Discusses issues related to the identification of psychosocial interventions for children that have demonstrated efficacy. Recent debate concerning differences between clinical trials research and clinical practice is summarized, including the tradeoff between interpretability (internal validity) and generalizability (external validity) of outcome studies. This article serves as an introduction to the special issue containing articles that have as their focus the identification of empirically supported psychosocial interventions for children as part of a task force. The article provides an overview of the history, agenda, and methodology used by the task force to define and identify specific empirically supported interventions for children with specific disorders. Whereas a number of well-established or probably efficacious interventions are identified within the series, more work directed at closing the gap between research and practice is needed.
Analyzed longitudinal data from 3 samples of the Pittsburgh Youth Study on boys ages 7 to 18 to examine the co-occurrence of persistent substance use with other problem behaviors, including attention deficit hyperactivity disorder (ADHD), persistent delinquency, and persistent internalizing problems (i.e., depressed mood, anxiety, shy or withdrawn behavior). In preadolescence, persistent substance users also tended to be persistent delinquents, and half of this group displayed persistent internalizing problems as well. In adolescence, a third of the persistent substance users did not manifest other persistent problems. Across the samples, the least common substance users were those who manifested persistent internalizing problems only. Logistic regression analyses showed that persistent substance use in preadolescence was predicted by persistent delinquency and internalizing problems and in adolescence by persistent delinquency only. The combination of persistent substance use and delinquency was predicted by oppositional defiant disorder in middle childhood and by persistent internalizing problems in middle to late childhood. ADHD was not a predictor of persistent substance use (and delinquency) in any of the analyses. Results are discussed in terms of developmental models of multiproblem youth with an eye on improving early interventions.
Required for optimal intervention for attention deficit hyperactivity disorder (ADHD) is evidence-based matching of child, treatment, and situation. The landmark Multimodal Treatment Study (MTA) of Children with ADHD documented the superiority of pharmacotherapy for the vast majority of children with ADHD. Although this study could not address the problem of the match directly, it is generating important leads for research on the use of psychosocial strategies to enhance the scope and durability of treatment gains while decreasing the risks attendant upon long-term use of medication. Given the inherent distinctions between pharmacological and psychosocial treatments, conclusive answers to questions about comparative efficacy will continue to elude scientist-practitioners. Needed next is research examining ways to improve outcomes beyond the effects of medication, using systematically tailored and sequenced psychosocial approaches and exploring new treatment targets, agents, and modalities. To illustrate, some emerging findings from an ongoing experience sampling study and implications for online therapy are discussed.
Reviewed panic attacks and panic disorders in children and adolescents critically and highlighted new developments. It is concluded that panic attacks and panic disorder are common in adolescence and that they are responsive to cognitive-behavioral treatment regimens. It is also concluded that although panic attacks and panic disorder are less common in children, they are nonetheless present. It is important to note, however, that their expression in childhood may vary from the clinical features seen in adolescence and adulthood. Specifically, it is suggested that most panic attacks in childhood are associated with particular events and are not unexpected or "out of the blue." Moreover, noncatastrophic interpretations of the symptoms of panic prevail. A developmental model for the onset, course, and correlates of panic in children is put forth.
Compared a probability sample of 118 homeless adolescents (ages 12-17) from 6 shelters from throughout the 7-county Detroit metropolitan area to a matched sample of 118 housed adolescents using the Diagnostic Interview Schedule for Children (DISC), which yields diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; DSM-III-R; American Psychiatric Association, 1987) criteria, and the Brief Symptom Inventory (BSI). Adolescents in the housed comparison group were matched on age, sex, race, and neighborhood characteristics. Analyses, including ones controlling for a set of 10 risk and resilience factors, indicated that the homeless showed more disruptive behavior disorders and alcohol abuse or dependence on the DISC and greater levels of symptomatology on the BSI. There were no significant group differences on drug abuse or affective disorders, and psychotic disorders were rare in both groups. This pattern of findings is not entirely consistent with popular stereotypes about homeless youth nor with many existing studies (which have often failed to include an appropriate comparison group).
Reviews psychosocial interventions for child and adolescent conduct problems, including oppositional defiant disorder and conduct disorder, to identify empirically supported treatments. Eighty-two controlled research studies were evaluated using the criteria developed by the Division 12 (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. The 82 studies were also examined for specific participant, treatment, and methodological characteristics to describe the treatment literature for child and adolescent conduct problems. Two interventions were identified that met the stringent criteria for well-established treatments: videotape modeling parent training program (Spaccarelli, Cotler, & Penman, 1992; Webster-Stratton, 1984, 1994) and parent-training programs based on Patterson and Gullion's (1968) manual Living With Children (Alexander & Parsons, 1973; Bernal, Klinnert, & Schultz, 1980; Wiltz & Patterson, 1974). Twenty of the 82 studies were identified as supporting the efficacy of probably efficacious treatments.
