Child and Adolescent Mental Health Division

Evidence Based Services

TIP OF THE WEEK

Week of 06-30-08
Exposure, along with CBT, has been found in over 20 randomized controlled studies to have the Best Support for the treatment of anxious and avoidant behaviors. Exposure has been found to be effective with children ages 3 to 19, for a variety of ethnicities and in different treatment settings (source: EBS Biennial Report 2007). [160]

Previous Tips

Week of 06-23-08
In general, most successful treatments for traumatic stress involves training the youth to identify and correct thinking associated with anxiety and to cope with avoidance and anxiety triggers through exposure, often in imaginal or narrative form. Other supportive strategies include teaching the youth how to manage personal safety, be assertive when necessary, and to solve problems that may be related to traumatic stress triggers (source: EBS Biennial Report 2007). [159]

Week of 06-16-08
Several treatments for anxious and avoidant behaviors in youth were tested in randomized trials and were found to have No Support (which means that they were tested and failed). These included: Attention, Client Centered Therapy, Eye Movement Desensitization and Reprocessing (EMDR), Relationship Counseling, and Teacher Psychoeducation (source: EBS Biennial Report 2007). [158]

Week of 06-09-08
The most common practice element (specific "clinical ingredient") of all "winning" treatments for attention and hyperactivity problems (27 altogether) was problem solving (44%). This was found across study groups (source: EBS Biennial Report 2007). [157]

Week of 06-02-08
When treating substance abuse disorders, contrary to popular belief, No Support has been found for using Twelve-step Programs, Client-Centered Therapy, Education, Group Therapy, or Project CARE (source: EBS Biennial Report 2007). [156]

Week of 05-26-08
In general, most successful treatments for depression and withdrawal problems involve training the youth to identify and correct thinking associated with lowered moode (e.g., "cognitive" techniques (source: EBS Biennial report 2007). [155]

Week of 05-19-08
The most common practice elements (specific "clinical ingredients") used in all successful treatments for autistic spectrum disorders involve teaching communication skills and modeling of appropriate communication or other behaviors (source: EBS Biennial report 2007). [154]

Week of 05-12-08
Eight different treatment approaches demonstrated Good Support for attention and hyperactivity problems. Among these, Physical Exercise was successful in 3 studies, beating alternative treatments one time, and beating a no treatment control two times (source: EBS Biennial Report 2007). [153]

Week of 05-05-08
For traumatic stress, No Support was found for the following treatment approaches: Client Centered Therapy, Cognitive Behavior Therapy with Parents Only (i.e., therapy that does not involve the child at all), and Eye Movement Desensitization and Reprocessing (EMDR; source: EBS Biennial Report 2007). [152]

Week of 04-28-08
Rational Emotive Therapy, Biofeedback, Psychodynamic Therapy, and Play Therapy all received Minimal Support for the treatment of anxious and avoidant behaviors in youth. Treatment families with minimal support should rarely if ever be the first line choice of treatment, unless no better options exist for that particular youth problem (source: EBS Biennial Report 2007). [151]

Week of 04-21-08
When treating youth substance abuse, as with delinquency and disruptive behavior, both Group Therapy and Project CARE treatment approaches demonstrated negative effects on outcomes, and are therefore considered treatments with risks (source: EBS Biennial Report). [150]

Week of 04-14-08
There are distinct patterns in the use of practice elements depending on the age of study participants with disruptive behavior. In studies of younger children, time out (58%) was the most common practice element. In studies of older children, communication skills (57%) was the most common practice element (source: EBS Biennial Report 2007). [149]

Week of 04-07-08
A Caregiver Psychoeducation program has not yet been analyzed for its autism outcomes, but it did beat a no-treatment control group on a measure of material depression in one study. Thus, it appears to be a promising approach for reducing maternal depression among mothers of youth with autism (source: EBS Biennial Report 2007). [148]

Week of 03-31-08
Of those treatments identified for traumatic stress in the 2007 EBS Biennial Report, only Cognitive Behavior Therapy with Parents was found to have Best Support Further, the great majority of the evidence for treatment of traumatic stress in youth supports the use of Cognitive Behavior Therapy (CPT). [147]

Week of 03-24-08
When treating delinquency and disruptive behaviors, both Group Therapy and Project CARE treatment approaches demonstrated negative effects on outcomes, and are considered treatments with risks (source: EBS Biennial Report 2007). [146]

