Almost clinically significant (p < .10): Current measures may only approach clinical significance

The review by Sheldrick et al. evaluates treatments for children and adoles cents with conduct disorder and whether they produce clinically significant changes. The present commentary focuses on the difficulties in interpretin g current measures of clinical significance, the reliance on symptom reduct ion as the sole or primary criterion, and the need to match the criteria an d measures of clinical significance to the clinical problems, treatment goa ls, and lives of the clients. Recommendations are made to establish measure s of clinically significant change, and include conceptual elaboration of t he construct, empirical research on the criteria (i.e., what it is that ref lects real or important therapeutic changes in everyday life), validation o f current measures of clinical significance, and development of a typology of clinical problems that might point to which indices of clinical signific ance are most pertinent. Clinically significant change can be measured in m any ways, but it is still not entirely clear what any of the ways means in the lives of clients.