Chapter 13 INTRODUCTION TO CLINICAL PSYCHOLOGY, THIRD CANADIAN EDITION by John Hunsley and Catherine M. Lee.

Chapter 13

INTRODUCTION TO CLINICAL

PSYCHOLOGY, THIRD CANADIAN EDITION

by John Hunsley and Catherine M. Lee

• Questions

• Who is the client in psychological services for childhood disorders?

• Landmarks in the evolution of evidence-based psychological services for children and adolescents

• Examples of evidence-based treatments

• Efficacy, effectiveness, and the dissemination of evidence-based treatments

• For next class

Outline

Who is the client in psychological services for children and adolescents?

1 in 5 children have a mental disorder (World Health Organization, 2007)

Half of all mental disorders begin before the age of 14 (World Health Organization, 2007)

Median age of onset of: impulse control problems—11 years anxiety disorders—11 years depression—14 years

(Kessler et al. 2005; Merikangas et al. 2010)

Who Needs Services?

Most disorders are chronic and persist into adulthood

Comorbidity is very common; 40% with 1 diagnosis have a 2nd diagnosis(Merikangas et al., 2010)

• Associated with

Substance abuse Suicide School problems and drop-out Delinquency Unprotected sex

Consequences of Problems in Youth

Child, his/her friends and siblings

Parents, caregivers

School, healthcare, and criminal justice

Burden of Child and Youth Mental Disorders

Only 1 in 3 adolescents requiring services for clinical problems received

them (Costello, Copeland, Cowell, & Keeler, 2007)

Only half of children and adolescents who begin psychological services

complete them (Nock & Ferriter, 2005)

Limited evidence that treatment as usual is helpful (e.g., Weiss et al.,1999)

Psychological Treatments: The Bad News

• Parental psychopathology• Parental isolation• Family conflict

Issues of Premature Termination/Drop-out

Landmarks in the Evolution of EB Psychological Services for Children and Adolescents

• 1000s of studies

• Different methodologies

• Contradictory findings

• Lag in development and evaluation of services for children and youth compared to services for adults

Evidence for Services for Children and Youth?

Does therapy work?

What therapy works for this problem?

What therapy works for this problem in this context?

• Levitt reviews– 1957 18 studies

– 1963 22 studies

– Echoes Eysenck’s review for adults; no evidence of efficacy, as 67-73% improved without treatment

• Casey & Berman (1985)

• First meta-analysis of 79 studies– Comparable effect sizes to adult; larger effect sizes for behavioural

approaches than for other orientations

Does Therapy Work?

• Kazdin, Bass, Ayers, & Rodgers (1990)– Although treatment works, samples in RCTs dissimilar to clinical

practice

• Weisz, Weiss, Alicke, & Klotz (1987)– Larger effect for behavioural approaches

• Weisz, Weiss, Han, & Granger (1995)– Larger effects for behavioural approaches; effects sustained at

follow-up

Does Therapy Work?

• Commissioned reviews designed to set out criteria by which research will be evaluated and to produce clear recommendations

• Focus on specific disorders or problems

Which Therapy Works for this Disorder?

• APA Division 12 (Clinical) Task Force on Promotion and Dissemination of Psychological Procedures– Chambless & Ollendick, 1999

• Society of Clinical Child and Adolescent Psychology (APA Division 53)– Journal of Clinical Child Psychology 1998– Journal of Pediatric Psychology, 1999– Journal of Clinical Child and Adolescent Psychology (JCCAP), 2008

Which Therapys Work for this Disorder?

Silverman & Hinshaw edited special issue (2008) on efficacious treatments for:

– Anxiety disorders: social anxiety, phobias, obsessive compulsive disorder;

– Attention-deficit/hyperactivity disorder– Autism– Depression– Disruptive behaviour disorders– Exposure to trauma– Substance abuse disorders

JCCAP

• Nathan and Gorman (1998; 2002; 2007)– Treatments that work

• Fonagy & colleagues (2002; 2005)– What works for whom?

• Hawaii Department of Health Task Force– Chorpita (2002)

What Works for this Disorder? Interdisciplinary Reviews

Clinical practice guidelines

Set standards based on reserarch

Based on research

Require regular updates

Influence services that are funded

• Disruptive behaviour disorders– Parent Management Training (PMT)

– Multisystemic Therapy (MST)

• Adolescent depression– Coping with Depression in Adolescence

Examples of Evidence-Based Treatments

Efficacy, Effectiveness, and Dissemination

Unknown how many receive treatments that are evidence-based (Kazdin, 2008)

Do results from RCTs generalize to regular clinical settings?

Can efficacious treatments be transported to other countries?

Can regular clinicians achieve similar results?

Do EBTs Work in Real World Settings?

Identify effectiveness

studies

Identify meta-analyses of

RCTs

Compare on two clinically

relevant benchmarks

To see whether EBTs can be transported to real-world settings….

• Internalizing disorders: n = 394 – Depression n = 3 studies

– Mixed anxiety n = 2 studies

– OCD = 2 studies

• Completion: over 80%

• Recovery: 50-75%

Effectiveness: Lee, Horvath, & Hunsley (2013)

• Disruptive behaviour disorders– N = 1118 parents

– n = 13 studies

• Completion: around 80%

• Improvement: moderate effect sizes

Effectiveness: Lee et al. (2013)

• Chorpita & Daleiden (2009) reviewed 322 randomized controlled trials of treatments for children and youth– Identified clusters of treatment strategies shown to be efficacious across

many trails, for various disorders

– Advocate using such strategies to individually tailor the treatment to client needs

• Weisz et al. (2012) developed modular treatment options for depression, anxiety, and conduct problemss– Modular treatment out-performed treatment as usual and specific EBTs for

depression, anxiety, and conduct problems

– Caveat—single trial requiring replication

Modular Treatment Options

For next class…

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