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Predicting the Outcome of Treatment

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Abstract

The clinical question—“Which treatment(s) for which patients with what set of subgrouping characteristics working by what mechanism(s)?”—rests at the heart of differential therapeutics. Experimentally, this question reduces to a test of how well we can predict the outcome of treatment using the treatment conditions plus other moderating and mediating variables. Reflecting the discussions held at a recent National Institute of Mental Health (NIMH) conference on psychosocial treatments, and using pediatric anxiety disorders as a case in point, we discuss the problem of prediction in treatment outcome studies from the standpoint of definition of terms, using the general linear model of prediction. We also outline types of studies that may be useful in testing potential predictors, and put forward a possible matrix of predictor variables as currently implemented in an NIMH-funded treatment outcome study of pediatric obsessive-compulsive disorder (OCD). We conclude by making specific suggestions for implementing a broader approach to the study of predictors.

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REFERENCES

  • Albano, A. M., Marten, P. A., et al., (1995). Cognitive-behavioral group treatment for social phobia in adolescents. A preliminary study. Journal of Mental and Nervous Disorders, 183, 649–656.

    Google Scholar 

  • Allen, A. J., Leonard, H. L., & Swedo, S. E. (1995). Case study: A new infection-triggered, autoimmune subtype of pediatric OCD and Tourette's syndrome. Journal of the American Academy of Child and Adolescent Psychiatry, 34(3), 307–311.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: Author.

    Google Scholar 

  • Baer, L., Jenike, M. A., Black, D. W., Treece, C., & et al. (1992). Effect of axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder. Archives of General Psychiatry, 49(11), 862–866.

    Google Scholar 

  • Barlow, D. H. (1994). Psychological interventions in the era of managed competition. Clinical Psychology: Science and Practice, 1, 109–122.

    Google Scholar 

  • Baron, R., & Kenny, D. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.

    Google Scholar 

  • Beidel, D., Turner, S., et al. (1994). The SPAI-C: A new child self-report inventory for children. Paper presented at the Annual Meeting of the Anxiety Disorders of America, Santa Monica, CA.

  • Clarke, G. N. (1995). Improving the transition from basic efficacy research to effectiveness studies: Methodological issues and procedures. Journal of Consulting and Clinical Psychology, 63, 718–725.

    Google Scholar 

  • Cohen, J. (1977). Statistical power analyses for the behavioral sciences. New York: Academic Press.

    Google Scholar 

  • Conners, C., Wells, K., March J., & Fiore, C. (1994). Methodological issues in the multimodal treatment of the disruptive behavior disorders. In L. Greenhill (Ed.), Psychiatric Clinics of North America: Disruptive behavior disorders (pp. 361–378). Philadelphia: Saunders.

    Google Scholar 

  • Costello, E., & Angold, A. (1995). Epidemiology. In J. March (Ed.), Anxiety disorders in children and adolescents. (pp. 109–124). New York: Guilford Press.

    Google Scholar 

  • Costello, E. J., Burns, B. J., Angold, A., & Leaf, P. J. (1993). How can epidemiology improve mental health services for children and adolescents? Journal of the Academy of Child and Adolescent Psychiatry, 32(6), 1106–1114.

    Google Scholar 

  • Costello, E. J., & Janiszewski, S. (1990). Who gets treated? Factors associated with referral in children with psychiatric disorders. Acta Psychiatrica Scandinavica, 81, 523–529.

    Google Scholar 

  • Cox, C., Fedio, P., & Rapoport, J. (1989). Neuropsychological testing of obsessive-compulsive adolescents. In J. Rapoport (Ed.), Obsessive-compulsive disorder in children and adolescents (pp. 73–86). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Denckla, M. (1989). Neurological examination. In J. Rapoport (Ed.), Obsessive-compulsive disorder in children and adolescents (pp. 107–118). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • DeVeaugh-Geiss, J., Katz, R., Landau, P., Goodman, W., & Rasmussen, S. (1990). Clinical predictors of treatment response in obsessive compulsive disorder: Exploratory analyses from multicenter trials of clomipramine. Psychopharmacology Bulletin, 26(1), 54–59.

    Google Scholar 

  • DeVeaugh-Geiss, J., Moroz, G., Biederman, J., Cantwell, D., Fontaine R., Greist, J. H., Reichler, R., Katz, R., & Landau, P. (1992). Clomipramine hydrochloride in childhood and adolescent obsessive-compulsive disorder—a multicenter trial. Journal of the American Academy of Child and Adolescent Psychiatry, 31(1), 45–49.

