Child Psychiatry & Human Development

, Volume 45, Issue 6, pp 686–694 | Cite as

Individualized Assessments in Treatment Research: An Examination of Parent-Nominated Target Problems in the Treatment of Disruptive Behaviors in Youth with Tourette Syndrome

  • Joseph F. McGuire
  • Denis G. Sukhodolsky
  • Karen Bearss
  • Heidi Grantz
  • Maryellen Pachler
  • Paul J. Lombroso
  • Lawrence Scahill
Original Article


Youth with Tourette syndrome (TS) often exhibit disruptive behaviors. Although improvement data on rating scales support the efficacy of structured psychotherapeutic interventions, there is growing interest in personalized outcome assessments. This report examined parent-nominated target problems (PTPs) as an individualized outcome measure in 48 youth with TS and disruptive behaviors, who participated in one of two randomized psychotherapy trials. At baseline, parents described two primary problems to an independent evaluator who generated a structured narrative for each problem. These narratives were reviewed and updated at endpoint. When rated by five treatment-blind judges, the PTP rating demonstrated excellent reliability and good convergent validity with the Disruptive Behavior Rating Scale (DBRS). The PTP rating exhibited comparable treatment effects to the DBRS, and accounted for additional variance in global treatment outcome. The PTP rating serves a reliable, valid, and sensitive personalized assessment in research trials that provides complementary information to standardized rating scales.


Chronic tic disorders Disruptive behaviors Treatment outcome Individualized assessment Personalized mental healthcare 


