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In children treated for internalising or externalising problems, sudden large improvements between sessions is associated with longer term outcomes

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Question: Among children and families treated for internalising and externalising problems within a randomised controlled trial (RCT) are sudden gains (rapid, sizeable changes between treatment sessions) associated with participant characteristics and longer term outcomes?

Participants: 161 children (aged 7–13 years; 70% male; 50% minority ethnic status) with anxiety, depression or conduct-disruptive disorders and their caregivers, who were participating in a multicentre RCT of three treatment modalities for internalising and externalising problems. Children and caregivers had initially sought outpatient treatment for the disorders and diagnoses confirming eligibility for the trial were made using the Children's Interview for Psychiatric Syndromes.

Setting: Community clinics, Massachusetts and Hawaii, USA.

Intervention: Modular treatment or standard manual treatment (not further described) compared with usual care. The therapist-completed consultation record was used to assess session content, which was broadly categorised into cognitive or behavioural content.

Outcomes: Internalising and externalising symptoms. The parent-reported and child-reported Brief Problem Checklist (BPC) were administered every 3 months during the first 18 months of the trial, which rates items from 0 (not true) to 2 (very true) with higher scores indicating greater symptom burden. Weekly phone …

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  • Sources of funding The John D and Catherine T MacArthur Foundation.


  • Competing interests None.