02/10/2012: Lecture 4
Assessment in Child Clinical Psychology: Symptoms and Behaviour Problems
o Gold standard for diagnosis
o Gold standard for clinical research (if structured)
Questionnaires: self-(depending on age of child), parent-, and teacher-report
Behavioural assessments and observations (read text closely about these)
IQ, achievement and neuropsych testing (read text closely about these)
Typical battery would include symptom checklists, intelligence and achievement testing, and
Not used for diagnosis, but widely used in research and practice to get information on child
Achenbach family of measures
o CBCl (preschool and school-age versions)
o TRF (preschool and school-age versions)
o YSR (school-age)
o Adult versions
Parent-Child Disagreement on Children’s Symptoms
Issue with interviews and checklists
Parents > children for children externalizing symptoms; may be more accurate for these
o Externalizing = disruptive, oppositional, defiant, rule-breaking, etc.
Children > parents for child internalizing symptoms; may be more accurate for these
o Internalizing = sad mood, fears, anxiety, etc.
Self-report important for internalizing symptoms; informants important for externalizing
Does Psychotherapy Work?
Do psychotherapy patients improve?
Does one approach work better than others?
Is psychotherapy better than medication?
Psychotherapy Outcome Research: Control Groups
o Weak evidence for efficacy
o Ethical problems
o Usually medication and psychotherapy
o Investigator bias Psychotherapy Outcome Research: Sampling Issues
o Participants screened for other diagnoses, age, language, intellectual ability, etc. to form
a homogenous group
Allows specific claims re: who will be helped by a treatment?
Increases statistical power to detect effects
However, limits generalizability
Psychotherapy Outcome Research: The Independent Variable
In psychotherapy research, the independent variable is therapy
o The treatment
Like any other independent variable, must be operationalized (made into something that can be
To do this, treatment studies develop a treatment manual
o Overview of principles of therapy
o Session-by-session guidelines
Psychotherapy Outcome Research: Acceptability and Attrition
Acceptability – how tolerable an approach is to a patient
If acceptability is low, this may lead to attrition – drop-outs from a study
Psychotherapy Outcome Research: Early Findings
Meta-analysis: combines results from many studies to get an overall estimate of effect
Smith, Glass and Miller (1980) meta-analysis of psychotherapy with adults
o Psychotherapy effect size = 0.85
i.e., average psychotherapy patient was better off post-treatment than over
80% of persons who went untreated
o major class of psychotherapy were equivalent in terms of efficacy
“Dodo Bird” Verdict
Hotly contested (especially by behaviour therapists)
o “Garbage in, garbage out” (insufficient screening of included studies)
Still actively debated
Majority opinion: some disorders – few differences in efficacy across several approaches (e.g.
major depression); others – important differences (e.g. OCD)
But What about the Children?
Weisz et al. (1987) meta-analysis o