Finding, evaluating, refining, and applying empirically supported treatments for children and adolescents

Identification of Emotional Expression With Cancer Survivors: Validation of Linguistic Inquiry and Word Count

Background

Given the high volume of text-based communication such as email, Facebook, Twitter, and additional web-based and mobile apps, there are unique opportunities to use text to better understand underlying psychological constructs such as emotion. Emotion recognition in text is critical to commercial enterprises (eg, understanding the valence of customer reviews) and to current and emerging clinical applications (eg, as markers of clinical progress and risk of suicide), and the Linguistic Inquiry and Word Count (LIWC) is a commonly used program.

Objective

Given the wide use of this program, the purpose of this study is to update previous validation results with two newer versions of LIWC.

Methods

Tests of proportions were conducted using the total number of emotion words identified by human coders for each emotional category as the reference group. In addition to tests of proportions, we calculated F scores to evaluate the accuracy of LIWC 2001, LIWC 2007, and LIWC 2015.

Results

Results indicate that LIWC 2001, LIWC 2007, and LIWC 2015 each demonstrate good sensitivity for identifying emotional expression, whereas LIWC 2007 and LIWC 2015 were significantly more sensitive than LIWC 2001 for identifying emotional expression and positive emotion; however, more recent versions of LIWC were also significantly more likely to overidentify emotional content than LIWC 2001. LIWC 2001 demonstrated significantly better precision (F score) for identifying overall emotion, negative emotion, and anxiety compared with LIWC 2007 and LIWC 2015.

Conclusions

Taken together, these results suggest that LIWC 2001 most accurately reflects the emotional identification of human coders.

Interventions for comorbid problem gambling and psychiatric disorders: Advancing a developing field of research

Despite significant psychiatric comorbidity in problem gambling, there is little evidence on which to base treatment recommendations for subpopulations of problem gamblers with comorbid psychiatric disorders. This mini-review draws on two separate systematic searches to identify possible interventions for comorbid problem gambling and psychiatric disorders, highlight the gaps in the currently available evidence base, and stimulate further research in this area. In this mini-review, only 21 studies that have conducted post-hoc analyses to explore the influence of psychiatric disorders or problem gambling subtypes on gambling outcomes from different types of treatment were identified. The findings of these studies suggest that most gambling treatments are not contraindicated by psychiatric disorders. Moreover, only 6 randomized studies comparing the efficacy of interventions targeted towards specific comorbidity subgroups with a control/comparison group were identified. The results of these studies provide preliminary evidence for modified dialectical behavior therapy for comorbid substance use, the addition of naltrexone to cognitive-behavioral therapy (CBT) for comorbid alcohol use problems, and the addition of N-acetylcysteine to tobacco support programs and imaginal desensitisation/motivational interviewing for comorbid nicotine dependence. They also suggest that lithium for comorbid bipolar disorder, escitalopram for comorbid anxiety disorders, and the addition of CBT to standard drug treatment for comorbid schizophrenia may be effective. Future research evaluating interventions sequenced according to disorder severity or the functional relationship between the gambling behavior and comorbid symptomatology, identifying psychiatric disorders as moderators of the efficacy of problem gambling interventions, and evaluating interventions matched to client comorbidity could advance this immature field of study.

Practitioner characteristics and organizational contexts as essential elements in the evidence-based practice versus cultural competence debate

The different pathways chosen to efficiently and effectively provide relief to those struggling with mental health challenges reflect different assumptions about the human condition and have led to disagreements over which intervention strategies are best suited to particular individuals or populations. Evidence-based practice and culturally competent services, as discussed within the United States, have been characterized as opposites. However, neither approach captures all of the elements that embody the full treatment experience. This article offers a framework that includes the personal identity of the practitioner and the organizational context as two elements that serve as active agents in the helping relationship, although they have rarely been included in the discourse about evidence-based practice or cultural competence. Suggestions for practice, education, and research are included based on this analysis.