Week of 03-17-08
No Support was found for Attenion, Counselors Care, Counselors Care and Anger Management, Life Skills, Problem-Solving, and Social Skills, when used in the treatment of depression and withdrawal problems (source: EBS Biennial Report 2007). [145]

Week of 03-10-08
For the treatment of autism, Auditory Integration Training was assigned an evidence level of "No Support" as the study did not report outcome data for effects at immediate post-treatment, and definitions for higher evidence levels require this. However, the study did report 3-month follow up data showing that Auditory Integration Training was superior to a control group (source: EBS Biennial Report 2007). [144]

Week of 03-03-08
Of the treatment families with Best Suport for attention and hyperactivity problems, Medication plus Behavior Therapy showed the largest effect size on average (source: EBS Biennial Report 2007). [143]

Week of 02-25-08
Five treatments were found to have Good Support for youth substance abuse. Family Therapy was successful in to studies, both times beating an alternative treatment. Cognitive Behavior Therapy Contingency Management, Family Systems Therapy and Purdue Brief Family Therapy also each beat an alternative treatment in one study (source: EBS Biennial Report 2007). [142]

Week of 02-18-08
Parent Management Training has by far the most substantial amount of supportive evidence for treating delinquency and disruptive behaviros, with 26 studies supporting this approach. It beat alternative treatments in nine comparisons and waitlist or no-treatment control groups in 18 comparisons (source: EBS Biennial Report 2007). [141]

Week of 02-11-08
Cognitive Behavior Therapy and Cognitive Behavior Therapy plus Medication demonstrate Best Support for depression and withdrawal problems. Cognitive Behavior Therapy was successful in 12 studies, beating alternative treatments in four tests and beating no-treatment control groups in eight tests. Cognitive Behavior Therapy plus Medication was successful in two studies, beating alternative treatments both times (source: EBS Biennial Report 2007). [140]

Week of 02-04-08
For treating Autism, Intensive Behavioral Treatment and Intensive Communication Training have been successful in three studies. As their names imply, both of these treatment approaches are intensive. The treatments are usually administered daily, and for Intensive Behavioral Treatment, in some cases the treatment lasted over five years (source: EBS Biennial Report 2007). [139]

Week of 01-28-08
Four treatment approaches have been found to have No Support for attention and hyperactivity problems. These include: Client Centered Therapy, Self-Control Training, Skill Development, and the combination of Parent Management Training and Self- Verbalization [source: EBS Biennial Report 2007). [138]

Week of 01-21-08
Of the 18 treatment families identified as used for anxiety in the 2007 EBS Biennial Report, four demonstrated Best Support. These were Cognitive Behavior Therapy, Exposure, modeling, and Education. [137]

Week of 01-14-08
Aldred, Green, and Adams (2004) found that Intensive Communication Training (involving communication and social skills training, attending, goal setting, modeling, monitoring, parent psychoeducation, and maintenance/relapse prevention) was better than routine care when comparing the two different treatment groups on the Autism Observation Scale (ADOS; 2000) and on a measure of communication skills. [136]

Week of 01-07-08
Attention, Counselors Care, Counselors Care and Anger Management, Life Skills, Problem Solving, and Social Skills are all level 5 Interventions for Depressive disorders in youth. Level 5 refers to treatments that were tested and found ineffective. The risk of using such treatments should be weighed against potential benefits (source: EBS Blue Menu 10/2007). [135]

Week of 12-31-07
Catharsis (a technique designed to bring about the release of intense emotions, with the intent to develop mastery of affect and conflict) is a level 5 Intervention for delinquency and disruptive behavior disorders in youth. Level 5 refers to treatments that were tested and found ineffective. The risk of using such treatments should be weighed against potential benefits (source: EBS Blue Menu 10/2007). [134]

Week of 12-24-07
Cognitive Behavioral Therapy (CBT) with parents only has received no support for the treatment of traumatic stress in children. Cognitive-Behavioral Therapy with children has the best support for treatment of traumatic stress in children (source: EBS Blue Menu 10/2007). [133]

Week of 12-17-07
In children 0-6, a low intensity behavioral treatment was found to be more effective than eclectic treatment (= combination of two or more treatments) for symptoms of autism (source: Eldevik, Eikeseth, Jahr, & Smith, 2006). [132]

