Group intervention to promote social skills in school-age children with pervasive developmental disorders: reconsidering efficacy

Applied human neuroscience: Fostering and designing inclusive environments with the 3E-Cognition perspective

The conventional medical paradigm often focuses on deficits and impairments, failing to capture the rich tapestry of experiences and abilities inherent in neurodiversity conditions. In this article, we introduce the 3E-Cognition perspective, offering a paradigm shift by emphasizing the dynamic interplay between the brain, body, and environment in shaping cognitive processes. The perspective fosters a more inclusive and supportive understanding of neurodiversity, with potential applications across various domains such as education, workplace, and healthcare. We begin by introducing the 3E-Cognition principles: embodied, environmentally scaffolded, and enactive. Then, we explore how the 3E-Cognition perspective can be applied to create inclusive environments and experiences for neurodiverse individuals. We provide examples in the realms of education, workplace, and healthcare. In all of these domains, spaces, methodologies, epistemologies, and roles that cater to diverse needs and strengths can be designed using the 3E principles. Finally, we discuss the challenges and benefits of implementing the 3E-Cognition perspective. We focus on the need for technological advancements and research in complex real-world scenarios; we suggest mobile brain/body imaging is a possible solution. We furthermore highlight the importance of recognizing and valuing the diverse manners of experiencing and interacting with the world, the promotion of diverse well-being, and the facilitation of innovation and creativity. Thus, we conclude that the 3E-Cognition perspective offers a groundbreaking approach to understanding and supporting neurodiversity: by embracing the inherent interconnectedness of the brain, body, and environment, we can create a more inclusive and supportive world.

Seeing and inviting participation in autistic interactions

What does it take to see how autistic people participate in social interactions? And what does it take to support and invite more participation? Western medicine and cognitive science tend to think of autism mainly in terms of social and communicative deficits. But research shows that autistic people can interact with a skill and sophistication that are hard to see when starting from a deficit idea. Research also shows that not only autistic people, but also their non-autistic interaction partners, can have difficulties interacting with each other. To do justice to these findings, we need a different approach to autistic interactions-one that helps everyone see, invite, and support better participation. I introduce such an approach, based on the enactive theory of participatory sense-making and supported by insights from indigenous epistemologies. This approach helps counteract the homogenizing tendencies of the "global mental health" movement, which attempts to erase rather than recognize difference, and often precludes respectful engagements. Based in the lived experiences of people in their socio-cultural-material and interactive contexts, I put forward an engaged-even engaging-epistemology for understanding how we interact across difference. From this perspective, we see participatory sense-making at work across the scientific, diagnostic, therapeutic, and everyday interactions of autistic and non-autistic people, and how everyone can invite and support more of it.

Social Knowledge & Performance in Autism: A Critical Review & Recommendations

Autistic social challenges have long been assumed to arise from a lack of social knowledge ("not knowing what to do"), which has undergirded theory and practice in assessment, treatment, and education. However, emerging evidence suggests these differences may be better accounted for by difficulties with social performance ("doing what they may know"). This distinction has important implications for research, practice, policy, and community support of autistic people. This review examines the theoretical and clinical implications and empirical status of the knowledge-performance distinction in autism. Current evidence suggests that social knowledge deficits are neither definitional nor reliably related to outcomes in autism. Prioritizing social knowledge, then, may produce unanticipated, problematic consequences in terms of accuracy of assessment, intervention effectiveness, and promotion of stigma. It may also yield unrealistic expectations around the value of knowledge for autistic people and their families, yielding important ethical considerations. Conversely, recent evidence highlights performance-related factors as being especially promising for better modeling and addressing social challenges in autism. Prioritizing performance, then, may offer new directions for assessment, substantially different intervention opportunities, and novel methods of inclusion and affirmation. This review touches upon each of these domains and implications, integrates these developments with broader models of social competence in youth, and provides direction for future research and practice regarding social competence in autism.

Performance- and Theater-Based Interventions for Supporting Social Cognition and Social Communication in Autistic Youth: A Review and Theoretical Synthesis

Social skills interventions (SSIs) are commonly used to improve social functioning in youth with autism spectrum disorder (ASD), which is a condition characterized by differences in social cognition and social communication. Although more traditional SSIs have used knowledge-based, didactic instruction, recent research has explored the utility of performance-based SSIs, which use various activities to support implicit learning of social skills in supportive, enriched environments. This article reviews the extant literature evaluating the effectiveness or efficacy of five performance-based SSIs using theater-based approaches on social cognition and social communication. Overall, this body of literature suggests social communication gains that include increased peer interactions, peer liking, and reciprocal friendships, as well as social cognitive gains in theory of mind and affect recognition. This review also discusses theoretical models that may help explain the emerging strengths of performance- and theater-based SSIs with underlying hypotheses related to the social communication and social cognitive differences in ASD. Limitations of performance-based SSIs in the evidence-base include several approaches in initial stages of research with small sample sizes and limited maintenance of effects. Future research should aim to bridge the research-to-practice gap and use more rigorous designs and more diverse samples, including those with cooccurring intellectual disability.

Prediction of social behavior in autism spectrum disorders: Explicit versus implicit social cognition

LAY ABSTRACT

Difficulties with social communication and interaction are a hallmark feature of autism spectrum disorder. These difficulties may be the result of problems with explicit social cognition (effortful and largely conscious processes) such as learning and recalling social norms or rules. Alternatively, social deficits may stem from problems with implicit social cognition (rapid and largely unconscious processes) such as the efficient integration of social information. The goal of this study was to determine how problems in explicit and implicit social cognition relate to social behavior in 34 youth with autism spectrum disorder. We measured aspects of implicit and explicit social cognition abilities in the laboratory using behavioral, cognitive, and brain (electrophysiological) measures. We then used those measures to predict "real-world" social behavior as reported by parents, clinicians, and independent observers. Results showed that overall better aspects of implicit and explicit social cognition predicted more competent social behavior. In addition, the ability to fluidly integrate social information (implicit social cognition) was more frequently related to competent social behavior that merely knowing what to do in social situations (explicit social cognition). These findings may help with the development of interventions focusing on improving social deficits.

