Journal of Pediatric Psychology Advance Access originally published online on January 13, 2008
Journal of Pediatric Psychology 2008 33(9):981-982; doi:10.1093/jpepsy/jsm140
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This article appears in the following Journal of Pediatric Psychology issue: Special Issue: Evidence-based Assessment in Pediatric Psychology [View the issue table of contents]
Commentary: Evidence-based Assessment—Strength in Numbers
University of Calgary and University of Ottawa
All correspondence concerning this article should be addressed to Eric J. Mash, Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, Canada T2N 1N4. E-mail: mash{at}ucalgary.ca
Evaluating the status of evidence-based assessment (EBA) of psychosocial adjustment and psychopathology in pediatric populations is an important and challenging undertaking. Holmbeck and colleagues (this issue) have done an admirable job of cataloging both the strengths and needs in this emerging area. Their review provides an extremely useful and manageable short-list of well-established psychological assessment instruments, along with specific information on these measures and how they may be obtained. The measures listed are likely to be recognized by most pediatric psychologists as the ones most commonly used in the field. Indeed, as these are commonly used instruments, it was reassuring to learn that 34 of the 37 of the instruments reviewed met the criteria developed for "well-established."
Given the long tradition of instrument development and validation in clinical child and pediatric psychology, some might question the need for an initiative focused on gauging the status of available tools for measuring psychosocial adjustment and psychopathology in pediatric populations. We see at least three reasons that necessitate such work. First, there is abundant evidence that many psychologists frequently use measures that have little or no supporting evidence of their reliability or validity (Hunsley, Lee, & Wood, 2003
). Second, the growing literature on evidence-based treatments (EBTs) for pediatric populations is predicated on the assumption that the data used to evaluate treatments are derived from scientifically sound measures. Without clear standards for what constitutes EBA tools, attempts to develop EBTs have been likened to building a house without first taking the time to design and construct the appropriate foundation (Achenbach, 2005). Third, quality assurance initiatives are now commonplace in health care systems and documentation regarding the impact of services is now mandatory in many settings. Pediatric psychologists, therefore, need to be able to have the utmost confidence in the quality of the measures they are using to develop their treatment plans, monitor the effects of their interventions, and evaluate the outcome of these interventions when services are terminated.
Holmbeck and colleagues used empirically supported treatment-like criteria to evaluate the quality of the evidence base of the instruments used with pediatric populations. We have adopted a somewhat different approach to EBA (Hunsley & Mash, 2007; Mash & Hunsley, 2005); in our most recent work, this involved requirements that, in the preponderance of research on an instrument, specific levels of reliability be attained along with evidence of several forms of validity (Hunsley & Mash, 2008). As Holmbeck and colleagues noted, our approach and the one they presented are not incompatible. To continue Achenbach's (2005) analogy, there may well be multiple options for building solid "foundations." Accordingly, we believe it most worthwhile for continuing discussions regarding how to best operationalize EBA.
Reliability and validity are obviously important psychometric characteristics, but they are just part of what must be considered in assessing psychosocial adjustment and psychopathology for both research and clinical purposes. As Holmbeck and colleagues pointed out, clinical utility, feasibility, incremental validity, validity generalization, and treatment sensitivity also need to be incorporated into criteria for EBA. This task is a difficult one because of the limited data base on these concepts and the relative absence of established, easy-to-use metrics to evaluate these aspects of the assessment tools and the assessment process. However, if the measures used to evaluate psychosocial adjustment and psychopathology in pediatric psychology are to have value in assessment decision-making, the challenge of developing criteria for assessing these practical and clinically relevant assessment facets needs to be addressed.
Conflicts of interest: None declared.
Received November 22, 2007; revision received December 18, 2007; accepted December 19, 2007
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Holmbeck GN, Thill AW, Bachanas P, Garber J, Miller KB, Abad M. Evidence-based assessment in pediatric psychology: Measures of psychosocial adjustment and psychopathology. Journal of Pediatric Psychology (2007) August 28. doi:10.1093/jpepsy/jsm059.
Hunsley J, Lee CM, Wood J. Controversial and questionable assessment techniques. In: Science and pseudoscience in clinical psychology.—Lilienfeld SO, Lynn SJ, Lohr J, eds. (2003) New York: Guilford. 39–76.
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