Single-case experimental designs: a systematic review of published research and current standards

This article systematically reviews the research design and methodological characteristics of single-case experimental design (SCED) research published in peer-reviewed journals between 2000 and 2010. SCEDs provide researchers with a flexible and viable alternative to group designs with large sample sizes. However, methodological challenges have precluded widespread implementation and acceptance of the SCED as a viable complementary methodology to the predominant group design. This article includes a description of the research design, measurement, and analysis domains distinctive to the SCED; a discussion of the results within the framework of contemporary standards and guidelines in the field; and a presentation of updated benchmarks for key characteristics (e.g., baseline sampling, method of analysis), and overall, it provides researchers and reviewers with a resource for conducting and evaluating SCED research. The results of the systematic review of 409 studies suggest that recently published SCED research is largely in accordance with contemporary criteria for experimental quality. Analytic method emerged as an area of discord. Comparison of the findings of this review with historical estimates of the use of statistical analysis indicates an upward trend, but visual analysis remains the most common analytic method and also garners the most support among those entities providing SCED standards. Although consensus exists along key dimensions of single-case research design, and researchers appear to be practicing within these parameters, there remains a need for further evaluation of assessment and sampling techniques and data analytic methods.

Bridging the research-to-practice gap in autism intervention: an application of diffusion of innovation theory

There is growing evidence that efficacious interventions for autism are rarely adopted or successfully implemented in public mental health and education systems. We propose applying diffusion of innovation theory to further our understanding of why this is the case. We pose a practical set of questions that administrators face as they decide about the use of interventions. Using literature from autism intervention and dissemination science, we describe reasons why efficacious interventions for autism are rarely adopted, implemented, and maintained in community settings, all revolving around the perceived fit between the intervention and the needs and capacities of the setting. Finally, we suggest strategies for intervention development that may increase the probability that these interventions will be used in real-world settings.

Credible knowledge: a pilot evaluation of a modified GRADE method using parent-implemented interventions for children with autism

BACKGROUND

Decision-making in child and youth mental health (CYMH) care requires recommendations that are developed through an efficient and effective method and are based on credible knowledge. Credible knowledge is informed by two sources: scientific evidence, and practice-based evidence, that reflects the "real world" experience of service providers. Current approaches to developing these recommendations in relation to CYMH will typically include evidence from one source or the other but do not have an objective method to combine the two. To this end, a modified version of the Grading Recommendations Assessment, Development and Evaluation (GRADE) approach was pilot-tested, a novel method for the CYMH field.

METHODS

GRADE has an explicit methodology that relies on input from scientific evidence as well as a panel of experts. The panel established the quality of evidence and derived detailed recommendations regarding the organization and delivery of mental health care for children and youth or their caregivers. In this study a modified GRADE method was used to provide precise recommendations based on a specific CYMH question (i.e. What is the current credible knowledge concerning the effects of parent-implemented, early intervention with their autistic children?).

RESULTS

Overall, it appeared that early, parent-implemented interventions for autism result in positive effects that outweigh any undesirable effects. However, as opposed to overall recommendations, the heterogeneity of the evidence required that recommendations be specific to particular interventions, based on the questions of whether the benefits of a particular intervention outweighs its harms.

CONCLUSIONS

This pilot project provided evidence that a modified GRADE method may be an effective and practical approach to making recommendations in CYMH, based on credible knowledge. Key strengths of the process included separating the assessments of the quality of the evidence and the strength of recommendations, transparency in decision-making, and the objectivity of the methods. Most importantly, this method combined the evidence and clinical experience in a more timely, explicit and simple process as compared to previous approaches. The strengths, limitations and modifications of the approach as they pertain to CYMH, are discussed.

Evaluation of individual and group grief and trauma interventions for children post disaster

This study evaluated a community-based grief and trauma intervention for children conducted postdisaster. Fifty six children (7 to 12 years old) who reported moderate to severe levels of symptoms of posttraumatic stress were randomly assigned to group or individual treatment. Treatment consisted of a manualized 10-session grief- and trauma-focused intervention and a parent meeting. Measures of disaster-related exposure, posttraumatic stress symptoms, depression, traumatic grief, and distress were administered at preintervention, postintervention, and 3 weeks postintervention. There was a significant decrease in all outcome measures over time, and there were no differences in outcomes between children who participated in group intervention and those who participated in individual intervention. Results suggest that this intervention using either treatment modality may be effective for addressing childhood grief and trauma postdisaster.