Exploratory factor analysis of the Adapted Skillstreaming Checklist for children with autism spectrum disorder

The Adapted Skillstreaming Checklist measures social/social-communication skills and behavioral flexibility/regulation of children with autism spectrum disorder without intellectual disability. Prior studies provided support for the reliability and criterion-related validity of the Adapted Skillstreaming Checklist total score for these children; however, no studies have examined the Adapted Skillstreaming Checklist factor structure. This exploratory factor analysis examined the factor structure and internal consistency of parent ratings on the Adapted Skillstreaming Checklist for a sample of 331 children, ages 6-12 years, with autism spectrum disorder without intellectual disability. Results yielded a correlated three-factor solution. The individual factors and total score demonstrated very good internal consistency reliability. Findings supported the presence and interpretability of three subscales, as well as derivation of a total composite reflecting overall prosocial and adaptive skills and behaviors. Implications for assessment and research are discussed.

A Systematic Review of Group Social Skills Interventions, and Meta-analysis of Outcomes, for Children with High Functioning ASD

Group social skills interventions (GSSIs) are a commonly offered treatment for children with high functioning ASD. We critically evaluated GSSI randomised controlled trials for those aged 6–25 years. Our meta-analysis of outcomes emphasised internal validity, thus was restricted to trials that used the parent-report social responsiveness scale (SRS) or the social skills rating system (SSRS). Large positive effect sizes were found for the SRS total score, plus the social communication and restricted interests and repetitive behaviours subscales. The SSRS social skills subscale improved with moderate effect size. Moderator analysis of the SRS showed that GSSIs that include parent-groups, and are of greater duration or intensity, obtained larger effect sizes. We recommend future trials distinguish gains in children’s social knowledge from social performance.

An Evaluation of Behavioral Skills Training for Teaching Caregivers How to Support Social Skill Development in Their Child with Autism Spectrum Disorder

Limited research has explored how to best train caregivers to support their child with autism spectrum disorder (ASD) despite caregivers being well suited to promote generalization and maintenance of their child's skills in the natural environment. Children with ASD have been shown to benefit from social skill training, which is not always conducted in the natural context. This research examined the efficacy of behavioral skills training (BST) with, and without in situ training (IST), for teaching caregivers how to also use BST to support their child's context-specific social skills. Although caregivers met mastery criterion within BST sessions, their skills did not generalize to the natural environment until IST was introduced. The implications of the findings are discussed.

Marching to the beat of your own drum?: A proof-of-concept study assessing physiological linkage in Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulty in dynamically adjusting behavior to interact effectively with others, or social reciprocity. Synchronization of physiological responses between interacting partners, or physiological linkage (PL), is thought to provide a foundation for social reciprocity. In previous work we developed a new technique to measure PL using dynamic linear time series modeling to assess cardiac interbeat interval (IBI) linkage in typically developing same-sex unacquainted dyads (Scarpa et al., 2017). The current article describes a proof-of-concept study with three dyads of young adults with ASD interacting with same-sex unacquainted typically developing (TD) partners. This pilot data is applied to propose potential benefits of using this technique to quantify and assess PL in individuals with ASD, both for basic research and for intervention science. Discussion focuses on applications of this measure to potentially advance knowledge of the biology-behavior link in ASD.

Social functioning in youth with attention-deficit/hyperactivity disorder and autism spectrum disorder: transdiagnostic commonalities and differences

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are both neurodevelopmental disorders originating in childhood with high associated impairments and public health significance. There has been growing recognition of the frequent co-occurrence, and potential interrelatedness, between ADHD and ASD without intellectual disability. In fact, the most recent (5th) edition of the DSM is the first to allow ADHD and ASD to be diagnosed in the same individual. The study of transdiagnostic features in ADHD and ASD is important for understanding, and treating, these commonly co-occurring disorders. Social impairment is central to the description and prognosis of both disorders, and many youth with some combination of ADHD and ASD present to clinics for social skills training interventions. However, the aspects of social functioning that are impaired may have both shared and distinct features between the two disorders, relating to some overlapping and some diverse etiologies of social problems in ADHD compared to ASD. These findings have implications for interventions to address social problems in youth with these conditions. We conclude with a discussion about areas for future research and novel intervention targets in youth with ADHD, ASD, and their comorbidity.

Signs of attachment disorders and social functioning among early adolescents with a history of institutional care

BACKGROUND

Institutional rearing is associated with increased risk for reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). Disorders of attachment involve disturbances in children's primary caregiving relationships, and are likely to disturb multiple domains of social functioning.

OBJECTIVE

To examine associations between signs of RAD and DSED and social functioning in early adolescence.

PARTICIPANTS AND SETTING

Our participants were 110 children with a history of institutional rearing and 50 community comparison adolescents from the Bucharest Early Intervention Project, based in Bucharest, Romania. Participants were assessed at age 12 years (M age in years = 12.80, SD = 0.71).

METHOD

Signs of RAD and DSED were obtained through caregiver report. Reports of social functioning were provided by caregivers and teachers. General and specific domains of social functioning were identified using bi-factor modeling. A general social functioning factor and four specific factors were revealed: peer conflict, caregiver views as victim, teacher views as victim, and social competence.

RESULTS

Signs of RAD predicted poorer general social functioning (β=-0.36, p < .01, 95% confidence interval [CI] [-.33, -.09]) and poorer social competence (β=-0.38, p < .01, 95% CI[-0.05, -.01]) above and beyond time spent in institutional care and placement disruptions. Signs of DSED (β=-0.38, p < .001, 95% CI[-0.49, -.16]) along with placement disruptions (β=-0.22, p < .05, 95% CI[-.29, -.01]) predicted poorer general social functioning above and beyond time spent in institutional care. Signs of DSED predicted higher scores on caregiver views as victim (β = 0.29, p < .05, 95% CI[0.02, 0.14]) and lower scores on social competence (β=-0.29, p < .01, 95% CI[-.06, -.01]) above and beyond time spent in institutional care and placement disruptions.

CONCLUSIONS

Attachment disorder signs in early adolescence are problematic for social functioning, although the manifestation of these social difficulties differs based on whether RAD or DSED signs are present.

Psychometric Properties of the Adapted Skillstreaming Checklist for High-functioning Children with ASD

This study examined the reliability and criterion-related validity of parent ratings on the Adapted Skillstreaming Checklist (ASC) for a sample of 275 high-functioning children, ages 6-12 years, with ASD. Internal consistency for the total sample was 0.92. For two subsamples, test-retest reliability was very good at the 6-week and good at the 9-month intervals. Child age, IQ, and language abilities were unrelated to the ASC score. The ASC total score was inversely and strongly related to parent ratings of ASD symptom severity. Significant positive correlations (moderate-to-high) were found between the ASC and prosocial skills scales and significant negative correlations (low-to-moderate) with problem behavior scales on a broad measure of child functioning. Implications and suggestions for future study are discussed.

