Comprehensive Evidence Based Interventions for Children and Adolescents E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1143

Veröffentlichungsjahr: 2014

Beschreibung

A complete guide to evidence based interventions for children and adolescents The past decade has witnessed the development of numerous interventions proved to be highly effective; several treatments are now considered to be "well established" or "probably efficacious" interventions for children. Given the range of providers working with children--clinical psychologists, child psychiatrists, clinical social workers, school psychologists, and marriage and family therapists--this book is designed to provide all professionals the information they now need about the use of these evidence-based interventions (EBIs), as well as the evaluation criteria used to determine their efficacy in in meeting the mental health needs of children. Alfano and Beidel have assembled a team of experts to write the disorder chapters. Each chapter begins with an overview of the disorder then delves into evidence-based approaches to treatment, the impact of parental involvement, case-by-case modifications, progress measurement, and clinical examples. In overview chapters the editors cover: * The role of development in treatment planning and implementation * Dissemination of EBIs into school and community settings * The use of controversial therapies with children * Emerging methods of service delivery and access improvement Comprehensive Evidence Based Interventions for Children and Adolescents provides clinicians, researchers, and students alike with the theoretical, conceptual, and practical skills to provide children and adolescents with the best care possible.

Leseprobe

Contents

Preface

About the Editors

Contributors

Section I: Treatment Considerations and Contextual Issues

Chapter 1: Development Considerations in Assessment and Treatment

Assessment

Treatment

Summary

References

Chapter 2: Ethical Considerations in Mental Health Treatment and Interventions with School-Age Children and Adolescents

Introduction

Competence and the Scientific Bases for Clinical Judgment

Informed Consent for Treatment

Privacy and Confidentiality

Conclusions

References

Chapter 3: Controversial Therapies for Children

Aromatherapy

Boot Camp Interventions and Disciplinary Boarding Schools

Drug Abuse Resistance Education

“Energy” Psychology and the Emotional Freedom Technique

Rebirthing Therapy

Reparative/Conversion Therapy

Seeking Resolution

References

Chapter 4: Evidence-Based Treatments for Mental, Emotional, and Behavioral Problems in Ethnic Minority Children and Adolescents

Defining Key Terms

Evidence for Using Current Treatment Protocols With Ethnic Minority Youth

Integrating Culture in the Treatment of Disorders in Ethnic Minority Youth

Toward Ebts With Ethnic Minority Youth: Theory-Based Approaches

Conclusions and Clinical Recommendations

References

Notes

Chapter 5: New Methods of Service Delivery for Children’s Mental Health Care

Innovative Solutions to Problems in Care Availability and Quality

Conclusions

References

Notes

Chapter 6: Dissemination and Implementation of Evidence-Based Treatments for Children and Adolescents

Conceptual Primer on Dissemination and Implementation

Why is Dissemination and Implementation Science Needed?

Models of Dissemination

Recent Exemplars of Ebt Implementation Research

Conclusion

References

Section II: Disorder-Focused Interventions

Chapter 7: Anxiety Disorders in Children

Brief Overview of Disorders

Evidence-Based Approaches

Common Components of Evidence-Based Treatments for Children With Anxiety Disorders

Evidence for the Efficacy of Cbt for the Treatment of Anxiety Disorders in Childhood

Parental Involvement

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example: Separation Anxiety Disorder

References

Notes

Chapter 8: Anxiety Disorders in Adolescents

Brief Overview of Adolescent Anxiety Disorders

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Notes

Chapter 9: Depressive Disorders in Children

Overview of the Disorder

Evidence-Based Approaches

Specific Treatment Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

Conclusion

References

Chapter 10: Depressive Disorders in Adolescents

Overview of the Disorders

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 11: Bipolar Disorders

Overview of Pediatric Bipolar Disorder

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 12: Evidence-Based Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

Overview of the Disorder

Evidence-Based Approaches to Treatment

Parental Involvement in Treatment

Adaptations and Modifications to Treatment

Measurement of Treatment Outcomes

Clinical Case Vignette

References

Chapter 13: Treatment of Conduct Problems and Disruptive Behavior Disorders

Brief Overview of Disorders

Evidence-Based Approaches: Children

Evidence-Based Approaches: Adolescents

Parent Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Notes

Chapter 14: Autism Spectrum Disorders

Brief Overview of Autism Spectrum Disorders

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 15: Evidence-Based Interventions for Eating Disorders

Brief Overview of Disorder/Problem

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 16: Elimination Disorders

Brief Overview of Disorders

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Section III: Other Interventions for Children

Chapter 17: Treatment of Insomnia and Nighttime Fears

Brief Overview of Disorder/Problem

Evidence-Based Approaches

Parent Involvement in Treatment

Adaptations and Modifications

Assessment/Measuring Treatment Effects

Clinical Case Example

References

Chapter 18: Problematic School Absenteeism

Brief Overview of Problematic School Absenteeism

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Examples

Final Comments

References

Chapter 19: Trauma-Related Problems and Disorders

Brief Overview of Disorder/Problem

Evidence-Based Approaches

Parental Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 20: Bullied Children

Brief Overview of the Problem

Evidence-Based Approaches

Parent (And Teacher) Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Examples

