Skip to main content
ABCT 2025 59th Annual Convention Main banner
Psychology Tools Ad
Final Program


Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Recorded Session
Recorded Session
Ticketed Session
Ticketed Session
Evaluation ViewAttendees 4

Child / Adolescent - Anxiety
Session Type:: Symposia

Symposium 5 - The SMART Study: A Clinical Effectiveness Trial of Pediatric Anxiety Treatment in a Diverse and Clinically Complex Sample

Saturday, November 22, 2025
3:30 PM - 5:00 PM CST
Location: Bolden 5, Level 2
CE: 1.5

Keywords: Child, Anxiety, Treatment
Level of Familiarity: Basic to Moderate
Recommended Readings: Peterson BS, West AE, Weisz JR, et al. A Sequential Multiple Assignment Randomized Trial (SMART)study of medication and CBT sequencing in the treatment of pediatric anxiety disorders. BMC Psychiatry. Jun 30 2021;21(1):323. doi:10.1186/s12888-021-03314-y,   Walkup JT, Albano AM, Piacentini J, et al. Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. New England Journal of Medicine. Dec 25 2008;359(26):2753-2766. doi:Doi10.1056/Nejmoa0804633,   Higa-McMillan CK, Francis SE, Rith-Najarian L, Chorpita BF. Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety. Journal of Clinical Child & Adolescent Psychology. 2016/03/03 2016;45(2):91-113. doi:10.1080/15374416.2015.1046177,   Wang Z, Whiteside S, Sim L, et al. Anxiety in Children. Comparative Effectiveness Review No. 192.(Prepared by the Mayo Clinic Evidence-based Practice Center under Contract No. 290-2015-00013-I .) AHRQ Publication No. 17-EHC023-EF. Rockville, MD: Agency for Healthcare Research and Quality; August 2017.,   Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review. Expert opinion on pharmacotherapy. 2018;19(10):1057-1070. doi:10.1080/14656566.2018.1491966

Objectives: To present the background, rationale, design, analyses, findings, and clinical implications for a Sequential Multiple Assignment Randomized Trial (SMART) that aimed to determine (1) whether, in real-world settings, with diverse and clinically complex patients, beginning treatment for pediatric anxiety disorders with fluoxetine or Cognitive Behavioral Therapy (CBT) yields better outcomes; and (2) when more improvement is needed, whether optimizing the initial treatment or transitioning to combination therapy is better.

Methods: This was 24-week SMART study employing two randomizations, one in each of two 12-week treatment stages. In Stage 1, youth received either fluoxetine or CBT. In Stage 2, non-remitters were randomized to either (1) optimization of Stage 1 treatment, or (2) combination therapy. Randomizations were stratified by age, sex, and symptom severity. Statistical analyses tested (1)whether fluoxetine or CBT as initial therapies yielded better 24-week outcomes; (2) whether non-remitters at week 12 had better outcomes if their initial treatment was optimized or if they transitioned to combination therapy; (3) whether any of the 4 possible treatment sequences(fluoxetine-->optimized fluoxetine; fluoxetine-->combination therapy; CBT-->optimized CBT; CBT-->combination therapy) yielded better 24-week outcomes than the other sequences.

Results: 316 youth, ages 8-17, who had moderate or severe and functionally impairing anxiety disorder were randomized. The sample was highly diverse: 64% were Hispanic, 56% had Medicaid, and they had a full range of co-occurring psychiatric diagnoses. Findings from the statistical analyses will be presented.

Conclusions: Our findings will show that CBT, fluoxetine, their combination, and variations in their sequencing delivered to diverse, anxious youth in community settings provide those youth, their families, and their care providers with a range of effective treatment options.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Identify the limitations of prior efficacy studies of pediatric anxiety disorders.
  2. Attendees will be identify whether medication alone or CBT alone as the initial treatment for pediatric anxiety disorders yields better outcomes.
  3. Identify whether optimizing monotherapy or transitioning to combination therapy yields better outcomes.

Presentations:

  • 3:35 PM - 3:52 PM CST
    (SYM 5) SMART Study for Pediatric Anxiety: Study Conceptualization and Design

    Speaker: Amy West, Ph.D. (she/her/hers) – Children's Hospital Los Angeles/University of Southern California

  • 3:52 PM - 4:09 PM CST
    (SYM 5) The Methods of a SMART Effectiveness Study of Medication and CBT Sequencing in Treating Pediatric Anxiety Disorder

    Speaker: Robert L. Findling, M.D. (he/him/his) – Virginia Commonwealth University

  • 4:09 PM - 4:26 PM CST
    (SYM 5) SMART Study for Pediatric Anxiety: Outcomes

    Speaker: Bradley Peterson, M.D. – University of Southern California, Children's Hospital Los Angeles

  • 4:26 PM - 4:43 PM CST
    (SYM 5) Exploring Exposures: Provider Perspectives of CBT Delivery to Underserved, Diverse Youth

    Speaker: Diana D. Woodward, M.A., M.S. (she/her/hers) – University of Southern California

    Co-author: Emma Lindquist, MA – University of Southern California

    Co-author: Reyna Rodriguez, PhD – Children's Hospital Los Angeles

    Co-author: Hans Oh, PhD – University of Southern California

    Co-author: V. Robin Weersing, Ph.D. (she/her/hers) – SDSU-UC San Diego JDP in Clinical Psychology

    Co-author: Kathryn Smith, RN, Other – Dept. of Pediatrics, Keck School of Medicine, USC

    Co-author: Bradley O. Hudson, ABPP, Psy.D. – University of Southern California

    Co-author: Bradley Peterson, M.D. – University of Southern California, Children's Hospital Los Angeles

    Co-author: Amy West, Ph.D. (she/her/hers) – Children's Hospital Los Angeles/University of Southern California

  • 4:43 PM - 5:00 PM CST
    (SYM 5) SMART Study for Pediatric Anxiety: Implications for Evidence-based Practice and Future Research

    Speaker: V. Robin Weersing, Ph.D. (she/her/hers) – SDSU-UC San Diego JDP in Clinical Psychology