Introduction to Special Issue: Evidence-based Assessment in Pediatric Psychology

In the past decade, there has been considerable attention devoted to evaluating the scientific merit of psychological treatments. In 1995, Division 12 (Clinical Psychology) of the American Psychological Association (APA) embarked on an evaluation of evidence-based (formerly referred to as empirically supported) treatments for psychopathology (Task Force on Promotion and Dissemination of Psychological Procedures, 1995). A similar venture soon followed from Division 53 (Society of Child Clinical and Adolescent Psychology) to identify psychosocial interventions for children and adolescents, which were supported by research findings (Lonigan, Elbert, & Johnson, 1998). Division 54 (Society of Pediatric Psychology) of the APA conducted an evaluation yielding a series of articles on evidence-based treatments germane to pediatric psychology (Spirito, 1999). The efforts to identify, describe, and disseminate information about treatments that are supported by sound scientific evidence are important endeavors for advancing scientist-practitioner approaches to therapy and research in psychology. Scientist-practitioners are equally concerned about the research base supporting their assessment instruments. Thus, in 1999, Division 12 conducted one of the first systematic evaluations of evidence-based assessments (Ollendick, 1999). A particular emphasis was placed on identifying the treatment utility of the measures, which refers to the extent that they provide information that helps guide the design of interventions (Hayes, Nelson, & Jarrett, 1987; Nelson-Gray, 2003). Thus, there was more attention devoted to measures of malleable state-like variables than measures of stable trait-like characteristics. In addition, this task force limited the scope of the review to laboratory and performance-based measures (e.g., observations under standardized conditions) of child clinical psychology (e.g., autism, anxiety, depression, and attention deficit hyperactivity disorder). In a summary of the findings, Frick (2000) concluded that the measures were useful in providing additional information about the disorders under study, but the instruments did little in guiding the design of treatment interventions. An explanation is that many of the laboratory-based measures reviewed were developed and employed to examine specific hypotheses about disorders rather than for clinical use. In 2005, Division 53 published a special issue focusing on evidence-based assessment of child and adolescent disorders. In the lead article, Mash and Hunsley (2005) discussed some of the difficulties of conducting a review of evidence-based assessments, including the large number of measurement tools, the varied purposes of assessment, the rapid developmental changes in children, and the need for multiple sources of information (e.g., teachers and parents). This series detailed assessment approaches with children with anxiety, depression, bipolar disorder, attention deficit hyperactivity disorder, conduct problems, learning disabilities, and autism spectrum disorders. Whereas there is a overlap in the concerns and issues in the fields of child psychopathology and pediatric psychology, there are also some distinctions that should be noted. The populations evaluated and foci of concern of pediatric psychology are distinct. For example, adherence to medical regimens, psychosocial issues related to having a chronic illness, and evaluations of medical pain management are issues more commonly addressed by pediatric psychologists than clinical child psychologists. Given that pediatric psychologists are often working with medical professionals and in busy medical care settings, pragmatics (e.g., cost-effective, time-efficient, and ease of use; Roberts & McNeal, 1995) and whether results lead to clear treatment implications (Blount, Bunke, & Zaff, 2000) might be prioritized over theory development and richness of information. The systematic evaluation of assessment instruments is essential to many areas of scientist-practitioner endeavors. When conducting therapy, professionals rely on the accuracy of measures for diagnostic and case conceptualization purposes, and decisions regarding the course and efficacy of treatment are often based on results from assessment tools. In scientific research, the assessment tools are essential in the accurate examination of the constructs of interest. Given that the quality of the assessment measures are crucial to whether a psychosocial treatment is deemed to be “empirically supported,” it seems that the horse has been put before the cart, or perhaps the hitch has unwittingly come undone somewhere along the way in the movement to identify evidence-based treatments. Evaluating pediatric psychology assessment measures presents a host of challenges (La Greca & Lemanek, 1996). For example, the instrument might be used across a variety of populations, and the validity and reliability might vary across these groups. In addition to the question of whether an assessment instrument is valid for a particular population, there is also the question of whether the instrument is valid for a particular purpose. For instance, the researcher might be using the instrument to broaden the understanding of a construct or of factors associated with a disorder, identify avenues for intervention, or assess treatment outcome. A given measure might prove valid for some of these purposes but not others. Because there are multiple purposes for which an assessment instrument could be used, the scope of articles reviewed is diverse and could encompass practically any type of empirical investigation. These various considerations might help explain why evidence-based assessment reviews have lagged behind evidence-based treatment reviews in the literature. In 2002, Annette La Greca assembled a task force of Division 54 (Society of Pediatric Psychology) to identify, critique, and disseminate information regarding the assessment measures used in pediatric psychology. Valid and reliable assessment is essential to the efforts of health care professionals who work with children. Diagnostic and treatment decisions are made based largely on results from the assessment devices used with children in medical settings. Unfortunately, some of the measures used with pediatric populations have had questionable utility (La Greca, 1994). Specifically, many instruments commonly used in pediatric settings were initially developed for use with healthy children or those with psychopathology; thus, no relevant norms are available for use with pediatric populations. Furthermore, many measures included in pediatric investigations are the modifications of adult measures without adequate developmental considerations. Some instruments do not readily yield clear treatment implications (Quittner, 2000), and others are too long or complicated to use in many busy health care settings. Related, there appears to be a split between those measures used in research and those used in clinical practice, which is likely due to the failure of researchers to adequately develop and disseminate practical measures and also to clinicians for not selecting instruments based on research findings (Beutler, 2000; Frick, 2000). Thus, it is apparent that a systematic review of pediatric psychology measures is in warranted to examine the state of the assessment field and to help determine where attention should be focused. The goal of this series of articles is to identify and systematically critique the assessment tools available to the child health care community. The reviews are designed to help guide child health professionals in identifying and selecting instruments for particular purposes, to focus researchers’ efforts in developing and evaluating measurement tools, and to foster greater integration of science and practice.