Parent/child informant discrepancies: Implications for youth anxiety treatment

父母/儿童信息差异：对青少年焦虑治疗的影响

• 批准号: 8784638
• 负责人: Emily Michele Becker Haimes
• 金额: $ 4.27万
• 依托单位: UNIVERSITY OF MIAMI CORAL GABLES
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8784638
• 关键词: Address; Adolescent; Affect; Agreement; Anxiety; Child; Childhood; Clinical; Cognitive Therapy; Communication; Data; Development; Emotions; Evidence based treatment; Exhibits; Family; Family Characteristics; Family psychotherapy; Foundations; Functional disorder; Future; Goals; Growth; Individual; Integration Host Factors; Intervention; Knowledge; Literature; Measures; Modality; Modeling; National Institute of Mental Health; Outcome; Parents; Pattern; Pharmaceutical Preparations; Pharmacotherapy; Placebos; Psychotherapy; Public Health; Relative (related person); Reporting; Research; Risk; Sampling; Sertraline; Symptoms; Time; Treatment Failure; Treatment outcome; Variant; Work; Youth; experience; informant; outcome forecast; psychologic; psychosocial; public health relevance; response; theories; treatment response; treatment trial; willingness

DESCRIPTION (provided by applicant): Disagreement between parents and children about a child's symptoms, termed parent/child informant discrepancies (PCIDs), is one of the most robust findings in the child clinical literature (Achenbach, McConaughy, & Howell, 1987; De Los Reyes, 2012). However, interpretation of these discrepancies is notoriously difficult (Smith, 2007). Despite advances in our understanding of how child and family characteristics relate to discrepancies (De Los Reyes et al., 2013), little is known of how PCIDs relate to treatment outcomes. Prior theoretical (Ferdinand, van der Ende, & Verhulst, 2004) and empirical (Kolko & Kazdin, 1993) work suggests greater discrepancies are associated with a host of factors thought to impede treatment outcomes (e.g., family functioning, willingness to discuss negative emotion), suggesting PCIDs likely represent important, easily collected, indicators for treatment prognosis. Consistent with this theory, preliminary evidence suggests higher agreement between parents and children regarding symptoms at the start of treatment, and increased concordance over the course of treatment, predict better outcomes (rated by an independent evaluator) for psychosocial anxiety treatment (De Los Reyes, Alfano, & Beidel, 2010; Panichelli-Mindel, Flannery-Schroeder, Kendall, & Angelosante 2005). However, to date, no studies have examined which patterns of PCIDs prior to (e.g., parent high/child low vs. child high/parent low) and throughout treatment (e.g., discrepancies that remain high or those that lessen over time) predict worse outcomes. Using data from the largest treatment trial of pediatric anxiety to date, the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008; Ginsburg et al 2011), the proposed study will apply the latest statistical advancements in the study of informant discrepancies (i.e., polynomial regression coefficients; Laird & De Los Reyes, 2013), as well as latent class growth modeling to examine how PCIDs prior to and throughout treatment predict treatment outcomes. Additionally, this study will also address how these relationships differ by treatment modality (psychosocial versus pharmacotherapy). Furthering this research is critical to understanding how PCIDs can be used to identify youth at risk for treatment failure or those in need of adjunctive treatments (e.g., family therapy). By addressing these questions, this proposal addresses NIMH Strategic Objective 3.2, which has the goal of expanding our understanding of clinical outcomes to understand individual variation in treatment response. Results from this study will greatly advance our understanding of how PCIDs impact anxiety treatment response, will inform the development of future interventions, and will provide a strong foundation for future work aimed at increasing treatment response rates for anxious youth.

描述（由申请人提供）：父母和孩子之间关于孩子症状的分歧，被称为父母/孩子信息差异（PCIDs），是儿童临床文献中最有力的发现之一（Achenbach, McConaughy, & Howell, 1987; De Los Reyes, 2012）。然而，解释这些差异是出了名的困难（Smith, 2007）。尽管我们对儿童和家庭特征如何与差异相关的理解有所进步（De Los Reyes et al., 2013），但对pcid与治疗结果的关系知之甚少。先前的理论研究（Ferdinand, van der Ende, & Verhulst, 2004）和实证研究（Kolko & Kazdin, 1993）表明，更大的差异与一系列被认为阻碍治疗结果的因素（例如，家庭功能，讨论负面情绪的意愿）有关，这表明pci可能是治疗预后的重要且易于收集的指标。与这一理论相一致的是，初步证据表明，父母和孩子在治疗开始时对症状的一致性较高，并且在治疗过程中一致性增加，预示着心理社会焦虑治疗的更好结果（由独立评估者评定）（De Los Reyes, Alfano, & Beidel, 2010; Panichelli-Mindel, Flannery-Schroeder, Kendall, & Angelosante, 2005）。然而，到目前为止，还没有研究检查在治疗之前（例如，父母高/孩子低vs孩子高/父母低）和整个治疗过程中（例如，差异仍然很高或随着时间的推移而减少）哪种PCIDs模式预示着更糟糕的结果。利用迄今为止最大的儿科焦虑治疗试验——儿童/青少年焦虑多模式研究（CAMS； Walkup等人，2008；Ginsburg等人，2011）的数据，本研究将应用信息差异研究的最新统计进展（即多项式回归系数；Laird & De Los Reyes, 2013），以及潜在类别增长模型来研究治疗前和整个治疗过程中的pids如何预测治疗结果。此外，本研究还将探讨这些关系如何因治疗方式（心理社会与药物治疗）而不同。进一步开展这项研究对于理解如何利用pcid来识别有治疗失败风险的青少年或需要辅助治疗（如家庭治疗）的青少年至关重要。通过解决这些问题，本提案解决了NIMH战略目标3.2，其目标是扩大我们对临床结果的理解，以了解治疗反应的个体差异。本研究的结果将极大地促进我们对pcid如何影响焦虑治疗反应的理解，将为未来干预措施的发展提供信息，并将为未来旨在提高焦虑青少年治疗反应率的工作提供坚实的基础。