Background We examined the longitudinal associations of autonomic nervous system (ANS) and hypothalamic-pituitary-adrenal (HPA) axis rest and reactivity measures with anxiety and depressive symptoms at one-year follow-up in children with anxiety disorders. Methods In a clinical sample of 152 children with a primary DSM-IV anxiety disorder, aged 8 to 12 years, anxiety and depressive symptoms were assessed with the Multidimensional Anxiety Scale for Children and the Children's Depression Inventory at pre-treatment baseline and one year later, after treatment with cognitive behavioral therapy. At baseline, children participated in a 70 min stress task. Salivary cortisol was measured directly prior to and 20 min post stress task. Skin conductance level (SCL), heart rate and high frequency heart rate variability (HRV) were continuously measured during rest and the stress task. To investigate if rest or reactivity measures predicted anxiety and depressive symptoms at one year follow-up, linear regression analyses were conducted for rest and reactivity measures of SCL, heart rate, HRV and cortisol separately. Results Higher SCL reactivity predicted less decrease of anxiety symptoms at one-year follow-up. Cortisol reactivity showed a weak association with depressive symptoms at one-year follow-up: lower cortisol reactivity predicted less decrease in depressive symptoms. Limitations Only self-reported anxiety and depressive symptoms were used. However, all predictors were objective biological measures, hence there is no risk of shared method variance bias. Conclusions These findings suggest that pre-treatment HPA and ANS responsiveness to stress are predictive biomarkers for a lack of symptom improvement in children with a clinical anxiety disorder.

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Keywords Anxiety disorders, Autonomic nervous system, Cognitive behavioral therapy, Cortisol, Depressive symptoms, Treatment outcome
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Journal Journal of Affective Disorders
Dieleman, G.C, Huizink, A.C, Tulen, J.H.M, Utens, E.M.W.J, & Tiemeier, H.W. (2016). Stress reactivity predicts symptom improvement in children with anxiety disorders. Journal of Affective Disorders, 196, 190–199. doi:10.1016/j.jad.2016.02.022