Author
Dara Sakolsky
Other affiliations: Temple University
Bio: Dara Sakolsky is an academic researcher from University of Pittsburgh. The author has contributed to research in topics: Anxiety & Bipolar disorder. The author has an hindex of 32, co-authored 91 publications receiving 3199 citations. Previous affiliations of Dara Sakolsky include Temple University.
Papers published on a yearly basis
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TL;DR: The sample had moderate to severe anxiety disorder and was highly comorbid, with 55.3% of participants meeting criteria for at least one non-targeted DSM-IV disorder.
325 citations
TL;DR: For the majority of children, some symptoms of anxiety persisted, even among those showing improvement after 12 weeks of treatment, suggesting a need to augment or extend current treatments for some children.
Abstract: An index of outcome in randomized controlled trials (RCTs) for pediatric anxiety disorders (ADs) is the response rate. Response has been defined as a meaningful improvement in symptoms. An important question for clinicians, patients, and families is, what are the chances of becoming nearly symptom free? That is, what is the chance for remission? Although there is no consensus on an operational definition of remission for childhood ADs, it is defined generally as the absence or near absence of symptoms following treatment for a predetermined period of time (Frank et al., 1991). It is considered a more stringent criterion than response. Identifying remission rates in RCTs is thus an important index of treatment outcome.
Reports of remission rates after acute treatment for pediatric ADs are sparse, though initial studies reveal that remission rates are typically lower than response rates. Hudson et al. (2009) reported that posttreatment response rates (defined as the percentage of children no longer meeting criteria for their principal anxiety diagnosis) were 45% after 10 weeks of CBT; the remission rate (percentage no longer meeting criteria for any AD) was 33%. Data on remission rates are similarly sparse for pharmacotherapy trials, although they show a similar pattern. Wagner et al. (2004) reported a 78% response rate (defined as a Clinical Global Impression Improvement Scale [CGI-I] score of 1 [very much improved] or 2 [much improved]) after 16 weeks of paroxetine for youth with social phobia (SOP) and a remission rate (defined as a CGI-I of 1 or a 70% or greater reduction on a social anxiety scale) of 48% and 47%, respectively.
Despite similar patterns of response and remission rates in both pharmacotherapy and cognitive behavioral therapy (CBT) trials for pediatric anxiety, variations in definitions and measurement methods undermine comparisons. The recent Child/Adolescent Anxiety Multimodal Treatment Study (CAMS; Walkup et al., 2008), which compared the efficacy of CBT (Coping Cat; Kendall & Hedtke, 2006), pharmacotherapy (sertraline [SRT]), and their combination (COMB) to pill placebo (PBO) in 488 youth with separation AD (SAD), generalized AD (GAD), and SOP, measured treatment outcome using a variety of methods. Thus, data from this trial are uniquely suited to describe remission rates (i.e., achieving a nearly symptom-free state) conferred by CBT, SRT, and COMB. The initial findings from the CAMS reported only on response rates (Walkup et al., 2008). This study (a) determined multiply defined posttreatment remission rates by treatment condition and (b) assessed predictors of remission.
275 citations
TL;DR: Subthreshold manic or hypomanic episodes were a diagnostic risk factor for the development of manic, mixed, or hypManic episodes in the offspring of parents with bipolar disorder and should be a target for clinical assessment and treatment research.
Abstract: Objective:The authors sought to identify diagnostic risk factors of manic, mixed, or hypomanic episodes in the offspring of parents with bipolar disorder (“high-risk offspring”).Method:High-risk offspring 6–18 years old (N=391) and demographically matched offspring (N=248) of community parents without bipolar disorder were assessed longitudinally with standardized diagnostic instruments by staff blind to parental diagnoses. Follow-up assessments were completed in 91% of the offspring (mean follow-up interval, 2.5 years; mean follow-up duration, 6.8 years).Results:Compared with community offspring, high-risk offspring had significantly higher rates of subthreshold mania or hypomania (13.3% compared with 1.2%), manic, mixed, or hypomanic episodes (9.2% compared with 0.8%), and major depressive episodes (32.0% compared with 14.9%). They also had higher rates of attention deficit hyperactivity disorder (30.7% compared with 18.1%), disruptive behavior disorders (27.4% compared with 15.3%), anxiety disorders (3...