    Google Scholar 

  • Flament, M. F., Whitaker, A., Rapoport, J. L., Davies, M., Berg, C. Z., Kalikow, K., Sceery, W., & Shaffer, D. (1988). Obsessive compulsive disorder in adolescence: An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 764–771.

    Google Scholar 

  • Foa, E., & Emmelkamp, P. (1983). Failures in behavior therapy. New York: John Wiley and Sons.

    Google Scholar 

  • Goisman, R. M., Rogers, M. P., Steketee, G. S., Warshaw, M. G., Cuneo, P., & Keller, M. B. (1993). Utilization of behavioral methods in a multicenter anxiety disorders study. Journal of Clinical Psychiatry, 54(6), 213–218.

    Google Scholar 

  • Goodman, W., Rasmussen, S., Foa, E., & Price, L. (1994). Obsessive-compulsive disorder. In R. Prien & D. Robinson (Eds.), Clinical evaluation of psychotropic drugs: Principles and guidelines (pp. 431–466). New York: Raven Press.

    Google Scholar 

  • Hamburger, S. D., Swedo, S., Whitaker, A., Davies, M., & Rapoport, J. L. (1989). Growth rate in adolescents with obsessive-compulsive disorder. American Journal of Psychiatry, 146(5), 652–655.

    Google Scholar 

  • Harris, C. V., & Wiebe, D. J. (1992). An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 23, 107–115.

    Google Scholar 

  • Hayes, S. (1981). Single case experimental design and empirical clinical practice. Journal of Consulting and Clinical Psychology, 49, 193–211.

    Google Scholar 

  • Hibbs, E. D. (1993). Psychosocial treatment research with children and adolescents: Methodological issues. Special Section: Design and methodology issues for clinical treatment trials in children and adolescents. Psychopharmacology Bulletin, 29, 27–33.

    Google Scholar 

  • Hibbs, E. D., Hamburger, S. D., Lenane, M., Rapoport, J. L., Kruesi, M. J., Keysor, C. S., & Goldstein, M. J. (1991). Determinants of expressed emotion in families of disturbed and normal children. Journal of Child Psychology and Psychiatry and Allied Disciplines, 32, 757–770.

    Google Scholar 

  • Hoagwood, K., Hibbs, E., Brent, D., & Jensen, P. (1995). Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63(5), 683–687.

    Google Scholar 

  • Hollander, E., Neville, D., DeCaria, C. M., & Mullen L. (1990). Neurological and structural involvement in OCD. Neuropsychiatry Neuropsychology and Behavioral Neurology, 3(4), 314–315.

    Google Scholar 

  • Hooper, S. R., & March, J. S. (1995). Neuropsychology. In J. March (Ed.), Anxiety disorders in children and adolescents (pp. 35–60). New York: Guilford Press.

    Google Scholar 

  • Kazdin, A. (1982). Single-case research designs: Methods for clinical and applied settings. New York: Oxford University Press.

    Google Scholar 

  • Kazdin, A. (1986). Comparative outcome studies of psychotherapy: Methodological issues and strategies. Journal of Consulting and Clinical Psychology, 46, 673–686.

    Google Scholar 

  • Kazdin, A. (1988). Child psychotherapy: Developing and identifying effective treatments. Elmsford, NY: Pergamon Press.

    Google Scholar 

  • Kearney, C. A., & Silverman, W. K. (1990). Treatment of an adolescent with obsessive-compulsive disorder by alternating response prevention and cognitive therapy: An empirical analysis. Journal of Behavior Therapy and Experimental Psychiatry, 21, 39–47.

    Google Scholar 

  • Keller, M. B., Lavori, P. W., Wunder, J., Beardslee, W. R., Schwartz, C. E., & Roth, J. (1992). Chronic course of anxiety disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 31(4), 595–599.

    Google Scholar 

  • Kendall, P. C., & Lipman, A. J. (1991). Psychological and pharmacological therapy: Methods and modes for comparative outcome research. Journal of Consulting and Clinical Psychology, 59, 78–87.

    Google Scholar 

  • Kendall, P. C., & Southam-Gerow, M. A. (1995). Issues in the transportability of treatment: The case of anxiety disorders in youths. Journal of Consulting and Clinical Psychology, 63, 702–708.