Exploring the Moderating Effects of Cognitive Abilities on Social Competence Intervention Outcomes

Many populations served by special education, including those identified with autism, emotional impairments, or students identified as not ready to learn, experience social competence deficits. The Social Competence Intervention-Adolescents’ (SCI-A) methods, content, and materials were designed to be maximally pertinent and applicable to the social competence needs of early adolescents (i.e., age 11-14 years) identified as having scholastic potential but experiencing significant social competence deficits. Given the importance of establishing intervention efficacy, the current paper highlights the results from a four-year cluster randomized trial (CRT) to examine the efficacy of SCI-A (n = 146 students) relative to Business As Usual (n = 123 students) school-based programming. Educational personnel delivered all programming including both intervention and BAU conditions. Student functioning was assessed across multiple time points, including pre-, mid-, and post-intervention. Outcomes of interest included social competence behaviors, which were assessed via both systematic direct observation and teacher behavior rating scales. Data were analyzed using multilevel models, with students nested within schools. Results suggested after controlling for baseline behavior and student IQ, BAU and SCI students differed to a statistically significant degree across multiple indicators of social performance. Further consideration of standardized mean difference effect sizes revealed these between-group differences to be representative of medium effects (d > .50). Such outcomes pertained to student (a) awareness of social cues and information, and (b) capacity to appropriately interact with teachers and peers. The need for additional power and the investigation of potential moderators and mediators of social competence effectiveness are explored.

Efficacy of group social skills interventions for youth with autism spectrum disorder: A systematic review and meta-analysis

Group-based social skills interventions (GSSIs) are widely used for treating social competence among youth with autism spectrum disorder (ASD), but their efficacy is unclear. Previous meta-analysis of the literature on well-designed trials of GSSIs is limited in size and scope, collapsing across highly heterogeneous sources (parents; youths; teachers; observers; behavioral tasks). The current meta-analysis of randomized control trials (RCTs) was conducted to ascertain overall effectiveness of GSSIs and differences by reporting sources. Nineteen RCTs met inclusion criteria. Results show that overall positive aggregate effects were medium (g=0.51, p<0.001). Effects were large for self-report (g=0.92, p<0.001), medium for task-based measures (g=0.58, p<0.001), small for parent- and observer-report (g=0.47 and 0.40, respectively, p<0.001), and nonsignificant for teacher-report (p=0.11). Moderation analyses of self-report revealed the effect was wholly attributable to youth reporting that they learned about skilled social behaviors (social knowledge; g=1.15, p<0.01), but not that they enacted them (social performance; g=0.28, p=0.31). Social skills interventions presently appear modestly effective for youth with ASD, but may not generalize to school settings or self-reported social behavior.

Food repertoire history in children with autism spectrum disorder in Japan

BACKGROUND

Food selectivity is commonly reported in children with autism spectrum disorder (ASD). The aim of this study was to investigate eating habit history in children with ASD.

METHODS

We analyzed 3 day food records completed by the parents and assessed how many unique foods each child consumed. The parents were also interviewed about their child's diet of complementary (i.e. transition) foods and estimated food repertoire at the ages of 3, 6, 12 and 18 years.

RESULTS

A total of 28 participants were enrolled in this study. Some participants had ongoing changes in food repertoire from the age of 3 years onward. In two cases, although the number of foods consumed at age 3 years was approximately 50, this decreased markedly, becoming severely limited, by age 5 years. One of the reasons for diminished repertoire was infection, such as acute gastroenteritis and upper respiratory tract infection. In contrast, five patients had a severely limited food repertoire at age 3 years, which later increased to 15 or more. Four patients had good opportunity at school to increase their food repertoire.

CONCLUSIONS

Diet history varied and changed in response to new opportunities, education and/or the environment. In some cases the number of foods consumed decreased gradually due to anxiety and stress, resulting in a severely limited food repertoire. Some patients had good opportunities to increase their repertoire at school. If an effective program in the early years achieves progress, the eating habits of children with ASD might be changed.

Peer-Mediated Intervention for the Development of Social Interaction Skills in High-Functioning Autism Spectrum Disorder: A Pilot Study

Autism Spectrum Disorder (ASD) is characterized by difficulties with social interaction and communication, which manifest at school especially in less structured situations such as recess. Recess provides opportunities for relationship with peers in a natural context, for which students with ASD may not be equipped with the necessary skills to use without support. Using a single-case design, we evaluated an intervention applied in recess to improve the social interaction skills of a student with high-functioning ASD mediated by his peers without ASD, in second grade of elementary school. This intervention includes different strategies to initiate the peers without ASD, using direct instruction, modeling, and social reinforcement carried out in the recess setting. After 14 sessions, changes were observed in the rates of initiating and responding to interactions, and a negative trend in the percentage of time that the student maintained low-intensity interactions or was alone. Teachers and family perceived improvements in social skills, more peer acceptance, and increase in the frequency and duration of social interactions. This intervention can help teachers to apply research-based practices to improve some social interaction skills in high-functioning students with autism in inclusive school environments.

Community Effectiveness RCT of a Comprehensive Psychosocial Treatment for High-Functioning Children With ASD

This community effectiveness randomized clinical trial examined the feasibility and effectiveness of a comprehensive psychosocial treatment, summerMAX, when implemented by a community agency. Fifty-seven high-functioning children (48 male, 9 female), ages 7-12 years with autism spectrum disorder participated in this study. The 5-week summerMAX treatment included instruction and therapeutic activities targeting social/social-communication skills, interpretation of nonliteral language skills, face-emotion recognition skills, and interest expansion. A behavioral program was also used to increase skills acquisition and decrease autism spectrum disorder symptoms and problem behaviors. Feasibility was supported via high levels of fidelity and parent, child, and staff clinician satisfaction. Significant treatment effects favoring the treatment group over waitlist controls were found on all 5 of the primary outcome measures (i.e., child test of nonliteral language skills and parent ratings of the children's autism spectrum disorder symptoms, targeted social/social-communication skills, broader social performance, and withdrawal). Staff clinician ratings substantiated the improvements reported by parents. Results of this randomized clinical trial are consistent with those of prior studies of summerMAX and suggest that the program was feasible and effective when implemented by a community agency under real-world conditions.

