Background: Identifying moderators of response to treatment for childhood anxiety can inform clinical decision-making and improve overall treatment efficacy. We examined moderators of response to child-based cognitive-behavioral therapy (CBT) and parent-based SPACE (Supportive Parenting for Anxious Childhood Emotions) in a recent randomized clinical trial. Methods: We applied a machine learning approach to identify moderators of treatment response to CBT versus SPACE, in a clinical trial of 124 children with primary anxiety disorders. We tested the clinical benefit of prescribing treatment based on the identified moderators by comparing outcomes for children randomly assigned to their optimal and nonoptimal treatment conditions. We further applied machine learning to explore relations between moderators and shed light on how they interact to predict outcomes. Potential moderators included demographic, socioemotional, parenting, and biological variables. We examined moderation separately for child-reported, parent-reported, and independent-evaluator-reported outcomes. Results: Parent-reported outcomes were moderated by parent negativity and child oxytocin levels. Child-reported outcomes were moderated by baseline anxiety, parent negativity, and parent oxytocin levels. Independent-evaluator-reported outcomes were moderated by baseline anxiety. Children assigned to their optimal treatment condition had significantly greater reduction in anxiety symptoms, compared with children assigned to their nonoptimal treatment. Significant interactions emerged between the identified moderators. Conclusions: Our findings represent an important step toward optimizing treatment selection and increasing treatment efficacy.
|Number of pages||8|
|Journal||Journal of Child Psychology and Psychiatry and Allied Disciplines|
|Early online date||24 Feb 2021|
|State||Published - Oct 2021|
Bibliographical noteFunding Information:
This study was supported through grants from NIMH to E.L. (K23MH103555; 1R61MH115113). The authors have declared that they have no competing or potential conflicts of interest. Key points
© 2021 Association for Child and Adolescent Mental Health.
- behavior therapy
- machine learning
- parent training
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Developmental and Educational Psychology
- Psychiatry and Mental health