the evidence base for psychosocial and psychopharmacological interventions for children with...

The Evidence Base for Psychosocial and Psychopharmacological Interventions for The Evidence Base for Psychosocial and Psychopharmacological Interventions for

Children with Children with

Attention-Deficit/Hyperactivity Disorder, Attention-Deficit/Hyperactivity Disorder,

Major Depressive Disorder,Major Depressive Disorder,

Disruptive Behavior Disorders, Disruptive Behavior Disorders,

Anxiety Disorders, Anxiety Disorders,

and Posttraumatic Stress Disorderand Posttraumatic Stress Disorder

Barbara J. Burns, Ph.D.Barbara J. Burns, Ph.D.

Scott N. Compton, Ph.D.Scott N. Compton, Ph.D.

Helen L. Egger, M.D.Helen L. Egger, M.D.

Elizabeth M. Z. Farmer, Ph.D.Elizabeth M. Z. Farmer, Ph.D.

Duke University Medical CenterDuke University Medical Center

Specific Aims of ProjectSpecific Aims of Project

I I .. To identify efficacious/effective interventions To identify efficacious/effective interventions

for the treatment of childhood mental disordersfor the treatment of childhood mental disorders

which could reduce the risk for substance usewhich could reduce the risk for substance use

problems in adolescence and later;problems in adolescence and later;

II II.. To identify mental health intervention studies To identify mental health intervention studies

in which substance use outcomes could be in which substance use outcomes could be

examined in adolescence and later.examined in adolescence and later.

Inclusion Criteria for Literature SearchInclusion Criteria for Literature Search

Study on one of five childhood disordersfive childhood disorders or related symptom group

Utilized a controlled designcontrolled design

Targeted children in 6-12 age range6-12 age range

Published 1985-19991985-1999 (except interventions studied earlier and not repeated later)

Focused on outpatientoutpatient treatment

Search ResultsSearch Results

Clinical Clinical References References References MeetingReferences MeetingConditionCondition Identified Identified Inclusion Criteria Inclusion Criteria

ADHDADHD 132132 31*31*

DepressionDepression 28 28 1919

DisruptiveDisruptiveBehavior Behavior 314314 30*30*DisordersDisorders

AnxietyAnxiety 75 75 3737DisordersDisorders

Posttraumatic Posttraumatic 58 58 5 5Stress DisorderStress Disorder

*Studies with *Studies with NN < 30 were excluded < 30 were excluded

Descriptors in MatricesDescriptors in Matrices

Study design and description

Target population

Demographic characteristics

(Age, gender, race/ethnicity)

Outcomes

Comments

Types of Interventions Types of Interventions

with Positive Findings with Positive Findings

by Clinical Conditionby Clinical Condition

PSYCHOSOCIALPSYCHOSOCIAL

PSYCHOPHARMACOLOGICALPSYCHOPHARMACOLOGICAL

ADJUNCTIVE ADJUNCTIVE (combined treatments)(combined treatments)

Interventions with Positive Findings forInterventions with Positive Findings for

Attention-Deficit/Hyperactivity DisorderAttention-Deficit/Hyperactivity Disorder

PsychosocialPsychosocial PsychopharmacologicalPsychopharmacological Adjunctive Adjunctive

cognitive behaviorcognitive behavior methylphenidate;methylphenidate; slight evidenceslight evidence

therapy;therapy; desipramine;desipramine; for psychosocial for psychosocial

pindolol; pindolol; in 2 of 8 studiesin 2 of 8 studies

social skills training;social skills training; buproprion; buproprion; for combinedfor combined

amphetamine sulfate amphetamine sulfate treatment;treatment;

biofeedbackbiofeedback

drugs superior todrugs superior to

psychosocialpsychosocial

treatment intreatment in

6 of 8 studies6 of 8 studies


DepressionDepression

PsychosocialPsychosocial Psychopharmacological Psychopharmacological Adjunctive Adjunctive

cognitive behaviorcognitive behavior fluoxetinefluoxetine none none

therapy;therapy;

self-control trainingself-control training


Disruptive Behavior DisordersDisruptive Behavior Disorders

PsychosocialPsychosocial PsychopharmacologicalPsychopharmacological AdjunctiveAdjunctive

parent training;parent training; lithium;lithium; none none

multisystemic therapy;multisystemic therapy; methylphenidatemethylphenidate

case management;case management;

anger-coping;anger-coping;

problem-solving skillsproblem-solving skills

PATHS; PATHS;

Project LIFT; Project LIFT;

First Step; First Step;

Fast TrackFast Track


Anxiety DisordersAnxiety Disorders


systematicsystematic sertraline sertraline none none

desensitization;desensitization; (for obsessive compulsive(for obsessive compulsive

mmodeling;odeling; disorder only)disorder only)

reinforced practice;reinforced practice;

cognitive behaviorcognitive behavior

therapy;therapy;

contingency contingency

management;management;

cognitive self-control;cognitive self-control;

educational supporteducational support


Posttraumatic Stress DisorderPosttraumatic Stress Disorder


stressstress inoculation;inoculation; none none none none

gradual exposure;gradual exposure;

cognitive behavior therapy cognitive behavior therapy

(for parent and child)(for parent and child)


I I .. to identify efficacious/effective interventions to identify efficacious/effective interventions

for the treatment of childhood mental disordersfor the treatment of childhood mental disorders

which could reduce the risk for substance usewhich could reduce the risk for substance use

problems in adolescence and later;problems in adolescence and later;

-- EFFICACY --

Response to Aim Response to Aim II. .

-- EFFICACY ---- EFFICACY --

Efficacious interventions exist for all disorders examinedEfficacious interventions exist for all disorders examined

Strength of psychopharmacological evidence Strength of psychopharmacological evidence

varies by disordervaries by disorder

Availability of efficacious interventions in clinical practiceAvailability of efficacious interventions in clinical practice

is unknown, but suspected to be lowis unknown, but suspected to be low

Increasing efficacious interventions through training and Increasing efficacious interventions through training and

quality monitoring is warrantedquality monitoring is warranted


II II.. to identify mental health intervention studies to identify mental health intervention studies

in which substance use outcomes could be in which substance use outcomes could be

examined in adolescence and later.examined in adolescence and later.

-- FOLLOW-UP STUDIES --

Response to Aim Response to Aim IIII..

-- FOLLOW-UP STUDIES ---- FOLLOW-UP STUDIES --

To select follow-up studies from existing studies, To select follow-up studies from existing studies,

decisions are needed relative to:decisions are needed relative to:

(1)(1) the standard for evidence-based interventionsthe standard for evidence-based interventions

(2)(2) current age of previously studied samplescurrent age of previously studied samples

(3)(3) adequacy of the methodsadequacy of the methods

(4)(4) risk of samples (i.e., disorders, ethnic diversity) risk of samples (i.e., disorders, ethnic diversity) for substance problemsfor substance problems

Prospective studies needed with substance assessment Prospective studies needed with substance assessment and follow-up incorporated to:and follow-up incorporated to:

(1)(1) replicate older efficacious treatmentsreplicate older efficacious treatments

(2)(2) develop psychosocial treatments (especially for PTSD) develop psychosocial treatments (especially for PTSD) and medications (except ADHD)and medications (except ADHD)

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