Integrating Language, Pragmatics, and Social Intervention in a Single-Subject Case Study of a Child With a Developmental Social Communication Disorder

PURPOSE

This clinical focus article presents an illustration of a complex communication intervention, the Social Communication Intervention Programme (SCIP), as delivered to a child who has a social communication disorder (SCD). The SCIP intervention combined language processing and pragmatic and social understanding therapies in a program of individualized therapy activities and in close liaison with families.

METHOD

The study used an enhanced AB single-subject design in which an 8-year-old child with an SCD participated in 20 therapy sessions with a specialist speech-language pathologist. A procedure of matching assessment findings to intervention choices was followed to construct an individualized treatment program. Examples of intervention content and the embedded structure of SCIP are illustrated. Observational and formal measurements of receptive and expressive language, conversation, and parent-teacher ratings of social communication were completed before therapy, after therapy, and at a 6-month follow-up session.

RESULTS

Outcomes revealed change in total and receptive language scores but not in expressive language. Conversation showed marked improvement in responsiveness, appreciation of listener knowledge, turn taking, and adaptation of discourse style. Teacher-reported outcomes included improved classroom behavior and enhanced literacy skills. Parent-reported outcomes included improved verbal interactions with family members and personal narratives.

CONCLUSIONS

This clinical focus article demonstrates the complexity of needs in a child with an SCD and how these can be addressed in individualized intervention. Findings are discussed in relation to the essential nature of language support including pragmatic therapy for children with SCDs. Discussion of the role of formal and functional outcome measurement as well as the proximity of chosen outcomes to the intervention is included.

Social skills group training in high-functioning autism: A qualitative responder study

Systematic reviews show some evidence for the efficacy of group-based social skills group training in children and adolescents with autism spectrum disorder, but more rigorous research is needed to endorse generalizability. In addition, little is known about the perspectives of autistic individuals participating in social skills group training. Using a qualitative approach, the objective of this study was to examine experiences and opinions about social skills group training of children and adolescents with higher functioning autism spectrum disorder and their parents following participation in a manualized social skills group training ("KONTAKT"). Within an ongoing randomized controlled clinical trial (NCT01854346) and based on outcome data from the Social Responsiveness Scale, six high responders and five low-to-non-responders to social skills group training and one parent of each child (N = 22) were deep interviewed. Interestingly, both high responders and low-to-non-responders (and their parents) reported improvements in social communication and related skills (e.g. awareness of own difficulties, self-confidence, independence in everyday life) and overall treatment satisfaction, although more positive intervention experiences were expressed by responders. These findings highlight the added value of collecting verbal data in addition to quantitative data in a comprehensive evaluation of social skills group training.

Is Using the Strengths and Difficulties Questionnaire in a Community Sample the Optimal Way to Assess Mental Health Functioning?

An important characteristic of a screening tool is its discriminant ability or the measure's accuracy to distinguish between those with and without mental health problems. The current study examined the inter-rater agreement and screening concordance of the parent and teacher versions of SDQ at scale, subscale and item-levels, with the view of identifying the items that have the most informant discrepancies; and determining whether the concordance between parent and teacher reports on some items has the potential to influence decision making. Cross-sectional data from parent and teacher reports of the mental health functioning of a community sample of 299 students with and without disabilities from 75 different primary schools in Perth, Western Australia were analysed. The study found that: a) Intraclass correlations between parent and teacher ratings of children's mental health using the SDQ at person level was fair on individual child level; b) The SDQ only demonstrated clinical utility when there was agreement between teacher and parent reports using the possible or 90% dichotomisation system; and c) Three individual items had positive likelihood ratio scores indicating clinical utility. Of note was the finding that the negative likelihood ratio or likelihood of disregarding the absence of a condition when both parents and teachers rate the item as absent was not significant. Taken together, these findings suggest that the SDQ is not optimised for use in community samples and that further psychometric evaluation of the SDQ in this context is clearly warranted.

A comprehensive peer network intervention to improve social communication of children with autism spectrum disorders: a randomized trial in kindergarten and first grade

The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with autism spectrum disorders. Trained school staff members provided direct instruction for 56 children in the intervention group, and 39 children participated in a comparison group. Results showed children in the intervention group displayed significantly more initiations to peers than did the comparison group during non-treatment social probes and generalization probes. Treatment session data showed significant growth for total communications over baseline levels. Children in treatment also showed more growth in language and adaptive communication. Finally, teachers' ratings of prosocial skills revealed significantly greater improvements for the intervention group.

Can findings from randomized controlled trials of social skills training in autism spectrum disorder be generalized? The neglected dimension of external validity

Systematic reviews have traditionally focused on internal validity, while external validity often has been overlooked. In this study, we systematically reviewed determinants of external validity in the accumulated randomized controlled trials of social skills group interventions for children and adolescents with autism spectrum disorder. We extracted data clustered into six overarching themes: source population, included population, context, treatment provider, treatment intervention, and outcome. A total of 15 eligible randomized controlled trials were identified. The eligible population was typically limited to high-functioning school-aged children with autism spectrum disorder, and the included population was predominantly male and Caucasian. Scant information about the recruitment of participants was provided, and details about treatment providers and settings were sparse. It was not evident from the trials to what extent acquired social skills were enacted in everyday life and maintained over time. We conclude that the generalizability of the accumulated evidence is unclear and that the determinants of external validity are often inadequately reported. At this point, more effectiveness-oriented randomized controlled trials of equally high internal and external validity are needed. More attention to the determinants of external validity is warranted when this new generation of randomized controlled trials are planned and reported. We provide a tentative checklist for this purpose.

The Use of Peer Networks to Increase Communicative Acts of First Grade Students with Autism Spectrum Disorders

Peer networks including social groups using typical peers, scripted instruction, visual text cues, and reinforcement were examined with students with autism spectrum disorders (ASD). A multiple baseline design across four participants was used to measure students’ use of communication acts with peers during free play following instruction. Peer Network groups occurred over a 3-month period for 30 min 3 times per week. Visual inspection of trends and TauU effect size calculations showed significant changes in total communication acts for all four participants during peer network sessions and increased initiations for three of the four participants. Generalization probes during classroom centers indicated increased communications following interventions for three of the four participants.