Implementation of evidence-based services for youth: assessing provider knowledge

Although provider knowledge is a potential barrier in the dissemination of evidence-based services for youth, research in this area is currently limited by a lack of instrumentation. The present study examined the utility of the Knowledge of Evidence-Based Services Questionnaire (KEBSQ), a 40-item self-report measure designed to assess reporter knowledge of evidence-based practices (EBPs) in the treatment of youth psychopathology. The KEBSQ items encompass practice elements identified in both empirically supported and unsupported protocols used in the treatment of four prevalent childhood problem areas: anxious/avoidant, depressed/withdrawn, disruptive behavior, and attention/hyperactivity. Findings from the present investigation lend support for the basic psychometric properties of the KEBSQ. Results supported temporal stability, discriminative validity, and sensitivity to training. Practical implications to the dissemination of EBPs, areas for future research, and limitations are discussed.

"I have always felt different": the experience of attention-deficit/hyperactivity disorder in childhood

Childhood attention-deficit/hyperactivity disorder (ADHD) is one of the most important psychiatric problems of our time. This study examined the experience of childhood ADHD within the contexts that are most significant to this age group--home, school, and friendships. The sample included 16 college-enrolled young adults (ages 18-25) with a self-reported history of ADHD. Participants revealed feelings of difference, misunderstanding, and struggle in all areas of their lives (home, school, and friendships). Nurses can use these findings to improve the care and long-term outcomes of children diagnosed with ADHD.

Preventing depression among early adolescents in the primary care setting: a randomized controlled study of the Penn Resiliency Program

This study evaluated the Penn Resiliency Program's effectiveness in preventing depression when delivered by therapists in a primary care setting. Two-hundred and seventy-one 11- and 12-year-olds, with elevated depressive symptoms, were randomized to PRP or usual care. Over the 2-year follow-up, PRP improved explanatory style for positive events. PRP's effects on depressive symptoms and explanatory style for negative events were moderated by sex, with girls benefiting more than boys. Stronger effects were seen in high-fidelity groups than low-fidelity groups. PRP did not significantly prevent depressive disorders but significantly prevented depression, anxiety, and adjustment disorders (when combined) among high-symptom participants. Findings are discussed in relation to previous PRP studies and research on the dissemination of psychological interventions.

Child and adolescent psychopharmacology in the new millennium: a workshop for academia, industry, and government

OBJECTIVE

To give academic researchers, government officials, and industry scientists an opportunity to assess the state of pediatric psychopharmacology and identify challenges facing professionals in the field.

METHOD

Increased federal spending and the introduction of pediatric exclusivity led to large increases in pediatric psychopharmacology research in the 1990s. Despite the increase in research, concerns exist about methods and incentives for making new medications available for use in pediatric psychiatric disorders. In recognition of these concerns, the Duke Clinical Research Institute held a roundtable in September 2004. Participants from the National Institutes of Health, regulatory agencies, academia, and the pharmaceutical industry spoke about the effects of government regulations such as the U.S. Food and Drug Administration Modernization Act and the Pediatric Research Equity Act on pediatric research from academic, clinical, and industry perspectives, and bioethical considerations of such research.

CONCLUSIONS

To ensure development of new drugs for treating psychiatric disorders in children and adolescents, we must address the challenges posed by the regulatory environment governing pediatric psychopharmacology research. Strategies were identified for improving the evidence base for psychopharmacologic interventions in youth before widespread use and for more effectively defining a research agenda for the future.

Closing the Research-Practice Gap: Factors Affecting Adoption and Implementation of a Children's Mental Health Program

Despite the availability of effective interventions, they are not widely used in community mental health centers. This study examined the adoption and implementation of The Arson Prevention Program for Children (TAPP-C), a program for juvenile firesetters developed at a teaching hospital and disseminated to community settings. Questionnaire data from mental health professionals were used to evaluate the roles of adopter, innovation, and dissemination characteristics in TAPP-C adoption and implementation. Results indicate that different factors are important at different diffusion stages. Moreover, they suggest that innovation characteristics may be particularly important to adoption, whereas adopter and dissemination characteristics may be more influential in implementation.

Identifying and selecting the common elements of evidence based interventions: a distillation and matching model

A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature. Benefits of the model include its potential to facilitate improved understanding of similarities and differences among treatments, to guide treatment selection and matching to clients, to address gaps in the literature, and to point to possibilities for new interventions based on the current research base.