References

Chapter 21: Adherence to Medical Regimens

Brief Overview of Problem

Evidence-Based Approaches to Dealing With Nonadherence

Parental Involvement

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Example

References

Chapter 22: Overweight and Obesity

Overview of the Problem

Evidence-Based Approaches

Parent Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Cases

Conclusions and Future Directions

References

Chapter 23: Obsessive-Compulsive Disorder and Trichotillomania

Brief Overview of Disorders/Problems

Evidence-Based Approaches

Parent Involvement in Treatment

Adaptations and Modifications

Measuring Treatment Effects

Clinical Case Examples

References

Author Index

Subject Index

End User License Agreement

List of Illustrations

Figure 22.1 Examples of Parent Involvement in Family-Based Behavioral Interventions

Figure 22.2 Proportion of Overweight and Obese Youth Reporting Aberrant Eating Patterns

List of Tables

TABLE 4.1 Summary of Evidence-Based Treatments for Ethnic Minority Youth

TABLE 7.1 Reliability of Common Childhood Anxiety Diagnoses With the Use of Structured or Semistructured Interviews

TABLE 9.1 Summary of Common Intervention Strategies Implemented in Childhood Depression Treatments

TABLE 17.1 ICSD-2: Diagnostic Criteria for Behavioral Insomnia of Childhood

TABLE 17.2 Description of Evidence-Based Approaches for Behavioral Insomnia of Childhood and Child Nighttime Fears

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Guide

Cover

Table of Contents

Begin Reading

COMPREHENSIVE EVIDENCE-BASED INTERVENTIONS FOR CHILDREN AND ADOLESCENTS

Edited by

CANDICE A. ALFANO

DEBORAH C. BEIDEL

Cover image: retrorocket/iStockphoto

Cover design: Wiley

Copyright © 2014 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data:

Comprehensive evidence-based interventions for children and adolescents / edited by Candice A. Alfano, Deborah C. Beidel.

1 online resource.

Includes bibliographical references and index.

Description based on print version record and CIP data provided by publisher; resource not viewed.

ISBN 978-1-118-48756-3 (cloth)

ISBN 978-1-118-86498-2 (epdf)

ISBN 978-1-118-86482-1 (epub)

1. Child psychopathology. 2. Adolescent psychopathology. 3. Evidence-based psychiatry. 4. Child mental health services. I. Alfano, Candice A., editor of compilation. II. Beidel, Deborah C., editor of compilation.

RJ499

618.92'8914—dc23

2013049602

This book is dedicated to my first love, my mother, Diane Ragusa Alfano, who passed away during its development. I have had many brilliant mentors throughout my schooling and years of training but no better teacher of how fundamentally important it is to prioritize and nurture the dreams of children.

LYD MYM, Candice

Preface

Child mental health disorders do not discriminate. They affect boys and girls of all ages, ethnic/racial backgrounds, socioeconomic sectors, and regions of the world. In the United States alone, 13%–20% of children (up to one out of five) are diagnosed with a mental disorder in any given year (National Research Council and Institute of Medicine, 2009) and rates appear to be on the rise (Centers for Disease Control, 2013). By translation, this means that millions of young people struggle with depression, anxiety, conduct disorders, autism, eating disorders, substance use, and a host of other emotional and behavioral problems every day. In comparison to youth without a mental health disorder, these children are also more likely to suffer from health-related, interpersonal, and school-based problems such as sleep disturbances, peer rejection and victimization, and school absenteeism. Clearly, child mental disorders are a significant public health concern for individuals, families, and society.

On a more optimistic note, the range of professionals who receive training in providing mental health services to children continues to expand. This list includes psychologists, child psychiatrists, social workers, school counselors, nurse practitioners, and family therapists, among others. However, just as the training and clinical experiences of these professionals can vary, so too might the intervention approaches adopted to treat various childhood disorders. The overarching goal of this book is to provide professionals, researchers, and students in clinical psychology and allied disciplines a comprehensive resource for understanding, selecting, and delivering the most effective, evidence-based treatments for school-age children and adolescents. The term evidence-based treatment specifically refers to psychosocial interventions that have been subject to scientific investigation and have been empirically demonstrated to produce beneficial effects in the form of symptom reduction and/or improvements in daily functioning.

In Section I, chapters cover a range of issues and topics central to treatment delivery, including developmental and cultural considerations, ethical concerns, and efforts toward the broad dissemination of evidence-based treatments. In line with the book’s focus on interventions grounded in science, we felt it important to include a chapter focused on unproven or “controversial” therapies, since awareness of treatments that are not clearly effective (and might even be harmful) should be considered equally essential for the child mental health professional. Finally, in the ever-evolving age of media and technology, we believe that readers will find Chapter 5, “New Methods of Service Delivery for Children’s Mental Health Care,” to be both timely and relevant.