  1. 1.
    Scahill L, Dalsgard S, Bradbury K (2013) The prevalence of Tourette syndrome and clinical characteristics in children. In: Martino D, Leckman JF (eds) Tourette sydrome. Oxford, New York, pp 121–136CrossRefGoogle Scholar
  2. 2.
    Lin H, Yeh CB, Peterson BS, Scahill L, Grantz H, Findley DB et al (2002) Assessment of symptom exacerbations in a longitudinal study of children with Tourette’s syndrome or obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 41:1070–1077PubMedCrossRefGoogle Scholar
  3. 3.
    Storch EA, Lack CW, Simons LE, Goodman WK, Murphy TK, Geffken GR (2007) A measure of functional impairment in youth with Tourette’s Syndrome. J Pediatr Psychol 32:950–959PubMedCrossRefGoogle Scholar
  4. 4.
    Bitsko RH, Danielson M, King M, Visser SN, Scahill L, Perou R (2012) Health care needs of children with Tourette syndrome. J Child Neurol 28:1626–1636PubMedCrossRefGoogle Scholar
  5. 5.
    Scahill L, Williams S, Schwab-Stone M, Applegate J, Leckman JF (2006) Disruptive behavior problems in a community sample of children with tic disorders. Adv Neurol 99:184–190PubMedGoogle Scholar
  6. 6.
    Kraft JT, Dalsgaard S, Obel C, Thomsen PH, Henriksen TB, Scahill L (2012) Prevalence and clinical correlates of tic disorders in a community sample of school-age children. Eur Child Adolesc Psychiatry 21:5–13PubMedCrossRefGoogle Scholar
  7. 7.
    Scahill L, Sukhodolsky DG, Bearss K, Findley D, Hamrin V, Carroll DH et al (2006) Randomized trial of parent management training in children with tic disorders and disruptive behavior. J Child Neurol 21:650–656PubMedCrossRefGoogle Scholar
  8. 8.
    Barkley RA (1997) Defiane children: a clinician’s manual for assessment and parent training. Guilford Press, New YorkGoogle Scholar
  9. 9.
    Sukhodolsky DG, Scahill L (2012) Cognitive-behavioral therapy for anger and aggression in children. Guilford Press, New YorkGoogle Scholar
  10. 10.
    Sukhodolsky DG, Vitulano LA, Carroll DH, McGuire J, Leckman JF, Scahill L (2009) Randomized trial of anger control training for adolescents with Tourette’s syndrome and disruptive behavior. J Am Acad Child Adolesc Psychiatry 48:413–421PubMedCrossRefGoogle Scholar
  11. 11.
    Barkley RA, Edwards G, Laneri M, Fletcher K, Metevia L (2001) The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent–adolescent conflict in teenagers with ADHD and ODD. J Consul Clin Psych 69:926–941CrossRefGoogle Scholar
  12. 12.
    Guy W (1976) ECDEU assessment manual for psychopharmacology (publication 76–338). Department of Health, Education and Welfare, WashingtonGoogle Scholar
  13. 13.
    Piacentini J, Woods DW, Scahill L, Wilhelm S, Peterson AL, Chang S et al (2010) Behavior therapy for children with Tourette disorder: a randomized controlled trial. JAMA 303:1929–1937PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Scahill L, Leckman JF, Schultz RT, Katsovich L, Peterson BS (2003) A placebo-controlled trial of risperidone in Tourette syndrome. Neurol 60:1130–1135CrossRefGoogle Scholar
  15. 15.
    Insel TR (2009) Translating scientific opportunity into public health impact: a strategic plan for research on mental illness. Arch Gen Psychiatry 66:128–133PubMedCrossRefGoogle Scholar
  16. 16.
    United States Food and Drug Administration (August 2011) Strategic plan for regulatory science (2012–2016). Retrieved from
  17. 17.
    Arnold LE, Wender PH, McCloskey K, Snyder SH (1972) Levoamphetamine and dextroamphetamine: comparative efficacy in the hyperkinetic syndrome. Assessment by target symptoms. Arch Gen Psychiatry 27:816–822PubMedCrossRefGoogle Scholar
  18. 18.
    Arnold LE, Vitiello B, McDougle C, Scahill L, Shah B, Gonzalez NM et al (2003) Parent-defined target symptoms respond to risperidone in RUPP autism study: customer approach to clinical trials. J Am Acad Child Adolesc Psychiatry 42:1443–1450PubMedCrossRefGoogle Scholar
  19. 19.
    Weisz JR, Chorpita BF, Frye A, Ng MY, Lau N, Bearman SK et al (2011) Youth top problems: using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. J Consul Clin Psych 79:369–380CrossRefGoogle Scholar
  20. 20.
    Weisz JR, Chorpita BF, Palinkas LA, Schoenwald SK, Miranda J, Bearman SK et al (2012) Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. Arch Gen Psychiatry 69:274–282PubMedCrossRefGoogle Scholar
  21. 21.
    Kaufman J, Birmaher B, Brent D, Rao U (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988PubMedCrossRefGoogle Scholar
  22. 22.
    Feindler E, Ecton R (1986) Adolescent anger control: cognitive-behavioral techniques. Pergamon Press, New YorkGoogle Scholar
  23. 23.
    Gomez R, Burns GL, Walsh JA (2008) Parent ratings of the oppositional defiant disorder symptoms: item response theory analyses of cross-national and cross-racial invariance. J Psychopathol Behav 30:10–19CrossRefGoogle Scholar
  24. 24.
    Leckman JF, Riddle MA, Hardin MT, Ort SI (1989) The yale global tic severity scale: initial testing of a clinician-rated scale of tic severity. J Am Acad Child Adolesc Psychiatry 28:566–573PubMedCrossRefGoogle Scholar
  25. 25.
    Storch EA, Murphy TK, Geffken GR, Sajid M, Allen P, Roberti JW, Goodman WK (2005) Reliability and validity of the yale global tic severity scale. Psychol Assess 17:486–491PubMedCrossRefGoogle Scholar
  26. 26.
    Scahill L, Riddle MA, McSwiggin-Hardin M, Ort SI (1997) Children’s yale-brown obsessive compulsive scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852PubMedCrossRefGoogle Scholar
  27. 27.
    Storch EA, Murphy TK, Geffken GR, Soto O, Sajid M, Allen P, Roberti JW, Killiany EM, Goodman WK (2004) Psychometric evaluation of the children’s Yale–Brown Obsessive-Compulsive Scale. Psychiatry Res 129:91–98PubMedCrossRefGoogle Scholar
  28. 28.
    Kaufman A, Kaufman N (1990) Kaufman brief intelligence test: manual. American Guidance Service, Circle PinesGoogle Scholar
  29. 29.
    Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174PubMedCrossRefGoogle Scholar
  30. 30.
    Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844PubMedCrossRefGoogle Scholar
  31. 31.
    Warnick EM, Bearss K, Weersing VR, Scahill L, Woolston J (2012) Shifting the treatment model: impact on engagement in outpatient therapy. Adm Policy Ment Health 41:93–103CrossRefGoogle Scholar
  32. 32.
    Garland AF, Kruse M, Aarons GA (2003) Clinicians and outcome measurement: what’s the use? J Behav Health Ser Res 30:393–405CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Joseph F. McGuire
    • 1
  • Denis G. Sukhodolsky
    • 2
  • Karen Bearss
    • 3
  • Heidi Grantz
    • 2
  • Maryellen Pachler
    • 4
  • Paul J. Lombroso
    • 2
  • Lawrence Scahill
    • 3
  1. 1.Department of PsychologyUniversity of South FloridaTampaUSA
  2. 2.Child Study CenterYale University School of MedicineNew HavenUSA
  3. 3.Marcus Autism CenterEmory UniversityAtlantaUSA
  4. 4.Anxiety Treatment Center of GreenwichGreenwichUSA

Personalised recommendations