Parent/child informant discrepancies: Implications for youth anxiety treatment

描述（由申请人提供）：父母和孩子之间关于孩子症状的不一致，称为父母/孩子信息不一致（PCID），是儿童临床文献中最有力的发现之一（Achenbach，McConaughy，&豪厄尔，1987; De洛斯雷耶斯，2012）。然而，对这些差异的解释是非常困难的（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洛斯雷耶斯等人，2013年），很少有人知道PCID如何与治疗结果相关。先前的理论（Ferdinand，货车der Ende，& Verhulst，2004）和经验（Kolko & Kazdin，1993）工作表明，更大的差异与被认为阻碍治疗结果的许多因素有关（例如，家庭功能，愿意讨论负面情绪），表明PCID可能代表重要的，容易收集的，治疗预后指标。与这一理论相一致，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，预测心理社会焦虑治疗的结果更好（由独立评估者评定）（De洛斯雷耶斯，Alfano，& Beidel，2010; Panichelli Mindel，Flannery-Schroeder，Kendall，& Angelosante 2005）。然而，到目前为止，还没有研究检查PCID的模式之前（例如，父母高/子女低对子女高/父母低）和整个治疗期间（例如，仍然很高的差异或随着时间的推移而减少的差异）预测更差的结果。使用来自迄今为止最大的儿科焦虑治疗试验的数据，儿童/青少年焦虑多模式研究（CAMS; Walkup等人，2008; Ginsburg et al 2011），拟议的研究将应用最新的统计进展，在研究线人的差异（即，多项式回归系数; Laird & De洛斯雷耶斯，2013年），以及潜在的类增长模型，以检查如何PCID之前和整个治疗预测治疗结果。此外，本研究还将讨论这些关系如何通过治疗方式（社会心理与药物治疗）而有所不同。进一步开展这项研究对于了解PCID如何用于识别有治疗失败风险的青少年或需要连续治疗的青少年（例如，家庭治疗）。通过解决这些问题，该提案解决了NIMH战略目标3.2，其目标是扩大我们对临床结局的理解，以了解治疗反应的个体差异。这项研究的结果将大大提高我们对PCIDs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年治疗反应率的工作提供坚实的基础。

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.