Beyond fear: Incompleteness and disgust in pediatric obsessive-compulsive disorder Cervin, Matti

LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00

Beyond fear: Incompleteness and disgust in pediatric obsessive-compulsive disorder

Cervin, Matti

2019

Document Version:

Publisher's PDF, also known as Version of record Link to publication

Citation for published version (APA):

Cervin, M. (2019). Beyond fear: Incompleteness and disgust in pediatric obsessive-compulsive disorder.

[Doctoral Thesis (compilation), Department of Clinical Sciences, Lund]. Lund University: Faculty of Medicine.

Total number of authors:

1

General rights

Unless other specific re-use rights are stated the following general rights apply:

Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.

• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.

• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal

Read more about Creative commons licenses: https://creativecommons.org/licenses/

Take down policy

If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim.

Download date: 30. Oct. 2022

Beyond fear:

Incompleteness and disgust in pediatric obsessive-compulsive disorder

MATTI CERVIN

FACULTY OF MEDICINE | LUND UNIVERSITY

Lund University, Faculty of Medicine Doctoral Dissertation Series 2019:81 ISBN 978-91-7619-810-0 ISSN 1652-8220 Matti Cervin is a clinical psychologist

and a researcher with an interest in emotion and cognition in pediatric mental disorders, particularly obsessive-compulsive disorder and anxiety disorders. The primary aim of his research is to outline factors that are involved in the onset and maintenance of these disorders so that treatment and prevention can be improved.

9789176198100

%H\RQGIHDU

,QFRPSOHWHQHVVDQGGLVJXVWLQSHGLDWULFREVHVVLYHFRPSXOVLYHGLVRUGHU

%H\RQGIHDU

,QFRPSOHWHQHVVDQGGLVJXVWLQSHGLDWULFREVHVVLYH

FRPSXOVLYHGLVRUGHU

0DWWL&HUYLQ

'2&725$/',66(57$7,21

E\GXHSHUPLVVLRQRIWKH)DFXOW\RI0HGLFLQH/XQG8QLYHUVLW\6ZHGHQ

7REHGHIHQGHGDW%DUDYlJHQ/XQG.RQIHUHQVUXP

6HSWHPEHU$0

Faculty opponent 7RUG,YDUVVRQ

2UJDQL]DWLRQ

/81'81,9(56,7<

%H\RQGIHDU,QFRPSOHWHQHVVDQGGLVJXVWLQSHGLDWULF

REVHVVLYHFRPSXOVLYHGLVRUGHU



0DWWL&HUYLQ /XQG8QLYHUVLW\

%H\RQGIHDU,QFRPSOHWHQHVVDQGGLVJXVWLQSHGLDWULFREVHVVLYHFRPSXOVLYHGLVRUGHU

$EVWUDFW

$FRPSUHKHQVLYHXQGHUVWDQGLQJRIWKHHPRWLRQDOPHFKDQLVPVWKDWPRWLYDWHWKHV\PSWRPVRISHGLDWULFREVHVVLYH

FRPSXOVLYHGLVRUGHU2&'LVLPSRUWDQWIRUPRGHOVRIWKHHWLRORJ\DQGWUHDWPHQWRIWKHGLVRUGHU([LVWLQJPRGHOV

KDYHHPSKDVL]HGWKHFHQWUDOUROHRIIHDUEXWUHFHQWUHVHDUFKKDVKLJKOLJKWHGWKDW2&'PD\DOVREHXQGHUSLQQHG

E\LQFRPSOHWHQHVVDQGGLVJXVW+RZHYHUZKHWKHULQFRPSOHWHQHVVLVUHOHYDQWIRUWKHXQGHUVWDQGLQJRISHGLDWULF

2&'KDVQRWEHHQH[DPLQHGDQGQRVWXGLHVKDYHFRQMRLQWO\H[DPLQHGIHDULQFRPSOHWHQHVVDQGGLVJXVWLQ

FOLQLFDOVDPSOHV7KHSUHVHQWWKHVLVFRQFHUQHGLWVHOIZLWKWKHGHJUHHWRZKLFKIHDULQFRPSOHWHQHVVDQGGLVJXVW

DFRXOGEHYDOLGO\DVVHVVHGLQ\RXWKZLWK2&'DQGDQ[LHW\GLVRUGHUVEGLVFULPLQDWHGSHGLDWULF2&'IURP

SHGLDWULFDQ[LHW\GLVRUGHUVFXQGHUSLQQHGWKHPDLQV\PSWRPGLPHQVLRQVRISHGLDWULF2&'DQGGSUHGLFWHG

WUHDWPHQWRXWFRPHIRU\RXWKZLWK2&'<RXWKVHHNLQJWUHDWPHQWIRUSHGLDWULF2&'DQGDQ[LHW\GLVRUGHUV

DVVHVVHGYLDVWUXFWXUHGGLDJQRVWLFLQWHUYLHZVFRPSOHWHGVHOIUHSRUWDQGLQWHUYLHZEDVHGPHDVXUHVRIWUDLW

HYHU\GD\H[SHULHQFHVDQGVWDWHGLUHFWHPRWLRQLQYROYHPHQWLQV\PSWRPVOHYHOVRIIHDULQFRPSOHWHQHVVDQG

GLVJXVW1RQFOLQLFDO\RXWKZHUHUHFUXLWHGIURPORFDOVFKRROVDQGFRPSOHWHGWKHVDPHWUDLWOHYHOPHDVXUHV

5HVXOWVVKRZHGWKDWERWKFKLOGUHQDQGDGROHVFHQWVZHUHDEOHWRFRPSUHKHQGWKHFRQFHSWRILQFRPSOHWHQHVVDQG

WRUHSRUWRQZKHWKHUWKLVHPRWLRQDVZHOODVIHDUDQGGLVJXVWZDVSDUWRIWKHLUJHQHUDOHPRWLRQDOUHVSRQVHVDQG

LQWKHLUV\PSWRPVRI2&'DQGDQ[LHW\GLVRUGHUV7UDLWOHYHOIHDUDQGGLVJXVWZHUHHOHYDWHGLQ\RXWKZLWK2&'DQG

DQ[LHW\GLVRUGHUVZKHQFRPSDUHGWRQRQFOLQLFDO\RXWKZKLOHLQFRPSOHWHQHVVZDVRQO\HOHYDWHGLQ\RXWKZLWK

2&':KHQH[DPLQLQJGLPHQVLRQDODVVRFLDWLRQVEHWZHHQVHOIUHSRUWHGWUDLWOHYHOHPRWLRQDQGVHOIUHSRUWHG

V\PSWRPVHYHULW\IHDUZDVSRVLWLYHO\DVVRFLDWHGZLWK2&'DQ[LHW\DQGGHSUHVVLRQZKLOHLQFRPSOHWHQHVVZDV

XQLTXHO\DVVRFLDWHGZLWK2&'DQGGLVJXVWXQLTXHO\DVVRFLDWHGZLWKDQ[LHW\5HJDUGLQJWKHGLUHFWLQYROYHPHQWRI

WKHVHHPRWLRQVLQWKHV\PSWRPVRI2&'DQGVRFLDODQ[LHW\GLVRUGHUDQGJHQHUDOL]HGDQ[LHW\GLVRUGHUIHDUZDV

DJDLQVKRZQWREHUHODWHGWRERWK2&'DQGDQ[LHW\GLVRUGHUVLQFRPSOHWHQHVVVSHFLILFDOO\UHODWHGWR2&'

SDUWLFXODUO\V\PPHWU\UHODWHG2&'DQGGLVJXVWVSHFLILFDOO\UHODWHGWRFRQWDPLQDWLRQEDVHG2&'<RXWKZLWK

2&'V\PSWRPVFKDUDFWHUL]HGE\KLJKOHYHOVRILQFRPSOHWHQHVVDQGGLVJXVWHYLGHQFHGDSRRUHUUHVSRQVHWR2&'

WUHDWPHQW2YHUDOOWKHSUHVHQWWKHVLVVXJJHVWVWKDWDGGLWLRQDOVWXGLHVDUHZDUUDQWHGWKDWH[DPLQHWKHUHODWLRQVKLS

EHWZHHQLQFRPSOHWHQHVVDQGGLVJXVWLQUHODWLRQWRWKHKHWHURJHQHLW\DQGWUHDWPHQWRISHGLDWULF2&')XUWKHUWR

EHWWHURXWOLQHIDFWRUVVSHFLILFDOO\UHODWHGWRWKHGHYHORSPHQWDQGPDLQWHQDQFHRISHGLDWULF2&'WKHRUHWLFDOPRGHOV

VKRXOGPRUHFOHDUO\DFFRXQWIRUHPRWLRQUHODWHGPRWLYDWRUVRWKHUWKDQIHDU

.H\ZRUGV2&'FKLOGUHQDGROHVFHQWVIHDUKDUPDYRLGDQFHLQFRPSOHWHQHVVGLVJXVWRXWFRPHHPRWLRQ

&ODVVLILFDWLRQV\VWHPDQGRULQGH[WHUPVLIDQ\

6XSSOHPHQWDU\ELEOLRJUDSKLFDOLQIRUPDWLRQ /DQJXDJH(QJOLVK

,661

%H\RQGIHDU,QFRPSOHWHQHVDQGGLVJXVWLQSHGLDWULFREVHVVLYH

FRPSXOVLYHGLVRUGHU

,6%1

5HFLSLHQW¶VQRWHV 1XPEHURISDJHV 3ULFH

6HFXULW\FODVVLILFDWLRQ

,WKHXQGHUVLJQHGEHLQJWKHFRS\ULJKWRZQHURIWKHDEVWUDFWRIWKHDERYHPHQWLRQHGGLVVHUWDWLRQKHUHE\JUDQWWRDOO

UHIHUHQFHVRXUFHVSHUPLVVLRQWRSXEOLVKDQGGLVVHPLQDWHWKHDEVWUDFWRIWKHDERYHPHQWLRQHGGLVVHUWDWLRQ

6LJQDWXUH 'DWH

%H\RQGIHDU

,QFRPSOHWHQHVVDQGGLVJXVWLQSHGLDWULFREVHVVLYH

FRPSXOVLYHGLVRUGHU

0DWWL&HUYLQ

&RYHUSKRWRE\-/*IURP3L[DED\

&RS\ULJKWSS0DWWL&HUYLQ 3DSHU‹(OVHYLHU

3DSHU‹(OVHYLHU

3DSHU‹E\WKH$XWKRUV0DQXVFULSWXQSXEOLVKHG 3DSHU‹E\WKH$XWKRUV0DQXVFULSWXQSXEOLVKHG 3DSHU‹E\WKH$XWKRUV0DQXVFULSWXQSXEOLVKHG

)DFXOW\RI0HGLFLQH

'HSDUWPHQWRI&OLQLFDO6FLHQFHV/XQG

,6%1

,661

3ULQWHGLQ6ZHGHQE\0HGLD7U\FN/XQG8QLYHUVLW\

/XQG

For Tova

7KHRQO\VXSHUKXPDQ,KDYHPHW

We do not hesitate to consider emotions as the primitive and fundamental element of the obsession.

$OEHUW3LWUHV (PPDQXHO5pJLV

Les obsessions et les impulsions

7DEOHRIFRQWHQWV

6YHQVNVDPPDQIDWWQLQJ /LVWRISDSHUV

$EEUHYLDWLRQV ,QWURGXFWLRQ 2EVHVVLYHFRPSXOVLYHGLVRUGHU 5LWXDOL]HGEHKDYLRUVDQGLQWUXVLYHWKRXJKWV 'LDJQRVWLFFULWHULDRIREVHVVLYHFRPSXOVLYHGLVRUGHU (SLGHPLRORJ\RIREVHVVLYHFRPSXOVLYHGLVRUGHU 7KHPHVRIREVHVVLRQVDQGFRPSXOVLRQV 7UHDWPHQWRIREVHVVLYHFRPSXOVLYHGLVRUGHU 3V\FKRORJLFDOWUHDWPHQW 3KDUPDFRORJLFDOWUHDWPHQW 3UHGLFWRUVRIWUHDWPHQWRXWFRPH 0RGHOVRIREVHVVLYHFRPSXOVLYHGLVRUGHU

*HQHWLFDQGHQYLURQPHQWDOFRQWULEXWLRQV 1HXURELRORJLFDOIUDPHZRUNV

&RJQLWLYHEHKDYLRUDOPRGHOV 1HZHUSV\FKRORJLFDOPRGHOV (PRWLRQ (PRWLRQLQREVHVVLYHFRPSXOVLYHGLVRUGHU 7KH&RUH'LPHQVLRQV0RGHO 'LVJXVW

$EURDGHUHPRWLRQIUDPHZRUNDQGOLQNVWRRXWFRPH

$LPV 0HWKRGV 3DUWLFLSDQWVSURFHGXUHDQGHWKLFV 0HDVXUHVDWEDVHOLQHDQGIROORZXS ,QWHUYLHZEDVHGPHDVXUHV 6HOIUHSRUWPHDVXUHV 6WDWLVWLFDODQDO\VLV

6XPPDU\RIVWXGLHV 3DSHU

%DFNJURXQGDQGDLP 0HWKRGV 5HVXOWV 'LVFXVVLRQ 3DSHU

%DFNJURXQGDQGDLP 0HWKRGV 5HVXOWV 'LVFXVVLRQ 3DSHU

%DFNJURXQGDQGDLP 0HWKRGV 5HVXOWV 'LVFXVVLRQ 3DSHU

%DFNJURXQGDQGDLP 0HWKRGV 5HVXOWV 'LVFXVVLRQ 3DSHU

%DFNJURXQGDQGDLP 0HWKRGV 5HVXOWV 'LVFXVVLRQ

*HQHUDOGLVFXVVLRQ 0DLQILQGLQJV 'LVFXVVLRQDQGIXWXUHGLUHFWLRQV /LPLWDWLRQV

&RQFOXVLRQV

$FNQRZOHGJPHQWV 5HIHUHQFHV

12

Svensk sammanfattning

Rädsla är centralt för nuvarande modeller av tvångssyndrom, men forskning har visat att känslor av ofullständighet och äckel kan vara lika viktiga för hur tillståndet uppstår och vidmakthålls. Huruvida känsla av ofullständighet är centralt för tvångssyndrom hos barn och ungdomar har dock aldrig undersökts och rädsla, ofullständighet och äckel har aldrig studerats parallellt i kliniska populationer.

