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Biomedical subjects

Alan E Kazdin

Publications and source records attributed to Alan E Kazdin.

At least 19 recordsLinked to original sources
PubMed2006

Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication.

BACKGROUND: Prior research indicates that conduct disorder (CD) is associated with a range of co-morbid mental disorders. However, the actual prevalence, subtypes and patterns of co-morbidity of DSM-IV-defined CD in the general US population remains unknown. METHOD: Retrospective assessment of CD and other DSM-IV disorders was conducted using fully structured diagnostic interviews among a nationally representative sample of respondents (n=3199) in the National Comorbidity Survey Replication (NCS-R). RESULTS: The estimated lifetime prevalence of CD in the US is 9.5% (12.0% among males and 7.1% among females), with a median age-of-onset of 11.6 (0.2) years. Latent class analysis (LCA) identified five CD subtypes characterized by rule violations, deceit/theft, aggression, severe covert behaviors, and pervasive CD symptoms. A dose-response relationship was revealed between CD subtype severity and risk of subsequent disorders. Results also indicated that CD typically precedes mood and substance use disorders, but most often occurs after impulse control and anxiety disorders. Although both active and remitted CD is associated with increased risk of the subsequent first onset of other mental disorders, remitted CD is associated with significantly lower risk of subsequent disorders. CONCLUSIONS: CD is prevalent and heterogeneous in the US population, and more severe subtypes and the presence of active CD are associated with higher risk of co-morbid disorders. Future prospective studies using general population samples will further inform the nature and course of this disorder.

Adolescent↗
PubMed2006

Arbitrary metrics: implications for identifying evidence-based treatments.

Research designed to establish the empirical underpinnings of psychotherapy relies heavily on arbitrary metrics, and researchers often do not know if clients receiving an evidence-based treatment have improved in everyday life or changed in a way that makes a difference, apart from the changes the arbitrary metrics may have shown. In other words, it is possible that evidence-based treatments with effects demonstrated on arbitrary metrics do not actually help people, that is, reduce their symptoms and improve their functioning. Clarifying the nature of arbitrary metrics and assessing their implications are important initial steps. Needed next steps are detailing the range of strategies to better connect arbitrary measures to real-world referents and developing measures in which arbitrariness is eliminated or minimized from the start.

Evidence-Based Medicine↗
PubMed2006

Pretreatment social relations, therapeutic alliance, and improvements in parenting practices in parent management training.

The authors examined the parent-therapist alliance in parent management training for children (N = 218; 53 girls and 165 boys, ages 2-14) referred clinically for oppositional, aggressive, and antisocial behavior. The interrelations of pretreatment parent social relationships, the parent-therapist alliance over the course of treatment, and improvements in parenting practices at the end of treatment were evaluated by different raters. As expected, the better the quality of the parent-therapist alliance, the greater the improvements in parenting practices by the end of treatment. Social relations of the parents prior to treatment were associated with the parent-therapist alliance during treatment and parental improvements at the end of treatment. The relation between the therapeutic alliance and improvement in parenting practices was partially explained by pretreatment parent social relations.

Adolescent↗
PubMed2006

Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior.

Comorbidity and complexity of cases seen in clinical work form a basis for discounting the applicability and generality of evidence-based treatments (EBTs). The authors evaluated treatment outcomes in 2 samples of clinically referred children who met criteria for oppositional defiant disorder (n = 183; 42 girls, 141 boys; ages 3-14) or conduct disorder (n = 132; 35 girls, 97 boys; ages 7-14) but varied in comorbidity (up to 5 additional disorders). In addition to comorbidity, 4 domains of case complexity were evaluated: scope and severity of child dysfunction, socioeconomic disadvantage, parent and family functioning, and barriers that emerged during treatment. Comorbidity was associated with greater therapeutic change. Children who varied in comorbidity did not differ on outcome measures at the end of treatment. Complexity was either unrelated or positively related to therapeutic change. As an exception, perceived barriers were associated with less child improvement, but, even with high barriers, effect sizes for these children were large. The findings suggest that comorbidity or complexity of cases does not necessarily influence outcome or limit the applicability of EBTs.

Adolescent↗
PubMed2006

Conceptualizing changes in behavior in intervention research: the range of possible changes model.

An international movement has focused on identifying evidence-based interventions that were developed to change psychological constructs and that are supported by controlled studies. However, inconsistent findings within individual intervention studies and among multiple studies raise critical problems in interpreting the evidence, and deciding when and whether an intervention is evidence-based. A theoretical and methodological framework (Range of Possible Changes [RPC] Model) is proposed to guide the study of change in intervention research. The authors recommend that future quantitative reviews of the research literature use the RPC Model to conceptualize, examine, and classify the available evidence for interventions. Future research should adopt the RPC Model to both develop theory-driven hypotheses and conduct examinations of the instances in which interventions may or may not change psychological constructs.

