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Using Parent Target Problem Narratives to Evaluate Outcomes in Children with Autism Spectrum Disorder

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Abstract

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.

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Data Availability

Associated data from this study is included in the National Database for Autism Research.

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The data for this project are confidential.

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Author information

Authors and Affiliations

  1. Drexel University, AJ Drexel Autism Institute, 3020 Market Street, Suite 560, Philadelphia, PA, USA

    Elisabeth Sheridan

  2. Emory University School of Medicine, Marcus Autism Center, 1920 Briarcliff Road NE, Atlanta, GA, USA

    Scott Gillespie, Andrea N. Evans & Lawrence Scahill

  3. Cleveland Clinic, Lerner College of Medicine of Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH, USA

    Cynthia R. Johnson

  4. Psychology and Psychiatry, The Ohio State University, 305 McCampbell Hall, 1581 Dodd Drive, Columbus, OH, USA

    Luc Lecavalier & Jill Pritchett

  5. University of Rochester Medical Center, 601 Elmwood Ave, Box 671, Rochester, NY, USA

    Tristram Smith & Daniel W. Mruzek

  6. Department of Psychiatry, Riley Hospital for Children, PC 1021D PSYC, Indianapolis, IN, USA

    Naomi Swiezy

  7. Simmons University, 300 The Fenway: W303N, Boston, MA, USA

    Kylan Turner

  8. Department of Psychiatry and Behavioral Sciences, Seattle Children’s Autism Center, University of Washington, 4909 25th Ave NE, Seattle, WA, USA

    Karen Bearss

Authors
  1. Elisabeth Sheridan
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  2. Scott Gillespie
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  3. Cynthia R. Johnson
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  4. Luc Lecavalier
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  5. Tristram Smith
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  6. Naomi Swiezy
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  7. Kylan Turner
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  8. Jill Pritchett
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  9. Daniel W. Mruzek
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  10. Andrea N. Evans
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  11. Karen Bearss
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  12. Lawrence Scahill
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Corresponding author

Correspondence to Lawrence Scahill.

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Funding

This work was supported by a grant from the National Institute of Mental Health (NIMH; R01 MH081148; principal investigator: Dr. Scahill) and funding from the Atlanta Children’s Trust, the Marcus Foundation, and the Whitehead Foundation.

Conflicts of Interest

Dr. Johnson reported having received book royalties from Oxford University Press and the American Psychological Association. Dr. Lecavalier reported having received book royalties from Oxford University Press. Dr. Turner reported having received book royalties from Cognella Publishing. Dr. Bearss reported having served as a consultant to Attend Behavior and Genial Care and having received book royalties from Oxford University Press. Dr. Scahill reported having served as a consultant to Roche, Janssen, Impel, and Yamo, and book royalties from Oxford University Press, Guilford Press, and the American Psychological Association. No other conflicts of interests or disclosures were reported.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in this study.

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Sheridan, E., Gillespie, S., Johnson, C.R. et al. Using Parent Target Problem Narratives to Evaluate Outcomes in Children with Autism Spectrum Disorder. Res Child Adolesc Psychopathol 49, 1527–1535 (2021). https://doi.org/10.1007/s10802-021-00843-8

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