A reevaluation of estimates of child therapy effectiveness.

In a recent review of nonbehavioral child and adolescent psychotherapy, it was concluded that the magnitude of methodological flaws in this body of research precluded an evaluation of effectiveness. However, recent quantitative reviews of child and adolescent therapy have concluded that nonbehavioral therapy is relatively ineffective compared with behavioral therapy. A sample of nonbehavioral studies was reviewed to evaluate the adequacy of estimates of effectiveness. Three contributions to inaccurate effect estimation were considered: methodological quality, investigator allegiance effects, and treatment representativeness. It was concluded that all three factors contribute to inaccurate estimates of the effectiveness of child and adolescent psychotherapy. Recommendations for improving child therapy research are considered in light of these revealed problems.     

Behavior therapy with children and adolescents: a twenty-year overview

A twenty-year overview of behavior therapy with children and adolescents is presented. The various techniques and their application to relevant major DSM-III-R categories are critically discussed. It is concluded that behavior therapy has made great progress and has proven applications in child and adolescent disorders but that its precise roles, comparative efficacy, and complementarity to other forms of psychotherapy and other treatments remain to be demonstrated. Much uncertainty stems from the relatively poor state of research in other forms of psychotherapy.     

Bridging Child,Adolescent, and Adult Psychotherapy: Directions for Research

Child and adolescent psychotherapy research has advanced in the past decade in terms of the number of controlled outcome studies and evidence attesting to the effectiveness of alternative forms of treatment. Therapy research with children has lagged behind research with adults, as reflected in the types of questions that are asked about treatment and the methods available to permit in-depth study of the treatment process. This article advocates efforts to build bridges between adult and child psychotherapy. The advantages of developing these bridges are to deepen our understanding of child and adolescent treatment, to provide a developmental perspective relevant to both child and adult therapy, and to identify broader models of change among children, adolescents, and adults. Three areas of research in adult therapy are used to illustrate the potential benefits of bridging adult and child therapy and include research on client and therapist variables, therapeutic processes, and models of change.     

Developing a research agenda for child and adolescent psychotherapy

Child and adolescent therapy has progressed considerably, as reflected in the sheer number of controlled studies, their methodological quality, and identification of empirically supported treatments. Even so, research is not likely to make significant advances, in light of the way in which treatment is studied and the emphasis on technique-focused questions. This article raises 3 questions: What are the goals of child and adolescent psychotherapy research? What type of research is needed to obtain these goals? How can we determine whether we are making progress toward the goals? This article provides a plan to advance research that (1) emphasizes understanding the mechanisms or processes through which therapeutic change occurs, (2) draws on developmental psychopathology research to inform treatment, (3) expands the range of questions that guide treatment research, and (4) elaborates multiple treatment outcomes on which to base conclusions. Recommendations are made to both develop the research agenda and to evaluate progress.     

How specific is the evidence base for child and adolescent psychotherapy?

Evidence-based psychotherapy (EBP) proposes the fit between a specific treatment, therapist, patient and mental disorder. At the same time, the generalization of psychotherapy research findings is intended. In this conflict between individualized and standardized treatment the search for specific active components of psychotherapy is essential to improve intervention methods as well as training of therapists. Many manualized treatments for children and adolescents are considered evidence-based, proven by its outcome. However, their active ingredients often remain unclear. The following methods to identify necessary active components for successful treatments are described: classical comparative randomized controlled trials, dismantling studies, add-on studies, meta-analyses, and the multiphase optimization strategy. Consequences for the future agenda for child and adolescent psychotherapy research are discussed.     

Changing views: New perspectives in child psychiatric research

Research in child and adolescent psychiatry has remarkably changed during the last two decades. In general, there is a strong trend towards empirically based research in all relevant areas, including basic research as well as psychotherapy and prevention. Important contemporary research fields are: epidemiology, developmental psychopathology, family psychopathology, electrophysiology, neuropsychology, genetics, and the application of the new imaging techniques in child psychiatric disorders. Several methods applied in these fields have been developed in non-medical disciplines so that it has been and will be an interdisciplinary task to integrate them into child psychiatry as a medical discipline. New journals, most of them using an interdisciplinary approach, have substantially contributed to the spread of knowledge and have improved the quality of scientific contributions worldwide. Nevertheless, there are also deficits and shortcomings: In general, there is not enough support for research in the field of child psychiatry and developmental psychopathology. In many countries, there is also a deficit with regard to education and training of young researchers. There are not enough positions for senior researchers within departments of child and adolescent psychiatry, and there is also a deficit of research departments in the field without an overload of clinical tasks. However, in many places the given resources are not adequately used, and very often, there is also a lack of interdisciplinary cooperation. Besides these general shortcomings, there are also deficits with regard to conceptualization and evaluation of treatment methods and measures of prevention. To overcome these deficits and shortcomings will be an important task for the future.     