Syftet med denna avhandling var att studera i vilken utsträckning rädsla, ofullständighet och äckel (a) kunde förstås och rapporteras av barn och ungdomar med tvångssyndrom och ångestsyndrom, (b) kunde användas för att differentiera unga med tvångssyndrom från unga med ångestsyndrom, (c) relaterade till heterogenitet i tvångssyndrom och (d) predicerade behandlingsutfall för unga med tvångssyndrom. Barn och ungdomar med tvångssyndrom och ångestsyndrom rekryterades från en barn- och ungdomspsykiatrisk klinik och genomgick strukturerade diagnostiska intervjuer, fyllde i formulär gällande benägenhet att uppleva rädsla, ofullständighet och äckel i vardagen samt intervjuades om i vilken utsträckning dessa känslor var direkt involverade i deras symptom. Unga utan psykiatrisk problematik rekryterades från lokala skolor och fyllde i samma formulär.

Resultaten visade att barn och ungdomar med tvångssyndrom och ångestsyndrom kunde förstå begreppet ofullständighetskänsla samt rapportera i vilken utsträckning denna känsla samt rädsla och äckel var närvarande i vardagen och i deras tvångs- och ångestsymptom. Unga med tvångssyndrom och ångestsyndrom upplevde mer rädsla i vardagen och rapporterade en starkare äckelbenägenhet jämfört med unga utan psykiatrisk problematik. Unga med tvångssyndrom upplevde mer ofullständighetskänslor i vardagen jämfört med unga med ångestsyndrom och unga utan psykiatrisk problematik. Rädslobenägenhet i vardagen var kopplat till självrapporterade symptom på tvång, ångest och depression. Ofullständighet var unikt kopplat till tvång. Äckel var unikt kopplat till ångest. Upplevelsen av rädsla var tydligt närvarande vid samtliga symptomdimensioner av tvång men tydligast kopplat till aggressiva tvång, där det låg i nivå med den grad av rädsla som unga med socialt och generaliserat ångestsyndrom upplevde. Ofullständighet var tydligt närvarande vid samtliga symptomdimensioner av tvång och mer närvarande i dessa dimensioner än vid socialt och generaliserat ångestsyndrom. Äckel var tydligt närvarande enbart vid kontaminationsrelaterade tvång. Att ha tvångssymptom karaktäriserade av höga nivåer av ofullständighet och äckel predicerade sämre behandlingsrespons för barn och ungdomar som fick behandling för tvångssyndrom.

Sammantaget visar avhandlingen att ramverket som används för att förstå tvångssyndrom hos barn och ungdomar bör breddas till att förutom rädsla också innefatta känslor av ofullständighet och äckel. Forskning som mer tydligt tar hänsyn till detta bredare ramverk kan ha större möjlighet att avgöra vad som är specifikt för tvångssyndrom i jämförelse med andra psykiatriska syndrom.



/LVWRISDSHUV

Paper 1

0DWWL&HUYLQ 6HDQ3HUULQ(OLQ2OVVRQ(PPD&ODHVGRWWHU.QXWVVRQ 0DJQXV

/LQGYDOO9DOLGDWLRQRIDQLQWHUYLHZRQO\YHUVLRQRIWKH'LPHQVLRQDO<DOH

%URZQ2EVHVVLYH&RPSXOVLYH6FDOH'<%2&6LQWUHDWPHQWVHHNLQJ\RXWKZLWK

REVHVVLYHFRPSXOVLYHGLVRUGHUPsychiatry Research, 271

Paper 2

0DWWL&HUYLQ  6HDQ3HUULQ0HDVXULQJKDUPDYRLGDQFHLQFRPSOHWHQHVV

DQG GLVJXVW LQ \RXWK ZLWK REVHVVLYHFRPSXOVLYH GLVRUGHU DQG DQ[LHW\ GLVRUGHUV

Journal of Obsessive-Compulsive and Related Disorders, 22, 

Paper 3

0DWWL&HUYLQ 6HDQ3HUULQ(OLQ2OVVRQ(PPD&ODHVGRWWHU.QXWVVRQ 0DJQXV

/LQGYDOO  ,QFRPSOHWHQHVV KDUP DYRLGDQFH DQG GLVJXVW $ FRPSDULVRQ RI

\RXWKZLWK2&'DQ[LHW\GLVRUGHUVDQGQRSV\FKLDWULFGLVRUGHUSubmitted

Paper 4

0DWWL&HUYLQ 6HDQ3HUULQ(OLQ2OVVRQ(PPD&ODHVGRWWHU.QXWVVRQ 0DJQXV

/LQGYDOO  )HDU RI KDUP LQFRPSOHWHQHVV DQG GLVJXVW LQ WKH PRPHQWWR

PRPHQWH[SHULHQFHRISHGLDWULFREVHVVLYHFRPSXOVLYHGLVRUGHUSubmitted

Paper 5

0DWWL&HUYLQ  6HDQ3HUULQ,QFRPSOHWHQHVVDQGGLVJXVWSUHGLFWWUHDWPHQW

RXWFRPHLQSHGLDWULFREVHVVLYHFRPSXOVLYHGLVRUGHUSubmitted



&RUUHVSRQGLQJDXWKRU

 