Long-Term Follow-Up to a Randomized Clinical Trial of Multisystemic Therapy With Serious and Violent Juvenile Offenders

In this study, the authors examined the long-term criminal activity of 176 youths who had participated in either multisystemic therapy (MST) or individual therapy (IT) in a randomized clinical trial (C. M. Borduin et al., 1995). Arrest and incarceration data were obtained on average 13.7 (range = 10.2-15.9) years later when participants were on average 28.8 years old. Results show that MST participants had significantly lower recidivism rates at follow-up than did their counterparts who participated in IT (50% vs. 81%, respectively). Moreover, MST participants had 54% fewer arrests and 57% fewer days of confinement in adult detention facilities. This investigation represents the longest follow-up to date of a MST clinical trial and suggests that MST is relatively effective in reducing criminal activity among serious and violent juvenile offenders.

Youth Psychotherapy Outcome Research: A Review and Critique of the Evidence Base

Over the past four decades, researchers have produced extensive evidence on psychotherapy for youth mental health problems and disorders. The evidence often has been evaluated through narrative reviews and through meta-analyses assessing the magnitude of treatment effects, but methodological analysis addressing the character and quality of the evidence base itself is an important complement, needed to place treatment effects in perspective and to suggest directions for future research. We carried out such an analysis, focusing on all the methodologically acceptable published randomized trials our search identified involving treatment of anxiety, depression, ADHD and related conditions, and conduct-related problems and disorders. The 236 studies tested 383 treatments and included 427 treatment-control comparisons, spanning the years 1962 through 2002. The analysis revealed considerable breadth, diversity, and rigor in the measurement approaches used to assess participant characteristics and treatment outcomes. However, reporting on important sample characteristics (e.g., ethnicity) showed major gaps, and more than half the studies failed to use well-standardized procedures to ensure appropriate sample selection. Because sample sizes left most studies underpowered, and procedures to enhance treatment fidelity were generally weak, many of the treatments investigated may not have received fair tests. Studies were particularly weak in clinical representativeness of their samples, therapists, and settings, suggesting a need for increased emphasis on external validity in youth treatment research.

A primer on current evidence-based review systems and their implications for behavioral medicine

BACKGROUND

Multiple review systems have been established within medicine and psychology to evaluate and disseminate research findings to clinical practice.

PURPOSE

Within this article, five evidence-based review systems are reviewed to inform the development or the use of an evidence review system for the behavioral medicine field.

METHODS

Each review system is described on several dimensions: history of the review system, the review process, and details about translation/sustainability efforts.

RESULTS

Various factors from each system have been identified that would benefit a behavioral medicine evidence review system, such as a discussion of clinical features that influence the generalizability of review findings (i.e., the American Psychiatric Association) and the use of pre-review protocols (i.e., the Cochrane Collaboration).

CONCLUSIONS

Although each review system has limitations, it is important for behavioral medicine to join one system because (a) systematic reviews are the only feasible means to evaluate and judge the usefulness of our interventions, and (b) reviews can inform policy, and, with effort, influence patient well-being. This group of behavioral medicine experts recommends that the Cochrane Collaboration review behavioral medicine interventions.

Enhancements to the behavioral parent training paradigm for families of children with ADHD: review and future directions

Behavioral parent training (BPT) is one of the empirically supported psychosocial treatments for ADHD. Over many years and in many studies, BPT has been documented to improve both child ADHD behavior and maladaptive parenting behavior. In some studies, BPT has also been found to result in benefits in additional domains, such as parenting stress and child classroom behavior. However, the BPT literature on children selected as having ADHD lags behind research conducted on BPT for children selected as having oppositional defiant and conduct disorders (ODD and CD, respectively) with regard to examination of factors that may limit treatment attainment, compliance, and outcomes, such as single parenthood, parental psychopathology, and child comorbidity. Because of the high degree of comorbidity between ADHD and ODD/CD, it is difficult to separate the two BPT literatures. The parameters of BPT (e.g.. format and setting), parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD are reviewed here and recommendations for future BPT research in the area of ADHD are made.

Child abuse victims' involvement in community agency treatment: service correlates, short-term outcomes, and relationship to reabuse

This study examines the correlates and impacts of child treatment in 68 cases referred to community agency providers after reports of child physical or sexual abuse. Standardized clinical assessments were conducted with child victims and their caregivers at intake and short-term follow-up (FUP-1), supplemented by official record reviews at a long-term follow-up (FUP-2). Child treatment was received by 19% and 50% of the children at FUP-1 and FUP-2, respectively. There were few correlates of initial child treatment involvement (sexual abuse or parent and family services received concurrently). Initial child treatment was not associated with significant gains in child outcomes. Child improvement in abuse-related outcomes was associated with post-traumatic stress disorder and lower adjustment at intake. Initial child treatment was unrelated to reabuse or out-of-home placement by FUP-2. Additional studies are needed to more fully evaluate the process and outcome of referral of child abuse victims to community-based services.

