Journal Highlights Effectiveness of Research Based Psychotherapies for Youth
• Science Update
Reviews of the current research on psychosocial and behavioral therapies, or psychotherapies, for children and adolescents found a number of "well established" and "probably efficacious" treatments for many mental disorders. For example, six were "probably efficacious" for anxiety disorders, and two were "well established" for attention deficit hyperactivity disorder (ADHD), according to scientists funded by NIMH and the National Institute on Drug Abuse, divisions of the National Institutes of Health.
The results were published in a special issue of the Journal of Clinical Child and Adolescent Psychology, and cover the current state of research psychotherapies for children and adolescents with mental disorders. NIMH grantees Wendy Silverman, Ph.D., of Florida International University, Miami, and Stephen Hinshaw, Ph.D., of the University of California, Berkeley, served as guest editors. This special issue provides a 10-year update on the original special issue on psychosocial treatments, published in 1998.
"Even for the most effective interventions, there is substantial individual variability in treatment response," said Benedetto Vitiello, chief of NIMH's Child and Adolescent Treatment and Preventive Intervention Research Branch. "Further research is needed to understand the factors accounting for treatment effects and to identify predictors of response, in order to eventually arrive at more targeted and specific intervention strategies."
Overall, the 10 articles in the special issue reveal considerable advances over the past decade in the quality and quantity of research on psychosocial treatments for children with mental disorders. Among notable findings:
A review of 32 studies by Silverman and her colleagues concluded that six therapies for anxiety disorders have substantial research support and met the criteria for "probably efficacious" and may be helpful for treating children and adolescents with anxiety disorders. These treatments are:
- Individual cognitive behavioral therapy.
- Group cognitive behavioral therapy (GCBT).
- GCBT with parents.
- GCBT for social phobia.
- Social effectiveness training for children with social phobia.
Few large-scale trials on anxiety disorders have compared specific psychosocial therapies with credible control conditions. As a result, to date, no specific psychotherapies met the most stringent criteria for "well-established treatments" used for this article. However, the second-highest ranking of "probably efficacious" denotes considerable research evidence supporting a treatment's usefulness, so mental health care providers can be confident in using the therapies listed, Silverman says.
A review of 46 studies by William Pelham, Jr., Ph.D., and Gregory Fabiano, Ph.D., both of the State University of New York at Buffalo, found that two psychosocial treatments are "well-established" for treating ADHD in children and adolescents:
- Behavioral parent training.
- Behavioral classroom management.
The authors also found a third type of well-established behavioral intervention called the Summer Treatment Program (STP), which focuses on peer relationships and is often given in recreational, summer camp-like settings. Children in STP typically receive more hours of treatment in a week compared to other weekly forms of psychotherapy, but STP is more expensive, and harder to provide in the community, and harder to find than behavioral parent training and behavioral classroom management.
In addition to anxiety and ADHD, the special issue also evaluates evidence-based psychosocial treatments for autism, eating disorders, depression, obsessive-compulsive disorder, exposure to traumatic events, disruptive behavior, and substance abuse. In addition, one of the articles focused on psychotherapies and treatment approaches specific to different ethnic and cultural backgrounds.
Mental disorders are generally treated with psychotherapy, medications, or a combination of the two. As scientists find out more about how mental disorders affect the brain and behavior, they also better understand what makes a treatment work for certain disorders or certain people. This can sometimes lead to new medications or therapies, or new uses for existing treatments. However, such treatments may not be proven by research (evidence-based).
The special issue helps address knowledge gaps by reporting on the current state of evidence-based psychosocial treatments in children and adolescents. For each article, scientists provided a review of the research literature in their field of expertise. The articles also:
- Identify the most effective psychosocial treatments, using and building on guidelines developed in 1995 by the American Psychological Association Task Force on Promotion and Dissemination of Psychological Procedures.
- Discuss factors that may affect a child's response to treatment.
- Suggest directions for future research.
Each article also discusses practice recommendations based on available research for doctors and other mental health care providers. However, these recommendations are intended more as a guide to current treatments and are not a requirement or prescription for best care.
"We can only hope that the current generation of child and adolescent psychosocial treatment researchers will heed the call expressed in these articles for even more sophisticated, more rigorous, and more statistically powerful studies," said Drs. Silverman and Hinshaw.
Silverman WK, Hinshaw SP. The Second Special Issue on Evidence-Based Psychosocial Treatments for Children and Adolescents: A Ten-Year Update. J Clin Child Adolesc Psychol. 2008 Jan-Mar;37(1)