Are clinicians' assessments of improvements in children's functioning "global"?

Abstract

In this study, the authors examined the relations among clinician ratings of treatment improvement and discrepancies between parent and blinded laboratory rater reports of child social functioning administered before and after treatment for social anxiety disorder. Participants included a clinic sample of 101 children (7-16 years old; M = 11.67, SD = 2.57; 51 girls, 81% Caucasian) receiving treatment as part of a two-site controlled trial. Overall, clinician ratings reflected lack of improvement when parents reported persistent (i.e., pre- to posttreament) social functioning deficits not reported by blinded raters. However, when blinded raters reported persistent social skill deficits not reported by parents, we did not observe the same effect on clinician ratings as we did when the direction of discrepant reports was reversed. We replicated these observations in a subset of participants (n = 81) providing parent and child pre-post reports of social anxiety symptoms. These findings have implications for the interpretations of clinical ratings as "primary outcome measures" within controlled trials.

Trial registration: ClinicalTrials.gov NCT00043537.

Figures

Figure 1

Flow chart of the total sample and the different subsamples employed in the statistical modeling of parent-observer pre-post reporting discrepancies of children’s social functioning (Primary Analyses) and parent-child pre-post reporting discrepancies of children’s social anxiety symptoms (Secondary Analyses). Although 101 and 81 participants were included in the Primary and Secondary Analyses (respectively), 100 and 80 participants were included in tests of hypotheses based on Primary and Secondary Analyses samples because one participant did not provide ethnicity/race data.