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Assessment in Child Clinical Psychology: Symptoms and Behaviour Problems

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Psychology 2320A/B
Elizabeth Hayden

02/10/2012: Lecture 4 Assessment in Child Clinical Psychology: Symptoms and Behaviour Problems  Clinical interviews 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 brief neuropsych Questionnaire Measures  Not used for diagnosis, but widely used in research and practice to get information on child symptoms  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  Waitlist/No treatment o Weak evidence for efficacy o Ethical problems  Placebo  Component/Dismantling design  Combination treatment o Usually medication and psychotherapy  Viable/Bona-fide Alternative o Impractical o Investigator bias Psychotherapy Outcome Research: Sampling Issues  Sample homogeneity 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 manipulated experimentally)  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
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