Barriers to remission from child and adolescent anxiety disorders following extensive treatment: An exploratory study

Although treatments for child and adolescent (hereafter, children) anxiety show good efficacy, a significant proportion of children do not remit, even 12 months after receiving treatment. Barriers to treatment responsiveness among chronically anxious children is not well studied. The current study evaluated barriers and predictors of poor treatment response among a small sample of children who reached the third step in a three-stage stepped-care intervention. Stepped-care involved low-intensity CBT, followed by standard CBT if required, and subsequently high intensity CBT if still warranted. Children moved to the next step of stepped-care if requested by their caregiver following feedback of clinical status and symptom change by their therapist. From the initial sample of 139 children entering step 1, 26 (18.7%) children provided data in the third step and were assessed approximately 12 months following their baseline assessment. Several baseline constructs and treatment engagement measures were completed both quantitatively and qualitatively. At the end of Step 3, 14 of 26 (54%) participants had not remitted from their primary disorder and 19 (77%) were not remitted from all anxiety disorders. Non-remission was associated with baseline measures of higher primary disorder severity, fewer anxiety disorders, higher child self-reported social anxiety and total difficulties, and poorer mood. Therapy factors associated with non-remission included greater avoidance, less engagement with exposure tasks, and poorer homework completion. Identifying factors that predict poor response to treatment can help to tailor intervention and improve outcomes for this very complex group of young people.