$EEUHYLDWLRQV

&%7 &RJQLWLYH%HKDYLRUDOWKHUDS\

&',6 &KLOGUHQ¶V'HSUHVVLRQ,QYHQWRU\±6KRUW9HUVLRQ

&)$ &RQILUPDWRU\IDFWRUDQDO\VLV

&*$6 &KLOGUHQ¶V*OREDO$VVHVVPHQW6FDOH

&*, &OLQLFDO*OREDO,PSUHVVLRQ6FDOH

&<%2&6 &KLOGUHQ¶V<DOH%URZQ2EVHVVLYH&RPSXOVLYH6FDOH

&67& &RUWLFR6WULDWR7KDODPR&RUWLFDO

'(6& 'LVJXVW(PRWLRQ6FDOHIRU&KLOGUHQ

'60 'LDJQRVWLFDQG6WDWLVWLFDO0DQXDORI0HQWDO'LVRUGHUV

'<%2&6 'LPHQVLRQDO<DOH%URZQ2EVHVVLYH&RPSXOVLYH6FDOH

(53 ([SRVXUHDQG5HVSRQVH3UHYHQWLRQ

0,1,.,' 0LQL,QWHUQDWLRQDO 1HXURSV\FKLDWULF ,QWHUYLHZ IRU &KLOGUHQ DQG

$GROHVFHQWV

2&&', 2EVHVVLYH&RPSXOVLYH&RUH'LPHQVLRQV,QWHUYLHZ

2&' 2EVHVVLYH&RPSXOVLYH'LVRUGHU

2&,&9 2EVHVVLYH&RPSXOVLYH,QYHQWRU\±&KLOG9HUVLRQ

2&7&'4 2EVHVVLYH&RPSXOVLYH&RUH'LPHQVLRQV4XHVWLRQQDLUH

5&7 5DQGRPL]HG&RQWUROOHG7ULDO

6&$5('5 6FUHHQIRU&KLOG$Q[LHW\'LVRUGHUV5HYLVHG

65, 6HURWRQLQ5HXSWDNH,QKLELWRU

665, 6HOHFWLYH6HURWRQLQ5HXSWDNH,QKLELWRU

<%2&6 <DOH%URZQ2EVHVVLYH&RPSXOVLYH6FDOH



,QWURGXFWLRQ

2EVHVVLYHFRPSXOVLYHGLVRUGHU

5LWXDOL]HGEHKDYLRUVDQGLQWUXVLYHWKRXJKWV

5HSHWLWLYH DQG ULWXDOL]HG EHKDYLRUV DUH FRPPRQ LQ WKH JHQHUDO SRSXODWLRQ DQG

DSSHDUHDUO\LQOLIH$ERXWRI\HDUROGVGLVSOD\ULWXDOL]HGEHGWLPHURXWLQHV

IXUWKHURUGHULQJULWXDOVFRQFHUQVDERXWJHUPVDQGKRDUGLQJEHKDYLRUVDUHIUHTXHQW

LQ\RXQJFKLOGUHQZLWKWKHILUVWWZRSHDNLQJDURXQGWKUHH\HDUVRIDJHDQGWKHODWWHU

LQFUHDVLQJXQWLODJHVL[/HFNPDQ %ORFK7KHVHULWXDOLVWLFEHKDYLRUVDUH

RIWHQDVVRFLDWHGZLWKVSHFLILFSODFHVRUFRQWH[WVDQGDUHRIWHQKLJKO\UHSHWLWLYHLQ

QDWXUH'(LODP=RU6]HFKWPDQ +HUPHVK7KHSUHVHQFHRIULWXDOL]HG

EHKDYLRUV GXULQJ QRUPDO KXPDQ GHYHORSPHQW DQG WKHLU VLPLODULW\ WR VWHUHRW\SLF

EHKDYLRUVLQRWKHUDQLPDOV%UXQH'DYLG(LODP=RU)LQHEHUJ +HUPHVK

KDVJLYHQULVHWRHYROXWLRQDU\PRGHOVRIKXPDQFRPSXOVLYLW\ZKLFKKDYHLQ

WXUQEHHQLQFRUSRUDWHGLQVRPHPRGHOVRIREVHVVLYHFRPSXOVLYHGLVRUGHU2&',Q

WKHVHPRGHOVKXPDQFRPSXOVLYLW\LVFRQVLGHUHGDWUDLWVKDSHGE\QDWXUDOVHOHFWLRQ

WKDWKDVIRVWHUHGVXUYLYDODQGUHSURGXFWLRQ)RUH[DPSOHULWXDOL]HGEHKDYLRUVVXFK

DVZDVKLQJWKHUHSHWLWLRQRIDFWLRQVXQWLOLWIHHOVµMXVWULJKW¶DQGUHSHWLWLYHFKHFNLQJ

DUHWKRXJKWWRKDYHEHHQSUHVHUYHGDQGVHOHFWHGEHFDXVHWKH\SOD\DQLPSRUWDQWUROH

LQDYRLGLQJKDUP%UXQHDQGEHFDXVHWKH\IUHHDWWHQWLRQDOUHVRXUFHV$ORQVR

/RSH]6ROD5HDO6HJDODV 0HQFKRQ

2EVHVVLYHOLNHFRJQLWLRQVLHH[SHULHQFHVRIXQZDQWHGDQGLQWUXVLYHWKRXJKWVRU

PHQWDOLPDJHVDUHDOVRFRPPRQLQKXPDQV,QDVHPLQDOVWXG\RQWKHSUHVHQFHRI

VXFKSKHQRPHQD5DFKPDQDQGGH6LOYDIRXQGWKDWREVHVVLYHOLNHFRJQLWLRQV

DUHH[SHULHQFHGE\PRUHWKDQRILQGLYLGXDOV7KHVHUHVXOWVKDYHEHHQUHSOLFDWHG

LQ QXPHURXV VWXGLHV 5DGRPVN\ HW DO  DQG SRLQW WRZDUG WKH QRUPDOLW\ RI

LQWUXVLYH WKRXJKWV +HQFH DV LQWUXVLYHREVHVVLRQDO WKRXJKWV GR QRW DSSHDU WR EH

DEQRUPDO per se UHVHDUFKHUV KDV GLUHFWHG WKHLU DWWHQWLRQ WRZDUG LQGLYLGXDO

GLIIHUHQFHVLQKRZVXFKWKRXJKWVDUHDSSUDLVHGDQGUHJXODWHG$EUDPRZLW]7D\ORU

0F.D\5DFKPDQ GH6LOYD,WKDVEHHQDUJXHGWKDWVLQFHLQWUXVLYH

WKRXJKWVDUHVLPLODULQIRUPDQGFRQWHQWLQSHRSOHXQDIIHFWHGE\2&'DVLQWKRVH

ZLWK2&'5DFKPDQ GH6LOYDHYHQWKRXJKILQGLQJVKDYHEHHQVRPHZKDW

PL[HG5DVVLQ 0XULVDQGVLQFHDODUJHSURSRUWLRQRI2&'VXIIHUHUVUHSRUW



WKDW REVHVVLRQV XVXDOO\ SUHFHGH WKHLU FRPSXOVLYH EHKDYLRUV 7D\ORU 0F.D\ 

$EUDPRZLW]  REVHVVLYHFRPSXOVLYH V\PSWRPV PD\ EH H[SODLQHG E\

GLIIHUHQFHVLQKRZREVHVVLRQVDUHDSSUDLVHG

7DNHQ WRJHWKHU REVHVVLYHFRPSXOVLYH SKHQRPHQD DUH FRPPRQ LQ KXPDQV DQG

DVVRFLDWHGZLWKHDUO\GHYHORSPHQWDOVWDJHV6LPLODUEHKDYLRUVDUHREVHUYHGLQRWKHU

DQLPDOVDQGKDYHSRVVLEO\EHHQFRQVHUYHGEHFDXVHRIWKHLULPSRUWDQFHIRUVXUYLYDO

DQGUHSURGXFWLRQ,QKXPDQVKRZHYHUFRPSXOVLYHEHKDYLRUVPD\EHFORVHO\OLQNHG

WRLQWUXVLYHWKRXJKWVDQGDVVXFKWKH\PD\EHGLVWLQJXLVKHGIURPVLPLODUEHKDYLRUV

LQQRQKXPDQDQLPDOV$EUDPRZLW]7D\ORU0F.D\ 'HDFRQ

'LDJQRVWLFFULWHULDRIREVHVVLYHFRPSXOVLYHGLVRUGHU

2EVHVVLYHFRPSXOVLYHGLVRUGHULVDGLDJQRVWLFFODVVWKDWFDSWXUHVSDWKRORJLFDOVWDWHV

RIREVHVVLRQVDQGRUFRPSXOVLRQV,QWKHWKHGLWLRQRIWKH'LDJQRVWLFDQG6WDWLVWLFDO

0DQXDO IRU 0HQWDO 'LVRUGHUV '60 WKH GLDJQRVWLF FULWHULD IRU 2&' DUH

VHSDUDWHG LQWR REVHVVLRQV DQG FRPSXOVLRQV UHVSHFWLYHO\ $PHULFDQ 3V\FKLDWULF

$VVRFLDWLRQ  2EVHVVLRQV DUH GHILQHG DV UHFXUUHQW DQG SHUVLVWHQW WKRXJKWV

XUJHVRULPDJHVWKDWDUHH[SHULHQFHGDVLQWUXVLYHDQGXQZDQWHGDQGFDXVHPDUNHG

DQ[LHW\RUGLVWUHVV&RPSXOVLRQVDUHGHILQHGDVUHSHWLWLYHEHKDYLRUVRUPHQWDODFWV

FDUULHG RXW WR SUHYHQW RU UHGXFH DQ[LHW\ GLVWUHVV RU WKH SUREDELOLW\ RI KDUP LQ

UHVSRQVHWRDQREVHVVLRQRUDFFRUGLQJWRVWULFWUXOHV7RIXOILOWKH'60FULWHULDIRU

2&'WKHLQGLYLGXDOPXVWKDYHDWOHDVWRQHREVHVVLRQRUFRPSXOVLRQZKLFKDUHDOVR

WLPHFRQVXPLQJ DQG FDXVH FOLQLFDOO\ VLJQLILFDQW GLVWUHVV DQGRU IXQFWLRQDO

LPSDLUPHQW ,W LV DOVR LPSRUWDQW WR GLVWLQJXLVK FRPSXOVLYH EHKDYLRU IURP RWKHU

UHSHWLWLYHEHKDYLRUDOV\PSWRPVFRPPRQO\VHHQLQSV\FKLDWULFVHWWLQJVVXFKDVWLFV

SHUVHYHUDQFH EHKDYLRUV LQ VFKL]RSKUHQLD DQG VWHUHRW\SLHV LQ DXWLVP 5REELQV

9DJKL %DQFD

,Q'602&'ZDVUHPRYHGIURPWKHDQ[LHW\GLVRUGHUVFKDSWHUDQGSODFHGLQWRD

QHZ FKDSWHU WLWOHG µ2EVHVVLYH&RPSXOVLYH DQG 5HODWHG 'LVRUGHUV¶ 2&' QRZ

DSSHDUVDORQJVLGHERG\G\VPRUSKLFGLVRUGHUKRDUGLQJGLVRUGHUWULFKRWLOORPDQLD

H[FRULDWLRQ GLVRUGHU VXEVWDQFHPHGLFDWLRQLQGXFHG 2&' DQG

RWKHUXQVSHFLILHGPHGLFDOO\LQGXFHG 2&' $PHULFDQ 3V\FKLDWULF $VVRFLDWLRQ

 7KH GHFLVLRQ WR JURXS WKHVH GLVRUGHUV WRJHWKHU ZDV EDVHG RQ HYLGHQFH

VKRZLQJ VLPLODULWLHV LQ FRXUVH FRPRUELGLW\ SDWWHUQV JHQHWLFV DQG WUHDWPHQW

UHVSRQVH IHDWXUHV WKDW GLVWLQJXLVKHG WKHVH GLVRUGHUV IURP WKH DQ[LHW\ GLVRUGHUV

6WHLQHWDO)XUWKHULWZDVDUJXHGWKDWIHDUDQGDQ[LHW\DOWKRXJKFRPPRQ

LQ2&'DQGUHODWHGGLVRUGHUVLVQRWDVLPSRUWDQWWRWKHSKHQRPHQRORJ\RIWKHVH

GLVRUGHUVDVLWLVWRWKHDQ[LHW\GLVRUGHUV9DQ$PHULQJHQ3DWWHUVRQ 6LPSVRQ

,WLVKRZHYHULPSRUWDQWWRQRWHWKDWWKHHPSLULFDOJURXQGVIRUWKLVUHPRYDO

KDYHEHHQTXHVWLRQHGHJ$EUDPRZLW] -DFRE\



(SLGHPLRORJ\RIREVHVVLYHFRPSXOVLYHGLVRUGHU

2&'KDVDELPRGDOGLVWULEXWLRQRIRQVHWZLWKRQHSHDNRFFXUULQJLQFKLOGKRRGHDUO\

DGROHVFHQFHDQGDQRWKHULQODWHDGROHVFHQFHHDUO\DGXOWKRRGZLWKWKHIRUPHUEHLQJ

PRUHFRPPRQLQPDOHVPRUHKHULWDEOHDQGPRUHFRPRUELGZLWKWLFVZKLOHWKHODWWHU

PD\ EH UHODWHG WR SRRUHU QHXURSV\FKRORJLFDO IXQFWLRQLQJ 7D\ORU D

3UHYDOHQFHUDWHVYDU\EHWZHHQVWXGLHVEXWPRVWHVWLPDWHVSRLQWWRZDUGDSUHYDOHQFH

RIDERXWWRLQFKLOGUHQDQGDGXOWVDOLNH$EUDPRZLW]HWDO*HOOHU

+RZHYHUDURXQGKDOIRIDOODGXOWVZLWK2&'UHSRUWRQVHWEHIRUHDGXOWKRRG

.HVVOHUHWDOVXJJHVWLQJWKDWWKHUHLVDJURXSRI\RXWKZLWK2&'WKDWUHPLW

VSRQWDQHRXVO\EHIRUHRUGXULQJDGXOWKRRG6WHZDUWHWDO3UHYDOHQFHUDWHVRI

2&'DUHVLPLODUDFURVVQDWLRQVDQGFXOWXUHV+RUZDWK :HLVVPDQ.HVVOHU

HW DO  :LOOLDPV &KDSPDQ 6LPPV  7HOODZL  ZLWK HYLGHQFH

VXJJHVWLQJERWKFURVVFXOWXUDOVLPLODULWLHVDQGGLIIHUHQFHVLQV\PSWRPH[SUHVVLRQ

1LFROLQL6DOLQ3DVFXDO&DEUHUD /DQ]DJRUWD:LOOLDPVHWDO

7KHPHVRIREVHVVLRQVDQGFRPSXOVLRQV

0XFK UHVHDUFK KDV EHHQ GHGLFDWHG WR PDNH VHQVH RI WKH KHWHURJHQHRXV DQG

LGLRV\QFUDWLFQDWXUHRIREVHVVLRQVDQGFRPSXOVLRQVZKLFKVSDQVDEURDGUDQJHRI

WKRXJKWVXUJHVEHKDYLRUVDQGPHQWDOLPDJHV0RVWRIWKLVUHVHDUFKKDVXVHGIDFWRU

RU SULQFLSDO FRPSRQHQW DQDO\WLF WHFKQLTXHV WR H[DPLQH V\PSWRP FKHFNOLVWV

W\SLFDOO\WKHV\PSWRPFKHFNOLVWRIWKH<DOH%URZQ 2EVHVVLYH&RPSXOVLYH6FDOH

<%2&6*RRGPDQHWDO7KHVHVWXGLHVKDYHFRQVLVWHQWO\IRXQGVHSDUDWH

IDFWRUV UHODWHG WR FRQWDPLQDWLRQ REVHVVLRQV DQG ZDVKLQJ FRPSXOVLRQV KRDUGLQJ

REVHVVLRQVDQGFRPSXOVLRQVDQGV\PPHWU\REVHVVLRQVDQGRUGHULQJFRPSXOVLRQV

%ORFK /DQGHURV:HLVHQEHUJHU 5RVDULR 3LWWHQJHU  /HFNPDQ  0DWDL[

&ROV5RVDULR&DPSRV /HFNPDQ$IRXUWKIDFWRUPDGHXSRISKHQRPHQD

UHODWHG WR IRUELGGHQ WKRXJKWV FKHFNLQJ EHKDYLRUV DQG PHQWDO FRPSXOVLRQV DOVR

IUHTXHQWO\ HPHUJHV +RZHYHU ZKLFK SKHQRPHQD WR LQFOXGH LQ WKLV IDFWRU DUH

LQFRQVLVWHQW DFURVV VWXGLHV ZLWKVHYHUDO VWXGLHVVXJJHVWLQJ WKDWWKLV IDFWRU LVEHVW

GLYLGHG LQWR WZR VHSDUDWH IDFWRUV ZLWK DJJUHVVLYH REVHVVLRQV DQG FKHFNLQJ

FRPSXOVLRQV EHLQJ RQH IDFWRU DQG VH[XDO DQG UHOLJLRXV REVHVVLRQV DQG UHODWHG

FRPSXOVLRQVDQRWKHUIDFWRU5RVDULR&DPSRVHWDO

7KHPDMRUV\PSWRPGLPHQVLRQVRI2&'KDYHEHHQVKRZQWREHWHPSRUDOO\VWDEOH

LQFKLOGUHQDQGDGXOWV)HUQDQGH]GHOD&UX]HWDO0DWDL[&ROV5DXFKHWDO

UHODWHGWRGLIIHUHQWQHXUDOVXEVWUDWHVLQDGXOWV0DWDL[&ROVHWDOYDQ

GHQ+HXYHOHWDODQGGLIIHUHQWLDOO\UHVSRQVLYHWRWUHDWPHQWLQFKLOGUHQDQG

DGXOWV 0DWDL[&ROV 0DUNV *UHLVW .REDN  %DHU  0F*XLUH 7DQ  3LDFHQWLQL:LOOLDPVHWDOEXWVHH6WRUFK0HUOR/DUVRQ%ORVVHWDO

IRUDVWXG\LQZKLFKV\PSWRPGLPHQVLRQVHYHULW\ZDVQRWUHODWHGWRRXWFRPH



LQ \RXWK ,W KDV DOVR EHHQ VKRZQ WKDW IRUELGGHQ WKRXJKWV DQG FRQWDPLQDWLRQ

V\PSWRPV DUH JHQHWLFDOO\ PRUH UHODWHG WR V\PSWRPV RI DQ[LHW\ WKDQ V\PPHWU\

V\PSWRPVZKLFKDUH PRUHJHQHWLFDOO\UHODWHGWRKRDUGLQJDQGERG\G\VPRUSKLF

V\PSWRPV/RSH]6RODHWDO)XUWKHUPRUHIRUDGXOWVWKHPDMRUV\PSWRP

GLPHQVLRQVRI2&'KDYHEHHQOLQNHGWRGLIIHUHQWSDWWHUQVRIFRPRUELGLW\ZLWKWLF

V\PSWRPV EHLQJ PRUH SUHYDOHQW LQ LQGLYLGXDOV ZLWK V\PPHWU\ V\PSWRPV HDWLQJ

GLVRUGHUVLQLQGLYLGXDOVZLWKFRQWDPLQDWLRQV\PSWRPVDQGGHSUHVVLRQDQGDQ[LHW\

LQ LQGLYLGXDOV ZLWK IRUELGGHQ WKRXJKWV +DVOHU HW DO  7RUUHV HW DO 

6WXGLHV UHJDUGLQJ OLQNV EHWZHHQ 2&' V\PSWRP GLPHQVLRQV DQG FRPRUELGLW\ LQ

\RXWK DUH IHZ EXW HYLGHQFH H[LVW IRU HOHYDWHG OHYHOV RI DQ[LHW\ DQG WLFV LQ

LQGLYLGXDOVZLWKIRUELGGHQWKRXJKWV+RMJDDUGHWDO1LNRODMVHQ1LVVHQ  7KRPVHQ  DQG DQ[LHW\ DQG GHSUHVVLRQ LQ LQGLYLGXDOV ZLWK V\PPHWU\