Investigated the abilities of children with mental retardation to remember the details of a personally experienced event. A simulated health check was administered to 20 children with mental retardation and 40 normally developing children, half matched on mental age (MA) and half matched on chronological age (CA) with the children with mental retardation. The children's memory was assessed immediately after the health check and 6 weeks later. Overall, the children with mental retardation accurately recalled the health check features, provided detail, and resisted misleading questions about features that did not occur. The group with mental retardation performed similarly to the MA matches on virtually all of the memory variables. The children with mental retardation performed worse than the CA matches on most of the memory variables, although they were able to recall a similar number of features. The findings are discussed in terms of the ability of children with mental retardation to provide accurate testimony.
Expanded on many of the points raised in the article by Greene and Ablon (this issue), which highlights many of the shortcomings of the Multimodal Treatment Study providing reasoned criticism of the design and some of its conclusions. However, we primarily comment on treatment matching and an alternative model of treatment matching, Systematic Treatment Selection (STS; Beutler & Clarkin, 1990). Our latest version of STS, prescriptive psychotherapy (Beutler & Harwood, 2000), is briefly described as it may apply to the treatment of attention deficit hyperactivity disorder.
Discussed several of Greene and Ablon's (this issue) key points in their article about the Multimodal Treatment Study (MTA) of Children with Attention Deficit Hyperactivity Disorder (ADHD). In particular, the following issues are addressed: (a) whether the medication management and behavioral arms of the MTA individualized treatment to comparable degrees; (b) whether cognitive-behavioral interventions were incorporated to an adequate extent; (c) whether core ADHD symptoms were overemphasized relative to other functional domains, both as treatment targets and outcome measures; and (d) whether parent and teacher characteristics warranted more emphasis than they were given. These issues are discussed and an attempt is made to fit the MTA findings into the larger context of prior studies on treatment of childhood ADHD. A theme of this commentary is the concern that in the current age of biological emphasis in the field of ADHD research, social, family, and motivational processes may not get the attention they deserve.
Examined possible relations among sociodemographic, clinical, and familial variables and level of school absenteeism in children with anxiety-based school refusal. These children exhibit a great deal of variability in the severity of school refusal, with some youngsters missing only an occasional day of school, whereas other exhibit pervasive school absenteeism. Participants were 76 children referred for treatment of anxiety-based school refusal. Children and a parent completed a structured clinical interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children) and self-report measures that assess children's levels of fear (Fear Survey Schedule for Children-Revised), trait and somatic anxiety (Modified State-Trait Anxiety Inventory for Children), and depressive symptomatology (Children's Depression Inventory), as well as family environment characteristics (Family Environment Scale). Regression analyses revealed that older age, lower levels of fear, and less active families were primary predictors of greater levels of school absenteeism.
Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.
Conducted a meta-analytic evaluation of the effectiveness of school-based child abuse prevention programs. Literature searches identified 27 studies meeting inclusion criteria for use in this meta-analysis. The average effect size for all programs studied was 1.07, indicating that children who participated in prevention programs performed 1.07 SD higher than control group children on the outcome measures used in the studies. Analysis of moderator variables revealed significant effects for age, number of sessions, participant involvement, type of outcome measure, and use of behavioral skills training. Most important, programs presented over 4 or more sessions that allowed children to become physically involved produced the highest effect sizes. Although most often used only with younger children, findings suggest that active, long-term programs may be more effective for children of all ages.
Family-based treatments for adolescent drug abuse and related behavior problems have been developed and evaluated with success. Empirical support exists for the efficacy of family-based treatments, and process studies have begun to identify mechanisms by which these treatments may achieve their effects. This article discusses theory and related clinical refinements in a contemporary family-based intervention, multidimensional family therapy. Expansions in the theoretical basis of the model are discussed. I highlight 2 aspects of the theory evolution process, resulting in a sharper clinical focus on intrapersonal development and on adolescents' and families' functioning vis-à-vis influential extrafamilial ecologies of development.
Introduces the special section on Child Psychopathology Risk Factors for Substance Use Disorders. This article summarizes important principles, the current literature, contributions to this section, and issues for future research. Psychopathological conditions are strongly associated with substance use disorders, and some childhood psychopathological conditions may constitute precursors to this comorbidity. Conduct disorder constitutes a strong risk factor for substance use disorders, and bipolar disorder, although more rare, may also constitute a significant risk. Data for other child psychiatric conditions are mixed or lacking; however, important subgroups may be at risk and merit further attention. Underlying characteristics, such as temperament and self-regulation, merit further study as possible explanatory variables. Such studies hold the key for targeting and improving preventive and therapeutic interventions.
