SPECIAL ARTICLE
Evidence-Based Treatments in Child and Adolescent Psychiatry: An Inventory

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ABSTRACT

Objective

To provide a list of evidence-based psychopharmacology and psychotherapy treatments for child psychiatry.

Method

Published reviews and Medline searches were examined to generate a list of treatments supported by randomized controlled trials.

Results

For psychopharmacology, the best evidence to date supports the use of stimulant medications for attention-deficit/hyperactivity disorder and selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder. There is also reasonable evidence addressing SSRIs for anxiety disorders and moderate to severe major depressive disorder, and risperidone for autism. The psychosocial interventions best supported by well-designed studies are cognitive-behavioral and behavioral interventions, especially for mood, anxiety, and behavioral disorders. Family-based and systems of care interventions also have been found effective.

Conclusions

Although the number of evidence-based treatments for child psychiatry is growing, much of clinical practice remains based on the adult literature and traditional models of care. Challenges toward adopting evidence-based practices are discussed.

Section snippets

ISSUES RELATING TO EVIDENCE

There are several issues and challenges in the development and adoption of evidence-based medicine as the standard of care for child psychiatry.

METHOD

Given the broad nature of the task, we narrowed the search to published reviews, supplemented with more recent studies. The American Academy of Child and Adolescent Psychiatry (AACAP)'s Practice Parameters, the Journal's 10-Year Reviews, a special section on pediatric psychopharmacology edited by Vitiello et al. (1999) in this Journal, two series of reviews on empirically supported treatments published in 1998 and 2001 in the Journal of Clinical Child Psychology, and a review by Fonagy (2000)

PHARMACOLOGY

TABLE 1, TABLE 2, TABLE 3, TABLE 4, TABLE 5 outline the current research support with regard to controlled clinical trials. We will outline the content briefly and by medication class rather than by diagnosis.

PSYCHOSOCIAL INTERVENTIONS

Psychotherapy remains a mainstay of psychiatric treatment. Unfortunately, the existing evidence suggests that the widely used traditional psychotherapies are not effective in youth (Weiss et al., 1999, Weiss et al., 2000; Weisz and Jensen, 2001). Conversely, although research-based psychotherapeutic interventions have documented effectiveness, they are generally not used in clinical practice.

Four meta-analytic studies of psychotherapy research (Casey and Berman, 1985; Kazdin et al., 1990; Weisz

DISCUSSION

Fortunately, there are an increasing number of available research-supported treatments for treating mental health problems in youth. However, most of child psychiatry practice is not evidence-based, in part because patient populations are much more complicated and diverse than research samples, and in part because clinicians are not always trained in, or willing to use, evidence-based modalities. This is a major public health issue, since approximately 20% of children and adolescents suffer

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    Drs. McClellan and Werry have compiled a snapshot of the status of our field with respect to evidence-based treatment. This is an unusual feature for the Journal, although our psychology colleagues have completed a similar task in a more comprehensive format. I would appreciate your feedback on whether you find the concept and/or the format useful in your clinical work and teaching. M.K.D.

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