    Google Scholar 

  • Kettl, P., & Marks, I. (1986). Neurological factors in obsessive-compulsive disorder. British Journal of Psychiatry, 149, 315–319

    Google Scholar 

  • Klein, R. G., & Slomkowski, C. (1993). Treatment of psychiatric disorders in children and adolescents. Psychopharmacol Bulletin, 29, 525–535.

    Google Scholar 

  • Kutcher, S., Reiter, S., & Gardner, D. (1995). Pharmacotherapy: Approaches and applications. In J. March (Ed.), Anxiety disorders in children and adolescents (pp. 341–385). New York: Guilford Press.

    Google Scholar 

  • Last, C. G., & Strauss, C. C. (1989). Obsessive-compulsive disorder in childhood. Journal of Anxiety Disorders, 3, 295–302.

    Google Scholar 

  • Leckman, J. F., Dolnansky, E. S., et al. (1990). Perinatal factors in the expression of Tourette's syndrome: An exploratory study. Journal of the Academy of Child and Adolescent Psychiatry, 29, 220–226.

    Google Scholar 

  • Lenane, M. (1989). Families in obsessive-compulsive disorder. In J. Rapoport (Ed.), Obsessive-compulsive disorder in children and adolescents (pp. 237–249). Washington, DC: American Psychiatric Press.

    Google Scholar 

  • Lenane, M. C., Swedo, S. E., Leonard, H., Pauls, D. L., Sceery, W., & Rapoport, J. L. (1990). Psychiatric disorders in first degree relatives of children and adolescents with obsessive compulsive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 29(3), 407–412.

    Google Scholar 

  • Lenhart, L., & March, J. (1996). Treatment of psychiatric disorders in children and adolescents. In B. Levin & J. Petrilla (Eds.), Mental Health Services: A Public Health Perspective (pp. 211–233). New York: Oxford University Press.

    Google Scholar 

  • Leonard, H., Lenane, M., et al. (1993a). Obsessive-compulsive disorder. In H. L. Leonard (Ed.), Child psychiatric clinics of North America: Anxiety disorders (Vol. 2, pp. 655–666). New York: Saunders.

    Google Scholar 

  • Leonard, H. L., Swedo, S. E., Rapoport, J. L., Koby, E. V., Lenane, M. C., Cheslow, D. L., & Hamburger, S. D. (1989). Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents: A double-blind crossover comparison. Archives of General Psychiatry, 46(12), 1088–1092.

    Google Scholar 

  • Leonard, H. L., Swedo, S. E., Lenane, M. C., Rettew, D. C., & et al. (1991). A double-blind desipramine substitution during long-term clomipramine treatment in children and adolescents with obsessive-compulsive disorder. Archives of General Psychiatry, 48(10), 922–927.

    Google Scholar 

  • Leonard, H. L., Lenane, M. C., Swedo, S. E., Rettew, D. C., & et al. (1993). Tics and Tourette's disorder: A 2-to 7-year follow-up of 54 obsessive-compulsive children. Annual Progress in Child Psychiatry & Child Development, 402–417.

  • Lewinsohn, P. M., Clarke, G. N., Hops, H., & Andrews, J. A. (1990). Cognitive-behavioral treatment for depressed adolescents. Behavior Therapy, 21(4), 385–401.

    Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & La Padula, M. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50(7), 565–576.

    Google Scholar 

  • March, J. (1995). Anxiety disorders in children and adolescents. New York: Guilford Press.

    Google Scholar 

  • March, J., Frances, A., Kahn, D., & Carpenter, D. (1997). Expert consensus guidelines: Obsessive-compulsive disorder. Journal of Clinical Psychiatry, 58(Suppl. 4), 1–72.

    Google Scholar 

  • March, J., Johnston, H., Jefferson, J., Greist, J., Kobak, K., & Mazza, J. (1990). Do subtle neurological impariments predict treatment resistance in children and adolescents with obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology, 1, 133–140.

    Google Scholar 

  • March, J. S., Leonard, H. L., & Swedo, S. E. (1995). Pharmacotherapy of obsessive-compulsive disorder. Child & Adolescent Psychiatric Clinics of North America, 4(1), 217–236.

    Google Scholar 

  • March, J., & Mulle, K. (1995). Manualized cognitive-behavioral psychotherapy for obsessive-compulsive disorder in childhood: A preliminary single case study. Journal of Anxiety Disorders, 9, 175–184.

    Google Scholar 

  • March, J. S. (1995). Cognitive-behavioral psychotherapy for children and adolescents with OCD: A review and recommendations for treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 7–18.

