Professor University of Miami Miami, Florida, United States
Abstract Text: Past work has demonstrated informant discrepancies between youth and parent report when assessing psychopathology. Greater parent-child discrepancy has been associated with greater family dysfunction, poorer communication between parent and child, and lack of child or parent insight into concerns. Moreover, past work has found that greater discrepancy is associated with poorer treatment outcomes for youth completing cognitive behavioral therapy for anxiety. However, it remains unclear if such informant discrepancy associations hold true for idiographic measures, such as the Top Problems Assessment (TPA). In the present study, we examine (a) if there are significant differences in the TPA severity ratings at session 1 between parent and child, (b) if discrepancies in TPA severity predict treatment outcomes for transdiagnostic CBT and (c) if age moderates the relationship between parent-child TPA discrepancies and treatment outcomes. Participants were 291 youth between the ages of 6-18 (M = 12.07, SD = 3.38, 50.58% female) with emotional disorders seeking treatment at a University based research clinic. The modal number of top problems identified by both parent and child was 3. To investigate discrepancies between parent and child TPA ratings, paired samples t-tests were conducted to examine mean differences in session 1 ratings for all top problems identified by the dyad. To investigate if discrepancies in TPA severity predict treatment outcomes, an aggregated variable was created to capture the average difference in child and parent TPA severity ratings across all top problems identified at session 1. This average difference was then used in linear regression models to predict pre-post difference scores in the Revised Child Anxiety and Depression Scale (RCADS) self- and parent-report. To further probe this relationship, the moderating role of age was examined. Results indicate that parent severity ratings across all reported top problems were significantly higher than youth ratings (ps < .001). Moreover, results indicate that average difference in child and parent TPA severity ratings did not significantly predict parent-reported (b=-0.67, SE=1.47, t(82) = -0.46, p >.05) or child-reported improvement on the RCADS (b=-0.94, SE=1.89, t(73) = -0.50, p >.05). The interaction between TPA mean difference and age was not significant, indicating that the relationship between parent-child TPA discrepancy and RCADS difference scores is not moderated by age. Results of the present study suggest that the TPA is sensitive to informant discrepancies; however, this discrepancy did not significantly impact treatment outcomes regardless of child age. These findings contrast with past work indicating that greater discrepancy is associated with poorer treatment outcomes. One possible explanation for the present findings is that discrepancy effects may be content-specific (e.g., internalizing or externalizing), or known better to one party than the other (e.g., social conflicts may be better known to the child than parent). It will be important for future work to employ a more nuanced approach to probe effects of TPA discrepancy, including discrepancies in the top problems content and discrepancies in ratings for various types of problems.
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