 years in the model. […] Parent-reported ADHD symptoms at 3 years was a significant predictor of Anx/Dep in the univariable analysis, though the estimate was attenuated when adjusted for the effects of anxiety and depressive symptoms at 3 years. […] Teacher-reported anxiety symptoms at 3 years also predicted Anx/Dep but did not contribute significantly when including the parent-reported symptoms. […] Symptoms of all the specific anxiety disorders at 3 years predicted Anx/Dep at 8 years in the univariable analysis. […] Among these, only symptoms of social phobia contributed to Anx/Dep when controlling for symptoms of other anxiety disorders as well as depression and ADHD at 3 years.
#29 Anxiety and depression from age 3 to 8Â years in children with and without ADHD symptoms | Scientific Reports
https://www.nature.com/articles/s41598-023-42412-7
Parent-reported anxiety and depressive symptoms when children were 3 years old predicted the fulfilment of diagnostic criteria for anxiety disorder and/or depression (i.e., Anx/Dep) at 8 years of age. […] For each one-unit increase in the symptom sum score of anxiety and depression at 3 years, the estimated odds for Anx/Dep increased by 38% and 78%, respectively. […] Anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep in the multivariable analysis, even after including co-occurring ADHD at 8 years in the model. […] Parent-reported ADHD symptoms at 3 years was a significant predictor of Anx/Dep in the univariable analysis, though the estimate was attenuated when adjusted for the effects of anxiety and depressive symptoms at 3 years. […] Teacher-reported anxiety symptoms at 3 years also predicted Anx/Dep but did not contribute significantly when including the parent-reported symptoms. […] Symptoms of all the specific anxiety disorders at 3 years predicted Anx/Dep at 8 years in the univariable analysis. […] Among these, only symptoms of social phobia contributed to Anx/Dep when controlling for symptoms of other anxiety disorders as well as depression and ADHD at 3 years.
#30 Quantifying Risk for Anxiety Disorders in Preschool Children: A Machine Learning Approach | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165524
Early childhood anxiety disorders are common, impairing, and predictive of anxiety and mood disorders later in childhood. Epidemiological studies over the last decade find that the prevalence of impairing anxiety disorders in preschool children ranges from 0.3% to 6.5%. Yet, less than 15% of young children with an impairing anxiety disorder receive a mental health evaluation or treatment. […] The ability to quickly and reliably detect and intervene with anxiety disorders, while the child’s brain is still developing, could directly alter the child’s developmental trajectory and may put the child at decreased risk for psychiatric illnesses later in life. […] There is an unmet need for screening tools for preschool anxiety that can be used in pediatric primary care settings or care-giving facilities, such as daycare centers and preschools, to assess risk and determine when a child should be referred for a specialty mental health evaluation.
#31 Quantifying Risk for Anxiety Disorders in Preschool Children: A Machine Learning Approach | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165524
Early childhood anxiety disorders are common, impairing, and predictive of anxiety and mood disorders later in childhood. Epidemiological studies over the last decade find that the prevalence of impairing anxiety disorders in preschool children ranges from 0.3% to 6.5%. Yet, less than 15% of young children with an impairing anxiety disorder receive a mental health evaluation or treatment. […] The ability to quickly and reliably detect and intervene with anxiety disorders, while the child’s brain is still developing, could directly alter the child’s developmental trajectory and may put the child at decreased risk for psychiatric illnesses later in life. […] There is an unmet need for screening tools for preschool anxiety that can be used in pediatric primary care settings or care-giving facilities, such as daycare centers and preschools, to assess risk and determine when a child should be referred for a specialty mental health evaluation.
#32 Quantifying Risk for Anxiety Disorders in Preschool Children: A Machine Learning Approach | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165524
Early childhood anxiety disorders are common, impairing, and predictive of anxiety and mood disorders later in childhood. Epidemiological studies over the last decade find that the prevalence of impairing anxiety disorders in preschool children ranges from 0.3% to 6.5%. Yet, less than 15% of young children with an impairing anxiety disorder receive a mental health evaluation or treatment. […] The ability to quickly and reliably detect and intervene with anxiety disorders, while the child’s brain is still developing, could directly alter the child’s developmental trajectory and may put the child at decreased risk for psychiatric illnesses later in life. […] There is an unmet need for screening tools for preschool anxiety that can be used in pediatric primary care settings or care-giving facilities, such as daycare centers and preschools, to assess risk and determine when a child should be referred for a specialty mental health evaluation.
