title: Trajectories of symptom reduction during treatment for behavior problems in pediatric primary-care settings.
abstract: We examined trajectories of symptom reduction during the course of on-site treatment for behavior problems in pediatric primary-care settings for a subset of children from a larger clinical trial. Participants (N = 80) were children (ages 6-11) referred for treatment due to moderate elevations (≥75th percentile) on the externalizing subscale of the Pediatric Symptom Checklist (PSC-17). The sample was recruited from six pediatric practices in an urban setting. The treatment (Protocol for an Office-based Nurse-administered Intervention; PONI) was administered on-site by trained nurses over the course of 3-6 months. Overall, symptom reduction from the first session to last session was moderate (ES = 0.61) and gradual. Roughly two-thirds (72%) of symptom reduction took place over the first 8 weeks of treatment. The average trajectory of symptom reduction was characterized by a negative slope that flattened over time, consistent with a quadratic growth model. Initial symptom severity predicted final symptom severity (r = .36, P < .01), even though patients with greater initial symptom severity remained in treatment for a significantly greater number of sessions (r = .24, P < .05). The implications of these findings for enhancing the efficiency and effectiveness of treatment are discussed.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O'Hara St, Pittsburgh, PA 15213, USA. lindhiemoj@upmc.edu
authors.forename: Oliver
authors.initials: O
authors.lastname: Lindhiem
authors.forename: David J
authors.initials: DJ
authors.lastname: Kolko
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009726:Nurses; D010372:Pediatrics; D011320:Primary Health Care / Q000379:methods*