Caregiver-Child Symptom Concordance: Links to Premature Termination From Trauma-Focused Therapy

Rates of attrition from child trauma-focused treatment are high, yet few predictors of premature termination are known. Caregiver-child symptom discrepancies are common in this population and have been related to treatment outcome. However, research has not examined whether caregiver-child symptom concordance is associated with attrition. The aim of the study was to determine whether pretreatment caregiver-child symptom agreement predicted premature termination from trauma-focused treatment. Two hundred and sixty-nine treatment-seeking children ages 8 to 12 (M = 9.97, SD = 1.49; 64.7% female, 51.3% Black) and their non-offending caregivers were included in the study. Two operational definitions of attrition are as follows: (a) clinician-rated dropout, and (b) whether the child received an adequate dose of treatment (i.e., 12 or more sessions), which were used to more thoroughly examine premature termination. Rates of attrition were high (68.1% clinician-rated premature termination, 37.4% received inadequate dose). Levels of symptom concordance between caregivers and children were low across symptom difficulties (intraclass correlations = .003-.16). Lower levels of discordance for posttraumatic stress symptoms (PTSS) were associated with an increased likelihood of receiving an adequate dose of treatment (odds ratio [OR] = 1.03). Nonetheless, unexpectedly, higher levels of caregiver-child discordance for anxiety symptoms at pretreatment predicted both clinician-rated treatment completion and adequate dose (ORs = .97, .96, respectively). However, caregiver's and children's perceptions of children's trauma-related difficulties may not converge, and thus, both reports are important to assess. Symptom disagreement regarding PTSS may help identify families at risk for attrition.