#33 Long-Term Outcomes in Children with Anxiety Disorderslogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b
https://www.jwatch.org/na33625/2014/02/20/long-term-outcomes-children-with-anxiety-disorders
Not quite half of participants in a randomized study were in remission 6 years later, and original treatment assignment was not predictive of the outcome. […] Remission was found in 46.5%, with no significant differences by original treatment assignment or interim treatment type. […] From a large number of variables analyzed, only male sex and higher family functioning significantly predicted remission. […] Patients without remission were significantly more likely than remitted patients to have comorbid internalizing disorders (47% vs. 10%) and externalizing disorders (27% vs. 10%). […] Low remission rates imply that clinicians need to work with families individually to decide how often to monitor for relapse and how long to continue treatment instituted after the first relapse.
#34
https://link.springer.com/article/10.1007/s10802-010-9394-1
Further, children with any comorbid disorder (total comorbidity) at pre-treatment were less likely to be free of a DSM-IV anxiety disorder at post-treatment. […] Pre-treatment non-anxiety comorbidity added to the prediction of recovery when recovery was assessed with child reported anxiety symptoms. […] Thus both increased symptom severity and having a non-anxiety comorbid disorder at pretreatment predicts recovery when outcome is assessed using self-reports of anxiety. […] Total comorbidity did not add to the prediction of recovery using child-reported anxiety nor parent-reported internalizing symptoms over and above the contribution of symptom severity. […] The current findings may help identify those children that need additional treatment after a basic CBT program. […] Future studies on stepped care, modular or prescriptive treatment could evaluate strategies targeting anxiety as well as strategies targeting comorbid problems for these children.
#35 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
Lower therapist experience was associated with a higher likelihood of remission. […] The findings of these models have implications for clinical practice. […] Understanding the combination of factors in determining idiographic patterns of outcome will be critical to improving the precision of individualized care for children and their families.
#36
https://link.springer.com/article/10.1007/s10802-010-9394-1
Further, children with any comorbid disorder (total comorbidity) at pre-treatment were less likely to be free of a DSM-IV anxiety disorder at post-treatment. […] Pre-treatment non-anxiety comorbidity added to the prediction of recovery when recovery was assessed with child reported anxiety symptoms. […] Thus both increased symptom severity and having a non-anxiety comorbid disorder at pretreatment predicts recovery when outcome is assessed using self-reports of anxiety. […] Total comorbidity did not add to the prediction of recovery using child-reported anxiety nor parent-reported internalizing symptoms over and above the contribution of symptom severity. […] The current findings may help identify those children that need additional treatment after a basic CBT program. […] Future studies on stepped care, modular or prescriptive treatment could evaluate strategies targeting anxiety as well as strategies targeting comorbid problems for these children.
#37 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
Research on potential predictors for CCBT for child anxiety, where computer-based interventions are used in conjunction with clinician involvement, are limited. Given the fact that a portion of youth do not respond to current anxiety treatments, additional work is needed to better clarify which treatments work for whom and to move the field closer to personalized treatment assignment decisions. […] This study examined predictors and moderators of treatment outcomes in a sample of one hundred children randomized to either CCBT or standard community care, from a treatment trial where CCBT was previously found to be superior to standard community care. Results indicated that parent-rated internalizing symptoms predicted anxiety severity at posttreatment for the whole sample and that pretreatment levels of anxiety predicted higher global impairment at posttreatment for the group receiving community care, but not for the CCBT group.
#38 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
As this is the first study to examine these predictors and moderators for CCBT treatment, and previous studies of traditional CBT delivery formats have yielded highly inconsistent results, these results should be interpreted as preliminary. Further research is needed to clarify which patient characteristics, if any, are consistently associated with CCBT outcomes.
#39 Predicting remission following CBT for childhood anxiety disorders: a machine learning approach | Psychological Medicine | Cambridge Core
https://www.cambridge.org/core/journals/psychological-medicine/article/predicting-remission-following-cbt-for-childhood-anxiety-disorders-a-machine-learning-approach/733FDA7311D52B2AD802300B7119F4FE
Lower therapist experience was associated with a higher likelihood of remission. […] The findings of these models have implications for clinical practice. […] Understanding the combination of factors in determining idiographic patterns of outcome will be critical to improving the precision of individualized care for children and their families.
#40 Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care
https://pmc.ncbi.nlm.nih.gov/articles/PMC10616955/
Research on potential predictors for CCBT for child anxiety, where computer-based interventions are used in conjunction with clinician involvement, are limited. Given the fact that a portion of youth do not respond to current anxiety treatments, additional work is needed to better clarify which treatments work for whom and to move the field closer to personalized treatment assignment decisions. […] This study examined predictors and moderators of treatment outcomes in a sample of one hundred children randomized to either CCBT or standard community care, from a treatment trial where CCBT was previously found to be superior to standard community care. Results indicated that parent-rated internalizing symptoms predicted anxiety severity at posttreatment for the whole sample and that pretreatment levels of anxiety predicted higher global impairment at posttreatment for the group receiving community care, but not for the CCBT group.