V\PSWRPV+RMJDDUGHWDO

7UHDWPHQWRIREVHVVLYHFRPSXOVLYHGLVRUGHU

3V\FKRORJLFDOWUHDWPHQW

3V\FKRORJLFDOWUHDWPHQWLQWKHIRUPRIH[SRVXUHEDVHGFRJQLWLYHEHKDYLRUDOWKHUDS\

&%7KDVUHFHLYHGVWURQJHPSLULFDOVXSSRUWDVDILUVWOLQHWUHDWPHQWIRU2&'LQ

FKLOGUHQDGROHVFHQWVDQGDGXOWV)RDHWDO2VW5LLVH:HUJHODQG+DQVHQ

.YDOH6NDSLQDNLV&DOGZHOO+ROOLQJZRUWK%U\GHQ)LQHEHUJ6DONRYVNLV

:HOWRQ %D[WHU .HVVOHU &KXUFKLOO HW DO  6NDSLQDNLV &DOGZHOO

+ROOLQJZRUWK%U\GHQ)LQHEHUJ6DONRYVNLV:HOWRQ%D[WHU.HVVOHU &KXUFKLOO

 7KH WUHDWPHQW LV SUHGLFDWHG RQ D PRGHO RI 2&' LQ ZKLFK V\PSWRPV DUH

PDLQWDLQHGE\QHJDWLYHO\UHLQIRUFHGEHKDYLRUVLHFRPSXOVLRQVDYRLGDQFHWKDW

SURYLGHVKRUWWHUPGLVWUHVVUHOLHIEXWORQJWHUPQHJDWLYHFRQVHTXHQFHVLQWKHIRUP

RIPRUHIUHTXHQWV\PSWRPVJUHDWHUDYRLGDQFHDQGUHLQIRUFHPHQWRIG\VIXQFWLRQDO

FRJQLWLYHEHOLHIV*KDVVHP]DGHK5RWKEDUW 3RVQHU7KHUHIRUHDNH\SDUW

RI&%7IRU2&'LVWKDWWKHSDWLHQWHQJDJHVLQH[SRVXUHDQGUHVSRQVHSUHYHQWLRQ

(53(53FRYHUVDUDQJHRIWHFKQLTXHVWKDWLQYROYHDVNLQJWKHSDWLHQWWRFRQIURQW

IHDUHG VWLPXOL RU VLWXDWLRQV LQ YLYR RU LPDJLQDU\ ZLWKRXW HQJDJLQJ LQ

QHXWUDOL]DWLRQFRPSXOVLRQVRUVDIHW\VHHNLQJEHKDYLRUVHJDYRLGDQFH7KLVLV

WKRXJKW WR OHDG WR KDELWXDWLRQ RI FRPSXOVLYHDYRLGDQFH UHVSRQVHV UHDSSUDLVDO RI

G\VIXQFWLRQDO FRJQLWLYH EHOLHIV DQG DWWHQXDWLRQ RU H[WLQFWLRQ RI HPRWLRQDO

SULPDULO\IHDUUHDFWLRQVWRWKHFRQIURQWHGVWLPXOLRUVLWXDWLRQV)RD 0F/HDQ



$SSUR[LPDWHO\RI\RXWKZLWK2&'ZKRFRPSOHWHDFRXUVHRIH[SRVXUHEDVHG

&%7UHDFKUHPLVVLRQ2VWHWDOZLWKVLPLODURXWFRPHVLQURXWLQHFDUHDVLQ



UDQGRPL]HGFRQWUROOHGWUHDWPHQWWULDOV5&7V)DUUHOO6FKOXS %RVFKHQ

0DVLHWDO9DOGHUKDXJ/DUVVRQ*|WHVWDP 3LDFHQWLQL/RQJWHUP

HIIHFWVDUHXQGHUH[DPLQHGEXWDSSUR[LPDWHO\WRRI\RXWKFRQWLQXHWR

KDYH2&'V\PSWRPVLQWKHFOLQLFDOUDQJHIROORZLQJWUHDWPHQW6WHZDUWHWDO

ZLWK VRPH LQGLYLGXDO VWXGLHV VKRZLQJ PRUH SURPLVLQJ UHVXOWV 0HOLQ

6NDUSKHGLQVVRQ6NDUVDWHU+DXJODQG ,YDUVVRQ

3KDUPDFRORJLFDOWUHDWPHQW

7KHUHLVUREXVWHYLGHQFHWKDWVHOHFWLYHVHURWRQLQUHXSWDNHLQKLELWRUV665,VDUHDQ

HIILFDFLRXV WUHDWPHQW IRU 2&' LQ FKLOGUHQ DGROHVFHQWV DQG DGXOWV ZLWK VLPLODU

HIIHFWV DFURVV GLIIHUHQW W\SHV RI 665,V +LUVFKWULWW %ORFK  0DWKHZV 

6NDSLQDNLV&DOGZHOO+ROOLQJZRUWK%U\GHQ)LQHEHUJ6DONRYVNLV:HOWRQ%D[WHU

.HVVOHU&KXUFKLOOHWDO,Q\RXWK665,VDVDPRQRWKHUDS\DUHVOLJKWO\OHVV

HIIHFWLYHWKDQFRPELQHGWUHDWPHQWZLWK&%7DQG665,V3HGLDWULF2&'7UHDWPHQW

6WXG\ 7HDP  )RU DGXOWV FORPLSUDPLQH LV DOVR UHFRJQL]HG DV DQ HIIHFWLYH

WUHDWPHQW+LUVFKWULWWHWDO7KHPHFKDQLVPVXQGHUO\LQJWKHHIIHFWLYHQHVVRI

665,V LQ 2&' DUH XQNQRZQ EXW LW KDV EHHQ VXJJHVWHG WKDW 665,V IRVWHU

UHHQJDJHPHQWRIQHXUDOQHWZRUNVLPSRUWDQWIRUFRJQLWLYHFRQWURODQGJRDOGLUHFWHG

DFWLRQV ZKLFK LQ WXUQ OHDGV WR LQFUHDVHG DELOLW\ WR ZLWKVWDQG XUJHV WR HQJDJH LQ

FRPSXOVLRQV5REELQVHWDO

3UHGLFWRUVRIWUHDWPHQWRXWFRPH

*LYHQWKHPRGHVWRXWFRPHVIRUERWK&%7DQG665,VLQSHGLDWULF2&'UHVHDUFKHUV

KDYHDWWHPSWHGWRLGHQWLI\LOOQHVVDQGSDWLHQWDQGIDPLO\FKDUDFWHULVWLFVWKDWSUHGLFW

WUHDWPHQWRXWFRPH$FURVVVWXGLHVWKHUHLVVRPHHYLGHQFHWKDWEDVHOLQHV\PSWRP

VHYHULW\ IXQFWLRQDO LPSDLUPHQW IDPLO\ DFFRPPRGDWLRQ RI WKH FKLOG¶V 2&'

V\PSWRPV DQG SV\FKLDWULF FRPRUELGLW\ SUHGLFW SRRUHU 2&' RXWFRPHV LQ \RXWK

UHFHLYLQJ &%7 DQGRU 665,V *DUFLD HW DO  *LQVEXUJ .LQJHU\ 'UDNH 

*UDGRV  /DYHOO )DUUHOO :DWHUV  &DGPDQ  6WRUFK 0HUOR /DUVRQ

*HIINHQHWDO7RUSHWDO)RUDGXOWVZLWK2&'KRDUGLQJV\PSWRPV

JUHDWHUEDVHOLQHVHYHULW\RI2&'DQGDQ[LHW\XQHPSOR\PHQWDQGEHLQJVLQJOHKDYH

EHHQVKRZQWRSUHGLFWDSRRUHUUHVSRQVHWRWUHDWPHQW.QRSS.QRZOHV%HH/RYHOO

%RZHU+RZHYHUDFURVVERWKWKHSHGLDWULFDQGDGXOW2&'OLWHUDWXUHWKHUH

LVFRQVLGHUDEOHYDULDELOLW\LQWKHFRGLQJVFKHPHVXVHGWRFODVVLI\WUHDWPHQWUHVSRQVH

DQG GLDJQRVWLF UHPLVVLRQ ZKLFK KDV OHG WR WKH GHYHORSPHQW RI LQWHUQDWLRQDOO\

UHFRJQL]HGFULWHULDIRUGHILQLQJUHVSRQVHDQGUHPLVVLRQLQ2&'WULDOV0DWDL[&ROV

HWDO



0RGHOVRIREVHVVLYHFRPSXOVLYHGLVRUGHU

*HQHWLFDQGHQYLURQPHQWDOFRQWULEXWLRQV

7KHUHLVDPSOHHYLGHQFHWKDW2&'UXQVLQIDPLOLHV3DXOV$EUDPRYLWFK5DXFK 

*HOOHUZLWKWKHGHJUHHRIFRQFRUGDQFHEHWZHHQUHODWLYHVLQFUHDVLQJZLWKWKH

GHJUHH RI JHQHWLF UHODWHGQHVV LH JUHDWHU OLNHOLKRRG RI 2&' LQ WKH ILUVW YHUVXV

VHFRQGRUWKLUGGHJUHHIDPLO\PHPEHUVRIDIIHFWHGSUREDQGV0DWDL[&ROVHWDO

7KHDYDLODEOHWZLQVWXGLHVVXJJHVWWKDWDGGLWLYHJHQHWLFIDFWRUVDFFRXQWIRU

DURXQGRIWKHYDULDWLRQLQ2&'DWWKHV\PSWRPDQGV\QGURPHOHYHO7D\ORU

E DQG QRQVKDUHG HQYLURQPHQWDO IDFWRUV IRU DURXQG  RI WKH YDULDWLRQ

OHDYLQJ D VPDOO SURSRUWLRQ H[SODLQHG E\ QRQDGGLWLYH JHQHWLF DQG VKDUHG

HQYLURQPHQWDOIDFWRUV3DXOVHWDO7D\ORUE7KHUHLVOLWWOHHYLGHQFH

IRUJHQGHUGLIIHUHQFHVLQKHULWDELOLW\EXWKHULWDELOLW\TXRWLHQWVDSSHDUWREHKLJKHU

IRUFKLOGKRRGWKDQDGXOW2&'$EUDPRZLW]HWDO7UDXPDWLFOLIHHYHQWV

HYHQWV UHODWHG WR WKH UHSURGXFWLYH F\FOH RI ZRPHQ HJ PHQDUFKH SRVWSDUWXP

PHQRSDXVHDQGSHULQDWDOFRPSOLFDWLRQVDUHDVVRFLDWHGZLWKDKLJKHUULVNIRU2&'

EXW VWXGLHV UHSRUWLQJ RQ HQYLURQPHQWDO ULVN IDFWRUV DUH RIWHQ PHWKRGRORJLFDOO\

FRQVWUDLQHG E\ XVH RI UHWURVSHFWLYH UHSRUWV DQG D IDLOXUH WR FRQWURO IRU JHQHWLF

FRQIRXQGLQJ%UDQGHU3HUH]9LJLO/DUVVRQ 0DWDL[&ROV

1HXURELRORJLFDOIUDPHZRUNV

7KHQXPEHURISXEOLVKHGQHXURLPDJLQJVWXGLHVRI2&'KDVEHHQJURZLQJVWHDGLO\

VLQFH WKH V SURGXFLQJ UHVXOWV WKDW DUH DUJXDEO\ DPRQJ WKH PRVW FRQVLVWHQW

DFURVVDOOSV\FKLDWULFGLVRUGHUV3DXOVHWDO6SHFLILFDOO\LQGLYLGXDOVZLWK

2&'PRVWRIWHQFRPSDUHGWRKHDOWK\FRQWUROVDUHURXWLQHO\IRXQGWRKDYHQHXUDO

DFWLYLW\ VXJJHVWLQJ G\VIXQFWLRQ LQ D FRUWLFRVWULDWRWKDODPRFRUWLFDO &67& IHHGEDFNPHFKDQLVPLQZKLFKDQLPEDODQFHEHWZHHQGLUHFWDQGLQGLUHFWSDWKZD\V