Each chapter in Sections II and III focuses on a specific childhood disorder or problem. The decision to structure the book in this way was guided by the proliferation of evidence-based child interventions that have emerged over the past two decades. In fact, based on criteria defined by the American Psychological Association (APA), several of these treatments are now considered “well established” or “probably efficacious” interventions for children. Accordingly, rather than inviting authors to submit narrowly focused chapters describing individual treatment programs, our vision was to provide readers with in-depth coverage of a range of validated interventions and strategies for discrete types of childhood disorders/problems. We believe that this breadth of content will serve professionals and students well, both in understanding the existing research base and in developing individualized treatment plans for child patients. Chapters in Sections II and III also follow the same basic format. For example, in each chapter the same subsections appear describing core features of the disorder/problem, available evidence-based interventions, the role of parents in treatment, and circumstances where treatment modifications may be necessary to ensure effectiveness. Additional sections include review of state-of-the-art assessment tools for measuring treatment progress and clinical examples that provide valuable descriptive information and sample treatment plans.

When this book was conceptualized, DSM-IV-TR (American Psychiatric Association, 2000) was the standard reference for diagnostic classification. By the time of publication, DSM-5 (American Psychiatric Association, 2013) had been introduced. In some cases, new disorders were introduced and new categories devised. We had to make decisions about how to integrate new material into the nearly completed book. For some new disorders, few data were available, suggesting that a chapter would not yet make a meaningful contribution. In the case of the newly introduced diagnostic category of Obsessive-Compulsive and Related Disorders, there was a strong empirical database and we made a decision that a separate chapter was warranted. Because the book was already in final production, we placed this chapter at the end of the volume rather than what would seem to be a more logical placement, that is, near the anxiety disorders chapter.

Even with a clear vision for the final product, we knew that the readability and utility of this book ultimately rest upon the quality of its individual chapters. We could not have wished for a more impressive list of child interventions scientists and professionals as authors. The collective expertise they brought to this shared project is immeasurable and we offer them our deepest thanks. We also wish to thank Patricia Rossi, Amanda Orenstein, and Kara Borbely from John Wiley & Sons for their guidance, support, and patience throughout the entire process. Finally, to the hundreds of child and adolescent patients we have worked with over the years, you inspire us every day!

Candice A. Alfano

Deborah C. Beidel

REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.) Washington, DC: Author.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Alexandria, VA: American Psychiatric Publishing.

Centers for Disease Control. (2013). Mental health surveillance among children—United States, 2005–2011. Morbidity and Mortality Weekly Report, 62(2), 1–35.

National Research Council and Institute of Medicine. (2009). Preventing mental, emotional, and behavioral disorders among young people: Progress and possibilities. Washington, DC: National Academies Press.

About the Editors

Candice A. Alfano, PhD, is associate professor of psychology and director of the Sleep and Anxiety Center for Kids at the University of Houston. She received her PhD in clinical psychology in 2005 from the University of Maryland at College Park. She previously held a faculty position at the George Washington University School of Medicine and founded and directed the Child and Adolescent Anxiety Program at Children’s National Medical Center in Washington, DC. Dr. Alfano serves on the Scientific Council of the Anxiety and Depression Association of America, the board of directors of the Society for Behavioral Sleep Medicine, and is associate editor for the Journal of Anxiety Disorders. She has authored more than 50 publications including journal articles, book chapters, books, and edited books. Her academic, research, and clinical interests focus on childhood anxiety disorders, pediatric sleep disorders, and effective interventions for these problems. Dr. Alfano is also a licensed clinical psychologist.

Deborah C. Beidel, PhD, ABPP, is professor of psychology and director of the Anxiety Disorders Clinic at the University of Central Florida. She received her PhD in clinical psychology in 1986 from the University of Pittsburgh and has held faculty positions at the University of Pittsburgh, the Medical University of South Carolina, the University of Maryland–College Park, and Penn State College of Medicine. She holds the American Board of Professional Psychology (ABPP) Diplomate in clinical psychology and behavioral psychology and is a fellow of the American Psychological Association and the Association for Psychological Science. She is the editor in chief of the Journal of Anxiety Disorders and has authored more than 200 publications including journal articles, book chapters, books, and edited books. Her academic, research, and clinical interests focus on child and adult anxiety disorders, including their etiology, psychopathology, and treatment. Dr. Beidel is also a licensed psychologist.

