In treatment outcome research I think what’s terribly important for the field, for clinicians, for families, for patients, and for the researchers is to be certain that the effects of treatment are impacting important areas in the lives of the people we’re treating and that the outcomes we’re using reflect aspects of functioning that are relevant in the lives of these people. And that if we can show change on those measures of functioning, that we have some sense that we’ve had an impact that is important and relevant to the families and hopefully to clinicians because they can understand what the data from those measures reflect.

And if one uses that as a jumping off point for assessment in treatment outcome studies, then I think the challenge is to look at what measures are available out there in assessing outcomes for example with a particular condition. And to take a step back and say, if I find change on this, and it’s significant change, statistically significant and perhaps even clinically significant, is it also something that has real-life relevance for these folks?

And if there’s any doubt about that, then the challenge is, okay what do we do then to get outcomes on “real life,” in quotes, assessments? That has driven much of my work in terms of my treatment outcome research.

And certainly that was the impetus and the justification for my working on classroom direct observation measures of children’s behavior since it is the school behavior of children with ADHD that often results in a referral for evaluation and treatment. And it’s one of the main aspects of functioning that’s relevant to the child, the teacher, the parent, and where it would be very important to see whether or not our treatments are impacting behavior in that classroom, if it can be collected by people who are not only objective but blind to the child’s treatment status and better yet perhaps even blind to the child’s diagnostic status.

Teachers and parents provide us with very important input, and in no way am I suggesting that rating scales, for example, are not relevant -- that’s not the case at all. They serve important purposes, but they can’t serve all purposes. And in treatment outcome, when you’re concerned about objectivity as well as ecological validity, then it behooves us to try and use other measures in addition to some of the standard rating scales. And the development of observational methodology I think is one way in which we can attempt to collect ecologically valid information.