Effective Treatment for Mental Disorders in Children and Adolescents

As pressure increases for the demonstration of effective treatment for children with mental disorders, it is essential that the field has an understanding of the evidence base. To address this aim, the authors searched the published literature for effective interventions for children and adolescents and organized this review as follows: (1) prevention; (2) traditional forms of treatment, namely outpatient therapy, partial hospitalization, inpatient treatment, and psychopharmacology; (3) intensive comprehensive community-based interventions including case management, home-based treatment, therapeutic foster care, and therapeutic group homes; (4) crisis and support services; and (5) treatment for two prevalent disorders, major depressive disorder and attention-deficit hyperactivity disorder. Strong evidence was found for the treatment of attention-deficit hyperactivity disorder, depression, anxiety, and disruptive behavior disorders. Guidance from the field relevant to moving the evidence-based interventions into real-world clinical practice and further strengthening the research base will also need to address change in policy and clinical training.     

Evidence Based Treatments for Bipolar Disorder in Children and Adolescents

Limited research has been devoted to developing and testing psychosocial treatments for bipolar disorder (BPD) in children and adolescents, a chronic and impairing mental illness that has received increased attention in recent years. Existing treatments are intended as adjuncts to medication, and share a family-based psychoeducation approach. Components of four treatments are discussed: family-focused treatment (FFT), the RAINBOW Program, multi-family psychoeducation groups (MFPG), and individual family psychoeducation (IFP). Evidence supporting each approach is detailed. Selected components of MFPG are described. A flowchart provides suggestions for sequencing interventions to maximize effectiveness. To illustrate the use of evidence-based treatment for children with BPD, a case example is provided.

Primary Prevention Mental Health Programs for Children and Adolescents: A Meta-Analytic Review

Used meta-analysis to review 177 primary prevention programs designed to prevent behavioral and social problems in children and adolescents. Findings provide empirical support for further research and practice in primary prevention. Most categories of programs produced outcomes similar to or higher in magnitude than those obtained by many other established preventive and treatment interventions in the social sciences and medicine. Programs modifying the school environment, individually focused mental health promotion efforts, and attempts to help children negotiate stressful transitions yield significant mean effects ranging from 0.24 to 0.93. In practical terms, the average participant in a primary prevention program surpasses the performance of between 59% to 82% of those in a control group, and outcomes reflect an 8% to 46% difference in success rates favoring prevention groups. Most categories of programs had the dual benefit of significantly reducing problems and significantly increasing competencies. Priorities for future research include clearer specification of intervention procedures and program goals, assessment of program implementation, more follow-up studies, and determining how characteristics of the intervention and participants relate to different outcomes.     

Assessment of Psychotic Disorders in Inpatient Children and Adolescents: Use of the Devereux Scales of Mental Disorders

The Devereux Scales of Mental Disorders (DSMD), with its 3-factor model of measurement (i.e., Internalizing, Externalizing, and Critical Pathology), may be useful in screening for psychotic disorders in children. This study assessed the ability of the DSMD to differentiate between inpatient children and adolescents with psychotic disorders (n = 18) and those with other clinical syndromes (n = 71). Results of ANCOVAs indicated that the psychotic group scored significantly higher on most DSMD scales and composites than the nonpsychotic clinical group. However estimates of effect size were particularly large for the Critical Pathology Composite and the Autism and Acute Problems Scales. Diagnostic efficiency statistics revealed that the DSMD's Critical Pathology Composite was highly accurate in differentiating between the 2 clinical groups. These findings support the utility of the DSMD in identifying children and adolescents with psychotic disorders.     

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children,Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients’ specific needs.     

Anxiety Disorders in Children and Adolescents with Autistic Spectrum Disorders: A Meta-Analysis

There is considerable evidence that children and adolescents with autistic spectrum disorders (ASD) are at increased risk of anxiety and anxiety disorders. However, it is less clear which of the specific DSM-IV anxiety disorders occur most in this population. The present study used meta-analytic techniques to help clarify this issue. A systematic review of the literature identified 31 studies involving 2,121 young people (aged <18 years) with ASD, and where the presence of anxiety disorder was assessed using standardized questionnaires or diagnostic interviews. Across studies, 39.6% of young people with ASD had at least one comorbid DSM-IV anxiety disorder, the most frequent being specific phobia (29.8%) followed by OCD (17.4%) and social anxiety disorder (16.6%). Associations were found between the specific anxiety disorders and ASD subtype, age, IQ, and assessment method (questionnaire versus interview). Implications for the identification and treatment of anxiety in young people with ASD are discussed.     

Virtual Reality Based Treatments in Eating Disorders and Obesity: A Review

Since the late 1990s the use of virtual reality (VR) has expanded in the field of mental disorders. During this time, several VR-based applications have been developed for the treatment of eating disorders (ED) and obesity. Both these pathologies involve disturbances related to eating behavior, weight, and body image. Although effective and well-established protocols are now available for the treatment of ED and obesity, relapses are frequent and a proportion of patients do not improve after intervention. In this context, VR has been shown to be a useful technology for enhancing traditional cognitive-oriented therapies. The main objective of this review was therefore to examine the evidence regarding the efficacy of VR-based treatments as a component of therapeutic interventions for ED and obesity. To this end, three databases (PsycInfo, Medline, and PsycArticles) were searched for the period 1986–2012. Only research articles and case studies were selected. Although several methodological deficiencies were detected in the reviewed studies, there is fair evidence for the effectiveness of VR-based treatments in ED and obesity. VR-based interventions usually combine exposure to VR environments with cognitive therapies. The VR component seems to be especially suitable for reducing body image disturbances, such as body image dissatisfaction, and for increasing self-esteem and self-efficacy. The rationale for the use of VR in these areas is also presented and discussed.     