    Google Scholar 

  • Marten, P. A., & Heimberg, R. G. (1995). Toward an integration of independent practice and clinical research. Professional Psychology Research and Practice, 26, 48–53.

    Google Scholar 

  • Maxwell, S., & Delaney, H. (1990). Designing experiments and analyzing data: A model comparison perspective. Belmont, CA: Wadsworth.

    Google Scholar 

  • McDougle, C. J., Goodman, W. K., Leckman, J. F., Barr, L. C., Heninger, G. R., & Price, L. H. (1993). The efficacy of fluvoxamine in obsessive-compulsive disorder: Effects of comorbid chronic tic disorder. Journal of Clinical Psychopharmacology, 13(5), 354–358.

    Google Scholar 

  • Parloff, M. (1986). Placebo controls in psychotherapy research: A sine qua non or a placebo for research problems? Journal of Consulting and Clinical Psychology, 54, 79–87.

    Google Scholar 

  • Pauls, D., Towbin, K., Leckman, J., Zahner, G., & Cohen, D. (1986). Gilles de la Tourette syndrome and obsessive compulsive disorder: Evidence supporting a genetic relationship. Archives of General Psychiatry, 43, 1180–1182.

    Google Scholar 

  • Pocock, S. (1983). Clinical Trials: A practical approach. New York: Wiley/Liss.

    Google Scholar 

  • Prien, R., & Robinson, D. (1994). Clinical evaluation of psychotropic drugs: Principles and guidelines. New York: Raven Press.

    Google Scholar 

  • Riddle, M. A., Scahill, L., King, R., Hardin, M. T., Towbin, K. E., Ort, S. I., Leckman, J. F., & Cohen, D. J. (1990). Obsessive compulsive disorder in children and adolescents: Phenomenology and family history. Journal of the American Academy of Child and Adolescent Psychiatry, 29(5), 766–772.

    Google Scholar 

  • Sanderson, W. C., & Barlow, D. H. (1991). Research strategies in clinical psychology. In C. Walker (Ed.), Clinical psychology: Historical and research foundations. (pp. 37–49). NY: Plenum Press.

    Google Scholar 

  • Santos, A. B., Henggeler, S. W., Burns, B. J., Arana, G. W., & Meisler, N. (1995). Research on field-based services: models for reform in the delivery of mental health care to populations with complex clinical problems. American Journal of Psychiatry, 152(8), 1111–1123.

    Google Scholar 

  • Silverman, W. K., & Kearney, C. A. (1991). The nature and treatment of childhood anxiety. Educational Psychology Review, 3, 335–361.

    Google Scholar 

  • Swedo, S., Leonard, H., & Rapoport, J. L. (1990). Childhood-on-set obsessvive-compulsive disorder. In M. Jenike, L. Baer, & Minichello (Eds.), Obsessive-compulsive disorder. Littleton, MA: PSG.

    Google Scholar 

  • Swedo, S., Leonard, H., & Kiessling, L. S. (1994). Speculations on anti-neuronal antibody-mediated neuropsychiatric disorders of childhood. Pediatrics, 93(2), 323–326.

    Google Scholar 

  • Swedo, S. E., Rapoport, J. L., Leonard, H., Lenane M., & Cheslow, D. (1989). Obsessive-compulsive disorder in children and adolescents: Clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry, 46(4), 335–341.

    Google Scholar 

  • Vermilyea, J. A., Boice, R., & Barlow, D. H. (1984). The importance of assessing treatment integrity: An example in the anxiety disorders. Journal of Behavioral Assessment, 22(6), 1–11.

    Google Scholar 

  • Wallace, A. E., & Kofoed, L. L. (1994). Statistical analysis of single case studies in the clinical setting: The example of methylphenidate trials in children with attention-deficit hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 4, 141–150.

    Google Scholar 

  • Weinstein, M., & Fineberg, H. (1980). Clinical decision analysis. Philadelphia: Saunders.

    Google Scholar 

  • Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. American Psychologist, 47(12), 1578–1585.

    Google Scholar 

  • Whalen, C. K., & Henker, B. (1991). Therapies for hyperactive children: Comparisons, combinations, and compromises. Journal of Consulting and Clinical Psychology, 59, 126–137.

    Google Scholar 

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March, J.S., Curry, J.F. Predicting the Outcome of Treatment. J Abnorm Child Psychol 26, 39–51 (1998). https://doi.org/10.1023/A:1022682723027

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