The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress Disorder Barbara J. Burns, Ph.D. Scott N. Compton, Ph.D. Helen L. Egger, M.D. Elizabeth M. Z. Farmer, Ph.D. Duke University Medical Center The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress Disorder Barbara J. Burns, Ph.D. Scott N. Compton, Ph.D. Helen L. Egger, M.D. Elizabeth M. Z. Farmer, Ph.D. Duke University Medical Center

Specific Aims of Project I. To identify efficacious/effective interventions for the treatment of childhood mental disorders which could reduce the risk for substance use problems in adolescence and later; I I.To identify mental health intervention studies in which substance use outcomes could be examined in adolescence and later.

Inclusion Criteria for Literature Search five childhood disorders 3 Study on one of five childhood disorders or related symptom group controlled design 3 Utilized a controlled design 6-12 age range 3 Targeted children in 6-12 age range Published (except interventions studied earlier and not repeated later) outpatient 3 Focused on outpatient treatment

Search Results Clinical ReferencesReferences Meeting Clinical ReferencesReferences Meeting Condition Identified Inclusion Criteria ADHD13231* Depression 2819 Disruptive Behavior 31430* Disorders Anxiety 7537 Disorders Posttraumatic 58 5 Stress Disorder *Studies with N < 30 were excluded

Descriptors in Matrices Study design and description Target population Demographic characteristics (Age, gender, race/ethnicity) Outcomes Comments 

Types of Interventions with Positive Findings by Clinical Condition  PSYCHOSOCIAL  PSYCHOPHARMACOLOGICAL  ADJUNCTIVE (combined treatments)

Interventions with Positive Findings for Attention-Deficit/Hyperactivity Disorder PsychosocialPsychopharmacological Adjunctive cognitive behaviormethylphenidate;slight evidence therapy;desipramine;for psychosocial pindolol; in 2 of 8 studies social skills training;buproprion; for combined amphetamine sulfate treatment; biofeedback drugs superior to psychosocial psychosocial treatment in 6 of 8 studies

Interventions with Positive Findings for Depression Psychosocial Psychopharmacological Adjunctive cognitive behaviorfluoxetine none therapy; self-control training

Interventions with Positive Findings for Disruptive Behavior Disorders PsychosocialPsychopharmacological Adjunctive parent training;lithium; none multisystemic therapy;methylphenidate case management; anger-coping; problem-solving skills PATHS; Project LIFT; First Step; Fast Track

Interventions with Positive Findings for Anxiety Disorders PsychosocialPsychopharmacologicalAdjunctive systematicsertraline none desensitization; (for obsessive compulsive m odeling; disorder only) reinforced practice; cognitive behavior therapy;contingencymanagement; cognitive self-control; educational support

Interventions with Positive Findings for Posttraumatic Stress Disorder PsychosocialPsychopharmacologicalAdjunctive stressinoculation; none none gradual exposure; cognitive behavior therapy (for parent and child)

Specific Aims of Project I. to identify efficacious/effective interventions for the treatment of childhood mental disorders which could reduce the risk for substance use problems in adolescence and later; -- EFFICACY --

Response to Aim I. -- EFFICACY -- Response to Aim I. -- EFFICACY -- Efficacious interventions exist for all disorders examined Strength of psychopharmacological evidence varies by disorder Availability of efficacious interventions in clinical practice is unknown, but suspected to be low Increasing efficacious interventions through training and quality monitoring is warranted

Specific Aims of Project I I.to identify mental health intervention studies in which substance use outcomes could be examined in adolescence and later. -- FOLLOW-UP STUDIES --

Response to Aim II. -- FOLLOW-UP STUDIES -- Response to Aim II. -- FOLLOW-UP STUDIES -- To select follow-up studies from existing studies, decisions are needed relative to: (1)the standard for evidence-based interventions (2)current age of previously studied samples (2)current age of previously studied samples (3)adequacy of the methods (4)risk of samples (i.e., disorders, ethnic diversity) for substance problems Prospective studies needed with substance assessment and follow-up incorporated to: (1)replicate older efficacious treatments (2)develop psychosocial treatments (especially for PTSD) (2)develop psychosocial treatments (especially for PTSD) and medications (except ADHD)