(PS11-A9) Can Idiographic and Ecological Momentary Assessment Data Help Evaluate Treatment Outcome and Response?

There has been increased recognition of the usefulness of idiographic assessment (IA) for case conceptualization, and treatment planning and evaluation.  IA may be especially useful when combined with Ecological Momentary Assessment (EMA). IA, or patient-generated measures, involves the use of individualized items or stimuli that describe patterns or consistencies in behaviors, emotions, and cognitions related to a specific individual’s functioning (1). EMA records an individual’s behaviors in real-time (momentary) in the natural environment (ecological) (2). Using both IA and standardized measurement (SM) may increase sensitivity to those aspects of the person’s experience and functioning particularly relevant for personalizing interventions. The present study explores how IA and EMA provide clinically relevant data to supplement the use of monthly SM for evaluating response to a cognitive-behavioral (CB) treatment of three adults with Attention-Deficit/Hyperactivity Disorder (ADHD) and comorbid depression and/or anxiety.

Method: The present study used data of three participants (Pts; two men) in an IRB-approved study using a replicated single-subject design that assessed the impact of manualized CB treatment for Adult ADHD (3) combined with a formulation-based CB treatment for the comorbid mood or anxiety disorder. Inclusion criteria: diagnosis of Adult ADHD (any type) and diagnosis of an anxiety or mood disorder. 

Measures: Diagnoses were made using structured interviews: CAADID and ADIS-5. Monthly SM included BDI-II, BAI, PSWQ, and BAARS-IV. Events relevant to each Pt’s most distressing problems were explored via a semi-structured clinical interview (4).

An individualized questionnaire (IndQ) was developed for each Pt using verbatim statements from interviews and items based on SM. Items rated highly relevant by the Pt were included in the IndQ.

Procedure: Each Pt was asked to complete EMA self-ratings twice a day sent via Qualtrics. EMA data was analyzed via time-series regression in SAS.

The Reliable Change Index (5) was used to evaluate the magnitude of changes in scores on SMs.

Results: Selected results for 2 Pts: Pt001. Compared to SM, EMA ratings were more sensitive to intraindividual pre- to post-treatment change for inattention (d = -6.16 vs. RCI = -5.17), hyperactivity (d = -4.50; RCI = -1.42), depression (d = -4.64; RCI = -1.98), and anxiety (d = -2.17; RCI = -1.96). SM was more sensitive to change in impulsivity.

Pt005 experienced a major life stressor that started between the pre-and early-treatment ratings. Although the BAARS Inattention percentile scores were in the clinical range -- 96^th to 99^th %tile. The EMA inattention (also depression and anxiety) scores show substantial variability both within and across days. This variability, missed by the monthly SM, may assist in developing a more fine-grained CB treatment plan.

Conclusion: IA combined with EMA provides incremental utility that 1) may supplement the evaluation of treatment response with scores on SM, 2) increase sensitivity to the pattern of change, and 3) may be useful even with substantial missing data. This incremental sensitivity may be due to the focus on certain relevant aspects of an individual’s experience/functioning not assessed with SM.