Comorbid ADHD: Implications for the Treatment of Anxiety Disorders in Children and Adolescents

Despite high comorbidity rates and potential clinical implications, the influence of co-occurring attention-deficit/hyperactivity disorder (ADHD) on outcomes of cognitive-behavioral treatment (CBT) for anxious youth remains poorly understood. In this qualitative review, the current literature on the influence of comorbid ADHD on CBT of youth with diverse anxiety disorders is explored. Peer-reviewed studies examining ADHD, at the diagnostic and symptom level, received highest priority. In addition, inasmuch as some studies did not isolate the effects of ADHD from other disruptive behavior disorders (DBDs: oppositional defiant disorder, conduct disorders), studies with the three DBDs were explored as well. Ten studies met our specified methodological criteria. Findings are discussed in relation to the following two factors: type of anxiety disorder and measurement of ADHD (diagnostic or symptom level) in these studies. There was evidence that youth with a variety of anxiety disorders and with co-occurring ADHD fared worse than their counterparts without ADHD. Additionally, grouping ADHD with other DBDs tended to obscure the negative impact of ADHD on treatment outcomes. Additional research is needed to delineate the influence of comorbid ADHD specifically on treatment outcomes for the various anxiety disorders. Clinical implications of treating anxious youth with comorbid ADHD are explored.     

REBT Used with Children and Adolescents who have Emotional and Behavioral Disorders in Educational Settings: A Review of the Literature

This article discusses the need for a comprehensive intervention strategy for students who experience difficulty managing self-defeating emotions and behaviors in educational settings. The review of the literature identifies related research and describes how the application of Rational Emotive Behavior Therapy (REBT), as a comprehensive educational intervention, has been implemented with children and adolescents who have been identified as having emotional disturbance in various educational settings.     

Refusal and Resistance Skills for Children and Adolescents: A Selected Review

The authors review the literature on refusal and resistance skill (RRS) training implemented with children and adolescents. RRS training is critically evaluated across different target behaviors and outcomes. RRS efficacy is considered for tobacco use, including smoking and smokeless tobacco, alcohol and substance abuse, and sexual activity. Factors that influence RRS training are identified and process variables are discussed. These include age and gender, media formats (video or live), and teacher-led versus peer-led approaches. Conclusions are drawn based on the reviewed literature.     

Family-based Psychoeducation for Children and Adolescents with Mood Disorders

Psychoeducation is often used for family members of adult patients with mood disorders. An increase in family’s knowledge of the patient’s illness course and outcome is thought to improve treatment compliance and may reduce relapse rates through identification of early symptoms and risks. While studies on family-based psychoeducation of adult patients with mood disorders have been reviewed, a similar review has not been conducted in patients who are children and adolescents. We conducted a systematic review of studies published between 1980 and 2006 on independently standing psychoeducation programs for families with children suffering from mood disorders. Results revealed eight treatment and preventive psychoeducation studies for families of affectively ill children or children at risk for depression. Findings indicate that psychoeducation models typically adopt a workshop approach incorporating didactic teachings and interactive discussion sessions, with or without specific skills training. Given the paucity of randomized controlled trials and lack of comparability between psychoeducation models, conclusions about the true efficacy of each program as a treatment or an adjunct to the treatment of mood disorders in children and adolescents cannot be made. Further research into psychoeducation for families of children with mood disorders is warranted.     

儿童青少年心理素质研究30年:回顾与展望

作为具有中国特色的心理学研究,心理素质已有30多年的研究历程,对其进行系统的回顾与展望,既是出于梳理总结以往研究得失的考虑,也是将心理素质研究推向新的高度的必然需要。首先,本文阐述了心理素质研究产生的背景,并详述了心理素质概念、结构和测量工具的提出、完善和成型的历程;其次,在整理以往研究的基础上,系统阐述了心理素质的发展特点及其形成和作用机制;最后,阐述了心理素质研究成果的学术影响及推广应用,并对心理素质的未来研究进行了展望。     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

Psychological Distress in Refugee Children: A Systematic Review

Nearly one-quarter of the refugees worldwide are children. There have been numerous studies reporting their levels of psychological distress. The aim of this paper is to review systematically and synthesize the epidemiological research concerning the mental health of refugee children residing in Western countries. A Cochrane Collaboration style review was conducted searching nine major databases, bibliographies, and grey literature from 2003 to 2008. Included studies had to meet the reporting standards of STROBE and investigate mental health in non-clinical samples of asylum seeking and refugee children residing in OECD countries. A total of twenty-two studies were identified of 4,807 retrieved citations, covering 3,003 children from over 40 countries. Studies varied in definition and measurement of problems, which included levels of post-traumatic stress disorder from 19 to 54%, depression from 3 to 30%, and varying degrees of emotional and behavioral problems. Significant factors influencing levels of distress appear to include demographic variables, cumulative traumatic pre-migration experiences, and post-migration stressors. Importantly, the research base demands greater contextual and methodological refining such that future research would have greater generalizability and clinical implications.