Contributors

Candice A. Alfano, PhD

Sleep and Anxiety Center for Kids, Department of Psychology

University of Houston

Houston, Texas

Cassidy C. Arnold, MS

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Jessica Balderas, BA

Sleep and Anxiety Center for Kids, Department of Psychology

University of Houston

Houston, Texas

Deborah C. Beidel, PhD, ABPP

Anxiety Disorders Clinic

Department of Psychology

University of Central Florida

Orlando, Florida

Stephen M. Borowitz, MD

Department of Pediatrics

University of Virginia Health System

Charlottesville, Virginia

Caroline L. Boxmeyer, PhD

Department of Psychiatry and Behavioral Medicine

University of Alabama

Tuscaloosa, Alabama

Catherine Byrne, BA

Department of Psychiatry

University of Chicago

Chicago, Illinois

Timothy A. Cavell, PhD

Department of Psychological Science

University of Arkansas

Fayetteville, Arkansas

Priscilla T. Chan, MA

Department of Psychology

Boston University

Boston, Massachusetts

Amanda Chiapa, MA

Department of Psychology

Arizona State University

Tempe, Arizona

Winnie W. Chung, MA

Departments of Psychology and Psychiatry

Ohio State University

Columbus, Ohio

Michelle A. Clementi, BS

Sleep and Anxiety Center for Kids, Department of Psychology

University of Houston

Houston, Texas

Jonathan S. Comer, PhD

Mental Health Interventions and Technology Program, Department of Psychology

Florida International University

Miami, Florida

Jennifer Cowie, BA

Sleep and Anxiety Center for Kids,

Department of Psychology

University of Houston

Houston, Texas

James T. Craig, BA

Department of Psychological Science

University of Arkansas

Fayetteville, Arkansas

Megan E. Crisler, MA

Department of Psychology

University of Alabama

Tuscaloosa, Alabama

Amber L. Daigre, PhD

Department of Pediatrics

University of Miami Miller School of Medicine

Miami, Florida

Alan M. Delamater, PhD

Department of Pediatrics

University of Miami Miller School of Medicine

Miami, Florida

Peter M. Doyle, PhD

Eating and Weight Disorders Center of Seattle

Seattle, Washington

Kimberly Dunbeck, BS

Department of Psychology

Case Western Reserve University

Cleveland, Ohio

R. Meredith Elkins, MA

Department of Psychology

Boston University

Boston, Massachusetts

Brian Fisak, PhD

Department of Psychology

University of North Florida

Jacksonville, Florida

Celia B. Fisher, PhD

Center for Ethics Education

Fordham University

Bronx, New York

Adam L. Fried, PhD

Center for Ethics Education

Fordham University

Bronx, New York

Mary A. Fristad, PhD

Departments of Psychology and Psychiatry

Ohio State University

Columbus, Ohio

Samantha J. Gregus, BA

Department of Psychological Science

University of Arkansas

Fayetteville, Arkansas

Juventino Hernandez Rodriguez, BA

Department of Psychological Science

University of Arkansas

Fayatteville, Arkansas

Lindsay E. Holly, MS

Prevention Research Center, Department of Psychology

Arizona State University

Tempe, Arizona

Megan Jeffreys, BA

Joint Doctoral Program in Clinical Psychology

San Diego State University/University of California

San Diego, California

Luis Alberto Jimenez-Camargo, MA

Department of Psychology

University of Alabama

Tuscaloosa, Alabama

Deborah J. Jones, PhD

Department of Psychology

University of North Carolina at Chapel Hill

Chapel Hill, North Carolina

Heather A. Jones, PhD

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Christopher A. Kearney, PhD

Department of Psychology

University of Nevada

Las Vegas, Nevada

Gerald P. Koocher, PhD

College of Science and Health

DePaul University

Chicago, Illinois

Nicole L. Kreiser, MS

Department of Psychology

Virginia Polytechnic Institute and State University

Blacksburg, Virginia

Daniel Le Grange, PhD

Department of Psychiatry

University of Chicago

Chicago, Illinois

Matthew D. Lerner, PhD

Department of Psychology

Stony Brook University

Stony Brook, New York

John E. Lochman, PhD

Department of Psychology

University of Alabama

Tuscaloosa, Alabama

Michael A. Mallott, PhD

Department of Psychology

University of Central Florida

Orlando, Florida

Ashley Marchante, BA

Department of Pediatrics

University of Miami Miller School of Medicine

Miami, Florida

Madeline McMann, BA

Department of Psychology

Simmons College

Boston, Massachusetts

Thomas H. Ollendick, PhD

Department of Psychology

Virginia Polytechnic Institute and State University

Blacksburg, Virginia

Freddie A. Pastrana, BA

Department of Psychological Science

University of Arkansas

Fayetteville, Arkansas

Amy T. Peters, BA

Department of Psychology

University of Illinois

Chicago, Illinois

Armando A. Piña, PhD

Prevention Research Center

Department of Psychology

Arizona State University

Tempe, Arizona

Nicole P. Powell, PhD

Department of Psychology

University of Alabama

Tuscaloosa, Alabama

Amy Przeworski, PhD

Department of Psychology

Case Western Reserve University

Cleveland, Ohio

Annie E. Rabinovitch, MA

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Julia Revillion Cox, BA

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Lee M. Ritterband, PhD

Department of Psychiatry and Neurobehavioral Sciences

University of Virginia Health System

Charlottesville, Virginia

Emma Ross, BA

Department of Psychology

University of Nevada

Las Vegas, Nevada

Laura D. Seligman, PhD

Department of Psychology

University of Toledo

Toledo, Ohio

Jaclyn A. Shepard, PsyD

Department of Psychiatry and Neurobehavioral Sciences

University of Virginia Health System

Charlottesville, Virginia

Angela Smyth, MD

Department of Psychiatry

The University of Chicago

Chicago, Illinois

Michael A. Southam-Gerow, PhD

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Annika Stout, BA

Department of Psychology

Simmons College

Boston, Massachusetts

Sara L. Stromeyer, MA

Department of Psychology

University of Alabama

Tuscaloosa, Alabama

Erin F. Swedish, MS