Measuring changes in social behavior during a social skills intervention for higher-functioning children and adolescents with autism spectrum disorder

The social behavior of children and adolescents with Autism Spectrum Disorder was evaluated weekly over 19 weeks of a social skills training program. Participants' vocalizations were coded as initiating, responding, or other (e.g., self-talk). Participants' interactions were coded as dyadic peer interactions, dyadic leader interactions, interactions with a group of peers, interactions with a group of peer(s) and leader(s), or time spent by self. Over the course of the intervention, participants made fewer initiating and other vocalizations, more responding vocalizations, spent more time interacting with a group of peers, and spent marginally less time interacting with a leader. Gender, age, and intervention attendance effects on social behavior are also noted.

Cognitive, sensory, and psychosocial characteristics in patients with Bardet-Biedl syndrome

Forty-two patients with a clinical diagnosis of Bardet-Biedl syndrome ages 2-61 years were given a neuropsychological test battery to evaluate cognitive, sensory, and behavioral functioning. These tests included the Wechsler scales of intelligence, Rey Auditory Verbal Learning Test, Boston Naming Test, D-KEFS Verbal Fluency Test, D-KEFS Color-Word Interference Test, D-KEFS Sorting Test, Wide Range Achievement Test: Math and Reading Subtests, Purdue Pegboard, The University of Pennsylvania Smell Identification Test, Social Communication Questionnaire, Social Responsiveness Scale, and Behavior Assessment System for Children, Second Edition, Parent Rating Scale. On the age appropriate Wechsler scale, the mean Verbal Comprehension was 81 (n = 36), Working Memory was 81 (n = 36), Perceptual Reasoning was 78 (n = 24) and Full Scale IQ was 75 (n = 26). Memory for a word list (Rey Auditory Verbal Learning Test) was in the average range with a mean of 89 (n = 19). Fine motor speed was slow on the Purdue with mean scores 3-4 standard deviations below norms. All subjects were microsmic on the University of Pennsylvania Smell Identification Test. Of these 42 patients, only 6 were able to complete all auditory and visual tests; 52% were unable to complete the visual tests due to impaired vision. A wide range of behavioral issues were endorsed on questionnaires given to parents. Most had social skill deficits but no pattern of either externalizing or internalizing problems. We identify a characteristic neuro-behavioral profile in our cohort comprised of reduced IQ, impaired fine-motor function, and decreased olfaction.

TEACCH-based group social skills training for children with high-functioning autism: a pilot randomized controlled trial

BACKGROUND

Although social skills training programs for people with high-functioning autism (HFA) are widely practiced, the standardization of curricula, the examination of clinical effectiveness, and the evaluation of the feasibility of future trials have yet to be done in Asian countries. To compensate for this problem, a Japanese pilot randomized controlled trial (RCT) of the Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH)-based group social skills training for children with HFA and their mothers was conducted.

METHODS

Eleven children with HFA, aged 5-6 years, and their mothers were randomly assigned to the TEACCH program (n=5) or a waiting-list control group (n=6). The program involved comprehensive group intervention and featured weekly 2-hour sessions, totaling 20 sessions over six months. The adaptive behaviors and social reciprocity of the children, parenting stress, and parent-child interactions were assessed using the Strengths and Difficulties Questionnaire (SDQ), Parenting Stress Index (PSI), Beck depression inventory-II (BDI-II), and Interaction Rating Scale (IRS).

RESULTS

Through this pilot trial, the intervention and evaluation of the program has been shaped. There were no dropouts from the program and the mothers' satisfaction was high. The outcome measurements improved more in the program group than in the control group, with moderate effect sizes (SDQ, 0.71; PSI, 0.58; BDI-II, 0.40; and IRS, 0.69). This pilot trial also implied that this program is more beneficial for high IQ children and mothers with low stress than for those who are not.

CONCLUSION

We have standardized the TEACCH program, confirmed the feasibility of a future trial, and successfully estimated the positive effect size. These findings will contribute to a larger trial in the future and to forthcoming systematic reviews with meta-analyses.

TRIAL REGISTRATION

UMIN000004560.

Strategic objectives for improving understanding of informant discrepancies in developmental psychopathology research

Developmental psychopathology researchers and practitioners commonly conduct behavioral assessments using multiple informants' reports (e.g., parents, teachers, practitioners, children, and laboratory observers). These assessments often yield inconsistent conclusions about important questions in developmental psychopathology research, depending on the informant (e.g., psychiatric diagnoses and risk factors of disorder). Researchers have theorized why informant discrepancies exist and advanced methodological models of informant discrepancies. However, over 50 years of empirical data has uncovered little knowledge about these discrepancies beyond that they exist, complicate interpretations of research findings and assessment outcomes in practice, and correlate with some characteristics of the informants providing reports (e.g., demographics and mood levels). Further, recent studies often yield take-home messages about the importance of taking a multi-informant approach to clinical and developmental assessments. Researchers draw these conclusions from their work, despite multi-informant approaches to assessment long being a part of best practices in clinical and developmental assessments. Consequently, developmental psychopathology researchers and practitioners are in dire need of a focused set of research priorities with the key goal of rapidly advancing knowledge about informant discrepancies. In this paper, I discuss these research priorities, review work indicating the feasibility of conducting research addressing these priorities, and specify what researchers and practitioners would gain from studies advancing knowledge about informant discrepancies in developmental psychopathology research.

Mechanisms of change in psychosocial interventions for autism spectrum disorders

Research into psychosocial interventions (particularly cognitive-behavior therapies and social skills training) for social-communication deficits among individuals with autism spectrum disorder (ASD) has proliferated over the past decade. While this research has provided some empirical support for the efficacy of these interventions, little work has begun to elucidate therapeutic mechanisms-the when, why, how, for whom, and under what conditions an intervention may produce change, identification of mechanisms underlying these effects should help advance ASD intervention research. This article describes methods for assessing such mechanisms (ie, mediators and moderators) and presents promising candidates for common mechanisms impacting treatment response: behavior modification, therapeutic relationship, social knowledge, social motivation, social information processing, executive functioning, and internalizing comorbidities. Finally, future directions are discussed as a program of psychosocial intervention research designed to identify predictors of individual differences in treatment response (including biomarkers), isolate active therapeutic ingredients, and promote dissemination of optimized interventions.

