Predictors of Treatment Response in Anxious-Depressed Adolescents With School Refusal

• NCJ Number: 199329
• Journal: Journal of the American Academy of Child & Adolescent Psychiatry Volume: 42 Issue: 3 Dated: March 2003 Pages: 319-326
• Author(s): Ann E. Layne; Gail A. Bernstein; Elizabeth A. Egan; Matt G. Kushner
• Date Published: March 2003
• Length: 8 pages
• Grant Number(s): R29 MH46534
• Sponsoring Agency: National Institute of Mental Health
• Publication Format: Article
• Publication Type: Report (Study/Research); Program/Project Description
• Language: English
• Country: United States of America

Annotation

This study identified predictors of response to treatment in 8 weeks of cognitive-behavioral therapy (CBT) for anxious-depressed adolescents who had poor school attendance, half of whom received imipramine plus CBT and half of whom received a placebo plus CBT.

Abstract

Criteria for inclusion in the CBT program included at least 20 percent of school days missed in the 4 weeks prior to the initial assessment, postpubertal based on a physical examination, diagnosis of one or more anxiety disorders and major depressive disorder, and a diagnosis of problematic anxiety. The sample included 23 females and 18 males aged 12 to 18. A hierarchical multiple regression analysis was used to assess the following variables as possible predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and the presence of avoidant disorder (AD). The study found that baseline school attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51 percent of the variance in outcome. A higher rate of school attendance at baseline and the reception of imipramine predicted a better response to treatment; whereas, the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also assessed. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than did the females. The study concludes that adolescents with a school-attendance problem are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity of symptoms at the start of treatment should be taken into consideration when planning treatment. Directions are suggested for future research. 1 table and 53 references