Kazdin & Weisz (1998). Identifying and developing empirically supported child and adolescent treatments.” - Article summary

There are several characteristics of therapy with children and adolescents:

1. Dysfunction is difficult to assess
   The problematic behaviour may represent short-lived problems or perturbations in development rather than signs of lasting clinical impairment.
2. Identifying cases is problematic
   Youth rarely refer themselves to treatment which makes that externalizing problems are overrepresented in treatment.
3. Dependence on adults
   The dependence of children on adults makes them vulnerable to multiple influences over which they have little control (e.g. living circumstances; parental mental health). Therefore, the family context needs to be addressed in treatment as well.
4. Social environment and treatment
   The social environment plays a very important role for children which makes that taking treatment alone (i.e. without a peer, parent or sibling) is often not possible.
5. Methodological challenges
   It is not clear whether self-report is an appropriate measure for young children and other methods may be flawed when used with youth (e.g. standardized assessment methods).
6. Heterogeneity of samples
   The studies that are conducted typically have very heterogeneous samples which makes interpretation of the results difficult.

Many emotional and behavioural problems that are treated in therapy are often evident in less extreme forms in early development. Treatments have shown beneficial effects in the treatment of children.

Most therapy studies focus on non-referred cases (1), provide relatively brief treatments conducted in group format (2), evaluate treatment in relation to symptom reduction and neglects impairment or adaptive functioning (3), do not evaluate clinical significance of symptom changes (4) and do not conduct a follow-up (5).

Diverse differences among different age groups (e.g. language skills) indicate that treatment with similar general features must differ in numerous specific details when applied in different developmental periods. This leads to a classification dilemma (i.e. what cut-off to use).

A study needs to meet the following criteria to be a good study:

1. Replicable treatment processes.
2. Uniform therapist training and therapists adhering to the planned procedures.
3. Random assignment.
4. Use of clinical samples.
5. Multimethod outcome assessment.
6. Tests of clinical significance.
7. Test of treatment effect on real world, functional outcomes.
8. Assessment of long-term outcomes.

It is likely that dysfunctional anxiety becomes a self-perpetuating cycle of elevated biological response to stress, debilitating cognitions and avoidance of stressful circumstances. CBT appears to be effective for child anxiety.

Depressed children are seen as subject to schemas and cognitive distortions that cast everyday experience in an unduly negative light and as lacking important skills needed to generate supportive social relationships and regulate emotion through daily activity.

Coping skills training (CST) appears to be effective in the treatment of depression for children. It includes structured homework assignments as well as peer or therapist modelling. The mediators and differential effectiveness relative to alternative, simpler treatments still need to be tested.

Cognitive processes refer to a broad class of constructs that pertain to how an individual perceives, codes and experiences the world. Youth who engage in externalizing behaviours show distortions and deficiencies in these processes (e.g. generating alternative solutions).

Problem-solving skill training (PSST) aims to develop interpersonal cognitive problem-solving skills. The emphasis is on how children approach situations. It appears to be effective. However, it is not clear why children improve as it is not clear which cognitive processes change.

Parent management training for oppositional and aggressive children (i.e. PMT) includes procedures in which parents are trained to alter their child’s behaviour in the home. It is based on the idea that conduct problems are inadvertently developed and sustained in the home by maladaptive parent-child interactions. It appears to be very effective.

Multisystemic therapy for antisocial behaviour among adolescents (MST) is a family-systems-based approach for the treatment of antisocial behaviour among adolescents. It maintains that problems emerge within the context of the family. It is used to alter the response repertoire of the adolescent. It appears to be more effective than alternatives.

Family-based treatments for child-obesity stress that learning processes and parental influence stimulates the development of a behaviourally oriented treatment emphasizing parent involvement. It learns children to classify food in three distinct categories and learns them social skills to cope with situations that threaten weight control (e.g. peer pressure).

Intensive, home-based behaviour modification for autism involves heavily involving the parents (1), starting treatment at an early age (2) and maximizing time spent in treatment (3). It states that extreme symptoms in autism are skill deficits which can be addressed via operant procedures. It appears to be effective and more effective than other, comparable treatments.

Video modelling preparation for paediatric medical and dental procedures involves the development of psychological procedures to prepare children for stressful medical and dental procedures. It makes use of coping models. It can make use of video modelling to prepare the children.

There are several issues for treatments:

1. Magnitude of therapeutic change
   The clinical significance needs to be assessed and few studies actually do this. It is important to assess the magnitude of the therapeutic change when it comes to treatment.
2. Maintenance of change
   Information about long follow-ups is often missing.
3. Identifying individual circumstances on which effective treatment depends
   It is important to assess and evaluate which individual circumstances make a treatment effective. Therefore, moderators need to be taken into account more often.
4. Comorbidity
   The effect of treatment with comorbid disorders needs to be taken account as this can lead to a differential recovery trajectory.
5. Mechanisms of change
   The mechanisms of change of the effect of treatment need to be identified more often. It is thus important to know more about the mediators of change.
6. Assess which treatments work and which treatments do not work well
   It is important to assess whether a treatment does not work or whether the treatment works but does not work well. It is also important to assess which treatments may have opposite effects.
7. Fit of the therapy in clinical settings
   It is important to assess how a therapy which has been tested in a research setting can fit in a clinical setting (e.g. training therapists).