Department of Psychology

University of Toledo

Toledo, Ohio

Marian Tanofsky-Kraff, PhD

Department of Medical and Clinical Psychology

Uniformed Services University of the Health Sciences

Bethesda, Maryland

Frances P. Thorndike, PhD

Department of Psychiatry and Neurobehavioral Sciences

University of Virginia Health System

Charlottesville, Virginia

Carrie B. Tully, MS

Department of Psychology

Virginia Commonwealth University

Richmond, Virginia

Anna Vannucci, MS

Department of Medical and Clinical Psychology

Uniformed Services University of the Health Sciences

Bethesda, Maryland

V. Robin Weersing, PhD

Joint Doctoral Program in Clinical Psychology

San Diego State University/University of California

San Diego, California

Amy E. West, PhD

Department of Psychiatry

University of Illinois

Chicago, Illinois

Susan W. White, PhD

Department of Psychology

Virginia Polytechnic Institute and State University

Blacksburg, Virginia

SECTION ITreatment Considerations and Contextual Issues

Chapter 1Development Considerations in Assessment and Treatment

Amy Przeworski and Kimberly Dunbeck

The developmental psychopathology approach emphasizes the interplay between psychopathology and cognitive, emotional, and social development of children and adolescents (Cicchetti & Cohen, 1995; Cicchetti & Toth, 1991). This approach has long been touted as essential to the conceptualization of psychopathology and intervention for children and adolescents. Despite its utility, few inroads have been made in integrating this approach into assessment and treatment. The developmental level of child or adolescent clients is important for therapists to consider during assessment, treatment planning, and therapy implementation.

ASSESSMENT

Despite significant improvements in the empirical basis for diagnostic categorization across the years, one area where there have been few changes is the integration of developmental changes into the diagnostic criteria. The diagnostic criteria for common childhood disorders often involve the application of adult criteria to children. Although the Diagnostic and Statistical Manual (5th ed.; DSM-5) (American Psychiatric Association [APA], 2013) includes descriptions of child manifestation of symptoms for some disorders, few disorders include guidance on how symptoms may manifest differently across children and adolescents of different ages. Thus, therapists are left to use their clinical judgment to apply DSM criteria in a developmentally sensitive manner.

The lack of attention to developmental variations in symptoms in the DSM and its application is consistent with a common misconception in psychopathology, the developmental uniformity myth (Kendall, Lerner, & Craighead, 1984), which holds that disorders manifest the same no matter the age of the individual. In fact, research indicates that psychological symptoms vary quite a bit across developmental stages.

For example, there are developmental differences in the frequency of specific anxiety disorders at different ages, with separation anxiety disorder more common in young children (ages 6 to 9) and social phobia more frequent in adolescents (Weems & Costa, 2005; Weems, Hammond-Laurence, Silverman, & Ginsburg, 1998). This may be related to physical developmental changes occurring during these ages, such as that young children learn individuation and independence from parents at ages 6 to 11 and experience fears related to loss or separation from parents (Weems & Costa, 2005) and adolescents emphasize peer relationships and social interactions (Warren & Sroufe, 2004; Westenberg, van Strien, & Drewes, 2001) and therefore more often experience anxiety related to social situations.

There are also differences in the rates of depression across childhood and adolescence, with low rates in children (less than 2%) and a dramatic increase in prevalence in adolescence (4%–8%) (Hankin et al., 1998), especially in females (Silberg et al., 1999). Bipolar disorder is also rare in young children but increases in prevalence around puberty, with 15 to 19 years of age as the typical age of onset (for a review, see Kim & Miklowitz, 2002).

There are also developmental differences in depressive symptoms over the long term. For example, children who have their first depressive episode before adolescence tend to have more severe, recurrent, and treatment-resistant major depressive disorder, and as many as 40% of children who have a depressive episode will have a second episode within 5 years (Kovacs et al., 1984). Childhood-onset bipolar disorder is also typically more chronic and treatment resistant than later-onset bipolar disorder (for a review see Kim & Miklowitz, 2002). Children are less likely to see their symptoms as causing functional impairment than are their parents or other reporters (APA, 1994; Langley, Bergman, & Piacentini, 2002). As such, it is essential for assessors to be sensitive to these developmental patterns in symptoms and to rely on multiple reporters in assessing child and adolescent psychopathology.

Despite the necessity of involving multiple reporters in the assessment of child and adolescent psychopathology, there is rarely agreement on symptoms (Achenbach, McConaughy, & Howell, 1987; Comer & Kendall, 2004; Grills & Ollendick, 2002; Rapee, Barrett, Dadds, & Evans, 1994). Parent–child agreement ranges from kappas of .09 for depressive symptoms to .32 for anxiety symptoms and .29 for symptoms of attention-deficit/hyperactivity disorder (Grills & Ollendick, 2002; Rapee et al., 1994). Children often report anxiety symptoms at higher rates and intensity than their parents (Bird, Gould, & Staghezza, 1992; Edelbrock, Costello, Dulcan, Conover, & Kala, 1986; Herjanic & Reich, 1997; Hodges, Gordon, & Lennon, 1990; Kolko & Kazdin, 1993; Lagattuta, Sayfan, & Bamford, 2012); however, it is unclear which report of child anxiety is more accurate or the weight that should be given to each reporter.