Investigated cognitive processing of fear-relevant information in sexually abused adolescent girls with posttraumatic stress disorder (PTSD) using a modified Stroop procedure (MSP). Participants were 20 sexually abused girls with PTSD, 13 sexually abused girls without PTSD, and 20 nonvictimized girls who served as controls, 11 to 17 years old. Word conditions included abuse-related threat, developmentally relevant (related to the experience of sexual abuse, e.g., trust, secrecy, and intimacy), general threat, positive, and neutral. Girls with PTSD were expected to show cognitive interference for trauma-related words as well as for developmentally relevant words, relative to adolescents without PTSD. Overall color naming was significantly slower in the PTSD group than in the nonabused controls. Contrary to expectation, all participants demonstrated cognitive interference for trauma-related words. Relevant theoretical and methodological issues are highlighted.
Examined which of several apparent risk variables were predictors of internalizing and externalizing problems in 48 girls who were referred for therapy after disclosing sexual abuse. Specifically, the effects of abuse characteristics, support from nonoffending parents, victims' coping strategies, and victims' cognitive appraisals on symptomatology were assessed. As hypothesized, results indicated that internalizing and externalizing problems were associated with different sets of predictor variables. Victims' self-reports of depression and anxiety were related to lower perceived support from nonoffending parents, more use of cognitive avoidance coping, and more negative appraisals of the abuse. These results were partially replicated when using parent-report measures of depression, but were not replicated for parent reports of victim anxiety. Incest was the only variable that was significantly related to parent-reported anxiety. Parent-reported aggressive behaviors were predicted by level of abuse-related stress; and aggression, social problems, and sexual problems were all related to the tendency to cope by controlling others. Social problems were also related to coping by self-distraction. Regression analyses were done for each dependent variable to examine which predictors accounted for unique variance when controlling for other significant zero-order correlates. Implications of these results for understanding variability in symptom expression among sexual abuse victims are discussed.
Examines the extent to which academic achievement and work habits of first and second graders are predicted by classroom social status over the kindergarten, first-, and second-grade period. Three hundred and forty five children (163 boys and 182 girls) from a southern California community comprised the sample. The ethnic distribution of the sample was approximately 45% Caucasian, 42% Latino, 9% African American, and 5% Asian or other ethnicity. Findings suggest that peer rejection assessed as early as kindergarten and social rejection that is stable across 2 years (kindergarten-first grade or first-second grade) are associated with deficits in first-grade work habits and second-grade academic achievement and work habits. In contrast, stable social acceptance appears to buffer children from early academic difficulty. The pattern of findings remain significant after controlling for initial kindergarten academic competence. The implications for clinical and educational intervention programs are discussed.
Studied the effect of student characteristics on teachers' ratings of treatment acceptability for attention deficit hyperactivity disorder (ADHD). Participants (N = 159) included experienced elementary school teachers who read 1 of 6 vignettes describing a child with symptoms representative of ADHD. Vignettes varied by sex and symptom-subtype classification. However, the number and specific type of symptoms described in the vignettes were consistent across all conditions. Next, teachers read a description of a daily report card (DRC), response cost technique, classroom lottery, and medication and rated their levels of agreement to the items of the Behavioral Intervention Rating Scale (BIRS). Teachers preferred the DRC to all other forms of treatment. However, there was a significant interaction between the type of treatment and sex of the student on the 3 factors (Treatment Acceptability, Treatment Effectiveness, and Timeliness) of the BIRS.
Predicted dysphoria in midadolescence using actual and perceived peer acceptance of 68 4th and 5th graders (48% male, 30% minority). Main effect, additive, and interactive models for predicting dysphoria were examined. Perceived acceptance predicted later dysphoria, after controlling for initial levels of dysphoria, supporting the main effect model. Actual acceptance did not uniquely contribute to prediction of later dysphoria, and actual acceptance did not moderate the prediction of dysphoria from perceived acceptance. Sex differences in dysphoria were significant, but sex did not moderate the predictive links between perceived acceptance and dysphoria.
Revisited the accuracy hypothesis in an examination of the relation between maternal depressive symptomatology and child conduct problems. All data were gathered as part of the pretreatment assessment in an outcome study of families with clinic-referred children with conduct problems (age 3 to 6). The mothers varied in their depressive symptomatology, from not at all symptomatic to severely symptomatic. Correlations indicated that with increasing depressive symptomatology, mothers (N = 97) displayed a higher rate of physical negative behaviors towards their child and reported more child conduct problems. Regression analyses revealed that at the lowest levels of maternal depressive symptomatology there was a discrepancy between mothers' reports of child behavior problems and child deviant behaviors observed during mother-child interaction. In contrast, at higher levels of depression, mothers' reports of child behavior were consistent with laboratory observations of their child's behavior. These findings provide evidence to support the accuracy hypothesis in reference to mothers who display a high degree of depressive symptomatology, but the results also call into question the validity of maternal report in families with children with conduct problems.
