Abstract

Background: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A; Ehrenreich-May et al., 2018) is efficacious in treating youth internalizing disorders; however, the positive benefits of this intervention approach from pre- to post-treatment has not yet been examined using a personalized or idiographic measure of change, such as the Top Problems assessment (TPA; Weisz et al., 2011). The TPA is an individualized measure which requires youth and their parents to identify three to five problems they would like to target in treatment and to rate the severity of such problems on a weekly basis using a scale from 0-8.

Method: Participants were youth aged 6-17 (M = 11.97, SD = 3.34, N = 133) who received at least eight sessions of UP-C/A for a primary emotional disorder (e.g. an anxiety, depression, or obsessive compulsive related disorder). First, we examined change in mean TPA ratings between the first and last sessions of the UP-C/A using paired samples t-tests for both parent- and youth-reported TPA severity ratings. To test the robustness of the results beyond statistical significance, we also calculated the reliable change index (RCI) for the difference scores of both informants. Furthermore, we examined if demographic and clinical variables predict TPA difference scores using linear regression.

Results: We found that youth-reported mean TPA ratings significantly decreased by an average of 2.87 units (t(132) = 16.29, p < .001) from pre- to post-treatment. Similarly, parent-reported TPA ratings significantly decreased by an average of 2.94 units (t(132) = 15.81, p < .001) during this interval. Results of the RCI analyses indicated that 87.4% of youth and 88.3% of parents reported a reliable decrease in TPA ratings from pre- to post-treatment. Controlling for age, sex, ethnicity, Hispanic identity, number of sessions attended, and pre-treatment symptom rating for anxiety and depression, we found early-treatment response (ETR) and mid-treatment response (MTR) (defined as a change in severity rating of at least one standard deviation below the mean within the first four sessions and eight sessions [mid-point], respectively) to be a significant predictor of both parent- and child- reported TPA severity change (p’s < .05).

Discussion: The results of the present study indicate that youth and their parents report a significant reduction in severity of problems that are individualized to their presenting concerns. We found that elevated levels of responsiveness recorded during treatment are associated with a greater decrease in TPA severity ratings at post-treatment. Overall, these findings not only speak to the ability of idiographic measures, such as the Top Problem assessment, to capture change in severity over the course of treatment but also speak to the potential efficacy of the UP-C/A in treating relevant primary concerns generated and endorsed by youth with emotional disorders.