Some have suggested that the age of the child should influence the degree to which assessors rely on parent versus child report. For example, it has been suggested that parental report should be relied on in assessing children below the age of 11 because such young children experience difficulties in self-report of behavior or mood problems (Achenbach et al., 1987; Ollendick & Hersen, 1993) most likely due to their limited verbal ability and insight. Further, self-report questionnaires are not commonly recommended for children under the age of 8 because children of that age typically are unable to complete such measures without assistance (Beidel & Stanley, 1993). Others have suggested that children are not always able to respond to self-report measures appropriately; for instance, they are likely to respond to questions on questionnaires based on their emotional reaction to a statement rather than based on the frequency of the event (King & Gullone, 1990; McCathie & Spence, 1991). However, the format of assessment also may influence children’s ability to complete a self-report questionnaire. Questionnaires with only three anchors are the most reliable and valid way to use such measures with children (Beidel, Turner, & Morris, 1995; Ollendick, 1983). Additionally, new information indicates that children as young as 4 can report on their daily emotional states when assessed using a pictorial Likert scale and simplified wording read to them by an assessor (Lagattuta et al., 2012). Thus the most important aspect of assessment of young children’s self-report may be the use of developmentally sensitive tools and techniques.

In children and adolescents 8 years of age and older, it is common to include the child’s self-report; however, the degree to which the child’s report is relied on may vary by the type of symptoms being assessed. Some have suggested that child report is most accurate in cases of internalizing symptoms (Jensen, Xenakis, Davis, & Degroot, 1988) versus externalizing or behavior symptoms, which are more reliably observed by parents and teachers (Kendall, 2006).

When assessing children, it can be difficult to know when and how to ask about behaviors such as sexual involvement, use of drugs or alcohol, and suicidal and homicidal ideations. The consumption of alcohol is common in late adolescents, with 4 out of 5 twelfth graders reporting that they have drunk alcohol, 50% to 62% of sixth graders reporting that they have tasted alcohol, and only 29% reporting that they have had more than a sip (Johnston, O’Malley, Bachman, & Schulenberg, 2002). This is an increase from fourth graders, where only 10% of children have had more than a sip of alcohol. Given this information and the increased rates of substance abuse in those who began drinking at age 11 and 12 (DeWit, Adlaf, Offord, & Ogborne, 2000), assessors should not assume that because a child is well below the drinking age he or she is not drinking. Therefore, while most children will not have consumed alcohol in large quantities, asking is likely recommended with children after the age of 11.

With regard to nicotine or illicit drugs, a similar pattern emerges. Sixty percent of high school seniors have smoked cigarettes; one third of them did so during the previous month. Further, 50% of high school seniors have used illicit drugs (drugs other than alcohol and nicotine) at some time in their lives (Johnston et al., 2002). Given that use of these substances is somewhat common in adolescents, assessors should be sure to ask about drug use, particularly given the association between drug use and psychological struggles (Deas & Brown, 2006; Kandel et al., 1999). Further, 7.8% of adolescents 12 to 17 years of age struggle with diagnosable substance abuse disorders; therefore, questions concerning these topics should be asked of children starting as early as late childhood (Kendall, 2006).

Other risky behaviors that should be assessed beginning in adolescence include sexual behaviors and the use of contraception. Twenty-one percent of adolescent males reported that they had sex by the age of 15 (Albert, Brown, & Flanigan, 2003; Sonenstein, Pleck, & Leighton, 1991) and 7.2% to 10% by the age of 13 (Albert et al., 2003; Kann et al., 1998). Similar rates were found in female adolescents (Albert et al., 2003). Close to 50% of high school students have had sex by the time that they graduate (Kann et al., 1998), with significantly higher rates among African American high school students (89% of males and 70% of females) (Kann et al., 1995). African American and Latino teens also report higher rates of sexual behaviors at earlier ages than Caucasians (Kann et al., 1998).

Although 57% to 74% of adolescents reported that they used contraception at their first sexual experience (Albert et al., 2003), only 10% to 20% of adolescents who are having sex use condoms consistently (DiClemente et al., 1992; Kann et al., 1995), a number that is lower in adolescents of diverse ethnicities (Airhihenbuwa, DiClemente, Wingood, & Lowe, 1992). Additionally, many adolescents have sex during monogamous relationships that are short term and therefore have multiple sexual partners over short periods of time (Overby & Kegeles, 1994). For that reason, it is important that assessment of adolescents includes assessment of sexual behaviors and the use of contraception in order to identify risky behaviors that adolescents may be engaging in as well as symptoms of psychological disorders that may be the target of treatment.

TREATMENT

Developmental sensitivity is equally important in therapy as it is in assessment. Although various types of child and adolescent therapy exist, as with adults, one of the most well-validated treatment options for children and adolescents is cognitive behavioral therapy (CBT) (Durlak, Fuhrman, & Lampman, 1991). CBT has been used with children and adolescents between the ages of 4 and 18, with the techniques included varying with the age and developmental level of the child.

