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Meta-Analysis
. 2013 Sep;30(9):829-41.
doi: 10.1002/da.22099. Epub 2013 May 8.

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis

Kathryn Bennett  1 , Katharina Manassis, Stephen D Walter, Amy Cheung, Pamela Wilansky-Traynor, Natalia Diaz-Granados, Stephanie Duda, Maureen Rice, Susan Baer, Paula Barrett, Denise Bodden, Vanessa E Cobham, Mark R Dadds, Ellen Flannery-Schroeder, Golda Ginsburg, David Heyne, Jennifer L Hudson, Philip C Kendall, Juliette Liber, Carrie Masia Warner, Sandra Mendlowitz, Maaike H Nauta, Ronald M Rapee, Wendy Silverman, Lynne Siqueland, Susan H Spence, Elisabeth Utens, Jeffrey J Wood
Affiliations
Meta-Analysis

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis

Kathryn Bennett et al. Depress Anxiety. 2013 Sep.

Abstract

Background: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap.

Question: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure?

Methods: All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects.

Results: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust.

Conclusions: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Keywords: anxiety disorders; child/adolescent; cognitive behavior therapy; empirical supported treatment; treatment.

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Conflict of interest statement

Conflict of interest: Dr. Manassis reports book royalties from Rout-ledge Publishing. Dr. Kendall reports royalties from sales of Coping CAT and related treatment materials. Remaining authors have no relevant conflicts of interest.

Figures

Figure 4
Figure 4
Age x treatment group interaction for four developmental age groups (model 5).
Figure 1
Figure 1
PRISMA flow diagram of eligible studies (and individuals).
Figure 2
Figure 2
Study level mean differences in ADIS-CSR-PT adjusted by ADIS-CSR-B.
Figure 3
Figure 3
Treatment effects by age group (adjusted for ADIS-CSR-B).
See this image and copyright information in PMC

References

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ELIGIBLE PRIMARY STUDIES—DATA OBTAINED

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