Are Clinicians' Assessments of Improvements in Children's Functioning “Global”?

In this study, the authors examined the relations among clinician ratings of treatment improvement and discrepancies between parent and blinded laboratory rater reports of child social functioning administered before and after treatment for social anxiety disorder. Participants included a clinic sample of 101 children (7–16 years old; M = 11.67, SD = 2.57; 51 girls, 81% Caucasian) receiving treatment as part of a two-site controlled trial. Overall, clinician ratings reflected lack of improvement when parents reported persistent (i.e., pre- to posttreament) social functioning deficits not reported by blinded raters. However, when blinded raters reported persistent social skill deficits not reported by parents, we did not observe the same effect on clinician ratings as we did when the direction of discrepant reports was reversed. We replicated these observations in a subset of participants (n = 81) providing parent and child pre–post reports of social anxiety symptoms. These findings have implications for the interpretations of clinical ratings as “primary outcome measures” within controlled trials.

[1]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  V. Neuhaus,et al.  Latent Class Analysis , 2010 .

[3]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[4]  Andres De Los Reyes Introduction to the Special Section: More Than Measurement Error: Discovering Meaning Behind Informant Discrepancies in Clinical Assessments of Children and Adolescents , 2011, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[5]  E. Youngstrom,et al.  Internal Consistency and Associated Characteristics of Informant Discrepancies in Clinic Referred Youths Age 11 to 17 Years , 2011, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[6]  D. Beidel,et al.  The Relations among Measurements of Informant Discrepancies within a Multisite Trial of Treatments for Childhood Social Phobia , 2010, Journal of abnormal child psychology.

[7]  Satish Iyengar,et al.  Child/Adolescent Anxiety Multimodal Study (CAMS): rationale, design, and methods , 2010, Child and adolescent psychiatry and mental health.

[8]  A. Kazdin,et al.  Identifying Evidence-Based Interventions for Children and Adolescents Using the Range of Possible Changes Model , 2009, Behavior modification.

[9]  A. Klin,et al.  Group Intervention to Promote Social Skills in School-age Children with Pervasive Developmental Disorders: Reconsidering Efficacy , 2009, Journal of autism and developmental disorders.

[10]  L. Wakschlag,et al.  Linking Informant Discrepancies to Observed Variations in Young Children’s Disruptive Behavior , 2009, Journal of abnormal child psychology.

[11]  Satish Iyengar,et al.  Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. , 2008, The New England journal of medicine.

[12]  A. Kazdin,et al.  When the Evidence Says, “Yes, No, and Maybe So” , 2008, Current directions in psychological science.

[13]  F. Sallee,et al.  SET-C versus fluoxetine in the treatment of childhood social phobia. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[14]  A. Kazdin,et al.  Conceptualizing changes in behavior in intervention research: the range of possible changes model. , 2006, Psychological review.

[15]  A. Kazdin,et al.  Informant Discrepancies in Assessing Child Dysfunction Relate to Dysfunction Within Mother-Child Interactions , 2006, Journal of child and family studies.

[16]  P. Kendall,et al.  A Longitudinal Look at Parent–Child Diagnostic Agreement in Youth Treated for Anxiety Disorders , 2005, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[17]  M. Nock,et al.  Randomized controlled trial of a brief intervention for increasing participation in parent management training. , 2005, Journal of consulting and clinical psychology.

[18]  T. Ollendick,et al.  Evidence-Based Assessment of Anxiety and Its Disorders in Children and Adolescents , 2005, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[19]  A. Kazdin,et al.  Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study. , 2005, Psychological bulletin.

[20]  John Hoey,et al.  Clinical trial registration: a statement from the International Committee of Medical Journal Editors. , 2005, Circulation.

[21]  J. Swanson,et al.  A double-blind, placebo-controlled trial of dexmethylphenidate hydrochloride and d,l-threo-methylphenidate hydrochloride in children with attention-deficit/hyperactivity disorder. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  Ray Berard,et al.  A multicenter, randomized, double-blind, placebo-controlled trial of paroxetine in children and adolescents with social anxiety disorder. , 2004, Archives of general psychiatry.

[23]  R. Horton,et al.  Clinical trial registration: a statement from the International Committee of Medical Journal Editors , 2004, Canadian Medical Association Journal.

[24]  A. Kazdin,et al.  Measuring informant discrepancies in clinical child research. , 2004, Psychological assessment.

[25]  P. Kendall,et al.  A symptom-level examination of parent-child agreement in the diagnosis of anxious youths. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[26]  J. Buitelaar,et al.  Relapse prevention in pediatric patients with ADHD treated with atomoxetine: a randomized, double-blind, placebo-controlled study. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[27]  H. Kraemer,et al.  A new approach to integrating data from multiple informants in psychiatric assessment and research: mixing and matching contexts and perspectives. , 2003, The American journal of psychiatry.

[28]  P. Kendall,et al.  Childhood anxiety disorders: parent-child (dis)agreement using a structured interview for the DSM-IV. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[29]  P. Hazell,et al.  A randomized controlled trial of clonidine added to psychostimulant medication for hyperactive and aggressive children. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[30]  M. Liebowitz,et al.  Evaluation of the Clinical Global Impression Scale among individuals with social anxiety disorder , 2003, Psychological Medicine.

