John R. Weisz

Parental caregiving and child externalizing behavior in nonclinical samples : a meta-analysis

A meta-analysis of 47 studies was used to shed light on inconsistencies in the concurrent association between parental caregiving and child externalizing behavior. Parent-child associations were strongest when the measure of caregiving relied on observations or interviews, as opposed to questionnaires, and when the measure tapped combinations of parent behaviors (patterns), as opposed to single behaviors. Stronger parent-child associations were also found for older than for younger children, and for mothers than for fathers. Finally, externalizing was more strongly linked to parental caregiving for boys than for girls, especially among preadolescents and their mothers. The meta-analysis helps account for inconsistencies in findings across previous studies and supports theories emphasizing reciprocity of parent and child behavior.

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.

Identifying and developing empirically supported child and adolescent treatments.

Child and adolescent therapy outcome research findings attest to the efficacy of a variety of treatments. This article illustrates promising treatments for selected internalizing (anxiety and depression), externalizing (oppositional, and antisocial behavior), and other (obesity and autism) conditions, and for other aims (preparation for medical and dental procedures). Studies in these areas illustrate worthwhile characteristics that can help inform the search for empirically supported treatments. These characteristics include randomized controlled trials, well-described and replicable treatments, tests with clinical samples, tests of clinical significance, broad-based outcome assessment including measures of real-world functioning, and others. Continued research progress will depend on greater attention to magnitude and maintenance of therapeutic change, long-term follow-up, moderators and mediators of change, and development and testing of treatment in conditions relevant to clinical practice.

Effects of psychotherapy for depression in children and adolescents: a meta-analysis.

Serious sequelae of youth depression, plus recent concerns over medication safety, prompt growing interest in the effects of youth psychotherapy. In previous meta-analyses, effect sizes (ESs) have averaged .99, well above conventional standards for a large effect and well above mean ES for other conditions. The authors applied rigorous analytic methods to the largest study sample to date and found a mean ES of .34, not superior but significantly inferior to mean ES for other conditions. Cognitive treatments (e.g., cognitive-behavioral therapy) fared no better than noncognitive approaches. Effects showed both generality (anxiety was reduced) and specificity (externalizing problems were not), plus short- but not long-term holding power. Youth depression treatments appear to produce effects that are significant but modest in their strength, breadth, and durability.

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.

Promoting and Protecting Youth Mental Health through Evidence-Based Prevention and Treatment.

For decades, empirically tested youth interventions have prevented dysfunction by addressing risk and ameliorated dysfunction through treatment. The authors propose linking prevention and treatment within an integrated model. The model suggests a research agenda: Identify effective programs for a broadened array of problems and disorders, examine ethnicity and culture in relation to intervention adoption and impact, clarify conditions under which programs do and do not work, identify change mechanisms that account for effects, test interventions in real-world contexts, and make tested interventions accessible and effective in community and practice settings. Connecting the science and practice of prevention and treatment will be good for science, for practice, and for children, adolescents, and their families.

Evidence-Based Youth Psychotherapies Versus Usual Clinical Care: A Meta-Analysis of Direct Comparisons.

In the debate over evidence-based treatments (EBTs) for youth, one question is central: Do EBTs produce better outcomes than the usual interventions employed in clinical care? The authors addressed this question through a meta-analysis of 32 randomized trials that directly compared EBTs with usual care. EBTs outperformed usual care. Effects fell within the small to medium range at posttreatment, increasing somewhat at follow-up. EBT superiority was not reduced by high levels of youth severity or by inclusion of minority youths. The findings underscore a need for improved study designs and detailed treatment descriptions. In the future, the EBT versus usual care genre can inform the search for the most effective interventions and guide treatment selection in clinical care.

Perceived Personal Control and Academic Achievement

Perceived control of events is one motivational variable that appears to affect children’s academic achievement. In this review the conceptualization and measurement of the control dimension is discussed from three theoretical perspectives: social learning theory, attribution theory, and intrinsic motivation theories. For each of these three perspectives evidence on the relationship between achievement and perceptions of control is summarized, and possible explanations for the relationship are discussed. Throughout this review similarities and differences among these orientations are pointed out. Specific recommendations are made for research which will advance our understanding of this relationship and which will provide the most useful information to educators.

Brief treatment of mild-to-moderate child Depression using Primary and Secondary Control Enhancement Training

Elementary school children with mild-to-moderate depressive symptoms were randomly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program. The program focused on (a) primary control (changing objective conditions to fit ones wishes; e.g., through activity selection and goal attainment) and (b) secondary control (changing oneself to buffer the impact of objective conditions; e.g., altering depressogenic thinking, practicing mood-enhancing cognitions). At immediate posttreatment and 9-month follow-up, the treatment group showed greater reductions than the control group in depressive symptomatology on the Childrens Depression Inventory and the Revised Childrens Depression Rating Scale, and treated children, more than controls, shifted from above to within the normal range on both measures. Future research is needed to test treatment effects with severely depressed youths.