OHDGVWRK\SHUDFWLYDWLRQRISDWKZD\VEHWZHHQRUELWRIURQWDOUHJLRQVRIWKHFRUWH[

DQGVXEFRUWLFDOUHJLRQVRIWKHEUDLQ3DXOVHWDO7KHGLUHFWSDWKZD\LQYROYHV

WKHYHQWURPHGLDOSUHIURQWDOFRUWH[ZKLFKLVOLQNHGWRHPRWLRQDOSURFHVVLQJDQGWKH

LQGLUHFW SDWKZD\ GRUVDO DQWHULRU FLQJXODWH FRUWH[ ZKLFK LV OLQNHG WR FRJQLWLYH

FRQWURODQGGRZQUHJXODWLRQRIHPRWLRQ/LX%LOHN )LW]JHUDOG$FWLYDWLRQ

LQWKHGLUHFWSDWKZD\OHDGVWRH[FLWDWLRQRIFRUWH[UHJLRQVZKLOHDFWLYDWLRQRIWKH

LQGLUHFWSDWKZD\UHVXOWVLQGHFUHDVHGFRUWH[DFWLYDWLRQYDQGHQ+HXYHOHWDO

,WKDVEHHQVXJJHVWHGWKDWK\SHUDFWLYLW\LQWKHGLUHFWSDWKZD\ZLWKRXWDFWLYDWLRQRI

WKHLQKLELWRU\SURFHVVHVIURPWKHLQGLUHFWSDWKZD\OHDGVWRDIHHGEDFNORRSLQZKLFK

EUDLQDFWLYLW\UHODWHGWRHPRWLRQDOSURFHVVLQJJLYHVULVHWRWKHLQWUXVLYHTXDOLW\RI

REVHVVLRQV DQG WKH XUJH WR SHUIRUP FRPSXOVLRQV GHVSLWH UHFRJQLWLRQ WKDW WKHVH

FRPSXOVLRQVDUHPHDQLQJOHVVRUH[DJJHUDWHG/LXHWDO3DXOVHWDO



YDQ GHQ +HXYHO HW DO  (YHQ WKRXJK WKH EXON RI HYLGHQFH IRU &67&

G\VIXQFWLRQVLQ2&'FRPHVIURPUHVHDUFKZLWKDGXOWVWKHUHLVDJURZLQJERG\RI

HYLGHQFHIRUWKHPRGHODOVRLQSHGLDWULF2&'/LXHWDO

&RJQLWLYHEHKDYLRUDOPRGHOV

7KH PRVW LQIOXHQWLDO SV\FKRORJLFDO PRGHOV RI 2&' DUH FRJQLWLYH EHKDYLRUDO LQ

QDWXUHDQGDUHSUHGLFDWHGRQWKHQRWLRQWKDW2&'LVHVVHQWLDOO\DQDQ[LHW\GLVRUGHU

DQGDVVXFKFKDUDFWHUL]HGE\WKHSUHVHQFHRIH[DJJHUDWHGIHDUVDQGZRUULHVZKLFK

DUHDSSUDLVHGLQDKLJKO\FDWDVWURSKLFPDQQHUZLWKERWKWKHHPRWLRQDQGDSSUDLVDOV

GULYLQJ  WKH GHYHORSPHQW RI KLJKO\ LGHRJUDSKLF DYRLGDQFH DQG HVFDSH EHKDYLRUV

FRPSXOVLRQV $EUDPRZLW] HW DO  3URSRQHQWV RI WKLV DSSURDFK RIWHQ

KLJKOLJKW WKDW XQZDQWHG FRJQLWLYH LQWUXVLRQV RI VLPLODU FRQWHQW WR SDWLHQWV ZLWK

2&'DUHFRPPRQLQWKHJHQHUDOSRSXODWLRQ5DFKPDQ+HQFHWKHPRGHO

SODFHVDVWURQJHPSKDVLVRQKRZWKHVHLQWUXVLRQVDUHDSSUDLVHGDQGWKHDFWVEHOLHYHG

QHFHVVDU\WRSUHYHQWWKHIHDUHGRXWFRPHRUUHGXFHGLVWUHVVSDUWLFXODUO\WKHQHHGWR

SHUIRUPKLJKO\ULWXDOL]HGQHXWUDOL]LQJRUDYRLGDQFHEHKDYLRUV$EUDPRZLW]HWDO

 5DFKPDQ  5DFKPDQ  GH 6LOYD  $ UDQJH RI SRWHQWLDOO\

PDODGDSWLYH DSSUDLVDOV KDYH EHHQ IRXQG WR EH HOHYDWHG LQ LQGLYLGXDOV ZLWK 2&'

FRPSDUHG WR FRQWUROV DQG WR EH DVVRFLDWHG ZLWK 2&' VHYHULW\ LQFOXGLQJ WKH

OLNHOLKRRG RI IHDUHG RXWFRPHV FDXVDOLW\ HJ PDJLFDO WKLQNLQJ WKRXJKWDFWLRQ

IXVLRQH[DJJHUDWHGSHUVRQDOUHVSRQVLELOLW\IRUSUHYHQWLQJKDUPDQHHGWRFRQWURO

RQH¶V RZQ WKRXJKWV SHUIHFWLRQLVP DQG LQWROHUDQFH RI XQFHUWDLQW\ &DONLQV

%HUPDQ :LOKHOP+RZHYHUVXFKEHOLHIVDUHDOVRHOHYDWHGLQLQGLYLGXDOV

ZLWKDQ[LHW\GLVRUGHUVDQGGHSUHVVLRQ*HQWHV 5XVFLR7ROLQ:RUKXQVN\

0DOWE\

&RJQLWLYHEHKDYLRUDOPRGHOVRI2&'DOVRSODFHDVWURQJHPSKDVLVRQWKHFODVVLFDO

FRQGLWLRQLQJRIIHDUUHVSRQVHVLHXQUHLQIRUFHGQRUHDOKDUPRFFXUVH[SRVXUHVWR

IHDUHGVWLPXOLVLWXDWLRQVSURGXFHVLPPHGLDWHDQGORQJWHUPUHGXFWLRQVH[WLQFWLRQ LQWKHIHDUUHVSRQVHDQGWKXVUHGXFWLRQVLQWKHXUJHQHHGWRFDUU\RXWFRPSXOVLYH

EHKDYLRUVRUHQJDJHLQJHQHUDODYRLGDQFH)RD 0F/HDQ,WLVWKRXJKWWKDW

D E\SURGXFW RI WKH H[WLQFWLRQ SURFHVV RU SHUKDSV WKH PHFKDQLVP RI FKDQJH LV

FKDQJHVLQPDODGDSWLYHDSSUDLVDOVDERXWWKHOLNHOLKRRGRIKDUPPDJLFDOWKLQNLQJ

SHUVRQDO UHVSRQVLELOLW\ DQG WKH LQGLYLGXDO¶V DELOLW\ WR WROHUDWH GLVWUHVV )RD  0F/HDQ

5&7VRI2&'IRFXVHG&%7XVHLQWHUYHQWLRQVWKDWDUHEURDGO\EDVHGRQWKLVPRGHO

RIIHDUH[WLQFWLRQDYRLGDQFHUHGXFWLRQDQGPRGLILFDWLRQRIPDODGDSWLYHDSSUDLVDOV

$EUDPRZLW] HW DO  $GDSWDWLRQV IRU SHGLDWULF 2&' RIWHQ LQFOXGH

LQWHUYHQWLRQV DLPHG DW SDUHQWV WR UHGXFH IDPLOLDO DFFRPPRGDWLRQ DQG FRQIOLFW

/HERZLW]3DQ]D6X %ORFK2YHUDOOH[SRVXUHEDVHG&%7SURGXFHVODUJH

UHGXFWLRQVLQ2&'V\PSWRPVZLWKVPDOOGLIIHUHQFHVEHWZHHQWUHDWPHQWVWKDWGRDQG



GR QRW LQFOXGH PRUH IRUPDO FRJQLWLYH LQWHUYHQWLRQV 2ODWXQML 'DYLV 3RZHUV  6PLWV  2VW HW DO  6NDSLQDNLV &DOGZHOO +ROOLQJZRUWK %U\GHQ

)LQHEHUJ6DONRYVNLV:HOWRQ%D[WHU.HVVOHU&KXUFKLOOHWDO:KLOHIDPLO\

DFFRPPRGDWLRQDSSHDUVWREHDQLPSRUWDQWPRGHUDWRURISHGLDWULF2&'VHYHULW\

:XHWDOLWUHPDLQVXQFOHDUZKHWKHUWKHDGGLWLRQRIIDPLO\LQWHUYHQWLRQV

WDUJHWLQJVXFKDFFRPPRGDWLRQWRVWDQGDUGH[SRVXUHEDVHG&%7LPSURYHVRXWFRPHV

,QLHVWD6HS~OYHGD5RVD$OFi]DU6iQFKH]0HFD3DUDGD1DYDV 5RVD$OFi]DU



1HZHUSV\FKRORJLFDOPRGHOV

$FHQWUDOIHDWXUHRI2&'LVWKHLQDELOLW\RUJUHDWGLIILFXOW\WRLQKLELWFRPSXOVLYH

EHKDYLRUV GHVSLWH WKH VXIIHUHU¶V DZDUHQHVV WKDW WKH FRPSXOVLRQV DUH LQHIIHFWLYH

DQGRU H[FHVVLYH $PHULFDQ 3V\FKLDWULF $VVRFLDWLRQ  7R H[SODLQ WKLV

SKHQRPHQRQDJURZLQJERG\RIOLWHUDWXUHVXJJHVWVWKDW2&'PD\EHXQGHUSLQQHG

E\ DQ LPEDODQFH EHWZHHQ JRDOGLUHFWHG DQG KDELWXDO EHKDYLRUDO FRQWURO *LOODQ

5REELQV6DKDNLDQYDQGHQ+HXYHO YDQ:LQJHQ5REELQVHWDO,Q

WKLV PRGHO JRDOGLUHFWHG EHKDYLRUDO FRQWURO UHIHUV WR LQWHQWLRQDO EHKDYLRUV

FKDUDFWHUL]HG E\ RQJRLQJ HYDOXDWLRQV ZKLOH KDELWXDO EHKDYLRUDO FRQWURO UHIHUV WR

DXWRPDWL]HGEHKDYLRUVFDUULHGRXWZLWKRXWFRQVFLRXVDZDUHQHVVFRQWURO*LOODQ  6DKDNLDQ$FFRUGLQJWRWKHPRGHOFRQWURORIJRDOGLUHFWHGEHKDYLRUVLVWLPH

