Improvement in Symptoms Versus Functioning: How Do Our Best Treatments Measure Up?

Abstract

We examined the effects of redefining standards of evidence for treatments targeting childhood mental health problems by expanding outcomes beyond symptom reduction to include functioning. Over 750 treatment protocols from 435 randomized controlled trials were rated based on empirical evidence. Nearly two-thirds (63.9%) demonstrated at least a minimum level of evidence for reducing symptoms; however, only 18.8% of treatments demonstrated evidence for reducing functional impairment. Of those treatments with empirical support for symptom reduction, the majority did not demonstrate empirical support for improvement in functioning because measures of functioning were not included in the studies in which these treatments were tested. However, even when measures of functioning were included, it was much more difficult for treatments to achieve improvement. Among treatments that achieved improvement in functioning, the most notable were Collaborative Problem Solving for disruptive behavior and Cognitive Behavioral Therapy plus Medication for traumatic stress because they demonstrated no support for symptom reduction but good support for improvement in functioning. Results are discussed within the context of evaluating the standards of evidence for treatments and the opportunity to move towards a multidimensional framework whose utility has the potential to exceed the sum of its parts.

Overgeneralized Beliefs, Accommodation, and Treatment Outcome in Youth Receiving Trauma-Focused Cognitive Behavioral Therapy for Childhood Trauma

“…In addition, parent-report may be particularly beneficial for accurate measurement of youth PTSD, especially given that high avoidance is characteristic of this disorder and may bias youth-report. Recent research has highlighted the importance of using broadband measures of functioning to assess symptom change in treatment studies for children, as symptom-specific measures, such as the UPID, may not always provide an accurate or comprehensive reflection of improvement in children (e.g., Becker et al, 2011). Utilizing parent- and youth-report on measures of both broadband functioning and symptom-specific measures can help address these limitations in future studies.…”

“…In an examination of 435 randomized control trials targeted at treating childhood mental health problems, Becker et al (2011) recommend using broadband measures of youth functioning over symptom-specific measures to best capture therapeutic change over the course of treatment. In addition to broadband measures of internalizing and externalizing functioning, the current study also included a symptom-specific measure to directly examine changes in PTSD symptoms over time.…”

“…These cognitive variables were examined as predictors of symptom-specific outcome (e.g., PTSD symptoms) and broadband measures of functioning (e.g., internalizing problems and externalizing behaviors, which have been identified as important indicators of treatment outcome in youth; Becker, Chorpita, & Daleiden, 2011) assessed at pretreatment, mid-treatment, post-treatment, 9 month follow-up, and 1 year follow-up. Overgeneralization and accommodation alone and in combination (i.e., cognitive overgeneralization*accommodation interaction) were examined as predictors of change in symptoms across the course of treatment and over the follow-up period.…”

Convergent and divergent validity of K-SADS-PL anxiety and attention deficit hyperactivity disorder diagnoses in a clinical sample of school-aged children

“…However, diagnostic decisions reached by clinical impressions or clinical interviews are often unreliable and typically differ significantly from those reached by way of systematic assessment (15,16). Consensual validity of ADHD has been demonstrated in several studies (e.g., 12, 13) but findings regarding the validity of anxiety diagnoses are less consistent (14,17). Lack of consistency in prior work in terms of methodology, as well as findings, underscores the continued need for validated diagnostic instruments that can help clinicians differentiate symptoms that are indications of psychopathology in need of treatment from RUNNING HEAD: VALIDITY OF K-SADS-PL 6 normal behaviours and also differentiating between types of disorders with overlapping symptoms.…”

Client Progress Monitoring and Feedback in School-Based Mental Health

“…Functional outcomes are infrequently reported in clinical trials and, when they are, they are less likely to demonstrate improvements in response to intervention (Becker, Chorpita, & Daleiden, 2011). These findings underscore the importance of developing case history and local aggregate evidence related to functional indicators as such information is likely to extend beyond the data available in the general services evidence base.…”