Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 62(1), 100-110. https://doi.org/10.1037/0022-006X.62.1.100

Type of Study: Randomized controlled trial
Number of Participants: 47

Population:

• Age — 9-13 years
• Race/Ethnicity — Treatment: 78% White and 22% African American, Control: 76% White
• Gender — 60% Male
• Status — Participants were children with anxiety disorders who were referred by community sources.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to investigate a psychosocial treatment for subjects with anxiety disorders. Children were randomly assigned to receive a cognitive-behavioral therapy [now called Coping Cat] or to a wait-list control group. Measures utilized include the Revised Children's Manifest Anxiety Scale (RCMAS), the State-Trait Anxiety Inventory for Children (STAIC), the Fear Survey Schedule for Children, the Children’s Depression Inventory (CDI), the Coping Questionnaire, the Child Behavior Checklist (CBCL), the State-Trait Anxiety Inventory for Adults (STAI), and the Anxiety Disorders Interview Schedule for Children (ADIS-C). Results indicate that over 60% of treated children had returned to within normal anxiety levels by the end of treatment and that this percentage was significantly greater than the control group. Treatment gains were maintained at one year. Limitations include a small sample size and an inability to rule out the children’s relationship with the therapist as a factor, since the waitlist participants received no treatment at the time of the study.

Length of controlled postintervention follow-up: 1 year (intervention only).

Kendall, P. C., & Southam-Gerow, M. A. (1996). Long-term follow-up of a cognitive-behavioral therapy for anxiety-disordered youth. Journal of Consulting and Clinical Psychology, 64(4), 724-730. https://doi.org/10.1037/0022-006X.64.4.724

Type of Study: Randomized controlled trial
Number of Participants: 36

Population:

• Age — 11-18 years
• Race/Ethnicity — Not specified
• Gender — 20 Males and 16 Females
• Status — Participants were youth who had completed treatment for an anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
This study uses the same sample as Kendall (1994). The purpose of the study was to examine the long-term effects of a psychosocial treatment. Participants were randomly assigned to either cognitive-behavioral therapy [now called Coping Cat] or a waitlist condition. Measures utilized include the Revised Children’s Manifest Anxiety Scale (RCMAS), the Coping Questionnaire, the Children’s Negative Affectivity Self-Statement Questionnaire, the Children’s Depression Inventory (CDI), the Child Behavior Checklist (CBCL), the State-Trait Anxiety Inventory (STAI), the Coping Questionnaire, and the Anxiety Disorders Interview Schedule for Children (ADIS-C). Results indicate that therapeutic gains were maintained according to measures of anxiety, self-reported anxious self-talk, and self-reported depression. Limitations include small sample size, there was no control group for this analysis because the entire original wait-list group had received treatment, and the study did not address the status of alternate disorders.

Length of controlled postintervention follow-up: 2-5 years (intervention only).

Kendall, P. C., Flannery-Schroeder, E., Panichelli-Mindell, S. M., Southam-Gerow, M., Henin, A., & Warman, M. (1997). Therapy for youths with anxiety disorders: A second randomized clinical trial. Journal of Consulting and Clinical Psychology, 65(3), 366-380. https://doi.org/10.1037/0022-006X.65.3.366

Type of Study: Randomized controlled trial
Number of Participants: 94

Population:

• Age — 9-13 years
• Race/Ethnicity — 85% Caucasian, 5% African American, 5% Other, 2% Hispanic, and 2% Asian
• Gender — 38% Female
• Status — Participants were children referred from community sources with a diagnosis of primary anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate a cognitive-behavioral therapy treatment [now called Coping Cat]. Participants were randomly assigned to receive cognitive-behavioral therapy or to an 8-week wait-list group. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C), the Revised Children’s Manifest Anxiety Scales (RCMAS), the State Trait Anxiety Inventory for Children (STAIC), the Coping Questionnaire, the Child Behavior Checklist (CBCL), and the Coping Questionnaire. Results indicate significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at 1-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Limitations include small sample size, the waiting-list duration was not identical to the duration of treatment, and reliance on self-reported measures.

Length of controlled postintervention follow-up: 1 year (intervention only).

Kendall, P. C., Safford, S., Flannery-Schroeder, E., & Webb, A. (2004). Child anxiety treatment: Outcomes in adolescence and impact on substance abuse and depression at 7.4 year follow-up. Journal of Consulting and Clinical Psychology, 72(2), 276-287. https://doi.org/10.1007/s10608-005-3168-z

Type of Study: Randomized controlled trial
Number of Participants: 86

Population:

• Age — 15-22 years
• Race/Ethnicity — 86% Caucasian, 6% African American, 4% Biracial, 2% Latino, and 2% Asian
• Gender — 35% Female
• Status — Participants were youth referred from community sources and diagnosed with a primary anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
This study used the sample from Kendall et al. (1997). The purpose of the study was to evaluate the maintenance of outcomes of children who received a 16-week cognitive–behavioral treatment (CBT) [now called Coping Cat] for primary anxiety disorders (generalized, separation, and social anxiety disorders). Participants were randomly assigned to the CBT condition or wait-listed children who received CBT after the conclusion of the initial study period. Measures utilized include the child and parent versions of the Anxiety Disorders Interview Schedule (ADIS), or the Lifetime version of the ADIS for those participants over 17, the Revised Children’s Manifest Anxiety Scale (RCMAS), the Children’s Depression Inventory (CDI), the Coping Questionnaire, the Adolescent Perceived Events Scale, the Child Behavior Checklist (CBCL), the Parent Version of the Coping Questionnaire, the State-Trait Anxiety Inventory for Children (STAIC), and the appropriate module of the Comprehensive Adolescent Severity Inventory (CASI). Results indicate according to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. Limitations include the lack of a comparison group for follow-up, retrospective nature of the data collection, poor generalizability due to ethnicity, and small sample size.