Understanding parent-child social informant discrepancy in youth with high functioning autism spectrum disorders

We investigated discrepancies between parent- and self-reported social functioning among youth with autism spectrum disorders (ASD). Three distinct samples showed discrepancies indicating that parents viewed their children as performing one standard deviation below a standardization mean, while youth viewed themselves as comparably-skilled relative to peers. Discrepancies predicted lower parental self-efficacy, and lower youth-reported hostile attributions to peers, marginally-lower depression, and decreased post-treatment social anxiety. Discrepancies predicted outcomes better than parent- or youth-report alone. Informant discrepancies may provide valuable additional information regarding child psychopathology, parental perceptions of parenting stress, and youth treatment response. Findings support a model where abnormal self-perceptions in ASD stem from inflated imputation of subjective experiences to others, and provide direction for improving interventions for youth and parents.

An Experimental Test of Whether Informants can Report About Child and Family Behavior Based on Settings of Behavioral Expression

Researchers and practitioners conduct multi-informant assessments of child and family behavior under the assumption that informants have unique perspectives on these behaviors. These unique perspectives stem, in part, from differences among informants in the settings in which they observe behaviors (e.g., home, school, peer interactions). These differences are assumed to contribute to the discrepancies commonly observed in the outcomes of multi-informant assessments. Although assessments often prompt informants to think about setting-specific behaviors when providing reports about child and family behavior, the notion that differences in setting-based behavioral observations contribute to discrepant reports has yet to be experimentally tested. We trained informants to use setting information as the basis for providing behavioral reports, with a focus on parental knowledge of children's whereabouts and activities. Using a within-subjects controlled design, we randomly assigned 16 mothers and adolescents to the order in which they received a program that trains informants to use setting information when providing parental knowledge reports (Setting-Sensitive Assessment), and a control program involving no training on how to provide reports. Relative to the control program, the Setting-Sensitive Assessment training increased the differences between mother and adolescent reports of parental knowledge, suggesting that mothers and adolescents observe parental knowledge behaviors in different settings. This study provides the first experimental evidence to support the assumption that discrepancies arise because informants incorporate unique setting information into their reports.

Group-based social skills interventions for adolescents with higher-functioning autism spectrum disorder: a review and looking to the future

In this paper, we synthesize the current literature on group-based social skills interventions (GSSIs) for adolescents (ages 10–20 years) with higher-functioning autism spectrum disorder and identify key concepts that should be addressed in future research on GSSIs. We consider the research participants, the intervention, the assessment of the intervention, and the research methodology and results to be integral and interconnected components of the GSSI literature, and we review each of these components respectively. Participant characteristics (eg, age, IQ, sex) and intervention characteristics (eg, targeted social skills, teaching strategies, duration and intensity) vary considerably across GSSIs; future research should evaluate whether participant and intervention characteristics mediate/moderate intervention efficacy. Multiple assessments (eg, parent-report, child-report, social cognitive assessments) are used to evaluate the efficacy of GSSIs; future research should be aware of the limitations of current measurement approaches and employ more accurate, sensitive, and comprehensive measurement approaches. Results of GSSIs are largely inconclusive, with few consistent findings across studies (eg, high parent and child satisfaction with the intervention); future research should employ more rigorous methodological standards for evaluating efficacy. A better understanding of these components in the current GSSI literature and a more sophisticated and rigorous analysis of these components in future research will lend clarity to key questions regarding the efficacy of GSSIs for individuals with autism spectrum disorder.

Parent and teacher perceptions of participation and outcomes in an intensive communication intervention for children with pragmatic language impairment

BACKGROUND

Treatment trials that enquire into parents' and teachers' views on speech-language interventions and outcomes for primary school-age children are relatively rare. The current study sought perceptions of the process of intervention and value placed on outcomes resulting from a trial of intervention, the Social Communication Intervention Project (SCIP), for children with communication disorders characterized by persistent needs in pragmatics and social use of language.

AIMS

To describe parent and teacher views around the process and experience of participating in SCIP intervention, including aspects of collaborative practice; and to gain understanding of parents' and teachers' perceptions of communication outcomes for children who had received intervention.

METHODS & PROCEDURES

Parents and teachers of eight children in the intervention arm of the SCIP study participated in semi-structured interviews with a researcher within 2 months of completion of SCIP intervention. The framework method of analysis was used to explore predetermined themes based around a list of topics informed by previous thinking and experience of the research.

OUTCOMES & RESULTS

Parents and teachers perceived liaison with the SCIP speech and language therapist as being an important element of the intervention. Indirect approaches to liaison with parents were perceived as effective in transferring information as were brief meetings with teachers. Teachers and parents were able to make explicit links between therapy actions and perceived changes in the child. Work on comprehension monitoring and emotional vocabulary was perceived to be particularly effective with respect to communication outcomes. Parents also reflected that they had adopted different strategies towards communication and behaviour in the home as a result of intervention. The limits of potential change in terms of child communication in areas such as non-verbal communication and pragmatic skills were discussed by parents.

CONCLUSIONS & IMPLICATIONS

This analysis has contributed essential information to the evaluation of SCIP by describing the experience of the intervention as delivered, exploring processes of effective implementation and change in the school setting and by describing the value placed on different outcomes by parents and teachers. These findings can inform planning for collaborations between speech and language therapists and teachers and provide useful information about mechanisms of change in different components of the SCIP intervention which have not been individually evaluated before. Information on changes in children's communication skills which were perceived as meaningful to those living and working with the children daily is crucial to the acceptance and translation of the SCIP intervention into practice.

Parent and family impact of autism spectrum disorders: a review and proposed model for intervention evaluation

Raising a child with an autism spectrum disorder (ASD) can be an overwhelming experience for parents and families. The pervasive and severe deficits often present in children with ASD are associated with a plethora of difficulties in caregivers, including decreased parenting efficacy, increased parenting stress, and an increase in mental and physical health problems compared with parents of both typically developing children and children with other developmental disorders. In addition to significant financial strain and time pressures, high rates of divorce and lower overall family well-being highlight the burden that having a child with an ASD can place on families. These parent and family effects reciprocally and negatively impact the diagnosed child and can even serve to diminish the positive effects of intervention. However, most interventions for ASD are evaluated only in terms of child outcomes, ignoring parent and family factors that may have an influence on both the immediate and long-term effects of therapy. It cannot be assumed that even significant improvements in the diagnosed child will ameliorate the parent and family distress already present, especially as the time and expense of intervention can add further family disruption. Thus, a new model of intervention evaluation is proposed, which incorporates these factors and better captures the transactional nature of these relationships.