[31]  B. Birmaher,et al.  Fluoxetine for the treatment of childhood anxiety disorders. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[32]  W. Staffen,et al.  A placebo-controlled study of lofexidine in the treatment of children with tic disorders and attention deficit hyperactivity disorder , 2003, Journal of psychopharmacology.

[33]  L. Ritz,et al.  The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[34]  Fiona Steele,et al.  The Analysis and Interpretation of Multivariate Data for Social Scientists , 2002 .

[35]  M K Shear,et al.  Reliability and validity of the Panic Disorder Severity Scale: replication and extension. , 2001, Journal of psychiatric research.

[36]  D. Beidel,et al.  Behavioral treatment of childhood social phobia. , 2000, Journal of consulting and clinical psychology.

[37]  A. Schatzberg,et al.  Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[38]  J. Calabrese,et al.  A Randomized, Placebo-Controlled 12-Month Trial of Divalproex and Lithium in Treatment of Outpatients With Bipolar I Disorder , 2000 .

[39]  Golda S. Ginsburg,et al.  Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial. , 1999, Journal of consulting and clinical psychology.

[40]  Golda S. Ginsburg,et al.  Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. , 1999, Journal of consulting and clinical psychology.

[41]  D. Beidel,et al.  Psychopathology of childhood social phobia. , 1999, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  Robert M. Post,et al.  Modification of the Clinical Global Impressions (CGI) scale for use in bipolar illness (BP): the CGI-BP , 1997, Psychiatry Research.

[43]  W. Goodman,et al.  Children's Yale-Brown Obsessive Compulsive Scale: reliability and validity. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[44]  D. Beidel,et al.  A New Inventory to Assess Childhood Social Anxiety and Phobia: The Social Phobia and Anxiety Inventory for Children. , 1995 .

[45]  D. Knopman,et al.  The Clinician Interview‐ Based Impression (CIBI) , 1994, Neurology.

[46]  R. Rapee,et al.  Reliability of the DSM-III-R childhood anxiety disorders using structured interview: interrater and parent-child agreement. , 1994, Journal of the American Academy of Child and Adolescent Psychiatry.

[47]  P. Kendall Treating anxiety disorders in children: results of a randomized clinical trial. , 1994, Journal of consulting and clinical psychology.

[48]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[49]  J. Richters Depressed mothers as informants about their children: a critical review of the evidence for distortion. , 1992, Psychological bulletin.

[50]  Jacob Cohen,et al.  Combining discrepant diagnostic information from multiple sources: Are complex algorithms better than simple ones? , 1992, Journal of abnormal child psychology.

[51]  T. Achenbach Manual for the child behavior checklist/4-18 and 1991 profile , 1991 .

[52]  M. Lambert,et al.  Agoraphobia outcome measurement: A review and meta-analysis. , 1990 .

[53]  R. Loeber,et al.  Mental Health Professionals' Perception of the Utility of Children, Mothers, and Teachers as Informants on Childhood Psychopathology , 1990 .

[54]  W. Silverman,et al.  The Anxiety Disorders Interview Schedule for Children. , 1988, Journal of the American Academy of Child and Adolescent Psychiatry.

[55]  M. Lambert,et al.  Zung, Beck, and Hamilton Rating Scales as measures of treatment outcome: a meta-analytic comparison. , 1986, Journal of consulting and clinical psychology.

[56]  A. Raftery Choosing Models for Cross-Classifications , 1986 .

[57]  J. Berman,et al.  The outcome of psychotherapy with children. , 1985, Psychological bulletin.

[58]  R. C. Young,et al.  A Rating Scale for Mania: Reliability, Validity and Sensitivity , 1978, British Journal of Psychiatry.

[59]  M. Hamilton A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[60]  C. Anderson‐Cook,et al.  Group-Based Modeling of Development , 2006 .

[61]  J. Weisz,et al.  Effects of psychotherapy for depression in children and adolescents: a meta-analysis. , 2006, Psychological bulletin.

[62]  J. Weisz,et al.  Youth psychotherapy outcome research: a review and critique of the evidence base. , 2005, Annual review of psychology.

[63]  J. Stockman,et al.  Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. , 2004, JAMA.

[64]  T. Ollendick,et al.  Multiple informant agreement and the anxiety disorders interview schedule for parents and children. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[65]  J. Weisz,et al.  Child, parent, and therapist (dis)agreement on target problems in outpatient therapy: the therapist's dilemma and its implications. , 2003, Journal of consulting and clinical psychology.

[66]  T. Achenbach Manual for ASEBA School-Age Forms & Profiles , 2001 .

[67]  J. Weisz,et al.  Why are we here at the clinic? Parent-child (dis)agreement on referral problems at outpatient treatment entry. , 2001, Journal of consulting and clinical psychology.

[68]  C. Izard,et al.  Dysphoria-related bias in maternal ratings of children. , 1999, Journal of consulting and clinical psychology.

[69]  Dc Washington Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. , 1994 .

[70]  M. Gould,et al.  Aggregating data from multiple informants in child psychiatry epidemiological research. , 1992, Journal of the American Academy of Child and Adolescent Psychiatry.

[71]  T. Achenbach,et al.  Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. , 1987, Psychological bulletin.