208 citations
TL;DR: Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders.
Abstract: Importance Pediatric anxiety disorders are highly prevalent and impairing and are considered gateway disorders in that they predict adult psychiatric problems. Although they can be effectively treated in the short term, data are limited on the long-term outcomes in treated children and adolescents, particularly those treated with medication. Objective To determine whether acute clinical improvement and treatment type (ie, cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization and to examine predictors of outcomes at follow-up. Design, Setting, and Participants This naturalistic follow-up study, as part of the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), was conducted at 6 academic sites in the United States and included 288 youths (age range, 11-26 years; mean age, 17 years). Youths were randomized to 1 of 4 interventions (cognitive behavioral therapy, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study (CAMS) and were evaluated a mean of 6 years after randomization. Participants in this study constituted 59.0% of the original CAMS sample. Exposures Participants were assessed by independent evaluators using a semistructured diagnostic interview to determine the presence of anxiety disorders, the severity of anxiety, and global functioning. Participants and their parents completed questionnaires about mental health symptoms, family functioning, life events, and mental health service use. Main Outcomes and Measures Remission, defined as the absence of all study entry anxiety disorders. Results Almost half of the sample (46.5%) were in remission a mean of 6 years after randomization. Responders to acute treatment were significantly more likely to be in remission (odds ratio, 1.83; 95% CI, 1.08-3.09) and had less severe anxiety symptoms and higher functioning; the assigned treatment arm was unrelated to outcomes. Several predictors of remission and functioning were identified. Conclusions and Relevance Youths rated as responders during the acute treatment phase of CAMS were more likely to be in remission a mean of 6 years after randomization, although the effect size was small. Relapse occurred in almost half (48%) of acute responders, suggesting the need for more intensive or continued treatment for a sizable proportion of youths with anxiety disorders. Trial Registration clinicaltrials.gov Identifier:NCT00052078
195 citations
Duke University1, Semel Institute for Neuroscience and Human Behavior2, University of Michigan3, University of Pittsburgh4, National Institutes of Health5, Temple University6, Philadelphia College of Osteopathic Medicine7, Johns Hopkins University8, Columbia University Medical Center9, University of Georgia10, Cornell University11
TL;DR: Overall, anxious children responded favorably to CAMS treatments, however, having more severe and impairing anxiety, greater caregiver strain, and a principal diagnosis of social phobia were associated with less favorable outcomes.
Abstract: Objective
To examine predictors and moderators of treatment outcomes among 488 youth ages 7-17 years (50% female; 74% ≤ 12 years) with DSM-IV diagnoses of separation anxiety disorder, social phobia, or generalized anxiety disorder who were randomly assigned to receive either cognitive behavior therapy (CBT), sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) in the Child/Adolescent Anxiety Multimodal Study (CAMS).
185 citations
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3,152 citations
01 Jan 2016
TL;DR: The applied missing data analysis is universally compatible with any devices to read and is available in the digital library an online access to it is set as public so you can download it instantly.
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1,924 citations
1,452 citations
TL;DR: CBT was no more effective than non-CBT active control treatments or TAU in reducing anxiety diagnoses and the few controlled follow-up studies indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant.
Abstract: Childhood and adolescent anxiety disorders are relatively common, occurring in between 5-18% of all children and adolescents. They are associated with significant morbidity and impairment in social and academic functioning, and when persistent, there is a risk of depression, suicide attempts and substance abuse in adulthood. There is accumulating evidence for the efficacy of cognitive behavioural therapy (CBT), with a number of randomised controlled trials (RCTs) suggesting benefit.
The objective of this review is to determine whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison to waiting list or attention controls.
836 citations