Rutgers University, United States.
Rutgers University, United States.
J Anxiety Disord. 2015 Apr;31:11-9. doi: 10.1016/j.janxdis.2014.12.015. Epub 2015 Jan 14.
Parents and youth often report discrepant target problems upon seeking treatment for youth psychopathology, which can have important impact on therapy processes (e.g., dropout) and treatment outcomes, as entry-level attitudes have been found to be influential in ultimate use and benefit of treatment. The current study examined parent-youth agreement within an anxiety disordered sample by assessing demographic and diagnostic factors that may predict matching, as well as the impact of matching on attrition, treatment outcome, and parental satisfaction. Ninety-five youth with principal anxiety disorders received cognitive-behavioral treatment for anxiety at a university outpatient clinic. Youth and parents independently identified target problems during the pretreatment assessment. Target problems were coded into 25 qualitative categories representing diagnostic, symptom, and functional impairment domains, including diffuse anxiety, social anxiety, academic achievement, oppositional/behavior problems, sleep problems, suicidal ideation, and family functioning. The majority of parent-youth dyads (67.4%) agreed on at least one target problem. Although problems related to diffuse anxiety and social anxiety were reported most frequently, relatively low rates of agreement were found in these domains. Kappa values demonstrated higher levels of agreement for problems with specific fears, school attendance, and panic and lower levels of agreement for difficulties with worry, shame, and self-esteem. Further, youth diagnosed with comorbid externalizing disorders were less likely to agree with their parents on at least one target problem. No effects were found for gender, age, or number of diagnoses in predicting agreement. Target problem agreement did not significantly impact rates of attrition or diagnostic remission, but did predict some measures of parental satisfaction. Results suggest that disagreement on treatment goals exists even within a narrow treatment population and may predict important consumer variables such as satisfaction. Findings emphasize that initial goals disagreement warrants careful assessment and monitoring.
父母和青少年在寻求青少年精神病理学治疗时经常报告目标问题不一致，这可能对治疗过程（例如，辍学）和治疗结果产生重要影响，因为入门级态度已被发现对治疗的最终使用和益处有影响。本研究通过评估可能预测匹配的人口统计学和诊断因素，以及匹配对流失、治疗结果和父母满意度的影响，检查了焦虑障碍样本中的父母-青少年一致性。95 名患有主要焦虑障碍的青少年在大学门诊诊所接受认知行为治疗。青少年和家长在治疗前评估期间独立确定目标问题。目标问题被编码为 25 个定性类别，代表诊断、症状和功能障碍领域，包括弥漫性焦虑、社交焦虑、学业成绩、对立/行为问题、睡眠问题、自杀意念和家庭功能。大多数父母-青少年对至少一个目标问题表示同意（67.4%）。尽管与弥漫性焦虑和社交焦虑相关的问题报告最为频繁，但在这些领域发现的一致性相对较低。Kappa 值表明，对于特定恐惧、上学和恐慌问题的一致性更高，而对于担忧、羞耻和自尊问题的一致性较低。此外，患有共患外化障碍的青少年不太可能与父母至少在一个目标问题上达成一致。性别、年龄或诊断数量对预测一致性没有影响。目标问题的一致性并不显著影响流失率或诊断缓解率，但确实预测了一些父母满意度的指标。结果表明，即使在狭窄的治疗人群中，治疗目标的不一致仍然存在，并且可能预测重要的消费者变量，如满意度。研究结果强调，最初的目标不一致需要仔细评估和监测。