Length of controlled postintervention follow-up: 5.5-9.3 years (intervention only).

Flannery-Schroeder, E., Choudhury, M. S., & Kendall, P. C. (2005). Group and individual cognitive-behavioral treatments for youth with anxiety disorders: 1-year follow-up. Cognitive Therapy and Research, 29(2), 253-259. https://doi.org/10.1007/s10608-005-3168-z

Type of Study: Randomized controlled trial
Number of Participants: 37

Population:

• Age — 8-14 years
• Race/Ethnicity — 11% Minority
• Gender — 51% Male
• Status — Participants were referred to a clinic for an anxiety disorder.

Location/Institution: Philadelphia, PA

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report the 1-year follow-up of a cognitive-behavioral treatment [now called Coping Cat] for anxiety disorders in children and adolescents. Participants were randomly assigned to individual cognitive-behavioral treatment (ICBT), group cognitive-behavioral treatment (GCBT), or a waitlist control (WLC) condition. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C), the Revised Children’s Manifest Anxiety Scale (RCMAS), the State-Trait Anxiety Inventory for Children (STAIC), the State-Trait Anxiety Inventory (STAI), the Child Behavior Checklist (CBCL), the Coping Questionnaire, and the Teacher Report Form (TRF). Results indicate that previously reported posttreatment results demonstrated significant reductions in anxiety whereas children in the WLC failed to demonstrate changes in report of anxiety or in diagnostic status. At 1-year follow-up, 81% of ICBT and 77% of GCBT children no longer met criteria for their primary anxiety disorder. Multivariate analyses of variance demonstrated maintenance of treatment gains for both ICBT and CGBT but failed to reveal differences between the conditions. Limitations include small sample size and inability to control for maturation.

Length of controlled postintervention follow-up: 1 year (intervention only).

Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76(2), 282-297. https://doi.org/10.1037/0022-006X.76.2.282

Type of Study: Randomized controlled trial
Number of Participants: 161

Population:

• Age — 7-14 years (Mean=10.27 years)
• Race/Ethnicity — 85% Caucasian, 9% African American, 3% Hispanic, and 3% Other/Mixed
• Gender — 44% Female
• Status — Participants were youth referred by community sources with a diagnosis of a principal anxiety disorder.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT) [now called Coping Cat], family cognitive-behavioral therapy (FCBT), and a family-based education/support/attention (FESA) active control for treating anxiety disordered youth. Participants were randomly assigned to ICBT for anxious children (FCBT with some Coping Cat components) or to a FESA comparison group. Measures utilized include the Anxiety Disorders Interview Schedule for Children (ADIS-C/P), the Multidimensional Anxiety Scale for Children (MASC), the Coping Questionnaire-Child (CQ-C), the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), and the Coping Questionnaire-Parent (CQ-P). Results indicate that children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Children whose parents also had an anxiety disorder showed greater improvement in the FESA condition. Limitations include relatively small sample size, poor generalizability due to ethnicity, and therapists were not blind to the comparison treatments

Length of controlled postintervention follow-up: 1 year.

Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359(26), 2753-2766. https://doi.org/10.1056/NEJMoa0804633

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7-17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, 1% American Indian, and 0.4% Pacific Islander
• Gender — 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to assess the relative or combined efficacy of adapted cognitive behavioral therapy (CBT) [now called Coping Cat], and selective serotonin-reuptake inhibitors. Participants were randomly assigned to receive CBT, sertraline (Zoloft) alone, a combination of CBT plus Zoloft, or a placebo. Measures utilized include the Clinical Global Impression Improvement Scale (CGII) and the Pediatric Anxiety Rating Scale (PARS). Results indicate that the percentages of children who were rated as very much or much improved on the CGII were 80.7% for combination therapy, 59.7% for cognitive behavioral therapy, and 54.9% for sertraline; all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies. Results on the PARS documented a similar magnitude and pattern of response; combination therapy had a greater response than CBT, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with CBT than with sertraline. Limitations include lack of follow-up, not including the most socio-economically disadvantaged children, children and teens with major depression and pervasive developmental disorders were excluded, thus may have limited the generalizability of the results.

Length of controlled postintervention follow-up: None.

