How Many Anxious Kids in Community Mental Health Would Be Eligible for an RCT? And Does It Matter? Insights from a Naturalistic Sample and a Non-Systematic Review

Bibliographic Data

ID15713368
AuthorsAnya C English (0000-0002-8284-9440, University of Pennsylvania), Megan Brady (0009-0002-2433-3478, University of Pennsylvania), Amanda L Sanchez (0000-0003-3269-4150, George Mason University), Emily M Becker‐Haimes (0000-0002-9922-8667, University of Pennsylvania), Emily Becker-Haimes (University of Pennsylvania Health System, corresponding author)
Year2026
Volume13
Issue3
Pages413-413
Publication date2026-03-18
Open AccessYes
TypeARTICLE
VenueChildren (JOURNAL)
Journal identifiersISSN: 2227-9067 • E-ISSN: 2227-9067
PublisherMultidisciplinary Digital Publishing Institute (PUBLISHER • CH)
DOI10.3390/children13030413
PMID41897126
OpenAlexW7138835943
LanguageEN
References cited121

Background : Decades of randomized controlled trials (RCTs) support cognitive behavioral therapy (CBT) for pediatric anxiety, but exclusion criteria may limit generalizability to routine settings. We examined common exclusion criteria in recent CBT RCTs for pediatric anxiety, trends in these criteria over time, and whether meeting RCT exclusion criteria affects outcomes in a naturalistic sample. Methods : We reviewed 81 RCTs from the past 25 years assessing CBT for pediatric anxiety or related disorders to identify common exclusion criteria. We examined how often youth seeking exposure-based treatment for anxiety or OCD at an urban community health center met these exclusion criteria and whether this impacted treatment response, using three-year retrospective chart review data ( n = 94). Results : Common exclusion criteria in identified RCTs included psychotropic medication use (66.7%), autism spectrum disorder (63.0%), and other psychiatric comorbidities. Suicidal ideation increased as an exclusion criterion over time ( p V = 0.23). Based on these criteria, 53% of participants in our naturalistic sample would have been excluded from one or more RCTs. Excluded patients did not differ in baseline characteristics. Excluded youth required nearly twice as many treatment sessions and had more than double the rate of case management utilization (all p s Conclusions : Youth who would have been excluded from at least one RCT had poorer prognoses. Findings support continued emphasis on pragmatic trials to advance understanding of how to augment treatments to better meet the diverse needs of youth

Anxiety · Anxiety disorder · Generalizability theory · Intervention (counseling · Mental health · Naturalistic observation · Randomized controlled trial · Suicidal ideation · Attention Deficit Hyperactivity Disorder · Autism Spectrum Disorder Research · Child and Adolescent Psychosocial and Emotional Development

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