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Asbrand J, Foltys L, Ebeling L, Tuschen-Caffier B. Übereinstimmung zwischen Eltern und Kind zur kindlichen Psychopathologie und deren Bedeutung für den Therapieerfolg. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Symptome psychischer Störungen werden von Kindern und Jugendlichen häufig anders als von den Eltern eingeschätzt. Als Einflussfaktoren für diese Urteilsdiskrepanzen im externalisierenden und internalisierenden Symptombereich werden kindliches Geschlecht und Alter untersucht. Zudem wird der prädiktive Wert der Diskrepanz für den wahrgenommenen Therapieerfolg analysiert. <b><i>Methode:</i></b> Kinder und Jugendliche (<i>n</i> = 271, 10–21 Jahre) in ambulanter Psychotherapie sowie Eltern gaben Auskunft über den Youth Self Report (YSR) und die Child Behavioral Checklist (CBCL). <b><i>Ergebnisse:</i></b> Neben einer grundsätzlich guten Übereinstimmung zwischen Eltern und Kind berichten Eltern über mehr psychische Symptome als die davon betroffenen Kinder. Mit zunehmendem Alter steigt die von den Kindern selbstberichtete externalisierende Symptomatik an. Mädchen geben mehr internalisierende Symptome als Jungen an. Ein hoher elterlicher Baselinewert (prä-Therapie) zur kindlichen externalisierenden Symptomatik sagt einen höheren Elternbericht nach Abschluss der Psychotherapie des Kindes vorher. Kinder berichten nach der Psychotherapie mehr Symptome, wenn Uneinigkeit zwischen Eltern und Kindern bezüglich der internalisierenden Symptomatik prä-Therapie besteht sowie eine hohe kindberichtete externalisierende bzw. elternberichtete internalisierende Symptomatik berichtet wird. <b><i>Schlussfolgerung:</i></b> Insgesamt zeigen sich einzelne Faktoren prädiktiv für die Symptomatik post-Therapie, jedoch die Eltern-Kind Urteilsdiskrepanz nur in geringem Maß. Beeinflussende Faktoren wie Alter und Geschlecht sollten in zukünftigen Studien standardmäßig aufgenommen werden.
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Walter D, Dachs L, Farwick Zum Hagen J, Goletz H, Goertz-Dorten A, Kinnen C, Rademacher C, Schuermann S, Viefhaus P, Wolff Metternich-Kaizman T, Doepfner M. Parent- and Teacher-Rated Effectiveness of Cognitive-Behavioral Therapy for Children and Adolescents Under Usual Care Conditions in a University Outpatient Clinic. Child Psychiatry Hum Dev 2019; 50:533-545. [PMID: 30565001 DOI: 10.1007/s10578-018-0860-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Compared to randomized controlled trials, studies examining the effectiveness of cognitive behavioral therapy (CBT) in children and adolescents with mental disorders are rare, and a teacher perspective is scarce. The present study investigated the effectiveness of routine CBT in 519 patients aged 6-18 years with mental disorders. Changes in mental health problems were assessed in teacher (Teacher Report Form, TRF) and parent rating (Child Behavior Checklist, CBCL) and were analyzed within the total sample, yielding statistically significant, small to medium effect sizes (teacher rating: d = .74-2.39; parent rating: d = .65-1.18). Changes in a subgroup of patients with elevated symptom scores at treatment start were compared to a historical control group receiving weekly academic tutoring. Net total score effect sizes lay between d = 0.98 and d = 1.29 for teacher rating (parent rating: d = 0.84 to d = 1.01). Nevertheless, a substantial number of patients remained in the clinical range. Symptom changes during family- and patient-based CBT interventions did not differ from treatments including additional school-based interventions, as was also the case for the comparison of treatments with and without additional pharmacotherapy.
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Affiliation(s)
- Daniel Walter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany. .,School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany.
| | - Lydia Dachs
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Johanna Farwick Zum Hagen
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Hildegard Goletz
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Anja Goertz-Dorten
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Claudia Kinnen
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Christiane Rademacher
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany
| | - Stephanie Schuermann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany
| | - Paula Viefhaus
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
| | - Tanja Wolff Metternich-Kaizman
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany
| | - Manfred Doepfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Robert-Koch-Str. 10, 50931, Cologne, Germany.,School of Child and Adolescent Cognitive Behavior Therapy (AKiP) at the University Hospital Cologne, Pohligstr. 9, 50969, Cologne, Germany
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Effectiveness of outpatient cognitive-behavioral therapy for adolescents under routine care conditions on behavioral and emotional problems rated by parents and patients: an observational study. Eur Child Adolesc Psychiatry 2018; 27:65-77. [PMID: 28685400 DOI: 10.1007/s00787-017-1021-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Few studies have examined the effectiveness of outpatient cognitive-behavioral therapy (CBT) delivered in routine care settings for children and adolescents with mental disorders. This observational study examined changes in behavioral and emotional problems of adolescents with mental disorders during routine outpatient CBT delivered at a university outpatient clinic and compared them with a historical control group of youths who received academic tutoring of comparable length and intensity. Assessments were made at the start and end of treatment (pre- and post-assessment) using parent ratings of the German versions of the Child Behavior Checklist (CBCL) and self-ratings of the Youth Self-Report (YSR) scale. For the main analysis, 677 adolescents aged 11‒21 years had complete data. Changes from pre- to post-assessment showed significant reductions in mental health problems on both parent- and self-ratings. Pre- to post-effect sizes (Cohen's d) were small-to-medium for the total sample (d = 0.23 to d = 0.62) and medium-to-large for those adolescents rated in the clinical range on each (sub)scale at the start of treatment (d = 0.65 to d = 1.48). We obtained medium net effect sizes (d = 0.69) for the CBCL and YSR total scores when patients in the clinical range were compared to historical controls. However, a substantial part of the sample remained in the clinical range at treatment end. The results suggest that CBT is effective for adolescents with mental disorders when administered under routine care conditions but must be interpreted conservatively due to the lack of a direct control condition.
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