Chapter 13 INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee

Questions Who is the client in psychological services for childhood disorders? Landmarks in the evolution of evidence-based psychological services for children and adolescents Examples of evidence-based treatments Efficacy, effectiveness, and the dissemination of evidence-based treatments For next class Outline

Who is the client in psychological services for children and adolescents?

1 in 5 children have a mental disorder (World Health Organization, 2007) Half of all mental disorders begin before the age of 14 (World Health Organization, 2007) Median age of onset of:  impulse control problems—11 years  anxiety disorders—11 years  depression—14 years (Kessler et al. 2005; Merikangas et al. 2010) Who Needs Services?

Most disorders are chronic and persist into adulthood Comorbidity is very common; 40% with 1 diagnosis have a 2 nd diagnosis(Merikangas et al., 2010) Associated with  Substance abuse  Suicide  School problems and drop-out  Delinquency  Unprotected sex Consequences of Problems in Youth

Child, his/her friends and siblingsParents, caregiversSchool, healthcare, and criminal justice Burden of Child and Youth Mental Disorders

Only 1 in 3 adolescents requiring services for clinical problems received them (Costello, Copeland, Cowell, & Keeler, 2007) Only half of children and adolescents who begin psychological services complete them (Nock & Ferriter, 2005) Limited evidence that treatment as usual is helpful (e.g., Weiss et al.,1999) Psychological Treatments: The Bad News

Parental psychopathology Parental isolation Family conflict Issues of Premature Termination/Drop-out

Landmarks in the Evolution of EB Psychological Services for Children and Adolescents

1000s of studies Different methodologies Contradictory findings Lag in development and evaluation of services for children and youth compared to services for adults Evidence for Services for Children and Youth?

Does therapy work? What therapy works for this problem? What therapy works for this problem in this context?

Levitt reviews – studies – studies – Echoes Eysenck’s review for adults; no evidence of efficacy, as 67-73% improved without treatment Casey & Berman (1985) First meta-analysis of 79 studies – Comparable effect sizes to adult; larger effect sizes for behavioural approaches than for other orientations Does Therapy Work?

Kazdin, Bass, Ayers, & Rodgers (1990) – Although treatment works, samples in RCTs dissimilar to clinical practice Weisz, Weiss, Alicke, & Klotz (1987) – Larger effect for behavioural approaches Weisz, Weiss, Han, & Granger (1995) – Larger effects for behavioural approaches; effects sustained at follow-up Does Therapy Work?

Commissioned reviews designed to set out criteria by which research will be evaluated and to produce clear recommendations Focus on specific disorders or problems Which Therapy Works for this Disorder?

APA Division 12 (Clinical) Task Force on Promotion and Dissemination of Psychological Procedures – Chambless & Ollendick, 1999 Society of Clinical Child and Adolescent Psychology (APA Division 53) – Journal of Clinical Child Psychology 1998 – Journal of Pediatric Psychology, 1999 – Journal of Clinical Child and Adolescent Psychology (JCCAP), 2008 Which Therapys Work for this Disorder?

Silverman & Hinshaw edited special issue (2008) on efficacious treatments for: – Anxiety disorders: social anxiety, phobias, obsessive compulsive disorder; – Attention-deficit/hyperactivity disorder – Autism – Depression – Disruptive behaviour disorders – Exposure to trauma – Substance abuse disorders JCCAP

Nathan and Gorman (1998; 2002; 2007) – Treatments that work Fonagy & colleagues (2002; 2005) – What works for whom? Hawaii Department of Health Task Force – Chorpita (2002) What Works for this Disorder? Interdisciplinary Reviews

Clinical practice guidelines Set standards based on reserarch Based on research Require regular updates Influence services that are funded

Disruptive behaviour disorders – Parent Management Training (PMT) – Multisystemic Therapy (MST) Adolescent depression – Coping with Depression in Adolescence Examples of Evidence-Based Treatments

Efficacy, Effectiveness, and Dissemination

Unknown how many receive treatments that are evidence- based (Kazdin, 2008) Do results from RCTs generalize to regular clinical settings? Can efficacious treatments be transported to other countries? Can regular clinicians achieve similar results? Do EBTs Work in Real World Settings?

Identify effectiveness studies Identify meta- analyses of RCTs Compare on two clinically relevant benchmarks To see whether EBTs can be transported to real- world settings….

Internalizing disorders: n = 394 – Depression n = 3 studies – Mixed anxiety n = 2 studies – OCD = 2 studies Completion: over 80% Recovery: 50-75% Effectiveness: Lee, Horvath, & Hunsley (2013)

Disruptive behaviour disorders – N = 1118 parents – n = 13 studies Completion: around 80% Improvement: moderate effect sizes Effectiveness: Lee et al. (2013)

Chorpita & Daleiden (2009) reviewed 322 randomized controlled trials of treatments for children and youth – Identified clusters of treatment strategies shown to be efficacious across many trails, for various disorders – Advocate using such strategies to individually tailor the treatment to client needs Weisz et al. (2012) developed modular treatment options for depression, anxiety, and conduct problemss – Modular treatment out-performed treatment as usual and specific EBTs for depression, anxiety, and conduct problems – Caveat—single trial requiring replication Modular Treatment Options

For next class…

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