Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders
Section snippets
Procedure
Standard computerized databases (PsycInfo and MEDLINE) were searched. For each of the four substantive areas (anxiety, depression, ADHD, and conduct problems), search terms included psychotherapy, counseling, treatment, clinical trial, child, adolescent, and comorbidity. Only articles written in English and published between 1980 and 2007 were sought. This timeframe was selected because it coincided with the advent of DSM-III and progressed through DSM-III-R and DSM-IV and up to the present
Anxiety disorders
Anxiety disorders are among the most common mental health problems in children and adolescents, with prevalence rates approximating 12% in community samples and 36% in clinical samples (cf, Kessler, Berglund, Demler, Jin, & Walters, 2005). DSM-IV specifies that all of the anxiety disorders of adulthood are recognized in childhood (i.e., generalized anxiety disorder — GAD, specific phobia — SP, social phobia — SOC, panic disorder — PD, agoraphobia — AG, obsessive–compulsive disorder — OCD, and
Affective disorders
Affective disorders evidenced by children and adolescents include major depressive disorder (MDD) and dysthymia. Epidemiological studies suggest the prevalence of unipolar affective disorders in youth to be between 1.5% and 8.0% (Angold et al., 1999, Costello et al., 1996). The diagnostic criteria for MDD and dysthymia in youth are similar to those specified for adults, except that children may experience irritability instead of depressed mood. In addition, weight and appetite disturbances may
Attention-deficit/hyperactivity disorder (ADHD)
ADHD is also a prevalent psychological disorder in childhood with studies typically showing prevalence rates ranging from 3%–7% (APA, 2000). In addition, the DSM-IV delineates three subtypes of the disorder based on the two symptom dimensions of inattention and hyperactivity-impulsivity: ADHD, predominantly inattentive type (ADHD-I), ADHD, combined type (ADHD-C), and ADHD, predominantly hyperactive/impulsive type (ADHD-H/I; APA, 2000). ADHD is often associated with significant short-term and
ODD/CD
Children with oppositional and conduct problems comprise a heterogeneous group of youth who engage in a broad array of problem behaviors ranging from relatively minor defiance and temper tantrums to more serious violations such as physical aggression, destructiveness, and stealing. ODD refers to a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures. CD consists of more severe antisocial and aggressive
Discussion
Findings from our qualitative review inform us about the current state of comorbidity and its potential effects on treatment outcomes of EBTs. First, contrary to the assertions of many (e.g., Dulcan, 2005, Westen et al., 2004), the vast majority of RCTs examined in this review included participants who had comorbid disorders. Although the majority of the studies excluded participants with psychosis, pervasive developmental disorders, and mental retardation, other more frequently occurring
References (185)
- et al.
Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder
Journal of the American Academy of Child and Adolescent Psychiatry
(2005) - et al.
Pilot study of community-based cognitive behavioral group therapy for adolescents with social phobia
Journal of the American Academy of Child and Adolescent Psychiatry
(2005) - et al.
Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial
Journal of the American Academy of Child & Adolescent Psychiatry
(2004) - et al.
SET-C versus fluoxetine in the treatment of childhood social phobia
Journal of the American Academy of Child and Adolescent Psychiatry
(2007) - et al.
Predictors of outcome in exposure-based cognitive and behavioral treatments for phobic and anxiety disorders in children
Behavior Therapy
(2000) - et al.
Predictors of treatment efficacy in a clinical trial of three psychosocial treatments for adolescent depression
Journal of the American Academy of Child and Adolescent Psychiatry
(1998) - et al.
Cognitive-behavioral group treatment of adolescent depression: Prediction of outcome
Behavior Therapy
(1992) - et al.
Group cognitive-behavioral treatment for depressed adolescent offspring of depressed parents in a health maintenance organization
Journal of the American Academy of Child and Adolescent Psychiatry
(2002) - et al.
Cognitive-behavioral treatment of adolescent depression: Efficacy of acute group treatment and booster sessions
Journal of the American Academy of Child and Adolescent Psychiatry
(1999) - et al.
