Evidence-based practice in psychology integrates research, clinical expertise, and client characteristics and preferences to provide the best possible services. Over the past few years, evidence-based methods have received much attention. However, most of this effort has been directed at identifying evidence-based treatments. Few evaluations have been devoted to evidence-based assessment. Studies have shown that evidence-based assessment is not typically applied with treatment-seeking children, and the applicability of such methods in real-world settings have been questioned by some. In order to advance the use of evidence-based assessment methods, we need to demonstrate the utility of such measures in the settings they are to be applied. The generalizability of research findings is contingent on the comparability of clients seen in research and the community. Assessment of theoretically important constructs, considered important in treatment, is also in need of attention in order to examine its evidence-base and potential clinical utility. The aim of this dissertation was to add to the understanding of evidence-based assessment of anxious children by examining assessment methods and participants in research and community settings.
In paper I, we examined 190 children aged 7-13 referred for treatment to child and adolescent mental health clinics (service clinics) in Norway. The sample was screened for internalizing symptoms. The objective of the study was to assess the utility of a commonly used self-report measure of anxiety symptoms, the Multidimensional Anxiety Scale for Children (MASC): How well can this measure distinguish anxiety-disordered children from non-anxiety disordered children referred to service clinics based on child and parent report? Next, we examined the incremental value of adding parent report to child report in identifying common anxiety disorders in children.
In paper II, we compared anxiety-disordered children from service clinics (N=111) in Norway and a research clinic (N=144) in the U.S. on diagnostic status, symptom levels, and functional impairment based on information from multiple informants. If evidence-based methods developed at research clinics are to be applicable in community settings, clients seen in both settings must be comparable on relevant characteristics.
Evidence-based treatments typically consider certain theoretically-based constructs significant to promote clinical change, yet few studies include assessment of such constructs specifically. More data on the association between key theoretical constructs, such as cognitions, and symptoms is warranted. In paper III, we examined the relationship between cognitions and symptoms of anxiety in the two samples of anxiety-disordered children.
Findings from our studies suggest that the use of evidence-based assessment of anxious children is relevant also in service clinics. The MASC was useful in screening for the presence of an anxiety disorder, and subscales were particularly useful in identifying separation anxiety disorder and social phobia. Combining information from child and parent increased the accuracy of identifying child anxiety disorders. Anxiety-disordered children seeking treatment in service clinics evidenced more severe symptoms of anxiety and conduct problems, as well as functional impairment, compared to treatment seeking children in a research clinic. Children from the research clinic met criteria for a greater number of diagnoses. Notably, the two samples evidenced important similarities in other problem areas. Finally, we observed some meaningful relationships between cognitions and symptoms in anxiety-disordered children, particularly pertaining to symptoms of anxiety, while findings were less clear with regard to depressive symptoms. Methodological constraints are discussed, as are the clinical implications of our findings.