Week of 12-10-07
Teacher psychoeducation (a teacher’s formal review of information with youth about the development of a problem and its relation to a proposed intervention) is a Level 5 Intervention for anxiety and avoidant behaviors in youth. Level 5 refers to treatments that were tested and found ineffective. The risk of using such treatments should be weighed against potential benefits (source: EBS Blue Menu 10/2007). [131]

Week of 12-03-07
Hosterler and Kirk (1997) found that the no treatment group did better than Project C.A.R.E. (a substance abuse prevention program for high-risk youth) when treating disruptive behavior. The use of Project C.A.R.E. interventions have a risk of negative effects on youth and should be weighed against potential benefits. [130]

Week of 11-26-07
Hypnosis, the induction of a trance-like mental state in the youth achieved through suggestion, has received good support (according to the Blue Menu) when treating children and adolescents with anxious or avoidant behaviors (source: EBS Blue Menu 10/2007). [129]

Week of 11-19-07
Auditory Integration Training, a therapy designed to help people with auditory processing problems, has now been found to be a Level 5 intervention (= “Known Risk”). It is advised to use this treatment with caution (source: EBS Blue Menu 10/2007). [128]

Week of 11-12-07
Twelve step programs (programs that involve a twelve-step model for recovery) are Level 5 Interventions for substance use problems disorders in youth. Level 5 refers to treatments that were tested and found ineffective. The risk of using such treatments should be weighed against potential benefits (source: EBS Blue Menu 10/2007). [127]

Week of 11-05-07
Self-verbalization refers to training and rehearsal for the youth in how to generate verbal prompts to guide the youth’s own behavior. Often this practice is used in the context of rehearsing the steps faced in a task or problem. Self-verbalization can be covert, aloud, or both. Self-verbalization is one of the best supported treatments for Attention and Hyperactivity Behaviors in children (source: EBS Blue Menu 10/2007). [126]

Week of 10-29-07
Play Therapy has only received minimal support for the treatment of youth depression, as compared to CBT, CBT with parents, Interpersonal Therapy, and Relaxation, all of which have received good or best support (source: EBS Blue Menu 07/2007).[125]

Week of 10-22-07
When comparing Group Based Parent and Teacher Training versus Individually Based Parent and Teacher Training for children with behavior problems in addition to severe learning disabilities (e.g., learning disorder, underachievement, speech difficulties), the two treatment formats had no difference in outcome on the Disability Assessment Schedule or the Parenting Stress Index (source: Chadwick et al., 2001). [124]

Week of 10-15-07
Evidence generally favors the idea that getting individuals personally involved in an idea will increase the probability that they will adopt that idea (Petty & Cacioppo, 1984). Thus, getting children to discuss their gains and why treatment worked may help them maintain a positive attitude toward using their CBT skills after treatment has ended. [123]

Week of 10-08-07
Santisteban et al. (1996) evaluated an intensity-based strategy designed to enhance engagement among families whose children were determined to be at risk for drug abuse. They found that 81% of families in the engagement condition attended the first treatment session as compared with an average of 60& of controls. These effects lasted beyond the first session. [122]

Week of 10-01-07
In one very early study, children who merely used confident self-statements (e.g., cognitive restructuring) significantly reduced their fear of the dark relative to children who used other kinds of self-statements (Kanfer et al., 1975). [121]

Week of 09-24-07
Hamilton and MacQuiddy (1984) demonstrated that a specific time-out procedure, used alone, resulted in clinically significant improvements in children with noncompliance problems relative to two control groups. [120]

Week of 09-17-07
Imaginal exposure has proven superior to control groups in over 10 controlled clinical tests (Bandura et al., 1969; Barabasz, 1973; Bornstein & Knapp, 1981; Deffenbacher & Kemper, 1974; Johnson et al., 1971; Kandel et al., 1977; Laxer & Walker, 1970; Parish et al., 1976; Saigh, 1986; Van Hasselt et al., 1979). [119]

Week of 09-10-07
Parent Management Training has received best support in the literature for Disruptive Behavior Disorders. However, one study with children 4-12 years found that Collaborative Problem Solving (consisting of communication skills training, problem solving, parent psychoeducation, and stimulus control/antecedent management) performed equally well when compared on an Oppositional-Defiant Rating scale (source: Greene et al., 2004). [118]

