Parent-youth informant disagreement: Implications for youth anxiety treatment

Abstract

Greater parent-youth disagreement on youth symptomatology is associated with a host of factors (e.g., parental psychopathology, family functioning) that might impede treatment. Parent-youth disagreement may represent an indicator of treatment prognosis. Using data from the Child/Adolescent Anxiety Multimodal Study, this study used polynomial regression and longitudinal growth modeling to examine whether parent-youth agreement prior to and throughout treatment predicted treatment outcomes (anxiety severity, youth functioning, responder status, and diagnostic remission, rated by an independent evaluator). When parents reported more symptoms than youth prior to treatment, youth were less likely to be diagnosis-free post-treatment; this was only true if the youth received cognitive-behavioral therapy (CBT) alone, not if youth received medication, combination, or placebo treatment. Increasing concordance between parents and youth over the course of treatment was associated with better treatment outcomes across all outcome measures ( ps < .001). How parents and youth "co-report" appears to be an indicator of CBT outcome. Clinical implications and future directions are discussed.

Keywords: Informant discrepancies; outcome monitoring; treatment; youth anxiety.

Figure 1

Model estimated mean differences between parent and youth report on the discrepancies across treatment. Separate trajectories are shown for when youth reported higher symptoms than parents (Youth Reported High, n = 128), and when parents reported higher symptoms than did youth (Parent Reported High, n = 357). Intercept and slope estimates significantly differed between the two groups.