Individual differences in the efficacy of a short theory of mind intervention for children with autism spectrum disorder: a randomized controlled trial

Background

Having a ‘theory of mind’, or having the ability to attribute mental states to oneself or others, is considered one of the most central domains of impairment among children with an autism spectrum disorder (ASD). Many interventions focus on improving theory of mind skills in children with ASD. Nonetheless, the empirical evidence for the effect of these interventions is limited. The main goal of this study is to examine the effectiveness of a short theory of mind intervention for children with ASD. A second objective is to determine which subgroups within the autism spectrum profit most from the intervention.

Methods

This study is a randomized controlled trial. One hundred children with ASD, aged 7 to 12 years will be randomly assigned to an intervention or a waiting list control group. Outcome measures include the completion of theory of mind and emotion understanding tasks, and parent and teacher questionnaires on children’s social skills. Follow-up data for the intervention group will be collected 6 months after the interventions.

Discussion

This study evaluates the efficacy of a theory of mind intervention for children with ASD. Hypotheses, strengths, and limitations of the study are discussed.

Trial registration

Netherlands Trial Register NTR2327

Principles underlying the use of multiple informants' reports

Researchers use multiple informants' reports to assess and examine behavior. However, informants' reports commonly disagree. Informants' reports often disagree in their perceived levels of a behavior ("low" versus "elevated" mood), and examining multiple reports in a single study often results in inconsistent findings. Although researchers often espouse taking a multi-informant assessment approach, they frequently address informant discrepancies using techniques that treat discrepancies as measurement error. Yet, recent work indicates that researchers in a variety of fields often may be unable to justify treating informant discrepancies as measurement error. In this review, the authors advance a framework (Operations Triad Model) outlining general principles for using and interpreting informants' reports. Using the framework, researchers can test whether or not they can extract meaningful information about behavior from discrepancies among multiple informants' reports. The authors provide supportive evidence for this framework and discuss its implications for hypothesis testing, study design, and quantitative review.

The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school-age children who have pragmatic and social communication problems with or without autism spectrum disorder

BACKGROUND

Children who show disproportionate difficulty with the pragmatic as compared with the structural aspects of language are described as having pragmatic language impairment (PLI) or social communication disorder (SCD). Some children who have PLI also show mild social impairments associated with high-functioning autism or autism spectrum disorder (ASD). There is little robust evidence of effectiveness of speech-language interventions which target the language, pragmatic or social communication needs of these children.

AIMS

To evaluate the effectiveness of an intensive manualized social communication intervention (SCIP) for children who have PLI with or without features of ASD.

METHODS & PROCEDURES

In a single-blind RCT design, 88 children with pragmatic and social communication needs aged 5;11-10;8, recruited from UK speech and language therapy services, were randomly assigned in a 2:1 ratio to SCIP or to treatment-as-usual. Children in the SCIP condition received up to 20 sessions of direct intervention from a specialist research speech and language therapist working with supervised assistants. All therapy content and methodology was derived from an intervention manual. A primary outcome measure of structural language and secondary outcome measures of narrative, parent-reported pragmatic functioning and social communication, blind-rated perceptions of conversational competence and teacher-reported ratings of classroom learning skills were taken pre-intervention, immediately post-intervention and at 6-month follow-up. Analysis was by intention to treat.

OUTCOMES & RESULTS

No significant treatment effect was found for the primary outcome measure of structural language ability or for a measure of narrative ability. Significant treatment effects were found for blind-rated perceptions of conversational competence, for parent-reported measures of pragmatic functioning and social communication, and for teacher-reported ratings of classroom learning skills.

CONCLUSIONS & IMPLICATIONS

There is some evidence of an intervention effect on blind and parent/teacher-reported communication outcomes, but not standardized language assessment outcomes, for 6-11-year-old children who have pragmatic and social communication needs. These findings are discussed in the context of the increasingly central role of service user outcomes in providing evidence for an intervention. The substantial overlap between the presence of PLI and ASD (75%) across the whole cohort suggests that the intervention may also be applicable to some verbally able children with ASD who have pragmatic communication needs.

Implementation of a manualized communication intervention for school-aged children with pragmatic and social communication needs in a randomized controlled trial: the Social Communication Intervention Project

BACKGROUND

Speech-language interventions are often complex in nature, involving multiple observations, variable outcomes and individualization in treatment delivery. The accepted procedure associated with randomized controlled trials (RCT) of such complex interventions is to develop and implement a manual of intervention in order that reliable treatment delivery can be achieved.

AIMS

To present the rationale, structure and content of an intensive manualized intervention as implemented within an RCT for children with complex pragmatic and social communication needs; to investigate factors associated with implementation in a mainstream school environment; and to determine treatment fidelity.

METHODS & PROCEDURES

The manualized SCIP intervention, including procedures for developing individualized treatment plans, was developed and then implemented within an RCT with 57 school-aged children with complex pragmatic communication needs (CwPLI). The paper describes the delivery protocol, staffing requirements, and content and structure of the intervention. A mapping procedure for individualization of intervention and the implemented components of intervention are presented. The findings from a school-therapy alliance checklist for recording factors affecting implementation in a school context are also reported. Treatment fidelity was carried out using measures of delivered versus planned treatment content and quality of therapy.

OUTCOMES & RESULTS

The manual was effective at detailing intervention procedures and allowing for development of individualized treatment plans whilst maintaining satisfactory treatment fidelity. Treatment planning and delivery required continuous specialist speech and language therapist input with assistants needing substantive training and supervision. Key components of intervention for CwPLI were therapies aimed at improving conversation skills, narrative construction, comprehension monitoring, understanding of social cues and metapragmatic awareness. The school-therapy alliance checklist indicated high rates of therapist-education staff and therapist-parent liaison. Parents were nearly always involved in treatment planning though only half-attended therapy sessions. Learning support provision in schools for participating children was highly variable.

CONCLUSIONS & IMPLICATIONS

Predetermining theoretical background, structure, and content in a treatment manual contributed towards the quality and reliability of intervention within the context of an RCT. The implementation of SCIP intervention in a broader clinical context is discussed with reference to staff expertise, the therapeutic process and the essential ingredients of social communication intervention.

Social skills training in children with PDD-NOS: an exploratory study

OBJECTIVE

A deficit in social interaction is characteristic for children with Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS). The aim of this exploratory study is to assess the effect of Social Skills Training (SST) in children with DSM-IV based PDD-NOS.