DQGDWWHQWLRQFRQVXPLQJEXWHQDEOHVEHKDYLRUDOIOH[LELOLW\KRZHYHUEHFDXVHRIWKH

³H[SHQVLYHQHVV´RIVXFKFRQWUROFHUWDLQEHKDYLRUVFDQEHFRPH³KDELWXDO´IUHHLQJ

FRJQLWLYH UHVRXUFHV *LOODQ HW DO  ,W LV DUJXHG WKDW DGDSWLYH IXQFWLRQLQJ

UHTXLUHV D IOH[LEOH LQWHJUDWLRQ RI JRDOGLUHFWHG DQG KDELWXDO EHKDYLRUDO FRQWURO

9RRQHWDO,Q2&'G\VIXQFWLRQVLQJRDOGLUHFWHGEHKDYLRUDOFRQWUROPD\

KHOSH[SODLQWKHDSSHDUDQFHDQGSHUVLVWHQFHRIKDELWVFRPSXOVLRQVGHVSLWHWKHVH

EHLQJ ERWK LQHIIHFWLYH DQG GLVWUHVVLQJ *LOODQ HW DO  )XUWKHU KDELWXDO

EHKDYLRUV DUH RIWHQ VWLPXOXVGULYHQ ZKLFK PD\ KHOS H[SODLQ ZK\ FRPSXOVLYH

EHKDYLRUVDUHRIWHQFORVHO\WLHGWRFHUWDLQFRQWH[WV.DODQWKURII+HQLN6LPSVRQ

7RGGHU $QKROW(YLGHQFHIRUDSUREDEOHLPEDODQFHEHWZHHQJRDOGLUHFWHG

DQGKDELWXDOEHKDYLRUDOFRQWUROKDVEHHQREVHUYHGLQDGXOWDQG\RXWK2&'VDPSOHV

*LOODQ 5REELQV*RWWZDOGHWDOEXWVWXGLHVDUHIHZDQGJHQHUDOO\

FDUULHGRXWZLWKVPDOOVDPSOHV

3DWKRORJLFDOOHYHOVRIGRXEWKDYHORQJEHHQUHFRJQL]HGDVLPSRUWDQWWR2&'ZLWK

D QXPEHU RIGLIIHUHQW SV\FKRORJLFDO PRGHOVHPHUJLQJWKDW HPSKDVL]H WKH UROH RI

GRXEWLQWKHHWLRORJ\DQGPDLQWHQDQFHRIWKHGLVRUGHU1HVWDGWHWDO$FURVV

PRGHOVSDWKRORJLFDOOHYHOVRIGRXEWDUHWKRXJKWWRDULVHIURPGHILFLWVLQWKHDELOLW\

WR DFFHVV LQWHUQDO VWDWHV LH FRJQLWLYH DIIHFWLYH YLVFHUDO 7KLV GHILFLW OHDGV WR

G\VIXQFWLRQDOGHFLVLRQPDNLQJDQGDQRYHUUHOLDQFHRQH[WHUQDOSUR[LHVDQGKHQFH

WKH UHSHWLWLYH EHKDYLRUDO URXWLQHV RIWHQ VHHQ LQ 2&' HJ FKHFNLQJ WKH ORFN



PXOWLSOHWLPHVUHSHDWHGZDVKLQJ,QVWXGLHVLQYROYLQJQRQFOLQLFDO/D]DURY'DU

2GHG /LEHUPDQDQGFOLQLFDOJURXSV/D]DURY/LEHUPDQ+HUPHVK 'DU

 SDUWLFLSDQWV KLJK RQ REVHVVLYHFRPSXOVLYH V\PSWRPDWRORJ\ RU WKRVH ZKR

KDG 2&' UHOLHG PRUH RQ IDOVH H[WHUQDO IHHGEDFN VLJQDOV DQG SHUIRUPHG ZRUVH

ZLWKRXW WKH KHOS RI VXFK IHHGEDFN WKDQ WKRVH ZKR ZHUH ORZ RQ REVHVVLYH

FRPSXOVLYHV\PSWRPDWRORJ\KDGDQ[LHW\GLVRUGHUVEXWQRW2&'DQGQRQFOLQLFDO

FRQWUROV

7KHVHWZRPRGHOVVKRZWKDWDVSHFWVRI2&'RWKHUWKDQIHDUKDYHEHHQSURSRVHGDV

LPSRUWDQWWRWKHHWLRORJ\DQGPDLQWHQDQFHRIWKHGLVRUGHU7KHGHYHORSPHQWDQG

WHVWLQJRIPRGHOVWKDWLQFRUSRUDWHVRXUFHVRIPRWLYDWLRQRWKHUWKDQIHDUDORQHLV

QHHGHG DQG PD\ KHOS LPSURYH RXU XQGHUVWDQGLQJ RI WKH KLJKO\ KHWHURJHQHRXV

V\PSWRP SUHVHQWDWLRQ FRXUVH DQG WUHDWPHQW UHVSRQVH IRXQG LQ LQGLYLGXDOV ZLWK

2&'2XLPHW$VKEDXJK 5DGRPVN\

(PRWLRQ

(PRWLRQLVFHQWUDOWRKXPDQH[SHULHQFHDQGEHKDYLRUDQGHPEHGGHGLQGD\WRGD\

OHDUQLQJDQGGHFLVLRQPDNLQJ/HUQHU/L9DOGHVROR .DVVDP,WVWURQJO\

LQIOXHQFHV SHUFHSWLRQ DQG FRJQLWLRQ 'DPDVLR  &DUYDOKR  :RUPZRRG

6LHJHO.RSHF4XLJOH\ %DUUHWWDQGDFWVDVDOLQNEHWZHHQH[WHUQDODQG

LQWHUQDO FXHV DQG EHKDYLRUDO UHVSRQVHV .ULQJ  7KH VWURQJ WLH EHWZHHQ

HPRWLRQDQGEHKDYLRUKDVORQJEHHQUHFRJQL]HGHJ'DUZLQ+XPH

-DPHVDQGPDNHVHPRWLRQFHQWUDOWRXQGHUVWDQGDGDSWLYHDQGQRQDGDSWLYH

KXPDQ IXQFWLRQLQJ /DQJ  $ SUHGRPLQDQW YLHZ RQ HPRWLRQV LV WKDW WKH\

FRQVLVWRIDVHWRIEDVLFELRORJLFDOµHQWLWLHV¶WKDWZHVKDUHZLWKRWKHUPDPPDOVDQG

ZKLFKKDYHEHHQVHOHFWHGDQGVKDSHGE\QDWXUDOVHOHFWLRQEHFDXVHWKH\PRWLYDWH

FRJQLWLYHDQGEHKDYLRUDOUHVSRQVHVWKDWIRVWHUVVXUYLYDODQGUHSURGXFWLRQ(NPDQ

 (YHQ WKRXJK LW LV LQWHQVHO\ GHEDWHG ZKHWKHU HPRWLRQV FDQ EH FRQVLGHUHG

³EDVLF´ HJ /LQGTXLVW :DJHU .REHU %OLVV0RUHDX  %DUUHWW  WKH

SURPLQHQW UROH WKDW HPRWLRQ SOD\V LQ UHODWLRQ WR KXPDQ EHKDYLRU LV ZLGHO\

DFNQRZOHGJHG/HUQHUHWDO

(PRWLRQLQREVHVVLYHFRPSXOVLYHGLVRUGHU

$VGHVFULEHGDERYHWKHGRPLQDQWSV\FKRORJLFDOPRGHORI2&'DQGLWVWUHDWPHQW KDVYLHZHG2&'DVMXVWDQRWKHUNLQGRIDQ[LHW\GLVRUGHUFKDUDFWHUL]HGE\UHSHWLWLYH

DQGULWXDOL]HGDYRLGDQFHEHKDYLRUVWKDWDUHGULYHQE\DKLJKIUHTXHQF\RILQWUXVLYH

WKRXJKWV RI D IHDUIXO QDWXUH DQG PDODGDSWLYH DSSUDLVDOV DERXW WKHLU PHDQLQJ

$EUDPRZLW]HWDO7KLVPRGHOLVDOVRHPEHGGHGLQWKHWUHDWPHQWRI2&'



WKDWUHVWVKHDYLO\RQLQYLYRH[SRVXUHWRIHDUHGVWLPXOLZKLOHDVNLQJWKHSDWLHQWWR

UHIUDLQ IURP FRPSXOVLRQV DQG VDIHW\VHHNLQJ EHKDYLRUV ,Q WKH SDVW GHFDGH WKH

YDOLGLW\RIWKLVIHDUIRFXVHGPRGHORI2&'KDVEHHQTXHVWLRQHGDQGH[SDQGHGXSRQ

E\ UHVHDUFKHUV ZKR KDYH KLJKOLJKWHG WKH UROH RI RWKHU HPRWLRQV 2XLPHW HW DO

7KLVWKHVLVFRQFHUQVLWVHOIZLWKWKHUROHSOD\HGE\IHDUKDUPDYRLGDQFH

LQFRPSOHWHQHVVDQGGLVJXVWLQUHODWLRQWRSHGLDWULF2&'

7KH&RUH'LPHQVLRQV0RGHO

2QHRIWKHFULWLTXHVRIWUDGLWLRQDOFRJQLWLYHEHKDYLRUDOPRGHOVRI2&'LVWKDWWKH\

GR QRW DGHTXDWHO\ DGGUHVV WKH IHDWXUHV RI 2&' WKDW GLVWLQJXLVK LW IURP RWKHU

GLVRUGHUVFKDUDFWHUL]HGE\KLJKOHYHOVRIIHDUHJDQ[LHW\GLVRUGHUV,QSDUWLFXODU

WKHWUDGLWLRQDOPRGHOVGRQRWDGGUHVVWKHRFFXUUHQFHRIREVHVVLRQVDQGFRPSXOVLRQV

WKDWDSSHDUGULYHQQRWE\IHDUEXWDQHHGIRUWKLQJVEHLQJ³FRPSOHWH´RU³MXVWULJKW´

RU EHFDXVH RI LQWHQVH IHHOLQJV RI GLVJXVW RU PRUDO DEKRUUHQFH ,Q UHODWLRQ WR WKH

IRUPHUDQGWREHWWHUH[SODLQWKHUHSHWLWLYHDQGULWXDOL]HGFKHFNLQJRUGHULQJDQG

V\PPHWU\ URXWLQHV RIWHQ VHHQ LQ 2&' LQFUHDVLQJ DWWHQWLRQ KDV EHHQ GLUHFWHG

WRZDUGV WKH HPRWLRQDO H[SHULHQFH RI LQFRPSOHWHQHVV ,QFRPSOHWHQHVV UHIHUV WR D

IHHOLQJRIGLVVDWLVIDFWLRQZLWKWKLQJVEHLQJ³QRWMXVWULJKW´DQGDQHPRWLRQDOXUJHWR

DFWLQRUGHUWRDGMXVWVWLPXOLLQWKHH[WHUQDORULQWHUQDOHQYLURQPHQWZLWKWKHJRDOWR

UHDFKDVHQVHRIFRPSOHWHQHVV3DOODQWL%DUQHV3LWWHQJHU (LVHQ7KHUHLV

HYLGHQFHWKDWDIHOWVHQVHRILQFRPSOHWHQHVVDWWKHWUDLWOHYHOLVSDUWO\KHULWDEOH6LFD

%RWWHVL&DXGHN2UVXFFL *KLVLDQGDVVRFLDWHGZLWKQHXUDOFRUUHODWHVWKDW

GLIIHUIURPWKRVHXVXDOO\REVHUYHGLQLQGLYLGXDOVGXULQJIHDUFKDOOHQJHVDQGZLWK

DQ[LHW\SUREOHPV%URZQHWDO

%XLOGLQJ XSRQ LGHDV IURP WKH )UHQFK QHXURORJLVW 3LHUUH -DQHW ZKR OLQNHG WKH

H[SHULHQFH RI LQFRPSOHWHQHVV WR 2&' RYHU D FHQWXU\ DJR 3LWPDQ 

6XPPHUIHOGWSURSRVHGDPRGHOLQZKLFKIHDUWHUPHG³KDUPDYRLGDQFH´LQ

WKH PRGHO DQG LQFRPSOHWHQHVV VKRXOG EH FRQVLGHUHG DV WZR FRUH GLPHQVLRQDO

PRWLYDWLRQDOSURFHVVHVLQ2&'HDFKFRQWULEXWLQJWRWKHVHYHULW\DQGKHWHURJHQHLW\

RIWKHGLVRUGHU,QVXSSRUWRIWKHPRGHOVWXGLHVKDYHIRXQGWKDWWUDLWLQFRPSOHWHQHVV

LVHOHYDWHGLQLQGLYLGXDOVZLWK2&'FRPSDUHGWRLQGLYLGXDOVZLWKDQ[LHW\GLVRUGHUV

&KLN&DODPDUL5HFWRU 5LHPDQQ(FNHU.XSIHU *|QQHU*KLVL

&KLUL0DUFKHWWL6DQDYLR 6LFDDQGJDPEOLQJDQGHDWLQJGLVRUGHUV6LFDHW

DO  XQLTXHO\ UHODWHG WR FRPSXOVLYH XUJHV GXULQJ EHKDYLRUDO WDVNV LQ QRQ

FOLQLFDOVDPSOHV&RXJOH)LWFK-DFREVRQ /HH3LHWUHIHVD &ROHV

UHODWHGWR2&'V\PSWRPVDIWHUFRQWUROOLQJIRUKDUPDYRLGDQFHDQGFRRFFXUULQJ

SV\FKLDWULFV\PSWRPVLQFOLQLFDO(FNHU *RQQHUDQGQRQFOLQLFDOVDPSOHV

%HOORFKHWDOPRUHVWURQJO\UHODWHGWR2&'WKDQWRJHQHUDOGLVWUHVV7D\ORU

HWDODQGUHGXFHGDVDQHIIHFWRI2&'WUHDWPHQW&ROHV 5DYLG

)XUWKHULQFRPSOHWHQHVVUHODWHGH[SHULHQFHVKDYHEHHQUHSRUWHGGXULQJV\PSWRPV



LQRYHURIDGXOWSDWLHQWVZLWK2&')HUUDRHWDO+RZHYHUWRGDWHDOO

VWXGLHV RQ LQFRPSOHWHQHVV KDYH EHHQ IRFXVHG RQ DGXOWV DQG XVXDOO\ QRQFOLQLFDO

VDPSOHV 7KHUHIRUH OLWWOH LV NQRZQ DERXW WKH UHODWLRQVKLS RI WKLV YDULDEOH WR WKH

V\PSWRPV RI 2&' LQ SHGLDWULF VDPSOHV DQG LQGHHG ZKHWKHU LQFRPSOHWHQHVV

GLVWLQJXLVKHV\RXWKZLWK2&'IURPWKRVHZLWKDQ[LHW\GLVRUGHUV

'LVJXVW

$QRWKHUHPRWLRQLQFUHDVLQJO\OLQNHGWR2&'DQGWRRWKHUSV\FKLDWULFGLVRUGHUVLV

GLVJXVW .QRZOHV -HVVXS  2ODWXQML  7KH IHHOLQJ RI GLVJXVW LV JOREDOO\

DFNQRZOHGJHGDQGFRQVLGHUHGRQHRIWKHEDVLFHPRWLRQVOLQNHGWRWKHQHHGWRDYRLG

LQIHFWLRXV DQG QR[LRXV VXEVWDQFHV 'DYH\  +RZHYHU GLVJXVW SURQHQHVV

ZKLFKUHIHUVWRWKHGHJUHHWRZKLFKDQLQGLYLGXDOUHDFWVZLWKGLVJXVWDQGKRZWKHVH

UHDFWLRQV DUH DSSUDLVHG 2ODWXQML (EHVXWDQL  .LP  YDU\ EHWZHHQ

LQGLYLGXDOVZLWKDERXWKDOIRIWKLVYDULDWLRQEHLQJDWWULEXWHGWRJHQHWLFFRQWULEXWLRQV

6KHUORFN=LHWVFK7\EXU -HUQ+LJKGLVJXVWSURQHQHVVKDVEHHQSURSRVHG

WRDFWDVDYXOQHUDELOLW\IDFWRUIRUWKHGHYHORSPHQWRI2&'DQGDQ[LHW\GLVRUGHUV

SDUWLFXODUO\LQUHODWLRQWRFRQWDPLQDWLRQEDVHGV\PSWRPV2ODWXQML7DUW&LHVLHOVNL

0F*UDWK 6PLWV

$JURZLQJERG\RIHPSLULFDOVWXGLHVVXSSRUWVWKHQRWLRQWKDWGLVJXVWSURQHQHVVLV

HOHYDWHGLQSV\FKLDWULFSRSXODWLRQV.QRZOHVHWDO2ODWXQML$UPVWURQJ  (OZRRGEXWZKHWKHULWVKRZVVSHFLILFLW\WR2&'LVXQFHUWDLQ0HOOL3ROL

