Evaluating change in symptomatic and functional level of children and youth with emotional disorders: a naturalistic observation study

The objective of the study is to describe the changes in symptomatic and functional impairment for children and youth with emotional disorders treated at child and adolescent mental health outpatient services (CAMHS) in Norway. The study was of naturalistic observational type in which the treatment can be classified as “treatment as usual” (TAU). The Strengths and Difficulties Questionnaire (SDQ), the Health of the Nation Outcome Scale (HONOSCA) and the Children’s Global Assessment Scale (CGAS) were used as measures of change. The information from multiple informants allowed the evaluation of change from different perspectives. The sample consisted of 84 children and youth with emotional disorders treated at two CAMHS in the North of Norway. The SDQ, the HONOSCA and the CGAS were administered at intake (T0), during assessment (T1) and approximately, 6 months after T1 (T2). Change was analysed by means of the Linear Mixed Models procedure. The results show that children and youth with emotional disorders experience a statistically significant improvement per month during outpatient treatment according to nearly all the measures of change. For the clinician rated scores, change rates during active assessment/treatment were larger than during the waitlist period. Evaluating change from the perspective of clinical significance showed that only a small proportion of the subjects had change scores that were statistically reliable and clinically significant. Whether an actual change has occurred is uncertain for the majority of patients.