Conclusion
Following the MTA, POTS, TADS and TORDIA
[27,39,40,49]–all randomized controlled trials in which
most CAMS investigators participated–CAMS is now
the fifth large-scale multicenter comparative pediatric
treatment trial funded by the NIMH in the last decade.
CAMS benefitted from lessons learned in these earlier
studies and as a result used best available methods in
experimental design, trial execution and data analysis.
With respect to its public health goals, CAMS directly
addresses the lack of research examining the efficacy of
CBT alone and PT alone in the same population of
anxious children that were recruited, assessed, and
treated using similar methodologies. CAMS also
addressed the critical question of whether combining
treatments provides additional benefit. Results of the
acute outcomes of the CAMS trial showed that all active
treatments were superior to pill PBO, that combination
treatment was superior to the monotherapies, and that
the monotherapies were equivalent. These findings are
encouraging and suggest that there are three effective
interventions for the treatment of three of the most
common anxiety disorders in child and adolescent
populations. The CAMS assessment protocol allowed
for the evaluation of changes in the symptom profile,
functional outcomes, and adverse events, as well as
putative mediators and moderators of response, in an
explicit multi-measure, multi-informant fashion and will
provide a platform to address many public health questions.
For example, results from the acute outcomes
reveals that that suicidal events are far less common in
anxious youth than in patients with depression,[50] with
no additional sertraline-associated suicidal events
reported [15]. Although the CAMS trial used experienced
and well-trained and closely monitored clinicians,
the CAMS manual-based protocols were designed to
directly translate into community practice making the
findings more relevant than they would have been had
less readily available treatments been used.
The primary findings from the CAMS suggest both
CBT and SRT reduced the severity of anxious symptoms
in children and adolescents diagnosed with moderate to
severe SAD, GAD or SoP; however, the combination of
the two therapies showed the most benefit. Subsequent
papers reviewing secondary outcomes, the durability and
safety of each treatment and moderators and mediators
of study outcome will inform practice-relevant questions
regarding the treatment of youth with anxiety disorders.