Adult↗
PubMed2006

Guidelines for interactions between clinical faculty and the pharmaceutical industry: one medical school's approach.

A productive and ethical relationship between the pharmaceutical industry and physicians is critical to improving drug discovery and public health. In response to concerns about inappropriate financial relationships between the pharmaceutical industry and physicians, national organizations representing physicians or industry have made recommendations designed to reduce conflicts of interest, legal exposure, and dissemination of biased information. Despite these initiatives, the prescribing practices of physicians may be unduly influenced by the marketing efforts of industry and physicians may inadvertently distribute information that is biased in favor of a commercial entity. Moreover, physicians may be vulnerable to prosecution through federal anti-kickback and false claims statutes because of potentially inappropriate financial relationships with pharmaceutical companies. Since academic medical centers have a critical role in establishing professional standards, the faculty of Yale University School of Medicine developed guidelines for the relationships of faculty with the pharmaceutical industry, which were approved in May 2005. Input from clinical faculty and from representatives of the pharmaceutical industry was utilized in formulating the guidelines. In contrast to existing recommendations, the Yale guidelines, which are presented as an Appendix here, ban faculty from receiving any form of gift, meal, or free drug sample (for personal use) from industry, and set more stringent standards for the disclosure and resolution of financial conflict of interest in Yale's educational programs. The growing opportunities for drug discovery, the need to use medications in a more evidence-based manner, and preservation of the public trust require the highest professional standards of rigor and integrity. These guidelines are offered as part of the strategy to meet this compelling challenge.

Codes of Ethics↗
PubMed2006

Child-therapist and parent-therapist alliance and therapeutic change in the treatment of children referred for oppositional, aggressive, and antisocial behavior.

BACKGROUND: We examined the therapeutic alliance in evidence-based treatment for children (N = 77, 19 girls, 58 boys, ages 6-14) referred clinically for oppositional, aggressive, and antisocial behavior. METHOD: Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at two points over the course of treatment. Both the quality of the child-therapist and the parent-therapist alliance predicted therapeutic changes in the children; the parent-therapist alliance also predicted improvements in parenting practices in the home. RESULTS: The findings could not easily be attributed to the influence of other domains (socioeconomic disadvantage, parent psychopathology and stress, and severity of child dysfunction) known to predict therapeutic change or to rater effects (common rater variance) in the predictors and criteria. CONCLUSION: The therapeutic alliance warrants increased attention to understand the precise role in treatment and whether or how the alliance can be mobilized to enhance change.

Adolescent↗
PubMed2005

The therapeutic alliance in cognitive-behavioral treatment of children referred for oppositional, aggressive, and antisocial behavior.

The authors examined the therapeutic alliance in evidence-based treatment for children (N = 185, 47 girls, 138 boys; ages 3-14 years) referred clinically for oppositional, aggressive, and antisocial behavior. Different alliances (child-therapist, parent-therapist) were assessed from each participant's perspective at 2 points over the course of treatment. As predicted, both child-therapist and parent-therapist alliances related to therapeutic change, family experience of barriers to participation in treatment, and treatment acceptability. Greater alliance was associated with greater therapeutic change, fewer perceived barriers, and greater treatment acceptability. The findings could not be attributed to the influence of socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction or to rater effects (common rater variance in the predictors and criteria).

Adolescent↗
PubMed2005

Randomized controlled trial of a brief intervention for increasing participation in parent management training.

Evidence-based treatments exist for a range of child and adolescent behavior problems; however, effects are often limited by poor treatment attendance and adherence. The authors developed and evaluated the efficacy of a brief (5 to 45 min) intervention designed to increase treatment attendance and adherence in a sample of 76 parents referred for treatment of their child's oppositional, aggressive, and antisocial behavior. The results of this randomized controlled trial showed that parents who received this brief intervention had greater treatment motivation, attended significantly more treatment sessions, and had greater adherence to treatment according to both parent and therapist report. This study provides researchers and clinicians with a brief and efficacious method of increasing motivation, attendance, and adherence for treatment.

Adolescent↗
PubMed2005

Informant discrepancies in the assessment of childhood psychopathology: a critical review, theoretical framework, and recommendations for further study.

