This paper examines the reliability and validity of parent target problems (PTPs) in a multi-site randomized controlled trial of parent training (PT) versus psychoeducation (PEP) in children (150 boys, 19 girls; mean age 4.7 ± 1.2 years) with autism spectrum disorder (ASD) and disruptive behavior. At baseline, treatment blind, independent evaluators asked parents to nominate the child’s top two problems. Each problem was documented in a brief narrative. Narratives were reviewed and revised at follow-up visits during the six-month trial. When the trial was completed, five judges, blind to treatment condition, independently rated change from baseline on a 9-point scale (1 = normal; 2 = markedly improved; 3 = definitely improved; 4 = equivocally improved; 5 = no change; 6 = possibly worse; 7 = definitely worse; 8 = markedly worse; 9 = disastrously worse) at Weeks 8, 12, 16, and 24 (inter-rater intraclass correlation = 0.78). PTP scores for the two target problems were averaged across the five raters, yielding a mean score for each child at each time point. Mean PTP scores showed improvement in both treatment groups over the 24-week study. Compared to PEP, PTP ratings showed a steeper decline in PT based on significant interaction of group and time (t(df) = 2.14(155.9), p = 0.034; Week 24 effect size = 0.75). In categorical analysis, we compared cutoffs mean PTP scores of 3.0 (definitely improved), 3.25, and 3.5 with the positive response rate on the Clinical Global Impressions-Improvement scale from the original study. Sensitivities ranged from 52–78%. PTP narratives offer a systematic, reliable, and valid way to track child-specific outcomes in clinical trials and clinical practice.

本文在儿童（150 名男孩，19 名女孩；平均年龄 4.7 ± 1.2 岁）的家长培训 (PT) 与心理教育 (PEP) 的多地点随机对照试验中检验了家长目标问题 (PTP) 的可靠性和有效性。自闭症谱系障碍（ASD）和破坏性行为。在基线时，治疗盲的独立评估者要求父母提名孩子的前两个问题。每个问题都记录在一个简短的叙述中。在为期 6 个月的试验期间，在后续访问中对叙述进行了审查和修订。试验完成后，五名不知道治疗条件的评委独立评估了与基线相比的 9 点量表变化（1 = 正常；2 = 显着改善；3 = 明显改善；4 = 模棱两可的改善；5 = 没有变化； 6 = 可能更糟；7 = 肯定更糟；8 = 明显更糟；在第 8 周、第 12 周、第 16 周和第 24 周时，9 = 更糟）（评分者组内相关性 = 0.78）。五个评估者对两个目标问题的 PTP 分数进行平均，得出每个孩子在每个时间点的平均分数。在为期 24 周的研究中，两个治疗组的平均 PTP 评分均有所改善。与 PEP 相比，基于组和时间的显着交互作用，PTP 评分显示 PT 下降幅度更大（t(df) = 2.14(155.9)，p = 0.034；第 24 周效应大小 = 0.75）。在分类分析中，我们比较了 3.0（肯定改善）、3.25 和 3.5 的临界值平均 PTP 分数与原始研究的临床总体印象-改善量表上的阳性反应率。灵敏度范围为 52-78%。PTP 叙述提供了一个系统的、可靠的、