2.8 Baseline Executive Function and Its Relationship to Escitalopram Response in Adolescents With Anxiety: A Double-Blind, Placebo-Controlled Trial

ObjectivesDespite recognized disrupted executive function (eg, task switching, monitoring, top-down attention) in adolescents with generalized anxiety disorder (GAD), systematic evaluation of executive function in these youth and its relationship to treatment has not been examined.MethodsHere, we used data from a placebo-controlled, double-blind trial of escitalopram in adolescents with GAD (N = 51; aged 12-17 years) to characterize baseline executive function with the Behavior Rating Inventory of Executive Function, Self-Report (BRIEF-SR), and examine its relationship to treatment response with the Pediatric Anxiety Rating Scale (PARS).ResultsThe t scores were significantly elevated in adolescents with GAD for all baseline subscores of the BRIEF-SR compared to an age- and sex-matched normative healthy sample. Baseline BRIEF-SR scores for Emotional Control (β = .256; credibility interval [CrI] 0.367 to 0.146; p < .001), Working Memory (β = .204; CrI 0.2952 to 0.1134; p < .001), Planning/Organizing (β = -.223; CrI -0.1021 to -0.3436; p = .004), and Task Completion (β = -.152; CrI 0.075 to 0.228; p = .002) predicted the trajectory of improvement in PARS score over the 8-week trial of escitalopram. In those who received placebo, only the Inhibit score was significantly, but weakly, associated with response trajectory (β = -.081; CrI -0.0167 to -0.1461; p = .015). The trajectory of improvement across the 8 weeks differed significantly when adolescents had clinically significant impairment (ie, t score > 65) in Emotional Control (p < .001), Working Memory (p < .001), Planning/Organizing (p = .004), and Task Completion (p = .002), when compared to patients whose scores were not in the clinically significant range.ConclusionsThese findings pose the possibility that assessing executive function might be considered for youths with anxiety disorders and suggest that executive function may predict treatment response before initiating and while undergoing treatment, raising questions about the interplay of executive function and the psychiatric armamentarium.AD, PPC, RCT ObjectivesDespite recognized disrupted executive function (eg, task switching, monitoring, top-down attention) in adolescents with generalized anxiety disorder (GAD), systematic evaluation of executive function in these youth and its relationship to treatment has not been examined. Despite recognized disrupted executive function (eg, task switching, monitoring, top-down attention) in adolescents with generalized anxiety disorder (GAD), systematic evaluation of executive function in these youth and its relationship to treatment has not been examined. MethodsHere, we used data from a placebo-controlled, double-blind trial of escitalopram in adolescents with GAD (N = 51; aged 12-17 years) to characterize baseline executive function with the Behavior Rating Inventory of Executive Function, Self-Report (BRIEF-SR), and examine its relationship to treatment response with the Pediatric Anxiety Rating Scale (PARS). Here, we used data from a placebo-controlled, double-blind trial of escitalopram in adolescents with GAD (N = 51; aged 12-17 years) to characterize baseline executive function with the Behavior Rating Inventory of Executive Function, Self-Report (BRIEF-SR), and examine its relationship to treatment response with the Pediatric Anxiety Rating Scale (PARS). ResultsThe t scores were significantly elevated in adolescents with GAD for all baseline subscores of the BRIEF-SR compared to an age- and sex-matched normative healthy sample. Baseline BRIEF-SR scores for Emotional Control (β = .256; credibility interval [CrI] 0.367 to 0.146; p < .001), Working Memory (β = .204; CrI 0.2952 to 0.1134; p < .001), Planning/Organizing (β = -.223; CrI -0.1021 to -0.3436; p = .004), and Task Completion (β = -.152; CrI 0.075 to 0.228; p = .002) predicted the trajectory of improvement in PARS score over the 8-week trial of escitalopram. In those who received placebo, only the Inhibit score was significantly, but weakly, associated with response trajectory (β = -.081; CrI -0.0167 to -0.1461; p = .015). The trajectory of improvement across the 8 weeks differed significantly when adolescents had clinically significant impairment (ie, t score > 65) in Emotional Control (p < .001), Working Memory (p < .001), Planning/Organizing (p = .004), and Task Completion (p = .002), when compared to patients whose scores were not in the clinically significant range. The t scores were significantly elevated in adolescents with GAD for all baseline subscores of the BRIEF-SR compared to an age- and sex-matched normative healthy sample. Baseline BRIEF-SR scores for Emotional Control (β = .256; credibility interval [CrI] 0.367 to 0.146; p < .001), Working Memory (β = .204; CrI 0.2952 to 0.1134; p < .001), Planning/Organizing (β = -.223; CrI -0.1021 to -0.3436; p = .004), and Task Completion (β = -.152; CrI 0.075 to 0.228; p = .002) predicted the trajectory of improvement in PARS score over the 8-week trial of escitalopram. In those who received placebo, only the Inhibit score was significantly, but weakly, associated with response trajectory (β = -.081; CrI -0.0167 to -0.1461; p = .015). The trajectory of improvement across the 8 weeks differed significantly when adolescents had clinically significant impairment (ie, t score > 65) in Emotional Control (p < .001), Working Memory (p < .001), Planning/Organizing (p = .004), and Task Completion (p = .002), when compared to patients whose scores were not in the clinically significant range. ConclusionsThese findings pose the possibility that assessing executive function might be considered for youths with anxiety disorders and suggest that executive function may predict treatment response before initiating and while undergoing treatment, raising questions about the interplay of executive function and the psychiatric armamentarium.AD, PPC, RCT These findings pose the possibility that assessing executive function might be considered for youths with anxiety disorders and suggest that executive function may predict treatment response before initiating and while undergoing treatment, raising questions about the interplay of executive function and the psychiatric armamentarium.