Child and Adolescent Psychiatric Clinics of North America
Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders☆
Section snippets
Research on the impact of youth treatment
Psychotherapy research developed later and more slowly than psychotherapy practice, with some of the earliest work published near the midpoint of the twentieth century. In a particularly influential report, Eysenck [5] reviewed studies of adult psychotherapy and concluded that the evidence did not show it to be effective. A few years later, Levitt [6], [7] reviewed studies that included children and adolescents and concluded that outcomes were about the same regardless of whether they had
Previous narrative and quantitative reviews
This body of evidence is examined periodically through narrative and quantitative reviews of outcome findings. Narrative reviews (eg, Kazdin [3] and Shirk and Russell [9]) can bring the perspectives of thoughtful experts to bear on what the outcome findings show and what the strengths and limitations of those findings are. Another approach to reviewing outcome research is the quantitative review of treatment effects, an approach called meta-analysis. Meta-analysts apply a common effect size
Identifying specific psychotherapies supported by evidence
Although narrative reviews and meta-analyses are useful in many ways, they generally are designed to characterize a body of evidence, not to identify specific treatments that are supported by the evidence. For that kind of identification to take place, a different type of review is needed that entails a search for specific psychotherapies that have been supported in clinical trials. We undertook such a review for the present article, with the goal of complementing the overall picture of
Methods employed in the review
To provide the most reliable evidence, we sought treatment outcome studies meeting uniform standards that were important for our particular purposes; this made our study collection somewhat different from those used in previous reviews. Here, we describe the search process, the inclusion criteria applied, and the coding system used to characterize the studies.
Treatments for internalizing conditions: anxiety, phobias, and fears
The 94 studies in the anxiety domain spanned the years 1967 to 2002 and included 169 separate treatment groups, with mean ages of the samples ranging from 3.8 to 17.6 years. Of the 169 treatment groups tested, 114 (67%) showed statistically significant treatment benefit over a control or alternate treatment group on at least one target problem outcome measure. A breakdown of the kinds of treatments that showed significant benefit is provided in Table 1. The table also lists the specific
Treatments for internalizing conditions: depressive symptoms and disorders
The 23 studies in the depression domain spanned the years 1986 to 2002 and included 35 separate treatment groups, with mean ages of the samples ranging from a low of 9.2 years to a high of 16.5 years. Of the 35 treatment groups tested, 26 (74%) showed statistically significant treatment benefit relative to a control or alternate treatment group on at least one target problem outcome measure. A list of the kinds of treatments that showed significant benefit is provided in Table 2. Most of these
Treatments for externalizing conditions: attention and hyperactivity symptoms and disorders
The 46 studies in the attention and hyperactivity domain spanned the years 1968 to 2001, with mean age of the samples ranging from a low of 4.1 years to a high of 13.9 years. Ninety separate treatment groups were tested; of these, 52 (58%) showed statistically significant treatment benefit over a control or comparison group on at least one target outcome measure. The kinds of treatments that showed significant benefit are listed in Table 3. Most of these treatments were child-focused
Treatments for externalizing conditions: conduct-related problems and disorders
The 135 studies in the conduct domain spanned the years 1963 to 2002 and included 229 separate treatment groups, with mean ages of the samples ranging from 3.5 to 17.5 years. Of the 229 treatment groups tested, 136 (59%) showed statistically significant treatment benefit over a control or comparison group on at least one target outcome measure. A breakdown of the kinds of treatments is provided in Table 4, along with the treatment name and the manual name.
One specific child-focused intervention
Summary
In this article, treatments that showed significant effects in studies published over a period of 4 decades were identified. Coverage focused on problems and disorders in four broad clusters: anxiety, depression, ADHD, and conduct. Across the 298 studies, 326 different treatment programs were identified that showed significant benefit relative to a control group or alternate treatment group. The studies and the treatment programs were not evenly distributed across the four problem clusters. In
Acknowledgements
The authors are grateful to Amie Bettencourt, BA, Vickie Chang, MA, Brian Chu, PhD, Jen Durham, MA, Samantha Fordwood, MA, Sarah Francis, MA, Dan Fulford, BA, Eunie Jung, MA, and V. Robin Weersing, PhD, for the important roles they played in this project.
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The authors are grateful to the John D. and Catherine T. MacArthur Foundation for its support of this work as a part of the Research Network on Youth Mental Health. The authors also were supported by National Institute of Mental Health grants R01 MH 547347 and R01 MH 068806 to (J.R. Weisz), F31 MH12853 to (K.M. Hawley), and F31 MH65811 to (A. Jenson Doss); San Diego State University's Oscar Kaplan Postdoctoral Fellowship (to K.M. Hawley); and Department of Health and Human Services Health Resources and Services Administration training grant 1 D40 HP00017-01 to (A. Jenson Doss).