The Role of Co-Occurring Attention Problems in Youth Psychotherapy Outcomes

Abstract

Objective: Attention problems are common among youths referred for psychotherapy and may affect their clinical outcomes. However, very little research has examined this possibility, and no studies have encompassed the broad range of internalizing and externalizing problems for which most youths are treated in everyday clinical practice. Accordingly, the present study investigated three questions: (1) Do youth attention problems change over the course of evidence-based psychotherapy for youth internalizing and externalizing problems? (2) Are youths’ baseline levels of attention problems associated with their trajectories of change in internalizing, externalizing, and idiographic top problem severity over the course of psychotherapy? and (3) Are youth attention problems associated with characteristics of the therapy process—e.g., therapeutic alliance, planned versus unplanned termination? Method: Participants were youths (N=200, age range = 7-15 years, 46% female) who received community-based outpatient therapy for various emotional and behavioral concerns using the same transdiagnostic treatment (the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems; MATCH). Longitudinal multilevel models were estimated to examine 18-month trajectories of change in attention problems, as well as trajectories of internalizing problems, externalizing problems, and top problems and whether these trajectories were moderated by baseline attention problems. Multiple regression models were estimated to examine associations between baseline attention problems and characteristics of the therapy process measured post-treatment. Results: On average, youths showed statistically significant reductions in attention problems over time per caregiver and youth report; however, these changes did not satisfy criteria for clinical significance. Attention problems were associated with higher caregiver-rated internalizing problems at baseline and throughout treatment, although similar effects were not found for youth-rated internalizing problems. Attention problems were associated with higher caregiver- and youth-rated externalizing problems at baseline and throughout treatment, and these slopes were moderated such that youths with greater attention problems showed slightly steeper-than-average reductions in externalizing problems over time. Finally, attention problems were associated with slower-than-average rates of improvement in parent-rated top problems, but showed no associations with youth-rated top problems. These results remained robust after controlling for stimulant medication use and translated to significantly poorer treatment outcomes for youth with greater attention problems. Attention problems were not associated with any characteristics of the therapy process examined in this study. Conclusions: Youths with attention problems, relative to their peers, exhibited poorer clinical outcomes following evidence-based psychotherapy. Future research should investigate candidate mechanisms, as attention problems may be linked to psychotherapy outcomes in ways that warrant attention in treatment planning and design.