Discrepancies often exist among different informants' (e.g., parents, children, teachers) ratings of child psychopathology. Informant discrepancies have an impact on the assessment, classification, and treatment of childhood psychopathology. Empirical work has identified informant characteristics that may influence informant discrepancies. Limitations of previous work include inconsistent measurement of informant discrepancies and, perhaps most importantly, the absence of a theoretical framework to guide research. In this article, the authors present a theoretical framework (the Attribution Bias Context Model) to guide research and theory examining informant discrepancies in the clinic setting. Needed directions for future research and theory include theoretically driven attention to conceptualizing informant discrepancies across informant pairs (e.g., parent-teacher, mother-father, parent-child, teacher-child) as well as developing experimental approaches to decrease informant discrepancies in the clinic setting.

Adolescent↗
PubMed2005

Evidence-based assessment for children and adolescents: issues in measurement development and clinical application.

Advances in measurement of child and adolescent social, emotional, and behavioral functioning and clinical disorders have been remarkable and remarkably reviewed in the prior articles. This commentary identifies common themes that emerge from the articles, discusses the proliferation of measures, and raises considerations regarding how one might proceed in developing evidence-based assessment (EBA). Developing EBA might begin by delineating the different purposes of assessment and then, for each purpose, identifying the special requirements and then the criteria for stating when these requirements are met. To illustrate the special requirements of different assessment goals, monitoring of patient progress in treatment is discussed.

Adolescent↗
PubMed2004

Evidence-based treatments: challenges and priorities for practice and research.

This article discusses key issues in identifying evidence-based treatments for children and adolescents. Among the issues discussed are obstacles in transporting treatments from research to clinical services, the weak criteria for delineating whether a treatment is evidence based, and barriers to training therapists. Recommendations for research are made to accord much greater attention to mechanisms of change in therapy so we understand why and how treatments work and can use this information to optimize treatment effects in clinical work. Other recommendations focus on the need for an expanded portfolio of therapies that consider disseminability, cost, and scale of applicability of treatment, and the importance of including systematic evaluation of patient progress over the course of therapy.

Diffusion of Innovation↗
PubMed2004

Measuring informant discrepancies in clinical child research.

Discrepancies among informants' ratings of child psychopathology have important implications for diagnosis, assessment, and treatment. Typically, parents and children complete measures (e.g., self-report checklists, diagnostic instruments) to assess child dysfunction. Ratings gathered from these sources reveal relatively little agreement on the nature and extent of the child's social, emotional, and behavioral problems. This article reviews and illustrates the most frequently used methods of measuring informant discrepancies in the clinical child literature (i.e., raw difference, standardized difference, and residual difference scores) and outlines key considerations to influence their selection. The authors conclude that frequently used methods of measuring informant discrepancies are not interchangeable and recommend that future investigations examining informant discrepancies in clinical child research use the standardized difference score as their measure of informant discrepancies.

Adolescent↗
PubMed2003

Spanking children: the controversies, findings, and new directions.

The use of spanking as a discipline technique is quite prevalent, even though whether or not to spank children is controversial among lay and professional audiences alike. Considerable research on the topic has been analyzed in several reviews of the literature that often reach different and sometimes opposite conclusions. Opposing conclusions are not inherently problematic as research develops in an area. However, we propose that both methodological limitations of the research to date as well as the limited focus of the research questions have prevented a better understanding of the impact of parental spanking on child development. The purpose of this article is to convey the basis for limited progress to date and, more importantly, to reformulate the research agenda. The goal is to move toward a resolution of the most relevant questions to parents, professionals, and policymakers. We propose an expanded research agenda that addresses the goals of parental discipline, the direct and concomitant effects of spanking, the influences that foster and maintain the use of spanking, and the processes through which spanking operates.

Adult↗
PubMed2003

Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior.

This study evaluated a parent problem-solving (PPS) intervention designed to augment the effects of evidence-based therapy for children referred to treatment for aggressive and antisocial behavior. All children (N = 127, ages 6-14 years) and their families received problem-solving skills training (PSST), and parents received parent management training (PMT). Families were randomly assigned to receive or not to receive an additional component (PPS) that addressed parental stress over the course of treatment. Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment. The implications of the findings for improving evidence-based treatment as well as the limitations of adding components to treatment are detailed.

Adolescent↗
PubMed2003

Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations.

BACKGROUND: Mechanisms of therapeutic change are rarely studied in child and adolescent therapy. Our central thesis is that the study of mechanisms of treatment is an excellent investment for improving clinical practice and patient care. Indeed, extending treatment trials to clinical settings, without complementary research that studies why and how treatment works, could have great limitations. METHOD: In this article, we discuss the importance of studying mechanisms, the logical and methodological requirements, and why almost no studies to date provide evidence for why or how treatment works. Standard statistical practices (tests of mediation) and designs (randomized controlled clinical trials) contribute greatly to outcome research but have little to say about mechanisms given the way they are commonly used. CONCLUSIONS: The article ends with recommendations to guide research on mechanisms of therapeutic change.

Adolescent↗