Culturally informed child psychiatric practice

Child and adolescent psychiatrists are already serving an increasing population of culturally and ethnically diverse patients and families in their practices and in different agency settings. This article discusses adaptations to practice that enable child and adolescent psychiatrists to address the diverse clinical and cultural needs of this emerging population. Special attention is given to work in psychotherapy and in agency settings where diverse children and youth are found in large numbers.     

15年间儿童心理门诊的资料分析

目的:了解从1985年8月本院正式成立儿少心理咨询门诊以来的15年患儿就诊的情况,以掌握了解儿童和少年精神障碍的发展趋势.方法:从1985年8月到1999年6月30日之间就诊患儿的病历中,每年随机抽取200份,共3000份病历,做逐一记载,然后将资料进行分析,结果:15年来门诊中外地患儿呈增高趋势;患儿年龄在门诊初期主要集中于儿童期,以后涉及到儿童和青少年的各年龄段,以儿童期和少年期最多;文化程度以中,小学生居多,在初期,精神障碍各类论断单一,论断不规范,90年代以后论断趋于标准化,位于前三位的论断是:儿童多动症,情绪障碍和精神发育迟滞,治疗以药物为充,利他林是治疗“多动症“的常用药物,各种心理治疗呈逐年增多趋势.结论:我国儿童和青少年精神卫生事业的发展已经达到一个新的水平,社会对儿童和青少年精神医学和需求普遍增国,加强儿少精神卫生知识的宣传,普及,提高干预和治疗是专业人员的责任.     

Differential diagnosis and pharmacotherapy of juvenile mania -- a review

Manic disorders and bipolar psychoses have long been underdiagnosed in child and adolescent psychiatry. Scientific research has been rare as well. In particular in adolescence and young adulthood bipolar disorders are not easy to diagnose. Therefore these disorders should be included in differential diagnosis as research from the U. S. shows that there is a significant number of these treatable patients. Being untreated sufficiently major setback in social development and quality of life occur, as severe as in schizophrenia. Adequate medication and psychotherapy in the early phases of these chronic disorders ameliorate the overall prognosis. Special attention should be drawn to hypomanic phases and phenomena as rapid cycling.     

The alliance in child and adolescent psychotherapy

The therapeutic alliance has a long history in the child and adolescent psychotherapy literature. This article examines prominent views on the alliance with youth and considers a number of issues that distinguish youth alliance from its adult counterpart. A meta-analysis of alliance-outcome associations in individual youth therapy is presented. In order to provide a direct comparison with the adult literature, the review included only prospective studies of individual youth therapy that used an explicit measure of alliance. Results from 16 studies revealed consistency with the adult literature with a weighted mean correlation of .22 (k = 16, n = 1306, p < .001) between alliance and outcome (CI = +/-.06). Although there were trends showing stronger alliance-outcome associations for child versus adolescent therapy and for behavioral versus nonbehavioral therapies, only problem type (substance abuse and mixed problems vs. eating disorders) significantly moderated alliance-outcome associations. Limitations of the research and implications for therapeutic practice are discussed.     

Current ethical issues in child and adolescent psychotherapy

Core ethical principles for the conduct of psychotherapy with children and adolescents transcend times, trends, and jurisdictions. Advances in technology, variations in state law, and the evolution of federal law should stimulate consideration of how these ethical principles apply to new situations; however, the guiding compass remains the psychotherapist's obligation to create and protect the integrity of the psychotherapeutic space to provide the child or adolescent the freedom to identify, examine, explore, and hopefully resolve the issues that bring one to treatment. Boundaries, privacy, confidentiality, and the patient's autonomy are components of this space. Together, they reflect a basic respect for the patient central to professional conduct and essential to any effective treatment process.     