&KLRUUL  2ODWXQML  ,Q UHODWLRQ WR FKLOGUHQ DQG DGROHVFHQWV SRVLWLYH

FRUUHODWLRQV EHWZHHQ GLVJXVW SURQHQHVV DQG 2&' V\PSWRPV KDYH EHHQ IRXQG LQ

QRQFOLQLFDOSRSXODWLRQVEXWHTXDOO\RUVWURQJHUFRUUHODWLRQVZHUHIRXQGLQUHODWLRQ

WRDQ[LHW\SKRELFV\PSWRPV0XULVYDQGHU+HLGHQ 5DVVLQ,QFOLQLFDO

VDPSOHV DQ DVVRFLDWLRQ EHWZHHQ GLVJXVW DQG 2&' KDV EHHQ IRXQG HYHQ ZKHQ

FRQWUROOLQJ IRU JHQHUDO GLVWUHVV 2ODWXQML (EHVXWDQL .LP 5LHPDQQ  -DFREL

DQGGLVJXVWSURQHQHVVKDVEHHQIRXQGWREHUHGXFHGDVDQHIIHFWRIWUHDWPHQW

IRU2&'DQGDQ[LHW\.QRZOHVHWDO7DERDV2MVHUNLV 0F.D\

$EURDGHUHPRWLRQIUDPHZRUNDQGOLQNVWRRXWFRPH

(YHQ WKRXJK PDODGDSWLYH HPRWLRQDO IXQFWLRQLQJ PD\ EH FRQVLGHUHG RQH RI WKH

GHILQLQJIHDWXUHVRI2&'DQGPD\EHRIKLJKUHOHYDQFHWRWKHRQVHWDQGPDLQWHQDQFH

RI LWV V\PSWRPV HPRWLRQ LQYROYHPHQW LQ SHGLDWULF 2&' KDV UHFHLYHG YHU\ OLWWOH

UHVHDUFKDWWHQWLRQ$VVWDWHGDERYHQRVWXGLHVH[LVWWKDWH[DPLQHWKHSRWHQWLDOUROH

RILQFRPSOHWHQHVVLQSHGLDWULF2&',QDGGLWLRQLQFRPSOHWHQHVVDQGGLVJXVWKDYH

QHYHUEHHQH[DPLQHGFRQMRLQWO\LQFOLQLFDOVDPSOHVHLWKHUFKLOGUHQRUDGXOWV$OVR

WKHGHJUHHWRZKLFKLQFRPSOHWHQHVVRUGLVJXVWDUHUHOHYDQWWRRXWFRPHVLQWUHDWPHQW

IRU2&'KDVQRWEHHQH[DPLQHGHLWKHULQFKLOGUHQRUDGXOWV7KLVLVDSRWHQWLDOO\



LPSRUWDQWJDSLQWKHOLWHUDWXUHJLYHQWKDWQRWDOOLQGLYLGXDOVZLWK2&'EHQHILWIURP

WKHILUVWOLQHUHFRPPHQGHGWUHDWPHQWH[SRVXUHEDVHG&%7ZKLFKGUDZVXSRQD

IHDUFHQWULFPRGHORI2&'+HQFHLWLVSRVVLEOHWKDWSDWLHQWVZLWK2&'V\PSWRPV

WKDWDUHQRWGULYHQE\IHDUPD\UHVSRQGPRUHSRRUO\WRWKHWUDGLWLRQDOIHDUIRFXVHG

&%7 DSSURDFKHV )XUWKHU D PDMRULW\ RI VWXGLHV KDYH H[DPLQHG HPRWLRQ

LQYROYHPHQWXVLQJPHDVXUHVWKDWFDSWXUHVJHQHUDOWUDLWOLNHSURQHQHVVIRUGLIIHUHQW

HPRWLRQV:KLOHLPSRUWDQW WKLV LV QRWWKHVDPH DV WKH GHJUHH WR ZKLFKGLIIHUHQW

HPRWLRQDO H[SHULHQFHV DUH GLUHFWO\ LQYROYHG LQ V\PSWRPV ZLWK WKH ODWWHU KDYLQJ

SRWHQWLDOVWURQJHULPSOLFDWLRQVIRUHWLRORJLFDOPRGHOVDQGWUHDWPHQW7DNHQWRJHWKHU

UHVHDUFK LV QHHGHG WKDW D H[DPLQHV ZKHWKHU D IHDUEDVHG PRGHO LV DGHTXDWH LQ

H[SODLQLQJ WKH V\PSWRPV RI SHGLDWULF 2&' E FRQMRLQWO\ H[DPLQHV IHDU

LQFRPSOHWHQHVVDQGGLVJXVWFLQYHVWLJDWHVHPRWLRQLQYROYHPHQWLQV\PSWRPVQRW

MXVW DW WUDLWOHYHO SURQHQHVV IRU WKHVH HPRWLRQV DQG G H[DPLQHV LI HPRWLRQ

LQYROYHPHQWLQV\PSWRPVLVDVVRFLDWHGZLWKWUHDWPHQWRXWFRPH

$LPV

7KH SULPDU\ DLPV RI WKH SUHVHQW WKHVLV DUH WR H[DPLQH WR ZKLFK GHJUHH IHDU

LQFRPSOHWHQHVVDQGGLVJXVWDWWKHWUDLWDQGVWDWHOHYHODFDQEHYDOLGO\PHDVXUHG

LQ FKLOGUHQ DQG DGROHVFHQWV E DUH UHODWHG WR WKH RYHUDOO VHYHULW\ RI 2&' DQG

VHYHULW\RIWKHPDLQ2&'V\PSWRPGLPHQVLRQVFGLVFULPLQDWH\RXWKZLWK2&'

IURPWKRVHZLWKDQ[LHW\GLVRUGHUVDQGQR2&'DQGIURP\RXWKZLWKQRSV\FKLDWULF

GLVRUGHUDQGGSUHGLFWRXWFRPHVIRU\RXWKXQGHUJRLQJWUHDWPHQWIRU2&'7KHVH

DLPV ZHUH LQYHVWLJDWHG WKURXJK D VHULHV RI GDWDGULYHQ VWXGLHV ZLWK WKH UHVXOWV

DSSHDULQJDFURVVILYHGLIIHUHQWSDSHUV

6SHFLILF DLPV IRU 3DSHU  DQG 3DSHU  DUH WR H[DPLQH WKH YDOLGLW\ RI PHDVXUHV

GHYHORSHGWRDVVHVVWKHGLPHQVLRQDOLW\RI2&'DQGWKHWUDLWDQGVWDWHOHYHOVRIIHDU

LQFRPSOHWHQHVVDQGGLVJXVW7KHVSHFLILFDLPIRU3DSHULVWRH[DPLQHZKHWKHU

VHOIUHSRUWHGWUDLWOHYHOIHDULQFRPSOHWHQHVVDQGGLVJXVWDUHUHODWHGWRGLDJQRVWLF

VWDWXV 2&' YV DQ[LHW\ GLVRUGHUV YV QR SV\FKLDWULF GLVRUGHU V\PSWRP VHYHULW\

2&'DQ[LHW\GHSUHVVLRQ2&'V\PSWRPGLPHQVLRQVHYHULW\DQGFKDQJHLQ2&'

V\PSWRPVIROORZLQJWUHDWPHQW7KHVSHFLILFDLPRI3DSHULVWRH[DPLQHZKHWKHU

VWDWHOHYHOVRIIHDULQFRPSOHWHQHVVDQGGLVJXVWGXULQJ2&'V\PSWRPVLVUHODWHGWR

2&' V\PSWRP VXEW\SH DJJUHVVLYH V\PPHWU\ FRQWDPLQDWLRQ DQG GLVFULPLQDWH

\RXWKZLWK2&'IURPWKRVHZLWKJHQHUDOL]HGDQ[LHW\GLVRUGHUDQGVRFLDODQ[LHW\

GLVRUGHU7KHVSHFLILFDLPIRU3DSHULVWRH[DPLQHZKHWKHUVWDWHOHYHOLQYROYHPHQW

RI IHDU LQFRPSOHWHQHVV DQG GLVJXVW LQ 2&' V\PSWRPV DW SUHWUHDWPHQW SUHGLFW

SRVWWUHDWPHQWRXWFRPHVIRU\RXWKXQGHUJRLQJWUHDWPHQWIRU2&'



0HWKRGV

3DUWLFLSDQWVSURFHGXUHDQGHWKLFV

'DWDIRUWKLVWKHVLVZDVFROOHFWHGIURPFOLQLFDOO\UHIHUUHGFKLOGUHQDQGDGROHVFHQWV

ZLWK 2&' DQG DQ[LHW\ GLVRUGHUV DQG QRQUHIHUUHG \RXWK ZLWK QR SV\FKLDWULF

GLVRUGHU 3DUWLFLSDQWV ZLWK 2&' DQG DQ[LHW\ GLVRUGHUV ZHUH UHFUXLWHG IURP D

VSHFLDOL]HG FKLOG DQG DGROHVFHQW SV\FKLDWULF RXWSDWLHQW FOLQLF LQ /XQG 6ZHGHQ

ZKHUHWKHDXWKRULVHPSOR\HGDVDFOLQLFDOSV\FKRORJLVW<RXWKZLWKQRSV\FKLDWULF

GLVRUGHU ZHUH UHFUXLWHG IURP /XQGDUHD VFKRROV &OLQLFDO SV\FKRORJLVWV ZLWK

H[SHULHQFHLQWKHDVVHVVPHQWDQGWUHDWPHQWRISHGLDWULF2&'DQGDQ[LHW\GLVRUGHUV

FDUULHG RXW WKH LQWHUYLHZEDVHG DVVHVVPHQWV DW WKH ILUVW DVVHVVPHQW DW WKH FOLQLF

EDVHOLQHDQGDJDLQDWIROORZXS2QO\\RXWKZLWK2&'ZHUHIROORZHGXSIRUWKH

SXUSRVHVRIWKHSUHVHQWVWXGLHV2IWKHIROORZXSDVVHVVPHQWVZHUHFDUULHG

RXWDWWKHFOLQLFDQGE\SKRQH<RXWKZLWKDPHQWDOGLVRUGHUWKDWUHTXLUHGPRUH

XUJHQWWUHDWPHQWWKDQ2&'RUDQDQ[LHW\GLVRUGHUDQG\RXWKZLWKLQWHOOHFWXDODQG

ODQJXDJH GLIILFXOWLHV ZHUH H[FOXGHG 1R RWKHU H[FOXVLRQ FULWHULD ZHUH XVHG 7KH

VWXG\ZDVUHYLHZHGDQGDSSURYHGE\WKHUHJLRQDOHWKLFVFRPPLWWHH'QU

'QUDQGDOOSDUWLFLSDQWVDQGWKHLUFDUHJLYHUVSURYLGHGZULWWHQLQIRUPHG

FRQVHQW

0HDVXUHVDWEDVHOLQHDQGIROORZXS

,QWHUYLHZEDVHGPHDVXUHV

Mini International Neuropsychiatric Interview for Children and Adolescents (MINI- KID)

7KH SUHVHQFH RUDEVHQFHRI WKHPRVW FRPPRQ PHQWDO GLVRUGHUV LQFKLOGUHQZHUH

DVVHVVHGXVLQJWKH0,1,.,'6KHHKDQHWDO7KH0,1,.,'LVEDVHGRQ

'60,9GLDJQRVWLFFULWHULDDQGKDVVKRZQVRXQGSV\FKRPHWULFSURSHUWLHVLQFKLOG

DQGDGROHVFHQWFOLQLFDOVHWWLQJVLQFOXGLQJLQD6ZHGLVKFOLQLFDOFRQWH[W+|JEHUJHW

DO2QO\VOLJKWPRGLILFDWLRQVZHUHQHHGHGWRWKH0,1,.,'WRKDUPRQL]H

WKLVDVVHVVPHQWZLWKWKH'60FULWHULDIRU2&'DQGWKHDQ[LHW\GLVRUGHUVLH



VHSDUDWLRQDQ[LHW\GLVRUGHUVRFLDODQ[LHW\GLVRUGHUJHQHUDOL]HGDQ[LHW\GLVRUGHU

VSHFLILFSKRELDSDQLFGLVRUGHUDQGWKHVHPRGLILFDWLRQVZHUHXQGHUWDNHQSULRUWR

DQ\LQWHUYLHZVZLWKWKHVFDOH

Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS)

7REHWWHUFDSWXUHWKHUROHSOD\HGE\HPRWLRQLQWKHPDMRUV\PSWRPGLPHQVLRQVRI

2&'DOOSDUWLFLSDQWVZLWK2&'ZHUHLQWHUYLHZHGZLWKWKH'<%2&67KLVVFDOH

PHDVXUHV 2&' GLPHQVLRQDOLW\ \LHOGLQJ LQGLYLGXDO VFRUHV  WLPH GLVWUHVV

LQWHUIHUHQFH IRU DJJUHVVLYH VH[XDOUHOLJLRXV V\PPHWU\ FRQWDPLQDWLRQ DQG

PLVFHOODQHRXVV\PSWRPV,QLWVRULJLQDOYHUVLRQWKH'<%2&6FRQVLVWVRIDVHOI

UHSRUW FKHFNOLVW DQG DQ LQWHUYLHZEDVHG VHFWLRQ ,W KDV VRXQG SV\FKRPHWULF

SURSHUWLHVLQ\RXWKVDQGDGXOWVZLWK2&'*DUFLD'HOJDUHWDO*XOHUHWDO

 5RVDULR&DPSRV HW DO  ,Q WKH SUHVHQW VWXGLHV RQO\ WKH LQWHUYLHZ

SRUWLRQRIWKH'<%2&6LVXVHGZLWKLWVFOLQLFDOXWLOLW\DQGSV\FKRPHWULFSURSHUWLHV

UHSRUWHGXSRQLQ3DSHU

Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS)

7KHRYHUDOOVHYHULW\RI2&'V\PSWRPVZDVPHDVXUHGZLWKWKH&<%2&67KLVLV

DLWHPLQWHUYLHZEDVHGVFDOHZKHUHWLPHLQWHUIHUHQFHGLVWUHVVUHVLVWDQFHDQG

FRQWURO DUH VFRUHG VHSDUDWHO\ IRU WKH PRVW SURPLQHQW FXUUHQW REVHVVLRQV DQG

FRPSXOVLRQV(DFKLWHPLVVFRUHGRQDVFDOH\LHOGLQJDQRYHUDOOVFRUHRIWR

 ZLWK KLJKHU VFRUHV LQGLFDWLQJ PRUH VHYHUH 2&' 7KH &<%2&6 KDV VRXQG

SV\FKRPHWULF SURSHUWLHV LQFOXGLQJ LQ D 6ZHGLVK FOLQLFDO FRQWH[W )UHHPDQ

)OHVVQHU *DUFLD6FDKLOOHWDO9DOGHUKDXJ ,YDUVVRQ

Obsessive-Compulsive Core Dimensions Interview (OC-CDI)

7KH 2&&', LV D FOLQLFLDQOHG LQWHUYLHZ GHYHORSHG WR DVVHVV WKH VWDWHOHYHO

LQYROYHPHQWRIIHDUDQGLQFRPSOHWHQHVVLQ2&'V\PSWRPV)RUWKHSXUSRVHVRIWKH

SUHVHQWVWXGLHVWKHLQWHUYLHZZDVPRGLILHGVRWKDWLWDOVRLQFOXGHGDQDVVHVVPHQWRI

GLVJXVW)RU\RXWKZLWK2&'HPRWLRQLQYROYHPHQWIHDULQFRPSOHWHQHVVGLVJXVW LQV\PSWRPVDFURVVDOOGLPHQVLRQVDIILUPHGGXULQJWKH'<%2&6LQWHUYLHZZDV