Week of 09-03-07
In their meta-analysis, Weisz, Jensen-Doss, and Hawley (2006) found that Evidenced Basted Therapies (EBTs) outperformed Usual Care (UC). EBT superiority was not just evident in samples of voluntary treatment seekers. The mean effect size (ES) for the studies with voluntary participants was .31; the mean ES for the studies with non-voluntary participants (e.g., incarcerated) was .33. This difference was not statistically significant (source: Weisz, Jensen-Doss, & Hawley, 2006). [117]

Week of 08-27-07
No well-established or promising treatments have been identified for the treatment of panic disorder in children and adolescents at this time. However, for anxiety disorders in general, CBT is the best supported treatment to date (source: Evidence Based Treatment for Children and Adolescents, www.wjh.harvard.edu/~nock/Div53/EST/index.htm). [116]

Week of 08-20-07
Patterson’s Living with Children (1976) is a well established treatment for ODD. This treatment approach attempts to change the patterns of interactions between parents and their children, by guiding parents in monitoring and ignoring or punishing specific problem behaviors, and monitoring and rewarding positive behaviors which conflict with problem behaviors. This treatment is usually 6 to 8 sessions in length. This treatment appears to be most successful for males and females ages 6-16 (source: Evidence Based Treatment for Children and Adolescents, www.wjh.harvard.edu/~nock/Div53/EST/index.htm). [115]

Week of 08-13-07
Eye-movement Desensitization and Reprocessing (EMDR) has received minimal or no support for the treatment of traumatic stress in children. Cognitive-Behavioral Therapy has the best support for treatment of traumatic stress in children (source: EBS Blue Menu 04/2007). [114]

Week of 08-06-07
Modeling a desired behavior to promote the child’s imitation and subsequent performance of that behavior is an evidenced-based technique for anxiety/avoidant, depressed/withdrawn, disruptive, and attention deficit/hyperactive behavior (source: Knowledge of Evidence Based Services Questionnaire, 2006). [113]

Week of 07-30-07
Several studies have demonstrated that involving the family in the treatment of a child’s anxiety has beneficial outcomes and enhances the efficacy of individual cognitive behavioral therapy (CBT) (e.g., King et al., 1998; Shortt, Barrett, & Fox, 2001; Silverman, Kurtines, Ginsburg, Weems, Lumpkin, & Carmichael, 1999; Waters, Barrett, & March, 2001). [112]

Week of 07-23-07
In a recent meta-analysis that compared outcomes achieved by groups randomly assigned to either usual care (UC) or evidence-based therapies (EBTs), the authors found that EBTs outperformed UC. EBT superiority was not due to EBT therapists being graduate students/research therapists. The mean effect size (ES) for EBTs delivered by research therapists was .43; the mean ES for EBTs delivered by non-research therapists was .25. This difference was not statistically significant (source: Weisz, Jensen-Doss, & Hawley, 2006). [111]

Week of 07-16-07
Cognitive-Behavior Therapy (CBT) has received good support (Level 1) for youth with conduct problems comorbid with depression/withdrawn behaviors (source: EBS Blue Menu 04/2007). [110]

Week of 07-09-07
To date, there have been 7 randomized controlled trials researching substance use treatment for youth. All of these were conducted in a clinic setting, either with the whole family (80%) or parent-child dyads (20%) as participants. The studies included Caucasian, African American, and Latino participants of ages 6-22. From the results of these 7 studies, it appears that involving at least one family member in the treatment of youth substance problems is beneficial (source: PracticeWise EBS Reporting Site: www.practicewise.us) [109]

Week of 07-02-07
Providing play therapy as a primary therapeutic strategy is not an evidenced-based technique for treating childhood disorders like ADHD, Disruptive Behavior Disorders, Anxiety Disorders and Depression (source: Knowledge of Evidence Based Services Questionnaire, 2006). [108]

Week of 06-25-07
Client-centered Therapy has received moderate support as an intervention for depression in children. Client-centered Therapy involves having a more personal relationship with the client, providing unconditional positive regard through supportive listening and reflective discussion, and demonstrating warmth, empathy and genuineness (source: EBS Blue Menu 01/2007). [107]