Perspective Taking

One aspect of developmental level that is important to consider when choosing therapy techniques for children and adolescents is the child’s level of perspective taking. Children between the ages of 2 and 3 years are often able to describe their own basic feelings, such as sadness and anger; however, they are not able to understand that other people have feelings and thoughts separate from their own (Dunn, Brown, Slomkowski, Tesla, & Youngblade, 1991). Therapy techniques that require a child to think about the impact of their behaviors on others may not be effective with young children because of their limited perspective-taking abilities (Selman, 1980). As children develop cognitively, they begin to understand that others see things differently and that others may hold opinions different from their own. However, they dismiss these opposing thoughts and feelings of others as wrong because they differ from their own. Once children have reached adolescence, they begin to understand that others’ thoughts and feelings, while different from their own, are not inherently wrong but instead represent an alternative and equally valid perspective (Chandler, 1988). Due to these developmental differences in children’s perspective-taking abilities, it is important to consider the child’s developmental level rather than assuming that lack of ability to consider others’ feelings reflects psychopathology.

A child’s ability to take the perspective of others also mirrors his or her ability to consider multiple potential solutions to a problem. Before the age of 14, it is difficult for children to understand and generate numerous solutions without significant scaffolding (Sternberg, 1977; Sternberg & Nigro, 1980). A child’s level of perspective taking and ability to consider numerous solutions is an important consideration when implementing cognitive restructuring. Cognitive restructuring emphasizes the notion that there are numerous ways to interpret a situation and that it is one’s interpretation that influences one’s emotional response to the situation. Cognitive restructuring requires that a child be able to generate and fully consider various interpretations of the same situation. Due to the limited perspective-taking abilities of children before late childhood, it may be challenging for them to identify alternative explanations for situations, let alone to consider the accuracy of each. Therefore, while cognitive restructuring is known to be an effective CBT technique, it may be somewhat challenging for children to implement.

A much more simplistic version of cognitive restructuring may be used with younger children. For example, younger children may be able to identify positive or negative aspects of a situation. One way of doing so with young children is to have them pretend to be “detective positive” or “detective negative.” Each detective looks for clues in a situation that are either positive or negative. This more simplistic way of engaging in cognitive restructuring may allow a child to combat a negative attentional or interpretive bias and to identify positive cues without having to engage in the more abstract cognitive restructuring techniques of comparing the evidence for and against a thought and then revising the thought.

Abstract Reasoning

It is also important to consider the level of a child’s abstract reasoning abilities when choosing among the various available therapy techniques (Weisz & Weersing, 1999). Abstract reasoning is difficult for children of all ages and is not consistently developed until approximately age 15 (Piaget, 1970; Siegler, 1986). Because of the limited abstraction ability of most children, hypothetical thinking techniques, such as role-play and brainstorming about possible outcomes, are not always helpful with children (Weisz, 1997). However, it is possible to consider multiple outcomes to an event when phrasing this concept in a developmentally sensitive manner. Children as young as 3 have hypothetical reasoning capabilities as long as they are future oriented (“What if something different happened next time?”) rather than past oriented (“What if this happened instead of what actually happened?”) (Robinson & Beck, 2000). Thus, therapists can introduce children to the concept that there may be various outcomes to an event by examining the possible outcomes that could occur in future situations that are similar to a current situation.

Causal Reasoning and Emotional Understanding

Another important developmental task that may influence the effectiveness of therapy techniques is causal reasoning. Causal reasoning is the understanding of complex cause-and-effect relationships—for instance, the connection among thoughts, behaviors, and emotions and understanding concepts such as rewards and punishments. Young children struggle to connect past events with current emotions or thoughts; therefore, therapeutic attempts to associate the past with the present often are unsuccessful with young children (Shirk, 1988). Young children also are likely to attribute events to conscious, concrete reasons or outside forces as opposed to psychological or internal experiences; therefore, often it is difficult for therapists to teach young children the ways in which emotions may influence one’s behaviors.

Children have a limited ability to understand emotions in themselves and others (Izard, 1994), with young children (under the age of 3) able to identify only primary emotions, such as happiness, anger, sadness, and fear. Preschool-age children begin to understand emotions as they relate to themselves (emotions such as shame, pride, and guilt) but cannot describe having two feelings at the same time or blends of emotions (Harris, 1989; Harter, 1977). Preschool children also view experience and expression of emotion as synonymous, meaning they define emotional experiences by outside behavior (Nannis, 1985; Nannis & Cowan, 1987). For that reason, a child may state that a person is happy only if the individual is smiling and may not understand that emotions are internal and may be experienced but not expressed. Although this may impact a therapist’s ability to teach a preschool child to inhibit emotional expression in situations, the ability of children of that age to recognize that facial expressions are linked to emotions provides an opportunity to teach them to identify their own cues for emotions, such as facial indications of fear, happiness, or sadness, and to begin to use words to describe their emotional experiences as a way of communicating their feelings. It is common for therapists to teach young children to recognize their own emotional experience by thinking about what they are expressing on their face and to convey these emotions using words rather than actions. For example, if a young child often acts out or throws temper tantrums when frustrated, a therapist may teach the child to express frustration by telling a parent that he/she is angry rather than acting out. This, when combined with the parental strategy of ignoring whining and temper tantrums that occur due to the child’s attention seeking, may be an effective way of introducing adaptive emotion regulation and expression strategies with young children.