DVVHVVHGUHVXOWLQJLQVWDWHOHYHOVFRUHVIRUHDFKHPRWLRQDWWKH2&'GLPHQVLRQ

VSHFLILF OHYHO DQG DW DQ RYHUDOO DJJUHJDWHG OHYHO )RU SDUWLFLSDQWV ZLWK VRFLDO

DQ[LHW\ GLVRUGHU DQG JHQHUDOL]HG DQ[LHW\ GLVRUGHU WKH 2&&', ZDV PRGLILHG WR

DVVHVVWKHVDPHWKUHHHPRWLRQVLQWKHLUDQ[LHW\V\PSWRPVDVGHILQHGE\'60

(YLGHQFHIRUWKHFOLQLFDOXWLOLW\DQGYDOLGLW\RIWKH2&&',DUHSUHVHQWHGLQ3DSHU





6HOIUHSRUWPHDVXUHV

Obsessive Compulsive Core Dimensions Questionnaire (OCTCDQ)

7KH 2&7&'4 LV D LWHP VHOIUHSRUW PHDVXUH ZLWK  LWHPV HDFK FRYHULQJ

HYHU\GD\WUDLWH[SHULHQFHVRIKDUPDYRLGDQFHDQGLQFRPSOHWHQHVV(DFKLWHPLV

VFRUHG RQ D  VFDOH ZLWK KLJKHU UDWLQJV FRUUHVSRQGLQJ WR PRUH IUHTXHQW

H[SHULHQFHVRIKDUPDYRLGDQFHDQGLQFRPSOHWHQHVVLHKLJKHUWUDLWOHYHOVRIWKHVH

HPRWLRQV7KH2&7&'4ZDVRULJLQDOO\GHYHORSHGIRUXVHZLWKDGXOWV:LWKWKH

SHUPLVVLRQ DQG LQSXW IURP WKH RULJLQDO DXWKRU / 6XPPHUIHOGW WKH VFDOH ZDV

WUDQVODWHG LQWR 6ZHGLVK DQG EDFNWUDQVODWHG LQWR (QJOLVK IROORZLQJ SXEOLVKHG

UHFRPPHQGDWLRQV RQ WKH WUDQVODWLRQ RI KHDOWKUHODWHG PHDVXUHV :RUOG +HDOWK

2UJDQL]DWLRQ  6PDOO DGMXVWPHQWV ZHUH PDGH WR VRPH LWHPV WR LQFUHDVH

LQWHUSUHWDELOLW\ IRU \RXQJHU SDUWLFLSDQWV DQG WKH RULJLQDO DXWKRU RI WKH VFDOH /

6XPPHUIHOGWDSSURYHGWKHILQDOEDFNWUDQVODWHGYHUVLRQDIWHUVRPHIXUWKHUVPDOO

DGMXVWPHQWV 5HVXOWV IRU WKH FOLQLFDO XWLOLW\ DQG YDOLGLW\ RI WKH 2&7&'4 DUH

SUHVHQWHGLQ3DSHU

Disgust Emotion Scale for Children (DES-C)

7KH'(6&LVDLWHPVHOIUHSRUWPHDVXUHWKDWDVVHVVHVGLVJXVWSURSHQVLW\WUDLW

OHYHOLQ\RXWK(DFKLWHPDVNVKRZPXFKGLVJXVWZRXOGEHHYRNHGE\GLIIHUHQW

VWLPXOLRQDVFDOHZLWKKLJKHUUDWLQJVLQGLFDWLQJDVWURQJHUGLVJXVWUHDFWLRQ7KH

'(6&\LHOGVERWKDQRYHUDOOVFRUHDQGILYHVXEVFDOHVFRUHVDQLPDOVLQMHFWLRQDQG

EORRGPXWLODWLRQDQGGHDWKURWWLQJIRRGVDQGRGRUV:LWKSHUPLVVLRQDQGLQSXW

IURPWKHVFDOH¶VDXWKRU30XULVWKH'(6&ZDVWUDQVODWHGLQWR6ZHGLVKDQGEDFN

WUDQVODWHGLQWR(QJOLVKIROORZLQJWKHVDPHSURFHGXUHVDVIRUWKH2&7&'4DERYH

7KH RULJLQDO DXWKRU RI WKH VFDOH 3 0XULV DSSURYHG WKH ILQDO EDFNWUDQVODWHG

YHUVLRQ7KHUHVXOWVIRUWKHSV\FKRPHWULFSURSHUWLHVRIWKH'(6&DUHSUHVHQWHGLQ

3DSHU

OCI-CV

7KH2&,&9LVDLWHPVHOIUHSRUWPHDVXUHFRYHULQJ2&'V\PSWRPVLQ\RXWK

(DFK LWHP LV UDWHG RQ D  VFDOH ZLWK KLJKHU UDWLQJV LQGLFDWLQJ PRUH VHYHUH

V\PSWRPV7KHVFDOH\LHOGVDQRYHUDOOVFRUHDQGVL[VHSDUDWHV\PSWRPGLPHQVLRQ

VFRUHV GRXEWLQJFKHFNLQJ REVHVVLQJ KRDUGLQJ ZDVKLQJ RUGHULQJ QHXWUDOL]LQJ

7KH2&,&9KDVVRXQGSV\FKRPHWULFSURSHUWLHVLQFOLQLFDOVDPSOHVRI\RXWKERWK

LQLWVRULJLQDODQGLQLWV6ZHGLVKYHUVLRQLQFOXGLQJLQWKHSUHVHQWVDPSOH$VSYDOO

HWDO)RDHWDO-RQHVHWDO

The Screen for Child Anxiety and Related Disorders-Revised (SCARED-R)

7KH6&$5('5LVDLWHPVHOIUHSRUWPHDVXUHRIDQ[LHW\V\PSWRPV(DFKLWHP

LVUDWHGRQDVFDOHZLWKKLJKHUUDWLQJVLQGLFDWLQJPRUHVHYHUHV\PSWRPV7KH



VFDOH\LHOGVDQRYHUDOOVFRUHDQGVFRUHVIRUGLIIHUHQWVXEVFDOHVVRFLDOJHQHUDOL]HG

SDQLFVFKRRODQGVHSDUDWLRQDQ[LHW\,QWKHSUHVHQWWKHVLVRQO\WKHRYHUDOOVFRUH

ZDVXVHG7KHRULJLQDODQG6ZHGLVKYHUVLRQRIWKHVFDOHKDVVRXQGSV\FKRPHWULF

SURSHUWLHV LQ FOLQLFDO VDPSOHV %LUPDKHU HW DO  ,YDUVVRQ 6NDUSKHGLQVVRQ

$QGHUVVRQ -DUELQ

Children’s Depression Inventory-Short Version (CDI-S)

7KH&',6LVDLWHPVHOIUHSRUWPHDVXUHRQGHSUHVVLYHV\PSWRPVLQ\RXWK(DFK

LWHPLVUDWHGRQDVFDOHDQGDOOLWHPVDUHVXPPHGWR\LHOGDQRYHUDOOVFRUH

+LJKHUVFRUHVLQGLFDWHPRUHVHYHUHV\PSWRPV7KHRULJLQDODQG6ZHGLVKYHUVLRQ

KDVVRXQGSV\FKRPHWULFSURSHUWLHV$KOHQ *KDGHUL$OOJDLHUHWDO

6WDWLVWLFDODQDO\VLV

7KHSV\FKRPHWULFSURSHUWLHVDQGYDOLGLW\RIWKHLQFOXGHGPHDVXUHVZHUHH[DPLQHG

XVLQJ&URQEDFK¶VDOSKDLQWHUQDOFRQVLVWHQF\FRQILUPDWRU\IDFWRUDQDO\VLV&)$

IDFWRU VWUXFWXUH DQG ]HURRUGHU 3HDUVRQ FRUUHODWLRQV ZLWK UHOHYDQW FOLQLFDO

PHDVXUHVFRQVWUXFWYDOLGLW\%HWZHHQJURXSFRPSDULVRQVZHUHDVVHVVHGYLDFKL

VTXDUHGWHVWVLQGHSHQGHQWVDPSOHVWWHVWVDQGDQDO\VHVRIFRYDULDQFHPRGHOV7R

H[DPLQHXQLTXHUHODWLRQVKLSVEHWZHHQVHWVRIYDULDEOHVVWDQGDUGUHJUHVVLRQPRGHOV

DV ZHOO DV VWUXFWXUDO HTXDWLRQ PRGHOV ZHUH HPSOR\HG 3UHGLFWRUV RI WUHDWPHQW

RXWFRPHZHUHH[DPLQHGXVLQJDKLHUDUFKLFDORUGLQDOUHJUHVVLRQPRGHO$OOVWDWLVWLFDO

DQDO\VHV ZHUH FDUULHG RXW LQ 6366 Y DQGY  DQG LQ 5 6WDWLVWLFDO 6RIWZDUH

YHUVLRQ



6XPPDU\RIVWXGLHV

3DSHU

%DFNJURXQGDQGDLP

7KHUHLVLQFUHDVLQJHYLGHQFHWKDWWKHV\PSWRPVRI2&'FDQEHFRQFHSWXDOL]HGLQWR

PDMRU V\PSWRP GLPHQVLRQV UHODWHG WR  DJJUHVVLYH REVHVVLRQV DQG FKHFNLQJ

FRPSXOVLRQV  WDERR FRQFHUQV  V\PPHWU\ REVHVVLRQV DQG RUGHULQJ

FRPSXOVLRQV DQG  FRQWDPLQDWLRQ REVHVVLRQV DQG ZDVKLQJ FRPSXOVLRQV

+RZHYHU IHZ PHDVXUHV H[LVW WKDW FRPSUHKHQVLYHO\ DVVHVV WKHVH GLPHQVLRQV LQ

SDWLHQWVZLWK2&'0RUHRYHUWKHPRVWFRPSUHKHQVLYHRIWKHVHPHDVXUHVWKH'<

%2&6LVWLPHFRQVXPLQJQRWEDVHGRQWKHODWHVW'60GLDJQRVWLFFULWHULDDQG

ZLWKXQNQRZQVHQVLWLYLW\WRFKDQJHLQV\PSWRPVGXULQJWUHDWPHQW7KHDLPRI3DSHU

 ZDV WR HYDOXDWH WKH SV\FKRPHWULF SURSHUWLHV DQG FOLQLFDO XWLOLW\ RI D '60

XSGDWHGLQWHUYLHZRQO\YHUVLRQRIWKH'<%2&6ZLWK\RXWKVHHNLQJWUHDWPHQWIRU

2&'

0HWKRGV

3DUWLFLSDQWVZHUHWUHDWPHQWVHHNLQJ\RXWKZLWK2&'ZKRZHUHDVVHVVHGZLWK

DQXSGDWHGLQWHUYLHZRQO\YHUVLRQRIWKH'<%2&6DVXEVHWRIZKRPn  ZHUH UHDVVHVVHG RQ DYHUDJH  PRQWKV DIWHU WKH LQLWLDO DVVHVVPHQW 7KH LQWHUQDO

FRQVLVWHQF\RIWKHPHDVXUHDQGLWVVXEVFDOHVLWVVHQVLWLYLW\WRV\PSWRPFKDQJHDQG

WKHWLPHIRUDGPLQLVWUDWLRQZHUHH[DPLQHG

5HVXOWV

5HVXOWVVKRZHGWKDWWKLVXSGDWHGEULHIHUYHUVLRQRIWKH'<%2&6UHWDLQHGLWVVRXQG

SV\FKRPHWULFSURSHUWLHVZKHQXWLOL]HGLQDQLQWHUYLHZRQO\YHUVLRQLHZLWKRXWWKH

FOLQLFLDQ KDYLQJ WKH EHQHILW RI WKH VHOIUHSRUW FKHFNOLVW XVXDOO\ FRPSOHWHG E\ WKH

SDWLHQW SULRU WR WKH LQWHUYLHZ 7KH PHDVXUH ZDV DOVR VKRZQ WR EH VHQVLWLYH WR

WUHDWPHQW FKDQJH ZLWK PRGHUDWH WR VWURQJ FRUUHODWLRQV ERWK DW WKH V\PSWRP

GLPHQVLRQVHOIUHSRUWHG2&,&9DQGDWWKHRYHUDOOGLVRUGHUOHYHOFOLQLFLDQUDWHG



&<%2&60RUHWKDQRIDOODVVHVVPHQWVZHUHFDUULHGRXWZLWKLQDPLQXWH

VHVVLRQ ZKLFK LV IDYRUDEOH FRPSDUHG WR D WRWDO DGPLQLVWUDWLRQ WLPH RI DERXW 

PLQXWHVIRUWKHRULJLQDO'<%2&6

'LVFXVVLRQ

,WDSSHDUVWKDWWKHPDMRUV\PSWRPGLPHQVLRQVRI2&'FDQEHYDOLGO\DVVHVVHGLQ

ERWKFKLOGUHQDQGDGROHVFHQWVXVLQJDEULHIFOLQLFLDQUDWHGLQWHUYLHZRQO\PHDVXUH

)XUWKHUYDOLGDWLRQVWXGLHVRIWKH'<%2&6DUHQHHGHGEHIRUHILUPFRQFOXVLRQVFDQ

EHGUDZQDERXWWKHYDOLGLW\RIWKHPHDVXUH+RZHYHUGXHWRWKHLPSRUWDQFHRI2&'

V\PSWRP GLPHQVLRQV WR WKH VWXG\ RI WKH HWLRORJ\ DQG WUHDWPHQW RI 2&' VXFK

YDOLGDWLRQVWXGLHVDUHZDUUDQWHG