Bahr Weiss

Effects of Psychotherapy With Children and Adolescents Revisited:: A Meta-Analysis of Treatment Outcome Studies

A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age x Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study.

Bridging the Gap Between Laboratory and Clinic in Child and Adolescent Psychotherapy

Meta-analyses of laboratory outcome studies reveal beneficial effects of psychotherapy with children and adolescents. However, the research therapy in most of those lab studies differs from everyday clinic therapy in several ways, and the 9 studies of clinic therapy the authors have found show markedly poorer outcomes than research therapy studies. These findings suggest a need to bridge the long-standing gap between outcome researchers and clinicians. Three kinds of bridging research are proposed and illustrated: (a) enriching the research data base on treatment effects by practitioners in clinical settings--including private practice and health maintenance organizations, (b) identifying features of research therapy that account for positive outcomes and applying those features to clinical practice, and (c) exporting lab-tested treatments to clinics and assessing their effects with referred youths. If these bridging strategies were widely adopted, despite the numerous obstacles described herein, real progress might be made toward more effective treatment in clinical practice.

Effectiveness of Psychotherapy With Children and Adolescents: A Meta-Analysis for Clinicians

How effective is psychotherapy with children and adolescents? The question was addressed by metaanalysis of 108 well-designed outcome studies with 4-18-year-old participants. Across various outcome measures, the average treated youngster was better adjusted after treatment than 79% of those not treated. Therapy proved rnore effective for children than for adolescents, particularly when the therapists were paraprofessionals (e.g., parents, teachers) or graduate students. Professionals (with doctors or masters degrees) were especially effective in treating overcontrolled problems (e.g., phobias, shyness) but were not more effective than other therapists in treating undercontrolled problems (e.g., aggression, impulsivity). Behavioral treatments proved more effective than nonbehavioral treatments regardless of client age, therapist experience, or treated problem. Overall, the findings revealed significant, durable effects of treatment that differed somewhat with client age and treatment method but were reliably greater than zero for most groups, most problems, and most methods.

Can Autism Be Diagnosed Accurately in Children Under 3 Years

This study investigated the reliability and stability of an autism diagnosis in children under 3 years of age who received independent diagnostic evaluations from two clinicians during two consecutive yearly evaluations. Strong evidence for the reliability and stability of the diagnosis was obtained. Diagnostic agreement between clinicians was higher for the broader discrimination of autism spectrum vs. no autism spectrum than for the more specific discrimination of autism vs. PDD-NOS. The diagnosis of autism at age 2 was more stable than the diagnosis of PDD-NOS at the same age. Social deficits and delays in spoken language were the most prominent DSM-IV characteristics evidenced by very young children with autism.

Children's Attributional Style Questionnaire—Revised: Psychometric Examination

This study examines the psychometric properties of the Childrens Attributional Style Questionnaire—Revised (CASQ-R; N. J. Kaslow & S. Nolen-Hoeksema, 1991), a 24-item shortened measure derived from the 48-item CASQ designed to assess childrens causal explanations for positive and negative events. The data for this study come from 1,086 children, 9 to 12 yean* old, with equal representation of boys and girls and African American and Caucasian children. Approximately one half (n = 475) of the youths also completed the CASQ-R 6 months later. Results revealed that although the CASQ-R was somewhat less reliable than the original CASQ, with moderate internal consistency reliability and fair test-retesl reliability, it demonstrated equivalent criterion-related validity with self-reported depressive symptoms. Psychometric properties of the CASQ-R showed some variation by race, such that the overall composite demonstrated better internal consistency and criterion-related validity among Caucasian youths than among African American youths.

Cognitions, depressive symptoms, and development in adolescents.

This study examined the generalizability of cognitive models of depression to adolescents and explored developmental differences with regard to depressotypic cognitions. Self-reported depressive symptoms and various hypothesized cognitive correlates (e.g., automatic thoughts, attributions, dysfunctional attitudes) were investigated in a sample of 688 adolescents in grades 7 through 12. Measures of normative adolescent cognitions (e.g., egocentrism, self-consciousness) also were included. There was a strong association between negative thinking and depression in adolescents. There was no association between depressogenic thinking and age, nor did the strength of the association between negative cognitions and depression vary from early to middle adolescence. Finally, negative cognitions were associated with self-report measures of both depressive and anxious symptoms.

The effectiveness of traditional child psychotherapy.

This study used a randomized design to evaluate the effectiveness of child psychotherapy as typically delivered in outpatient settings. Overall results were similar to the results of nonrandomized studies of traditional child psychotherapy: Little support was found for its effectiveness, with treatment producing an overall effect size of -.08. Despite the lack of significant differences between treatment and control groups in regard to changes in child functioning, parents of children who received treatment reported higher levels of satisfaction with services than control group parents whose children received academic tutoring. Overall, the findings highlight the importance of developing, validating, and transporting effective treatments to clinical settings.

Cognitive-Behavioral Therapy versus Usual Clinical Care for Youth Depression: An Initial Test of Transportability to Community Clinics and Clinicians

Community clinic therapists were randomized to (a) brief training and supervision in cognitive-behavioral therapy (CBT) for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), ages 8-15, of whom 33% were Caucasian, 26% were African American, and 26% were Latino/Latina. Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) depressive disorders (plus multiple comorbidities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists. At posttreatment, depression symptom measures were at subclinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared with UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services (including all psychotropics combined and depression medication in particular), and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement--a hypothesis that warrants testing in future research.

Epidemiology of Behavioral and Emotional Problems Among Thai and American Children: Parent Reports for Ages 6 to 11

Abstract Behavioral and emotional problems of childhood may reflect the influence of culture: prevailing values and socialization practices may suppress development of some problems while fostering others. The authors explored this possibility, comparing 360 6‐to 11‐year‐olds in the Buddhist‐oriented, emotionally controlled culture of Thailand with 600 American 6‐ to 11‐year‐olds. Standardized parent reports on 118 child problems revealed 54 Thai‐U.S. differences ( p

Developmental Differences in the Factor Structure of the Children's Depression Inventory

The factorstructure of theChildrens Depression Inventory (GDI), the most widely used self-report measure of depression for children, has been studied, but we still know relatively little about how developmental differences relate to CD1 structure. Here, we evaluated whether the GDI factor structure differed in large samples of clinic-referred children versus adolescents. Our results indicated real but modest differences. Both groups produced 5 first-order factors, but the composition of the factors differed somewhat for children versus adolescents. Both groups also produced a 2nd-order, general depression factor, although items loading on the factor differed somewhat for the 2 groups: For children but not adolescents, several externalizing behavior items (e.g., / never do what I am told} loaded on the general factor: in contrast, for adolescents but not children, several vegetative items (e.g.. / am tired all the time} loaded on the general factor. Overall, the child-factor pattern appeared to involve fewer CD1 items than did the adolescent pattern.