Training in cognitive behavioral therapy in psychiatry residency: an overview for educators

In January 2001, Accreditation Council of Graduate Medical Education accredited general psychiatry training programs were charged with the requirement to train residents in cognitive-behavioral therapy (CBT) to a level of competence. Programs were given the responsibility to delineate standards for trainees, to determine measures of competence, and to provide remediation for deficiencies in performance. Effective education in CBT in general and child and adolescent psychiatry residency training can be more successful when educators understand the barriers to implementation of empirically supported therapies (ESTs). Robust training programs in CBT must take into account cultural barriers to psychotherapy training and the educational demands placed on residents in adult and child and adolescent psychiatry. Resources for training and evaluation materials are available to training directors and teachers.     

Debate: Child and adolescent mental health services in Pakistan; Do we need in-patient mental health facilities for children and young people?

Depression and anxiety are leading causes of morbidity in children and adolescents worldwide. In Pakistan, young people are exposed to many chronic adversities including violence, social and economic inequalities, and are at greater risk of developing mental health problems. Yet there is a lack of trained human resources, in-patient child and adolescent mental healthcare facilities, and training opportunities in child and adolescent psychiatry and mental health in Pakistan. Given the poor economic condition of the country, which has been made even worse by the COVID-19 pandemic, it is very unlikely that dedicated resources will be made available in near future to develop specialist child and adolescent mental health services in Pakistan. To bridge this treatment gap, we propose a multitiered, transdiagnostic, task-shifting strategy-based model for child and adolescent mental health services in Pakistan.     

On internalization in group psychology: the group within

A review of the relevant psychoanalytic literature suggests that internalization processes are generally depicted as occurring only within the framework of the family. By contrast, the developmental psychology literature stresses the additional importance of internalized child and adolescent group experiences. Salient recollections from professionals' and patients' group life were offered to buttress the contention that gratifying as well as stressful group experiences are subject to internalization and to subsequent externalization, especially in the context of free-associative psychotherapy.     

Clinical guidelines for depressive disorders in childhood and adolescence

 Major depressive and dysthymic disorders are recurrent and sometimes persistent unipolar mood disorders, which often present in childhood and adolescence. Depressive episodes may increase in severity and duration with recurrence and are associated with substantial morbidity and risk of suicide. The role of child and adolescent mental health services in early intervention and management is thus of major importance. This paper draws together current research evidence and common clinical practice, in guidelines for the specialist management of depressive disorders in childhood and adolescence. Both psychotherapy and pharmacotherapy have been found to be beneficial for the acute treatment of children and adolescents with depressive disorders. Based on current evidence, psychotherapy may be the first treatment for most depressed youngsters, but antidepressants should be considered for those with severe depression. All patients need continuation therapy, and some will need maintenance treatment. Evidence supporting the efficacy of psychological and psychopharmacological treatments are reviewed. An integration of approaches is suggested as a guideline for treatment planning. Accepted: 15 February 2000     

Involving parents in child psychoanalytic psychotherapy

Contacts with parents or other care giving persons accompanying child psychotherapy necessarily result from the emotional and material dependency of the child or adolescent. The professional guidelines for the therapeutic work with parents are contradictory and confusing. Experts' concepts are complex and inconsistent. Considering the immense impact of environmental influences on the development of children and adolescents a precise conceptualisation of this elementary part of therapy is needed in order to be able to influence the parental involvement in the disorder of the child. Three different kinds of parental involvement may be differentiated: 1. parental misunderstanding about what is beneficial for the development of the child, 2. parental involvement resulting from unconscious conflicts and 3. disturbances resulting from structural immaturity of the care giving persons. In regard of these different forms of parental involvement therapeutic aims and options for interventions are delineated.     

Exploring 'clinical judgement': how do child and adolescent mental health professionals decide whether a young person needs individual psychotherapy?

This article reports on a small-scale, qualitative study based in a single CAMHS team, exploring the decision-making process used by mental health professionals when deciding whether or not to refer a child for one particular modality of treatment--individual psychotherapy. Building on an initial audit of child psychotherapy referrals within the team, this study analyses a small number of in-depth interviews with members of the multidisciplinary CAMHS team. Three themes emerged from the analysis, suggesting that referral-making decisions depend on wider conceptions of the particular modality of therapy, particular features of the child and family referred (but not reducible to diagnostic categories), and the stage at which therapeutic work with the family has reached at the time of referral. The implications of these findings are discussed specifically in relation to child psychotherapy, and more generally in relation to evidence-based practice. The authors conclude by arguing for the use of more clinically relevant research methodologies within evidence-based research.