Mental health assessments in juvenile justice: report on the consensus conference

OBJECTIVE

At national, state, and local levels, there is increasing recognition of the importance of identifying and responding to the mental health needs of youths in the juvenile justice system, as policymakers and practitioners struggle to find ways to address causes and correlates of juvenile crime and delinquency. The proposed guidelines for mental health assessment provide explicit information about how, why, and when to obtain mental health information on justice youths at each important juncture in processing.

METHOD

A national group of expert researchers and practitioners convened in April 2002. Experts derived six recommendations, following the expert consensus method, for conducting mental health assessments in juvenile justice settings. Experts had broad experience creating collaborations between juvenile justice, mental health, and child welfare systems and understood the policy and health implications of conducting such assessments in juvenile justice settings.

RESULTS

Consensus Conference recommendations regarding screening for emergent risk, screening and assessment of mental health service needs, comprehensive mental health assessment components, assessment before community re-entry, need for periodic reassessment, and staff training are presented.

CONCLUSION

Deriving specific recommendations that can be implemented systematically is a necessary first step toward policy changes that will optimize the standard of care for this vulnerable population.

Cognitive change and enhanced coping: missing mediational links in cognitive behavior therapy with anxiety-disordered children

In this review, we examine the recent cognitive behavior therapy (CBT) outcome literature with anxiety-disordered children and, specifically, explore the status of cognitive change and increased coping ability as (1) specific treatment effects, and (2) possible mediators of the efficacy of CBT. In the past decade, the number of controlled CBT studies with clinically diagnosed anxiety-disordered children has increased substantially. CBT aims to restructure distorted or maladaptive cognitions and teach the anxious child to effectively use diverse coping strategies. Our review shows that in recent CBT research with anxiety-disordered children the use of domain-specific measures like cognitive and coping measures is, unfortunately, not common practice. Furthermore, only one study examined the issue of treatment mediation. Generally, recent CBT research has not been designed to test mediational issues and does not clarify whether cognitive change and enhanced coping--the presumed central components of CBT--are in fact responsible for its efficacy. Implications for the direction of future CBT research with anxiety-disordered children are discussed.

Assessing change in early intervention programs for children with autism

Assessing the efficacy of any intervention can be a difficult task. In the case of children with autism who require comprehensive and long-lasting interventions, the task becomes even more difficult. In this paper, intervention studies based on comprehensive interventions for young children with autism are reviewed and examined in reference to elements that are essential to a well-designed treatment study, e.g., randomization/matching procedures, and outcome measures. Given the complexity of these comprehensive intervention programs, and the few data available on interventions with clear empirical validation, a plea is made for studies to consider the active ingredients or component parts of an intervention, e.g., number of hours, type of setting, and teaching approach. Suggestions are further made for improving future studies, including more rigorous designs, and measuring change.

Transporting efficacious treatments to field settings: the link between supervisory practices and therapist fidelity in MST programs

Validated a measure of clinical supervision practices, further validated a measure of therapist adherence, and examined the association between supervisory practices and therapist adherence to an evidence-based treatment model (i.e., multisystemic therapy [MST]) in real-world clinical settings. Evidence of linkages between supervisor adherence to the MST supervisory protocol, as assessed through therapist reports, and therapist adherence to MST principles, as assessed through caregiver reports, was obtained from 285 families of youths presenting serious clinical problems, and 74 therapists and 12 supervisors of 16 teams in 9 organizations providing MST across 3 states. The findings provide a valuable step in examining the determinants of therapist fidelity to complex treatments in real-world clinical settings.

Developmental factors in the treatment of adolescents

Most empirically supported interventions for adolescent mental health problems are either downward adaptations of adult treatments or upward adaptations of child treatments. Although these treatments show respectable effects with teens, a review of the outcome research reveals significant gaps. both in coverage of adolescent conditions and problems (e.g., eating disorders, suicidality) and in attention to the biological, psychological, and social dimensions of adolescent development. The authors critique the field, propose a biopsychosocial framework for the development of dysfunction and intervention, and discuss ways the developmental literature can and cannot inform intervention and research. A long-term goal is an array of developmentally tailored treatments that are effective with clinically referred teens and an enriched understanding of when, how, and why the treatments work.

