Chapter 13Intervention:Children and Adolescents

INTRODUCTION TO CLINICAL PSYCHOLOGY 2EHUNSLEY & LEE

PREPARED BY DR. CATHY CHOVAZ, KING’S COLLEGE,

UNIVERSITY OF WESTERN ONTARIO

Topics

Who is the Client? Does Psychotherapy work for

Children and Adolescents? Evidence-Based Practice for Children

and Adolescents Evidence-Based Treatment Examples Efficacy of Evidence-Based Treatment

Children rarely refer themselves for treatment – they also do not usually pay for their services

Parents/Guardians usually make the referrals

Goals for children/adolescents often do not match goals for parents/teachers

Legal issues around consent are often complex

Who is the Client for Child and Adolescent Services?

Levitt (1957, 1963) – published findings saying no clear evidence of efficacy

Subsequent meta-analyses indicated similar positive results (effect sizes) as treatment of adults Weisz found effect sizes of .79 (and larger

for behavioural approaches) Weighted Least Squares Method:

assigns less weight to studies with smaller samples or greater error

Does Psychotherapy Work for Children and Adolescents?

Evidence-Based Practice exists for many childhood disorders. However, they are not routinely offered in

standard care

Difficulty in translating clinical trials into actual care

State of Hawaii Task force developed comprehensive care based on current research

Canadian Pediatric Society (CPS) has prepared research-based position statements

Evidence-Based Practice for Children and Adolescents

Many of the current treatments with evidence for their effectiveness are cognitive behavioural, behavioural, or interpersonal in approach

Questions about appropriateness of treatment for ethnically diverse youth: Ethnic invariance: no differences when

treatment is applied to diverse sample Ethnic disparity: differences when treatment is

applied to a diverse sample

Evidence-Based Practice for Children and Adolescents

No current guidelines for children by a psychological organization (unlike adults)

Some guidelines have been published for particular disorders such as the NICE guidelines – depression (2005), conduct disorder (2006), and ADHD (2008)

There are current efforts to develop interdisciplinary evidence-based guidelines for the assessment and treatment of childhood disorders

Evidence-Based Practice for Children and Adolescents

Parent Management Training (PMT) Based on social learning theory and importance of

changing child’s environment Often used for Oppositional Defiant Disorder (ODD)

and Conduct Disorder (CD) Delivered in a structured format using a treatment

manual and repeated practice Focuses on changing coercive exchanges –

parent inadvertently rewards whining or aggression Highlights the importance of cognitive and affective

variables Trains parents to work with children in prosocial

ways

Evidence-Based Treatment Examples

PMT Core Parenting Skills

Multisystemic Therapy for ODD and CD Grounded in ecological theory Works within the context of numerous

systems – family, school, community, peer, juvenile justice

Interventions developmentally appropriate Evaluated continuously from multiple

perspectives Caregiver plays a key role in this

behavioural approach

Evidence-Based Treatment Examples

Nine Principles of Multisystemic Therapy for ODD and CD:

1. Assessment is to understand the problems in their broader context.

2. Therapeutic contacts emphasize the positive and use systemic strengths as levers for change.

3. Interventions are designed to promote responsible behavior among family members.

4. Interventions are present focused and action oriented, targeting specific problems.

Evidence-Based Treatment Examples

1. Interventions target sequences of behaviour within and between multiple systems.

2. Interventions are developmentally appropriate

3. Interventions require daily or weekly effort by family members.

4. Intervention effectiveness is evaluated continuously from multiple perspectives.

5. Interventions are designed to promote treatment generalization and long-term change

Evidence-Based Treatment Examples

Coping with Depression in Adolescence (CWDA) Behavioural strategies

Increasing pleasant activities Developing problem solving skills Assertiveness

Cognitive strategies Positive self-talk, coping, cognitive management

Evidence-Based Treatment Examples

Coping with Depression in Adolescence (CWDA)

Affect managementRelaxationAnger managementDealing with negative emotionMood monitoring

Group format - psychoeducational

Evidence-Based Treatment Examples

Growing evidence that standard community care for children and adolescents is not effective

Research needed to assess whether the efficacy studies are translatable to community settings; and how to disseminate efficacy study findings

Efficacy of Evidence-Based Treatment

Strategies to Facilitate the Dissemination of Evidence-based Treatment (Exhibit 13.4)

Copyright © 2010 John Wiley & Sons Canada, Ltd. All rights reserved. Reproduction or translation of this work beyond that permitted by Access Copyright (The Canadian Copyright Licensing Agency) is unlawful. Requests for further information should be addressed to the Permissions Department, John Wiley & Sons Canada, Ltd. The purchaser may make back-up copies for his or her own use only and not for distribution or resale. The author and the publisher assume no responsibility for errors, omissions, or damages caused by the use of these programs or from the use of the information contained herein.

Copyright