Compared the effectiveness of discriminating attention deficit/hyperactivity disorder (ADHD) subtypes using the Parent Rating Scale (PRS) and Teacher Rating Scale (TRS) of the Behavior Assessment System for Children (BASC) and the Parent Report Form and Teacher Report Form (TRF) of the Achenbach Child Behavior Checklist (CBCL). To determine the extent to which these scales measured similar behaviors, Pearson Product-Moment Correlations were computed for the parent scales (PRS and CBCL) and for the teacher scales (TRS and TRF). Results indicated that correlations were significant for a number of scales. Discriminant analysis does not suggest a strong advantage of either measure in differentiating children with ADHD from those who do not meet criteria for ADHD, except for the BASC TRS which has better predictive ability for children who do not meet ADHD criteria. For subtypes of ADHD, and specifically the ADHD: Predominantly Inattentive subtype, however, results would favor the use of the BASC PRS and TRS.
Examined a conceptual model in which dual developmental pathways (behavioral and cognitive) are hypothesized to account for the relation among internalizing behavior problems, intelligence, and later scholastic achievement using a cross-sectional sample of 325 children. Classroom behavior and select aspects of cognitive functioning (vigilance, short-term memory) were hypothesized to mediate the relations among internalizing problems, IQ, and long-term scholastic achievement. Hierarchical tests applied to a nested series of models demonstrated that (a) individual differences in measured intelligence among children are associated with variations in classroom performance and cognitive functioning, (b) classroom performance and cognitive functioning make unique contributions to prediction of later achievement over and above the influence of intelligence, (c) anxious/depressive features are correlated but separable constructs, and (d) anxiety/depression and withdrawal contribute to prediction of classroom performance and cognitive functioning over and above the effects of intelligence. Classroom performance and cognitive functioning thus appear to mediate the effects of internalizing behaviors as well as intelligence. Particular attention to the presence and potential impact of social withdrawal on children's functioning, both alone and concomitant with anxiety/depression, appears warranted during the course of clinical evaluations owing to the strong continuity among these variables.
Adapted methods of behavioral assessment to assess home and school functioning in a way that maps directly to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., [DSM-IV]; American Psychiatric Association, 1994). The study was conducted in a school-based sample with 5- to 12-year-old children referred to a school intervention team. A multigate set of procedures was used to assign children to one of 3 groups: attention deficit hyperactivity disorder (ADHD), inattentive group; ADHD, combined group; and a non-ADHD control group. The ADHD Rating Scale-IV was used to assess parent and teacher ratings of ADHD symptoms as delineated in DSM-IV. The findings suggest that the use of a fixed cutoff point (i.e., 6 or more symptoms), which is employed in the DSM-IV, is often not the best strategy for making diagnostic decisions. The optimal approach depends on whether diagnostic information is being provided by the parent or teacher and whether the purpose of assessment is to conduct a screening or a diagnostic evaluation. Also, the results indicate that a strategy that aggregates symptoms in the order in which they are accurate in predicting a diagnosis of ADHD is a more effective strategy than the approach used in DSM-IV, which aggregates any combination of a specific number of items. Implications for using methods of behavioral assessment to make diagnostic decisions using DSM-IV criteria are discussed.
Examined the free-field interaction of 32 mother-child dyads who volunteered to participate in a 1-hr home observation. Observers coded mother instructions, child compliance, and child prosocial approaches plus mothers' social attention as potential reinforcers for the children's compliance and social approaches. Herrnstein's matching law was used to analyze covariations between mothers' attention and the children's 2 responses. This analysis was followed by correlational and sequential probability analyses to determine linkages between these 2 child responses and the children's willingness to obey their mothers' instructions. Results showed consistent matching between mothers' social attention and the children's production of prosocial approaches and acts of compliance. An index of the proportions of these 2 responses also covaried with the children's compliance probabilities, and the prosocial approach component was the direct covariate. These findings are discussed within an interactional synchrony framework in which children's willingness to obey their mothers is influenced by opportunities for the dyad to engage each other in specific forms of social interaction.
Discussed the importance of play in creative problem solving and its implications for play interventions. Theory and research in the areas of play and creative cognitive processes and play and creative affective processes are reviewed. Play has been associated with the development of creative problem solving. Creative problem solving is thought to be a resource for everyday coping and adjustment. Play intervention studies that investigate the effects of specific aspects of play on specific criteria would be appropriate for the creative problem-solving and coping area. A systematic program integrating laboratory research on play and creativity, research on play techniques, and play intervention with specific populations is needed.