Child and Adolescent Empirical Psychotherapy Research

This paper reviews child and adolescent psychotherapy research, with a focus on two major theoretical classes of psychotherapies: cognitive-behavior and psychoanalytic psychotherapies. Our interest is particularly drawn to different issues: definition of psychotherapy and research on outcome and process. Specific attention is given developmental issues. We identify the major results and problems and propose methodological strategies for improving psychotherapeutic treatment research for child and adolescent disorders. Some areas that need to be addressed in the future are also discussed, such as the effects of specific techniques, the intensity and duration of treatment outcome and process, the effect of comorbidity, and the relationship between research and clinical practice.

Considering the clinical utility of performance-based measures of childhood anxiety

Examines general issues regarding the clinical utility of performance-based measures and specifically considers the utility of performance measures relevant to childhood anxiety and fear. First, we discuss the limitations of questionnaire and interview measures of childhood anxiety and the ways in which performance-based measures may compensate for or augment the use of such measures. Second, we review the major groups of performance-based measures that are potentially relevant to childhood anxiety and discuss evidence regarding their reliability and validity. Third, in the context of a general discussion of the various ways in which an assessment procedure may have clinical utility, we discuss the extent to which the performance-based techniques reviewed possess utility. Although many of these measures show promise of one or more types of clinical utility, none currently possess sufficient documented utility to warrant their dissemination for clinical use. We conclude by recommending directions for future research to demonstrate and improve the utility of such measures.

Family-based therapy for adolescent drug abuse: knowns and unknowns

Family-based therapy is one of the most thoroughly studied treatments for adolescent drug abuse. Considerable empirical support exists for the efficacy of family-based therapy in curtailing adolescent drug use and cooccurring behavior problems. This article extends knowledge of the effects of family-based therapy for adolescent drug abuse by reviewing 16 controlled trials and 4 therapy process studies from a treatment development perspective. We articulate "knowns and unknowns" regarding the outcomes of treatment as well as the components, processes, mechanisms, moderators, and boundaries of effective family-based therapy for adolescent drug abuse. The review highlights areas of progress and future research needs within the specialty of family-based therapy for adolescent drug abuse.

Behavioral versus behavioral and pharmacological treatment in ADHD children attending a summer treatment program

As part of the behavioral treatment in the Multimodal Treatment Study of Children with ADHD (MTA9), children participated in an intensive summer treatment program (STP). This study examined the differences between 57 children in the combined treatment (Comb) group, who were medicated, and 60 children in the behavioral treatment (Beh) group, who were unmedicated throughout the STP. Comb children were significantly better than Beh on 5 measures: rule following, good sportsmanship, peer negative nominations, and STP teacher posttreatment ratings of inattention/overactivity. Groups did not differ on any of the other 30 measures, and responded similarly to the STP over time. Comparisons to normative data revealed that Comb children were more likely to fall within the normative range on 6 measures. The differences between these results and the main MTA results, in which Comb was always superior to Beh, are discussed in terms of the relative intensity of combined treatments. The implications for future studies of pharmacological and behavioral treatment for ADHD are discussed.

The efficacy, safety, and practicality of treatments for adolescents with attention-deficit/hyperactivity disorder (ADHD)

Studies examining interventions for adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD) were reviewed to evaluate their efficacy. These efficacy findings were supplemented with a preliminary system for judging safety and practicality. Results suggest that the stimulant drug methylphenidate (MPH) is safe and well-established empirically, but has some problems with inconvenience and noncompliance. Preliminary research supports the efficacy, safety, and practicality of some psychotherapeutic interventions, including behavioral classroom interventions, note-taking training, and family therapy. Treatment with tricyclic antidepressants was judged to have minimal empirical support and debatable safety. Very little is known about long-term effectiveness of treatments, long-term compliance, or multimodal treatments for adolescents such as stimulants plus behavior therapy.

Research on the cognitive-behavioral treatment of school refusal: a review and recommendations

Cognitive-behavior therapy is frequently used in the treatment of school refusal, a challenging problem for mental health professionals and school authorities. We review the clinical and research support for the efficacy of cognitive-behavior therapy using recently published guidelines for determining the level of evidentiary support for psychosocial interventions. Although cognitive-behavior therapy appears to be a useful treatment for school refusal, further research is needed before it can be considered as having "well-established" empirical status. Several other important methodological and theoretical issues are emphasized.