SMART Treatment Sequencing Project

Project Description 

The Sequential Multiple Assignment Randomized Trial (SMART) study for youth anxiety, funded by the Patient-Centered Outcomes Research Institute (PCORI) and led by Dr. Brad Peterson, utilizes an advanced trial design that allows researchers to evaluate different treatment sequences based on participants’ response to initial treatment. It is particularly valuable for identifying the most effective treatment paths for diverse youth populations with anxiety disorders. The primary aim of the SMART study is to compare outcomes of fluoxetine, cognitive behavioral therapy, and their combination in treating pediatric anxiety. This multi-site study enrolled 300+ children and adolescents from the greater Los Angeles area. At the 12-week assessment, participants who did not remit underwent a second randomization to (a) an intensified version of their current treatment or (b) transition to the alternative treatment for an additional 12 weeks. The findings from this study will offer behavioral health providers and families clear, evidence-based guidance for selecting effective treatment strategies for youth with anxiety. Data collection for the short-term outcomes of this study is complete, and youths are entering the long-term follow-up phase.

For more information, visit Children's Hospital Los Angeles SMART Study for Pediatric Anxiety. You can also find the protocol manuscript here.