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Review
. 2017 Feb;27(1):10-18.
doi: 10.1089/cap.2015.0263. Epub 2016 Apr 29.

Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome

Alessandro S De Nadai  1   2   3 , Marc S Karver  3 , Tanya K Murphy  1   2 , Mark A Cavitt  2   4 , Jeffrey L Alvaro  2   4 , Michael Bengtson  5 , Saundra Stock  2 , Andrew C Rakhshani  3 , Eric A Storch  1   2   3   4   6
Affiliations
Review

Common Factors in Pediatric Psychiatry: A Review of Essential and Adjunctive Mechanisms of Treatment Outcome

Alessandro S De Nadai et al. J Child Adolesc Psychopharmacol. 2017 Feb.

Abstract

Objective: 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.

Method: 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.

Results: 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.

Conclusion: 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.

Keywords: adherence; alliance; common factors; expectancies; motivation.

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Conflict of interest statement

Dr. Murphy receives or has received research funding from the Florida Agency for Healthcare Administration, AstraZeneca Research and Development, Brain and Behavior Research Foundation, the Center for Disease Control and Prevention (CDCP), F. Hoffmann-La Roche Ltd., Indevus Pharmaceuticals, IOCDF, NIMH, Otsuka Pharmaceuticals, Pfizer, Inc., Psyadon Pharmaceuticals, Inc, and Shire Pharmaceuticals. She is on the Scientific and Clinical Advisory Board for the IOCDF. She has received travel support from the Tourette Syndrome Association (TSA) and honoraria from grand rounds/CME lectures. Dr. Cavitt has served as a consultant for Otsuka Pharmaceuticals. Dr. Storch has received grant funding from the National Institutes of Health (NIH), All Children's Hospital Research Foundation, the Centers for Disease Control (CDC), the Agency for Healthcare Research and Quality (AHRQ), the National Alliance for Research on Schizophrenia and Affective Disorders (NARSAD), the International OCD Foundation, the TSA, Janssen, and the Foundation for Research on Prader-Willi Syndrome. He receives honoraria from Springer, Elsevier, Wiley, the American Psychological Association, and Lawrence Erlbaum. He has served as an educational consultant for Rogers Memorial Hospital, Prophase, CroNos, and RuiJin Hospital. He has served on the speakers' bureau and scientific advisory board for the International OCD Foundation. He has received research support from the All Children's Hospital Guild Endowed Chair.

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