• clinical significance;
  • therapeutic change;
  • assessment

The review by Sheldrick et al. evaluates treatments for children and adolescents with conduct disorder and whether they produce clinically significant changes. The present commentary focuses on the difficulties in interpreting current measures of clinical significance, the reliance on symptom reduction as the sole or primary criterion, and the need to match the criteria and measures of clinical significance to the clinical problems, treatment goals, and lives of the clients. Recommendations are made to establish measures of clinically significant change, and include conceptual elaboration of the construct, empirical research on the criteria (i.e., what it is that reflects real or important therapeutic changes in everyday life), validation of current measures of clinical significance, and development of a typology of clinical problems that might point to which indices of clinical significance are most pertinent. Clinically significant change can be measured in many ways, but it is still not entirely clear what any of the ways means in the lives of clients.