A Pragmatic SMART Study of Medication and CBT Sequencing in Pediatric Anxiety Disorders: A Randomized Clinical Trial.
Bradley S Peterson, Amy E West, V Robin Weersing et al.
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In 30 seconds
This randomized clinical trial evaluated treatment sequencing for pediatric anxiety disorders in 316 youths aged 8-17. It compared initial treatment with fluoxetine or cognitive-behavioral therapy (CBT) and subsequent strategies if initial treatment failed. Overall, youth-reported anxiety scores decreased by 31.7% over 24 weeks, with no significant difference in outcomes based on initial treatment type.
Key findings
- Youth-reported SCARED scores declined 31.7% over the 24-week trial.
- CBT showed a nonsignificant advantage over fluoxetine with a 24-week difference in mean group change of 1.45.
- Combination treatment did not yield superior improvement over monotherapy for nonremitters at week 12.
- Non-Hispanic White youths benefited more from fluoxetine, while racial and ethnic minority youths preferred combination therapy.
Why it matters
This study provides insights into treatment options for pediatric anxiety disorders, highlighting that both medication and CBT can be effective. Understanding the nuances of treatment sequencing can help clinicians tailor interventions to individual patient needs and preferences.