{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T12:09:19Z","timestamp":1778587759013,"version":"3.51.4"},"reference-count":33,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2020,3,30]],"date-time":"2020-03-30T00:00:00Z","timestamp":1585526400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Child and Adolescent Psychopharmacology"],"published-print":{"date-parts":[[2020,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>Study goals were to (1) provide a rationale for developing a composite primary outcome score that includes symptom severity for attention-deficit\/hyperactivity disorder (ADHD) and emotional dysregulation, plus symptom-induced impairment; (2) demonstrate weighting methods to calculate the composite score using a sample of children diagnosed with ADHD and aggression; and (3) identify the optimal weighting method most sensitive to change, as measured by effect sizes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We conducted secondary data analyses from the previously conducted Treatment of Severe Childhood Aggression (TOSCA) study. Children aged 6\u201312 years were recruited through academic medical centers or community referrals. The composite primary outcome comprised the ADHD, oppositional defiant disorder, disruptive mood dysregulation disorder, and peer conflict subscales from the Child and Adolescent Symptom Inventory (CASI), a DSM (\n                      <jats:italic toggle=\"yes\">Diagnostic and Statistical Manual<\/jats:italic>\n                      )-referenced rating scale of symptom severity and symptom-induced impairment. Five weighting methods were tested based on input from senior statisticians.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The composite score demonstrated a larger (Cohen's\n                      <jats:italic toggle=\"yes\">d<\/jats:italic>\n                      ) effect size than the individual CASI subscales, irrespective of the weighting method (10%\u201355% larger). Across all weighting methods, effect sizes were similar and substantial: approximately a two-standard deviation symptom reduction (range: \u22121.97 to \u22122.04), highest for equal item and equal subscale weighting, was demonstrated, from baseline to week 9, among all TOSCA participants. The composite score showed a medium positive correlation with the Clinical Global Impressions-Severity scores, 0.46\u20130.47 for all weighting methods.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>A composite score that included severity and impairment ratings of ADHD and emotional dysregulation demonstrated a more robust pre\u2013post change than individual subscales. This composite may be a more useful indicator of clinically relevant improvement in heterogeneous samples with ADHD than single subscales, avoiding some of the statistical limitations associated with multiple comparisons. Among the five similar weighting methods, the two best appear to be the equal item and equal subscale weighting methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/cap.2019.0179","type":"journal-article","created":{"date-parts":[[2020,2,26]],"date-time":"2020-02-26T15:13:51Z","timestamp":1582730031000},"page":"166-172","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Development of a Composite Primary Outcome Score for Children with Attention-Deficit\/Hyperactivity Disorder and Emotional Dysregulation"],"prefix":"10.1177","volume":"30","author":[{"given":"Jeanette M.","family":"Johnstone","sequence":"first","affiliation":[{"name":"Helfgott Research Institute, National University of Natural Medicine, Portland, Oregon."},{"name":"Department of Child and Adolescent Psychiatry, Oregon Health &amp; Science University, Portland, Oregon."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brenda M.Y.","family":"Leung","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Priya","family":"Srikanth","sequence":"additional","affiliation":[{"name":"School of Public Health, Oregon Health &amp; Science University-Portland State University (OHSU-PSU Program), Portland, Oregon."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Hatsu","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, The Ohio State University, Columbus, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leanna","family":"Perez","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, The Ohio State University, Columbus, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara","family":"Gracious","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio."},{"name":"Orange Park Medical Center, Orange Park, Florida."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Tost","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Oregon Health &amp; Science University, Portland, Oregon."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael G.","family":"Aman","sequence":"additional","affiliation":[{"name":"The Nisonger Center UCEDD and Department of Psychology, The Ohio State University, Columbus, Ohio."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kenneth D.","family":"Gadow","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Stony Brook University, Stony Brook, New York."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert L.","family":"Findling","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oscar","family":"Bukstein","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L. 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