Predictors and moderators of acute outcome in the Treatment for Adolescents with Depression Study
Journal of the American Academy of Child and Adolescent Psychiatry
(2006)
Practitioner perspectives on evidence-based practice
Group therapy for adolescent depressive disorder: A comparison of social skills and therapeutic support
Journal of the American Academy of Child and Adolescent Psychiatry
Parent-assisted transfer of children's social skills training: Effects of children with and without attention-deficit hyperactivity disorder
Journal of the American Academy of Child and Adolescent Psychiatry
A brief group cognitive-behavioral intervention for social phobia in childhood
Journal of Anxiety Disorders
School-based treatment for anxious African-American adolescents: A controlled pilot study
Journal of the American Academy of Child and Adolescent Psychiatry
Stimulant medications
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral group therapy for social phobia in female adolescents: Results of a pilot study
Journal of the American Academy of Child and Adolescent Psychiatry
Evaluation of child therapy and caregiver training in the treatment of school refusal
Journal of the American Academy of Child and Adolescent Psychiatry
Additive effects of psychostimulants, parent training, and self-control therapy with ADHD children
Journal of the American Academy of Child and Adolescent Psychiatry
The effects of a multimodal intervention with attention-deficit hyperactivity disorder children: A 9-month follow-up
Journal of the American Academy of Child and Adolescent Psychiatry
3-year follow-up of the NIMH MTA Study
Journal of the American Academy of Child and Adolescent Psychiatry
ADHD comorbidity findings from the MTA Study: Comparing comorbid subgroups
Journal of the American Academy of Child and Adolescent Psychiatry
Comorbidity in ADHD: Implications for research, practice, and DSM-IV
Journal of the American Academy of Child and Adolescent Psychiatry
Comorbidity in childhood anxiety disorders and treatment outcome
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral treatment of school-refusing children: A controlled evaluation
Journal of the American Academy of Child and Adolescent Psychiatry
Treating sexually abused children with posttraumatic stress symptoms: A randomized clinical trial
Journal of the American Academy of Child and Adolescent Psychiatry
Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: Main and incremental effects across settings
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral treatment of school phobia
Journal of the American Academy of Child and Adolescent Psychiatry
Treating comorbid anxiety and aggression in children
Journal of the American Academy of Child and Adolescent Psychiatry
Cognitive-behavioral treatment for depressed adolescents
Behavior Therapy
Major depressive disorder in older adolescents: Prevalence, risk factors, and clinical implications
Clinical Psychology Review
Oppositional defiant disorder and conduct disorder: A review of the past 10 years, Part I
Journal of the American Academy of Child and Adolescent Psychiatry
Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children
Behavior Research and Therapy
Diagnostic and statistical manual of mental disorders
Parent training for attention-deficit hyperactivity disorder: Its impact on parent functioning
Journal of Abnormal Child Psychology
Comorbidity
Journal of Child Psychology and Psychiatry and Allied Disciplines
Social skills in children with attention deficit hyperactivity disorder: A randomized-controlled clinical trial
Journal of Clinical Child and Adolescent Psychology
A combined cognitive-behavioral family education intervention for depression in children: A treatment development study
Cognitive Therapy and Research
Parent-child interaction therapy for disruptive behavior in children with mental retardation: A randomized control trial
Journal of Clinical Child and Adolescent Psychology
The efficacy of problem-solving communication training alone, behavior management training alone, and their combination for parent-adolescent conflict in teenagers with ADHD and ODD
Journal of Consulting and Clinical Psychology
A comparison of three family therapy programs for treating family conflicts in adolescents with attention deficit hyperactivity disorder
Journal of Consulting and Clinical Psychology
Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders
Journal of Clinical Child Psychology
Family treatment of childhood anxiety: A controlled trial
Journal of Consulting and Clinical Psychology
Cognitive-behavioral treatment of anxiety disorders in children: Long-term (6-year) follow-up
Journal of Consulting and Clinical Psychology
Mediators, moderators, and predictors of one-year outcomes among children treated for early-onset conduct problems: A latent growth curve analysis
Journal of Consulting and Clinical Psychology
Behavioral treatment of childhood social phobia
Journal of Consulting and Clinical Psychology
Efficacy of child cognitive behavioral interventions for antisocial behavior: A meta-analysis
Child and Family Behavior Therapy
Outcome evaluation of behavioral parent training and client-centered parent counseling for children with conduct problems
Journal of Applied Behavior Analysis
Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder
Archives of General Psychiatry
Children with ADHD and depression: A multisource, multimethod assessment of clinical, social, and academic functioning
Journal of Attention Disorders
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