Sofie Kuppens

Performance of Evidence-Based Youth Psychotherapies Compared With Usual Clinical Care A Multilevel Meta-analysis

IMPORTANCE Research across more than 4 decades has produced numerous empirically tested evidence-based psychotherapies (EBPs) for psychopathology in children and adolescents. The EBPs were developed to improve on usual clinical interventions. Advocates argue that the EBPs should replace usual care, but this assumes that EBPs produce better outcomes than usual care. OBJECTIVE To determine whether EBPs do in fact produce better outcomes than usual care in youth psychotherapy. We performed a meta-analysis of 52 randomized trials directly comparing EBPs with usual care. Analyses assessed the overall effect of EBPs vs usual care and candidate moderators; we used multilevel analysis to address the dependency among effect sizes (ES) that is common but typically unaddressed in psychotherapy syntheses. DATA SOURCES We searched the PubMed, PsychINFO, and Dissertation Abstracts International databases for studies from January 1, 1960, through December 31, 2010. STUDY SELECTION We identified 507 randomized youth psychotherapy trials. Of these, the 52 studies that compared EBPs with usual care were included in the meta-analysis. DATA EXTRACTION AND SYNTHESIS Sixteen variables (participant, treatment, outcome, and study characteristics) were extracted from studies, and ESs were calculated for all comparisons of EBP vs usual care. We used an extension of the commonly used random-effects meta-analytic model to obtain an overall estimate of the difference between EBP and usual care while accounting for the dependency among ESs. We then fitted a 3-level mixed-effects model to identify moderators that might explain variation in ESs within and between studies by adding study or ES characteristics as fixed predictors. MAIN OUTCOMES AND MEASURES Primary outcomes of our meta-analysis were mean ES estimates across all studies and for levels of candidate moderators. These ES values were based on measures of symptoms, functioning, and other outcomes assessed within the 52 randomized trials. RESULTS Evidence-based psychotherapies outperformed usual care. Mean ES was 0.29; the probability was 58% that a randomly selected youth would have a better outcome after EBP than a randomly selected youth after receiving usual care. The following 3 variables moderated treatment benefit: ESs decreased for studies conducted outside North America, for studies in which all participants were impaired enough to qualify for diagnoses, and for outcomes reported by informants other than the youths and parents in therapy. For certain key groups (eg, studies of clinically referred samples and youths with diagnoses), significant EBP effects were not demonstrated. CONCLUSIONS AND RELEVANCE Evidence-based psychotherapies outperform usual care, but the EBP advantage is modest and moderated by youth, location, and assessment characteristics. The EBPs have room for improvement in the magnitude and range of their benefit relative to usual clinical care.

Individual and classroom variables associated with relational aggression in elementary-school aged children : A multilevel analysis

Relational aggression was studied within classroom environments by examining individual and classroom correlates among 2731 children (3rd-5th graders) during two successive measurement years. Multilevel analyses yielded small gender differences for relational aggression, indicating that such aggressive behavior was more associated with girls as compared to boys. Findings further demonstrated that relational aggression was positively associated with perceived popularity and peer rejection. Relational aggression was also found to be highly stable over time. Additionally, higher classroom aggression norms, reflected by the classroom level for relational aggression, were associated with increased relational aggression in children. Although variation in relational aggression was situated both at class- and individual-level, differences between individuals were considerably larger than differences between classes. Limitations and further research suggestions are provided and practical implications are discussed.

What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice

Across 5 decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, attention deficit and hyperactivity disorder) disorders and problems. Since the last broad-based youth meta-analysis in 1995, the number of trials has almost tripled and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths), synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects using multilevel modeling to address ES dependency that is common, but typically not modeled, in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: Mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multiproblem treatment (0.15). ESs differed across control conditions, with “usual care” emerging as a potent comparison condition, and across informants, highlighting the need to obtain and integrate multiple perspectives on outcome. Effects of therapy type varied by informant; only youth-focused behavioral therapies (including cognitive-behavioral therapy) showed similar and robust effects across youth, parent, and teacher reports. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science.

Measuring Parenting Dimensions in Middle Childhood Multitrait-Multimethod Analysis of Child, Mother, and Father Ratings

Questionnaire ratings were used to obtain child, mother, and father ratings on three major parenting dimensions (behavioral control, psychological control, and support) in a sample of 600 children aged 8-to-10 years old. Results indicated that mothers, fathers, and children were able to reliably differentiate between the three parenting dimensions by means of questionnaire ratings. Convergent and discriminant validity were tested by analyzing a multitrait-multimethod matrix via confirmatory factor analysis. Convergence between mothers and fathers was satisfactory, while convergence between child and parents was significant, but fairly low. Discriminant validity was sufficiently supported, whereas informant-specific error was related to both child and father ratings. Criterion validity of the parenting dimension with regard to child behavior was established. Overall, behavioral control and support were positively associated with child prosocial behavior, while psychological control was positively correlate...

Associations between parental control and children's overt and relational aggression.

