The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress - PowerPoint PPT Presentation

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The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress

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Title: The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress


1
The Evidence Base for Psychosocial and
Psychopharmacological Interventions for Children
with Attention-Deficit/Hyperactivity Disorder,
Major Depressive Disorder, Disruptive Behavior
Disorders, Anxiety Disorders, and Posttraumatic
Stress Disorder Barbara J. Burns, Ph.D. Scott
N. Compton, Ph.D. Helen L. Egger, M.D. Elizabeth
M. Z. Farmer, Ph.D. Duke University Medical
Center
2
Specific Aims of Project
I . To identify efficacious/effective
interventions for the treatment of childhood
mental disorders which could reduce the risk for
substance use problems in adolescence and
later I I. To identify mental health
intervention studies in which substance use
outcomes could be examined in adolescence and
later.
3
Inclusion Criteria for Literature Search
  • Study on one of five childhood disorders or
    related
    symptom group
  • Utilized a controlled design
  • Targeted children in 6-12 age range
  • Published 1985-1999
  • (except interventions studied earlier and not
    repeated later)
  • Focused on outpatient treatment

4
Search Results
  • Clinical References References Meeting
  • Condition Identified Inclusion Criteria
  • ADHD 132 31
  • Depression 28 19
  • Disruptive
  • Behavior 314 30
  • Disorders
  • Anxiety 75 37
  • Disorders
  • Posttraumatic 58 5
  • Stress Disorder
  • Studies with N lt 30 were excluded

5
?
Descriptors in Matrices
  • Study design and description
  • Target population
  • Demographic characteristics
  • (Age, gender, race/ethnicity)
  • Outcomes
  • Comments

6
Types of Interventions with Positive Findings
by Clinical Condition
  • PSYCHOSOCIAL
  • PSYCHOPHARMACOLOGICAL
  • ADJUNCTIVE
  • (combined treatments)

7
Interventions with Positive Findings
for Attention-Deficit/Hyperactivity Disorder
  • Psychosocial Psychopharmacological Adjunctive
  • cognitive behavior methylphenidate slight
    evidence
  • therapy desipramine for psychosocial
    pindolol in 2 of 8 studies
  • social skills training buproprion for
    combined
  • amphetamine sulfate treatment
  • biofeedback
  • drugs superior to
  • psychosocial
  • treatment in
  • 6 of 8 studies

8
Interventions with Positive Findings
for Depression
  • Psychosocial Psychopharmacological
    Adjunctive
  • cognitive behavior fluoxetine none
  • therapy
  • self-control training

9
Interventions with Positive Findings
for Disruptive Behavior Disorders
  • Psychosocial Psychopharmacological Adjunctive
  • parent training lithium none
  • multisystemic therapy methylphenidate
  • case management
  • anger-coping
  • problem-solving skills
  • PATHS
  • Project LIFT
  • First Step
  • Fast Track

10
Interventions with Positive Findings for Anxiety
Disorders
  • Psychosocial Psychopharmacological Adjunctive
  • systematic sertraline none
  • desensitization (for obsessive compulsive
  • modeling disorder only)
  • reinforced practice
  • cognitive behavior
  • therapy
  • contingency
  • management
  • cognitive self-control
  • educational support

11
Interventions with Positive Findings
for Posttraumatic Stress Disorder
  • Psychosocial Psychopharmacological Adjunctive
  • stress inoculation none
    none
  • gradual exposure
  • cognitive behavior therapy
  • (for parent and child)

12
Specific Aims of Project
I . to identify efficacious/effective
interventions for the treatment of childhood
mental disorders which could reduce the risk for
substance use problems in adolescence and
later
-- EFFICACY --
13
Response
to Aim I.
-- EFFICACY --
Efficacious interventions exist for all disorders
examined Strength of psychopharmacological
evidence varies by disorder Availability of
efficacious interventions in clinical
practice is unknown, but suspected to be
low Increasing efficacious interventions through
training and quality monitoring is warranted
14
Specific Aims of Project
I I. to identify mental health intervention
studies in which substance use outcomes could
be examined in adolescence and later.
-- FOLLOW-UP STUDIES --
15

Response to Aim II.
-- FOLLOW-UP STUDIES --
To select follow-up studies from existing
studies, decisions are needed relative
to (1) the standard for evidence-based
interventions (2) current age of previously
studied samples (3) adequacy of the
methods (4) risk of samples (i.e., disorders,
ethnic diversity) for substance
problems Prospective studies needed with
substance assessment and follow-up incorporated
to (1) replicate older efficacious treatments
(2) develop psychosocial treatments (especially
for PTSD) and medications (except ADHD)
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