This policy consisted of only recording adverse events
that caused moderate to severe distress or resulted in
functional impairment. The implication of the policy
was that mild adverse events that did not result in functional
impairment were not recorded. However, several
months into the trial the DSMB reversed its decision
and mandated the collection and reporting of all adverse
events, including mild events. Further complicating
adverse event collection procedures, several years into
the study the DSMB required CAMS clinicians to systematically
query and collect information about the presence
of any harm related adverse events from all study
participants and parents at each study visit (i.e., non-suicidal
self-harm, suicidal ideation, homicidal ideation,
suicidal behavior, and homicidal behavior). Although
moderate and severe adverse event data were systematically
collected throughout the entire trial, the shifting
methods used to elicit and record adverse events complicates
the conclusions that can be made about the presence
or absence of adverse events throughout the
entire trial for all subjects.
Despite this limitation, CAMS utilized an adverse
event procedure that was very effective. In response to
the finding in the TADS study that CBT therapists did
not monitor adverse events as closely as did the PT
therapists, a different procedure was implemented in
CAMS for eliciting adverse events than is typically used
in clinical trials. In most clinical trials, clinicians
(whether a psychologist or psychiatrist) asks the participant
or parent(s) if they noticed any changes since their
last treatment visit. However, to avoid the problem
found in TADS, the elicitation of adverse events was
assessed immediately before each treatment visit by the
site project coordinator across all treatment conditions.
This ensured that the elicitation of adverse events did
not vary by treatment condition. This novel adverse
event monitoring procedure was effective in standardizing
the elicitation of adverse events across different
treatment conditions and will allow for comparisons of
relative safety across the four treatment conditions.