METHODS

Ten consecutively referred children (n = 3 girls and n = 7 boys, mean age = 8.5, mean Full Scale Intelligence Quotient [FSIQ] = 104) participated in the standardized SST in a university outpatient department of child psychiatry. The valid and reliable Children's Social Behaviour Questionnaire (CSBQ) and Self-Perception Profile for Children (SPPC) were filled out pre- and post treatment by parents and children respectively.

RESULTS

Parent's CSBQ total and subscale "Social understanding" scores were significantly lower after the SST. Children's scores on the subscale "Scholastic Competence" of the SPPC were significantly higher after SST, whereas their scores on the SPPC subscale "Physical Appearance" were significantly lower after SST as compared to before.

CONCLUSIONS

This study provides a first indication of positive effects of SST in children with PDD-NOS.

Pleasure, Throwing Breaches, and Embodied Metaphors: Tracing Transformations-in-Participation for a Child with Autism to a Sensory Integration—Based Therapy Session

In occupational therapy practice, the rich interweaving of procedural and narrative reasoning results in healing transformations. However, a lack of research focus on transformational processes perpetuates a focus on observable and measurable behaviors. In line with the movement toward evidence-based implementation research, this article focuses on a case study drawn from an ethnography of therapist—child—family interactions in a sensory integration—based clinic to provide a thick description of the moments leading up to and following changes in bodily and social engagement for a child with autism. Using theoretical resources on acted narratives and aesthetics, this article provides a developing method and language to show how an occupational therapist and a child with autism throw breaches to jointly create embodied metaphors of what matters to the child in his or her everyday life. A microanalysis of therapist—child bodily and sensing interactions also reveals how narrative and procedural reasoning converge in moments of pleasure that ultimately lead to outcomes in participation outside the clinic and confound characterizations of autistic aloneness. Implications for research on sensory integration approaches in general and social interventions for children with autism are discussed.

Theory of Mind training in children with autism: a randomized controlled trial

Many children with Autism Spectrum Disorders (ASD) participate in social skills or Theory of Mind (ToM) treatments. However, few studies have shown evidence for their effectiveness. The current study used a randomized controlled design to test the effectiveness of a 16-week ToM treatment in 8–13 year old children with ASD and normal IQs (n = 40). The results showed that, compared to controls, the treated children with ASD improved in their conceptual ToM skills, but their elementary understanding, self reported empathic skills or parent reported social behaviour did not improve. Despite the effects on conceptual understanding, the current study does not indicate strong evidence for the effectiveness of a ToM treatment on the daily life mindreading skills.

Are clinicians' assessments of improvements in children's functioning "global"?

In this study, the authors examined the relations among clinician ratings of treatment improvement and discrepancies between parent and blinded laboratory rater reports of child social functioning administered before and after treatment for social anxiety disorder. Participants included a clinic sample of 101 children (7-16 years old; M = 11.67, SD = 2.57; 51 girls, 81% Caucasian) receiving treatment as part of a two-site controlled trial. Overall, clinician ratings reflected lack of improvement when parents reported persistent (i.e., pre- to posttreament) social functioning deficits not reported by blinded raters. However, when blinded raters reported persistent social skill deficits not reported by parents, we did not observe the same effect on clinician ratings as we did when the direction of discrepant reports was reversed. We replicated these observations in a subset of participants (n = 81) providing parent and child pre-post reports of social anxiety symptoms. These findings have implications for the interpretations of clinical ratings as "primary outcome measures" within controlled trials.

Introduction to the special section: More than measurement error: Discovering meaning behind informant discrepancies in clinical assessments of children and adolescents

Discrepancies often arise among multiple informants' reports of child and adolescent psychopathology and related constructs (e.g., parenting, family relationship quality and functioning, parental monitoring). Recently, studies using various designs (laboratory, longitudinal, randomized controlled trial, meta-analysis) have revealed that discrepancies among informants' reports (a) yield important information regarding where children express behaviors (time course, features of the context[s] of behavioral expression) and about the informants who observe their expression, (b) demonstrate stability over time in both community and clinic settings, (c) predict poor child and adolescent outcomes in ways that the individual informants' reports do not, and (d) can be used to identify meaningful treatment outcomes patterns within randomized controlled trials. Using existing data sources, the articles in this special section expand upon this emerging body of research. In particular, the articles illustrate how clinical science and practice can use informant discrepancies to increase understanding of the causes and consequences of, as well as treatments for, child and adolescent psychopathology.

Internal consistency and associated characteristics of informant discrepancies in clinic referred youths age 11 to 17 years

In this study, we examined the internal consistency of informant discrepancies in reports of youth behavior and emotional problems and their unique relations with youth, caregiver, and family characteristics. In a heterogeneous multisite clinic sample of 420 youths (ages 11-17 years), high internal consistency estimates were observed across measures of informant discrepancies. Further, latent profile analyses identified systematic patterns of discrepancies, characterized by their magnitude and direction (i.e., which informant reported greater youth problems). In addition, informant discrepancies systematically and uniquely related to informants' own perspectives of youth mood problems, and these relations remained significant after taking into account multiple informants' reports of informant characteristics widely known to relate to informant discrepancies. These findings call into question the prevailing view of informant discrepancies as indicative of unreliability and/or bias on the part of informants' reports of youths' behavior.

The relations among measurements of informant discrepancies within a multisite trial of treatments for childhood social phobia

Discrepancies between informants' reports of children's behavior are robustly observed in clinical child research and have important implications for interpreting the outcomes of controlled treatment trials. However, little is known about the basic psychometric properties of these discrepancies. This study examined the relation between parent-child reporting discrepancies on measures of child social phobia symptoms, administered before and after treatment for social phobia. Participants included a clinic sample of 81 children (7-16 years old [M = 11.75, SD = 2.57]; 39 girls, 42 boys) and their parents receiving treatment as part of a multisite controlled trial. Pretreatment parent-child reporting discrepancies predicted parent-child discrepancies at posttreatment, and these relations were not better accounted for by the severity of the child's pretreatment primary diagnosis. Further, treatment responder status moderated this relation: Significant relations were identified for treatment non-responders and not for treatment responders. Overall, findings suggest that informant discrepancies can be reliably employed to measure individual differences over the course of controlled treatment trials. These data provide additional empirical support for recent work suggesting that informant discrepancies can meaningfully inform understanding of treatment response as well as variability in treatment outcomes.