Provided by David Satcher, M.D., Ph.D.
Surgeon General of the United States of America
Chapter 3: Children and Mental Health
Overview of Mental Disorders in Children
Psychotherapy
The major types of psychotherapy for children are supportive,
psychodynamic, cognitive-behavioral, interpersonal, and family systemic. With
the exception of the latter, these therapies originally were developed for
adults and then tailored for use in children.
Most psychotherapies are deemed effective for children and adolescents because
they improve more than with no treatment, as discussed later in this chapter
under Treatment Interventions (Casey & Berman, 1985; Hazelrigg et al., 1987;
Weisz et al., 1987; Kazdin et al., 1990; Baer & Nietzel, 1991; Grossman &
Hughes, 1992; Shadish et al., 1993; Weisz & Weiss, 1993; Weisz et al., 1995).
But despite this strong body of research on children comparing treatment with no
treatment, far less attention has been paid to, and guidance provided about, the
efficacy of a given psychotherapy for a specific diagnosis (Lonigan et al.,
1998). In other words, it is not clear which therapies are best for which
conditions. The American Psychological Association sought to rectify this
problem by convening two task forces, the second of which exhaustively reviewed
the professional literature to evaluate the strength of the evidence for
treating individual disorders in children. The second task force refined two
sets of criteria against which to evaluate the evidence: the first, and more
rigorous, set of criteria was for Well-Established Psychosocial Interventions,
while the other was for Probably Efficacious Psychosocial Interventions (Lonigan
et al., 1998). The findings of the task force’s comprehensive evaluation were
published, disorder by disorder, in an entire issue of the Journal of Clinical
Child Psychology in June 1998. While findings relating to individual disorders
are presented in the next section of this chapter, this was the overarching
conclusion: “. . . the majority of these [psychosocial] interventions do not
meet criteria for the highest level of empirical support, the well-established
criteria” (Lonigan et al., 1998). The problem, according to these authors, is
that too few well-controlled studies have been performed for each disorder. To
meet the criteria for a Well-Established Psychosocial Intervention, there must
be at least two well-conducted group-design studies conducted by different teams
of researchers, among other criteria. Hereafter, these criteria4 are referred to
as the American Psychological Association Task Force Criteria.
Some other general points are warranted about the value of psychotherapies for
children. Psychotherapies are especially important alternatives for those
children who are unable to tolerate, or whose parents prefer them not to take,
medications. They also are important for conditions for which there are no
medications with well-documented efficacy. They also are pivotal for families
under stress from a child’s mental disorder. Therapies can serve to reduce
stress in parents and siblings and teach parents strategies for managing
symptoms of the mental disorder in their child (see later sections on Disruptive
Disorders and Home-Based Services).
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