The long-held view that medicine or therapy is an “art” is quickly becoming obsolete. To procure referrals and reimbursement, clinicians are being forced to be accountable (ie, use empirically supported, effective, reproducible, and efficient treatment interventions) by insurance companies, professional credentialing bodies, and their consumers. This article focuses on reviews of treatment interventions by scholars, researchers, clinicians, and study groups who have examined multiple databases of published studies and ongoing treatment protocols. Behavioral and cognitive-behavioral therapies were most often identified as well-established treatments for specific mental and behavioral health disorders in children and adolescents. Psychotherapy alone or in conjunction with pharmacotherapy can be powerful tools in helping youth manage or eliminate negative outcomes of mental and behavioral disorders.
The long-held view that medicine or therapy is an “art” is quickly becoming obsolete. To procure referrals and reimbursement, clinicians are being forced to be accountable (ie, use empirically supported, effective, reproducible, and efficient treatment interventions) by insurance companies, professional credentialing bodies, and their consumers. This article focuses on reviews of treatment interventions by scholars, researchers, clinicians, and study groups who have examined multiple databases of published studies, and ongoing treatment protocols. Evidence-based and empirically supported treatments (ESTs) for children and adolescents for treatment of mental and behavioral disorders are reviewed.
A literature review
Significant controversy continues to exist in the medical and psychological fields surrounding which therapies become designated as evidence based or empiric. Problems in methodology, subject selection, and measures plague most published studies. Review articles were drawn from 9 major search engines: 4 where peer-reviewed articles on psychopharmacology versus psychotherapy with children and adolescents were the search criteria (First Search, Psych abstracts, Medline, EBSCOhost) and 5 research databases where reviewers had specified specific inclusion criteria, the topic, exclusion criteria, and identified treatment interventions. These databases included (1) National Registry of Evidence-based Programs and Practices (NREPP), (2) The Office of Behavioral and Social Sciences Research (OBSSR), (3) Evidence-based Mental Health Treatment for Children and Adolescents, (4) National Association of Cognitive-Behavioral Therapists (NACBT), and (5) Cochrane Database of Systematic Reviews.
Four of the 5 databases defined and described criteria for selection of articles and reviews from primarily behavioral and cognitive behavioral resources and were procured from a wide variety of search engines ( Box 1 ). Criteria for Cochrane Database of Systematic Reviews matched the 4 others but included articles and reviews from a variety of disciplines (eg, psychology, psychiatry, nursing, ambulatory medicine). Keywords used were psychopharmacology versus psychotherapy, mental health + psychotherapy, and psychotherapy + treatment interventions for children and adolescents. Only empiric studies were included and details for the methodology are included on specific Web sites. These databases include a range of reviews and a variety of studies from several disciplines.
Applied Social Sciences Index and Abstracts (ASSIA)
British Nursing Index (1994 to 2006)
Campbell Library (including SPECTR and CENTRAL)
Computer Retrieval of Information on Scientific Projects (CRISP)
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Cochrane Depression, Anxiety and Neurosis Trial Register
Cochrane Central Register of Controlled Trials
Cochrane Depression, Anxiety and Neurosis Group Register
Dissertation-Abstracts International
EBSCOhost
Education Resources Information Center (ERIC)
EMBASE is a biomedical database
OCLC First Search
Latin American and Caribbean Health Sciences Literature (LILACS)
MEDLINE
MetaRegister of Controlled Trials Ongoing and unpublished trials
National Research Register (NRR)
Pharmaceutical companies Ongoing and unpublished trials
PsycINFO
RCN database
System for Information on Gray Literature in Europe Archive (SIGLE)
Study Reference Lists
Sociofile Sociologic Abstracts
Sociologic Abstracts
Sportdiscus part of Sports Research Intelligence Supportive
Web of Science
World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP)
Note: most of these databases are fee for service.
This search yielded 130 reviews; 22 reviews focused on children or adolescents and also reviews of treatment interventions for mental health disorders. One review looked at pharmacologic versus psychological treatments for specific diseases and concluded that there were no significant differences between the two types of intervention, although both were effective. The Cochrane reviews also supported the findings from reviews conduced as part of the Evidence-Based Mental Health Treatment for Children and Adolescents group, Evidence-based Therapy site, and the National Registry of Evidence-based Programs and Practices (NREPP) site.
Pharmacotherapy
Empiric evidence supports that a combination of pharmacotherapy and psychotherapy is more beneficial to children and adolescents (attention deficit hyperactivity disorder [ADHD], body dysmorphic disorder, depression, oppositional defiant disorder, and substance abuse). The Multimodal Treatment Study of Children with Attention Deficit and Hyperactivity Disorder study comparing pharmacology and psychotherapy in the treatment of children diagnosed with ADHD is the exception; however, these results are highly controversial and contested by several research psychologists. For discussion of specific drugs effective in the treatment of mental health disorders outside the scope of practice and training of the current author, readers are referred to an excellent text written for clinicians and edited by Greydaus and colleagues entitled Pediatric and Adolescent Psychopharmacology: A Practical Manual for Pediatricians .
Psychotherapy
Psychotherapy can be a very effective tool for management of mental health disorders with children and adolescents, especially for parents and patients who may object to the use of pharmacotherapy. Some parents may not want their children medicated for a number of reasons. Some children and adolescents do not physiologically tolerate medications used to treat mental and behavioral health disorders. Additional obstacles to prescribing medication are the following: (1) some children reach the maximum dosage of a specific medication and can no longer be given higher dosages; (2) some youth are on multiple medications and are at the point where adding more medications or increasing dosages causes serious neurologic, gastrointestinal, or emotional side effects; and (3) many behavioral problems are not resolved with medication when there is an emotional component or environmental cause for the child’s behavioral responses (eg, family conflict). Table 1 contains a list of evidence- and empirically supported treatments. Cognitive behavior therapy was the most researched form of psychotherapy and provided the most evidence to support its effectiveness in the treatment of depression, anxiety, disruptive behavior problems, posttraumatic stress disorder (PTSD), and substance abuse in adolescents.
| Well-Established | Probably Efficacious | ||
| Anxiety, general symptoms | None | I CBT | |
| School refusal behavior | None | None | |
| Child and adolescent OCD | None | I CBT individual CBT, plus sertraline (Zoloft) | |
| Child and adolescent PTSD | CBT trauma focused CBT | CBT | |
| Social phobia | None | CBT | |
| Specific phobia Children | None | None CBT | |
| Behavior therapy | |||
| Adolescents | IPT Individual IPT | CBT | |
| Child and adolescent ADHD | Behavior therapy | N/A | |
| Disruptive behavior problems | |||
| Oppositional defiant disorder | Behavior therapy | CBT | |
| Conduct disorder | Behavior therapy | ||
| Multisystemic therapy | |||
| Depression | |||
| Children | CBT | CBT Behavior therapy | |
| Adolescents | CBT IPT | CBT IPT | |
| Adolescent Substance abuse | CBT Group CBT Family therapy | Family therapy Multisystemic therapy | |
| Anorexia nervosa | |||
| Adolescent anorexia nervosa | Family therapy | N/A | |
| Bulimia nervosa | |||
| Adolescent bulimia nervosa | N/A | N/A | |
| Bipolar disorder | |||
| Child and adolescent BPD | N/A | Family therapy N/A | |
| Autism | |||
| Early autism | Behavior therapy | N/A | |
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