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A 10-year-old male was diagnosed with generalized anxiety disorder and separation anxiety disorder eight months ago. He was started on sertraline 25 mg daily, which was increased to 50 mg daily after four weeks. He has also been receiving weekly cognitive behavioral therapy (CBT) for the past six months. At today's evaluation, his parent reports he no longer cries at school drop-off, can attend birthday parties with mild initial anxiety that resolves within 15 minutes, and is sleeping in his own bed most nights. His Screen for Child Anxiety Related Disorders (SCARED) parent-report score has decreased from 38 to 18, and his child self-report SCARED score has decreased from 42 to 22. His teacher reports improved classroom participation but notes he still avoids raising his hand and becomes visibly anxious during unannounced quizzes. The PMHNP is evaluating the treatment response across informants. Which evaluation is most appropriate?
Explanation
Evaluating treatment response in pediatric anxiety requires integrating multi-informant data from parent, child, and teacher reports alongside functional outcome measures across home, school, and social settings. A robust response is characterized by convergence of improvement across informants and concrete behavioral gains, with residual symptoms serving as targets for continued psychotherapy.
Key Takeaway
Multi-informant evaluation integrating symptom measures and functional outcomes across settings provides the most comprehensive assessment of pediatric anxiety treatment response, and residual school-based symptoms in the context of substantial overall improvement are appropriate psychotherapy targets.