title: Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome.
abstract: The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes.
  
  
  
  A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes.
  
  
  
  Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters.
  
  
  
  Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
authors.affiliation: 1 Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine , Tampa, Florida.|2 Department of Psychiatry, University of South Florida , Tampa, Florida.|3 Department of Psychology, University of South Florida , Tampa, Florida.
authors.forename: Alessandro S
authors.initials: AS
authors.lastname: De Nadai
authors.affiliation: 3 Department of Psychology, University of South Florida , Tampa, Florida.
authors.forename: Marc S
authors.initials: MS
authors.lastname: Karver
authors.affiliation: 1 Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine , Tampa, Florida.|2 Department of Psychiatry, University of South Florida , Tampa, Florida.
authors.forename: Tanya K
authors.initials: TK
authors.lastname: Murphy
authors.affiliation: 2 Department of Psychiatry, University of South Florida , Tampa, Florida.|4 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Cavitt
authors.affiliation: 2 Department of Psychiatry, University of South Florida , Tampa, Florida.|4 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Alvaro
authors.affiliation: 5 James A. Haley Veterans' Hospital , Tampa, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Bengtson
authors.affiliation: 2 Department of Psychiatry, University of South Florida , Tampa, Florida.
authors.forename: Saundra
authors.initials: S
authors.lastname: Stock
authors.affiliation: 3 Department of Psychology, University of South Florida , Tampa, Florida.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Rakhshani
authors.affiliation: 1 Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, University of South Florida Morsani College of Medicine , Tampa, Florida.|2 Department of Psychiatry, University of South Florida , Tampa, Florida.|3 Department of Psychology, University of South Florida , Tampa, Florida.|4 All Children's Hospital-Johns Hopkins Medicine , St. Petersburg, Florida.|6 Rogers Behavioral Health -Tampa Bay, Tampa, Florida.
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D002648:Child; D002665:Child Psychiatry; D006801:Humans; D055118:Medication Adherence; D001523:Mental Disorders / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D009042:Motivation; D011369:Professional-Patient Relations; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011619:Psychotropic Drugs
keywords: adherence; alliance; common factors; expectancies; motivation