The present study examined specialized associations between parental control and child aggression in a sample of 600 8- to 10-years old children. Parental control dimensions and aggression subtypes were assessed using multiple informants (i.e. children, mothers, fathers, peers, and teachers). In line with expectations, parental physical punishment was positively associated with overt aggression, whereas parental psychological control was positively associated with relational aggression in both girls and boys. In addition, this study demonstrated that if both parents employed similar parenting strategies, it appeared to have a cumulative effect on child aggressive behaviour. Associations involving overt aggression were more pronounced for boys than girls, whereas associations involving relational aggression were not moderated by gender. Overall, the present study contributes to an emerging research field by supporting the hypothesis of specialized associations between parental control and child aggression.

Associations between parental psychological control and relational aggression in children and adolescents: A multilevel and sequential meta-analysis

Youth aggression has been associated with negative parenting practices, but previous research about this association has mainly focused on physical and verbal aggression. Because more subtle forms of aggression are considered at least as harmful as their physical and verbal counterparts, there is a growing scientific interest in parenting practices that are linked with relational aggression. Guided by social learning theory, a link between youth relational aggression and parental psychological control has been postulated, but the empirical evidence is inconsistent. The present meta-analysis provides a multilevel and sequential quantitative synthesis of 165 dependent effect sizes (23 studies) encompassing 8,958 youths. Across studies, a positive, albeit weak, association between parental psychological control and relational aggression was found. The sequential analysis demonstrated that sufficient cumulative knowledge was attained to yield convincing evidence on this overall association. Moderator analyses revealed that developmental period and assessment method were associated with differences in research findings. Overall, however, results suggest that clarifying the precise role of psychological control in the development and maintenance of relational aggression requires more targeted primary research, which in turn would allow additional and more complex synthesis efforts with potentially more nuanced conclusions.

Relations Between Parental Psychological Control and Childhood Relational Aggression : Reciprocal in Nature?

Using a cross-lagged panel design, this study examined the directionality of relations between parental psychological control and child relational aggression. Data were collected from a proportionally stratified sample of 600 Flemish 8- to 10-year-old children at 3 measurement points with 1-year intervals. Reciprocal effects were evident in mother–child dyads. Maternal psychological control was positively related to child relational aggression 1 year later, and child relational aggression was positively related to maternal psychological control 1 year later. The father–child dyads were best represented by unidirectional parent effects. Paternal psychological control was positively related to child relational aggression 1 year later. Surprisingly, these effects emerged only for relational aggression as indexed by mother and father reports and not for relational aggression as indexed by teacher and peer measures.

Perceptions of Maternal and Paternal Attachment Security in Middle Childhood: Links with Positive Parental Affection and Psychosocial Adjustment.

This study aimed at determining whether paternal parenting behaviours (attachment and positive affection) added significant information on children’s psychosocial adjustment beyond that provided by maternal reports. Five hundred and fifty‐two children (fourth through sixth graders) from a non‐clinical sample completed a brief measure of perceived attachment security to their mother and father. Parents and teachers of the children filled out the Strengths and Difficulties Questionnaire, which covers behavioural problems (i.e. emotional symptoms, conduct problems, hyperactivity and peer problems) and prosocial behaviour. Parents also reported on their positive affection towards their child. For the full sample, emotional symptoms, peer problems and prosocial behaviour could be predicted from the parenting measures. Paternal factors added to the variance explained in all models in which significance was found and outweighed maternal factors in predicting emotional symptoms for the total sample as well as for girls.

The Signature Pedagogy of Social Work? An Investigation of the Evidence

Objective: Many professions use some form of internship in professional education. Social work has utilized field instruction throughout much of its history. Recently, the Council on Social Work Education (CSWE) designated field instruction as social work’s signature pedagogy. A systematic review was undertaken to examine evidence related to this designation. Method: Twenty-five primary databases, three grey literature sources, a research university library (for monographs and collections) were searched in addition to a survey of the invisible colleges and hand searching of journals. The goal was to uncover quantitative studies of social work field instruction in the United States. Results: None of the studies that passed the initial review and were acquired for full examination met the inclusion criteria, precluding a meta-analytic integration. Conclusion: The assertion that field instruction is the signature pedagogy of social work would be more credible if supported by stronger evidence.

Usefulness of the Supports Intensity Scale (SIS) for persons with other than intellectual disabilities

In response to the shift from a system-centred care model to a person-centred support model, the Supports Intensity Scale (SIS) has been developed as an instrument to assess the support needs of persons with intellectual disabilities. The instrument is used as a tool for constructing individual support plans, as well as a tool for resource allocation. The aim of the present study was to evaluate the usefulness of the SIS for persons with other than intellectual disabilities. Therefore, the psychometric properties of the SIS were investigated in a sample of 1303 persons with other than intellectual disabilities. Confirmatory factor analysis failed to support the originally proposed six-factor model within this sample. However, an explorative examination of the underlying structure resulted in a shortened version of the SIS, including four subscales and 22 items. Further analyses revealed satisfying results for reliability, construct validity, and criterion validity of the shortened assessment tool (SIS-NID).