Ginsburg, G. S., Becker, E. M., Keeton, C. P., Sakolsky, D., Piacentini, J., Albano, A. M., Compton, S. N., Lyengar, S., Sullivan, K., Caporino, N., Peris, T., Birmaher, B., Rynn, M., March, J., & Kendall, P. C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. Journal of the American Medical Association Psychiatry (JAMA Psychiatry), 71(3), 310-318. https://doi.org/10.1001/jamapsychiatry.2013.4186

Type of Study: Randomized controlled trial
Number of Participants: 288

Population:

• Age — 11-26 years (Mean=17 years)
• Race/Ethnicity — 82% White, 9% African American, 8% Hispanic, 7% Other, and 3% Asian
• Gender — 56% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: Six academic sites in the United States

Summary: (To include basic study design, measures, results, and notable limitations)
This study used a subsample from Walkup et al. (2008). The purpose of the study was to determine whether acute clinical improvement and treatment type (i.e., Coping Cat, 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. Participants were randomly assigned to 1 of 4 interventions (Coping Cat, medication, combination, or pill placebo) in the Child/Adolescent Anxiety Multimodal Study. Measures utilized include the Clinical Global Impression–Severity scale, the Children’s Global Assessment Scale, the Brief Family Assessment Measure, the Brief Symptom Inventory, the State-Trait Anxiety Inventory–Trait, the Anxiety Disorders Interview Schedule Supplemental Services Form, and the Life Events Scale. Results indicate that almost half of the sample (46.5%) was in remission at follow-up. Responders to acute treatment were significantly more likely to be in remission at follow-up and had less severe anxiety symptoms and higher functioning. Limitations include the attrition rate of the original study sample at the follow-up time point, the naturalistic nature of the follow-up study (as other treatments may have occurred), and the generalizability of the findings (particularly to youth from nonwhite and lower-SES backgrounds).

Length of controlled postintervention follow-up: 4-9 years with a mean of 6 years.

Silk, J. S., Tan, P. Z., Ladouceur, C. D., Meller, S., Siegle, G. J., McMakin, D. L., Forbes, E. E., Dahl, R. D., Kendall, P. C., Mannarino, A., & Ryan, N. D. (2018). A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. Journal of Clinical Child & Adolescent Psychology, 47(4). 542-554. https://doi.org/10.1080/15374416.2016.1138408

Type of Study: Randomized controlled trial
Number of Participants: 133

Population:

• Age — 9-14 years (Mean=10.96 years)
• Race/Ethnicity — 89% Caucasian, 5% Biracial, 4% African-American, and 2% Hispanic
• Gender — 56% Female
• Status — Participants were children with a primary diagnosis of generalized anxiety disorder.

Location/Institution: United States

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare individual cognitive behavioral therapy (CBT) for child anxiety disorders [now called Coping Cat] and child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at post-treatment and one-year follow-up, as well as on real-world measures of emotional functioning. Participants were randomly assigned to CBT or CCT. Measures utilized include the Wechsler Abbreviated Scale of Intelligence, the Schedule for Affective Disorders and Schizophrenia in School-Age Children—Present and Lifetime version (K-SADS-PL), the Pediatric Anxiety Rating Scale (PARS), and the Positive and Negative Affect Scale for Children (PANAS-C). Results indicate that the majority of youth in both CBT and CCT were classified as treatment responders, but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms. Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at one-year follow-up. Limitations include findings may not generalize to treatments combined with medication, high attrition rate, and sample was primarily Caucasian and middle class, limiting generalization to more diverse samples.

Length of controlled postintervention follow-up: 1 year.

Villabø, M. A., Narayanan, M., Compton, S. N., Kendall, P. C., & Neumer, S.-P. (2018). Cognitive-behavioral therapy for youth anxiety: An effectiveness evaluation in community practice. Journal of Consulting and Clinical Psychology, 86(9), 751-764. https://doi.org/10.1037/ccp0000326

Type of Study: Randomized controlled trial
Number of Participants: 165

Population:

• Age — 7-13 years (Mean=10.46 years)
• Race/Ethnicity — 100% Norwegian
• Gender — 54% Male
• Status — Participants were youth with a primary diagnosis of generalized anxiety disorder or social phobia.

Location/Institution: South-Eastern Norway

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to compare the effectiveness of individual Cognitive Behavioral Therapy (ICBT) [now called Coping Cat] and group Cognitive Behavioral Therapy (GCBT) for referred children with anxiety disorders within community mental health clinics. Participants were randomly assigned to ICBT, GCBT, or wait list (WL). WL participants were randomized to one of the two active treatment conditions following the wait period. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV-TR (ADIS), the Questionnaire for Evaluation of Treatment, the Multidimensional Anxiety Scale for Children - child and parent versions (MASC), the Child Behavior Checklist (CBCL), and the Child Global Assessment of Severity (CGAS). Results indicate both ICBT and GCBT were superior to WL on all outcomes. Additionally, planned pairwise comparisons found no significant differences between ICBT and GCBT. GCBT was superior to ICBT for children diagnosed with social anxiety disorder. Improvement continued during two-year follow-up with no significant between group differences. Limitations include CBT was compared to a waitlist and not to treatment as usual, which may inflate the treatment results, insufficient power to detect small differences between the two active groups, and it is not known what other services children received during the follow-up period.

Length of controlled postintervention follow-up: 2 years (intervention only).