As children age (ages 6–10), they begin to see emotions as internal events that can be shared externally with others or kept a secret. Children of these ages also recognize that emotional experiences can be caused by external events (Carroll & Steward, 1984; Gnepp & Gould, 1985; Harris, Olthof, & Terwogt, 1981; Nannis, 1988). At around age 8 children also begin to understand the emotional experiences of others better and to recognize that the same situation can lead to different reactions in different people (Gnepp & Klayman, 1992). It is also around this age that children begin understanding that emotional experiences are not discrete and that an individual can experience multiple, and even opposing, emotions at the same time (Friend & Davis, 1993). By age 11 or 12, children can understand that they have control over their emotions and can choose whether to express or hide them (Nannis, 1985; Nannis & Cowan, 1987).

The emotional work that can be accomplished in therapy with children in middle childhood may involve the recognition of blends of emotions, conflicting emotions, and the link between events and subsequent emotions. Children’s emotional understanding during this middle childhood phase provides them with the abilities necessary to comprehend most cognitive behavioral techniques, such as linking antecedent events, emotions, and behaviors; using behavioral techniques to impact the strength of emotions, such as relaxation techniques to reduce anxiety; and the negative reinforcement that occurs when one escapes from a feared stimulus. Many of the CBT packages developed for children were developed specifically for those between the ages of 7 and 12 in mind (Barrett, Dadds, & Rapee, 1996; Kendall, 1994; Sanders, 1999; Webster-Stratton, 1992).

Language

When working with children, it is important to be aware of their language abilities. When talking with a child, a therapist should always use vocabulary that the child understands (Weisz & Weersing, 1999). The type of vocabulary that a therapist uses will vary by age and across children. It is also important to understand the role that language development has on a child’s emotional understanding. It is believed that emotional competence is intertwined with the ability to use emotionally descriptive language (Beck, Kumschick, Eid, & Klann-Delius, 2012). Therefore, children who have not yet developed sophisticated emotional vocabularies will also struggle with understanding their own emotional experience and recognizing emotions in others, which will greatly impact the techniques that will be effective in therapy. For instance, until a child’s emotional vocabulary has been fostered to a certain degree, training in emotion regulation techniques will not be effective. Further, children become better at perspective taking as they acquire more sophisticated vocabulary, particularly more verbs (Astington & Filippova, 2005). Therefore, a child’s language level will impact the therapist’s ability to utilize role-playing and other social problem-solving techniques that rely heavily on perspective-taking ability.

Therapy Format

Children are inextricably linked to their parents because they rely on their parents for all of their basic needs as well as many of their social and emotional needs. The younger the child, the more important their parents are going to be in the therapeutic process. This is illustrated in a study by Barrett et al. (1996), which found that children ages 7 to 10 benefited from family involvement in CBT but the addition of a family component was not more beneficial than individual CBT for children ages 11 to 14. Further, adolescents showed better treatment response to individual CBT than adolescents in individual CBT plus parent training (Cobham, Dadds, & Spence, 1998). Inclusion of parents, while particularly important in younger children, also seems to be particularly important when working with children with externalizing disorders and with eating disorders. This is because parental monitoring and parental regulation of behavior are of critical importance in the treatment of both behavior problems and eating dysfunctions in children and adolescents.

When working with children and adolescents, it is also important to determine if group therapy is appropriate. Group therapy for children can be extremely beneficial, particularly when used to teach social skills and build social connections and friendships, which can be relevant for a variety of presenting problems (Harrington, Whittaker, Shoebridge, & Campbell, 1998; Larson & Lochman, 2010; Rose & Edleson, 1987). However, group settings are not ideal for addressing conduct or delinquency problems in adolescents because of the tendency for antisocial teens to encourage and reinforce antisocial tendencies, a process known as deviancy training (Dishion, McCord, & Poulin, 1999; Steinberg, 2005).

Activity in Therapy

Therapy with children is going to involve quite a bit more activity than treatment with adults. Activity is important in keeping engagement with children. Further, teaching coping skills, cognitive restructuring, and emotional awareness will need to be accomplished through concrete means. Both engagement and clarity can be achieved through the use of play. Play can make common cognitive behavioral techniques, such as modeling and role-playing, more concrete and accessible. This can be done by using puppets to demonstrate skills, to externalize the problem, or to play various roles relevant to the child’s life. Active play during therapy also can allow a child to brainstorm and communicate thoughts to the therapist in an enjoyable manner. For example, the “quick decision catch” of Pincus, Chase, Chow, Weiner, and Pian (2011) asks children and the therapist to pass a ball and to give a solution to a problem quickly when they catch the ball. Once solutions have been generated, the child must choose which solution he/she would use in the situation. Because this process occurs in the context of a game, it may increase a child’s engagement while also helping the child with the process of decision making and solution generation.

The use of play to act out emotions and experiences allows the child and therapist to communicate without the demands on the child’s expressive language, which, as explained previously, is slower to develop. It has been hypothesized that children do not naturally communicate through dialogue; they express their inner experience through the concrete world of play and activity. Therefore, play in therapy should be viewed as a vehicle for communication, particularly with younger children (Axline, 1947; Bratton, Ray, Rhine, & Jones, 2005; Kottman, 2001; Landreth, 2002; Schaefer, 2001).

SUMMARY

Many developmental considerations need to be made when assessing and treating children. These considerations include degree of parental involvement, use of group therapy, and implementation of games or activities. Overall, in order to make clinical work applicable to children of all ages, clinicians need to be sensitive to their client’s cognitive, social, and emotional developmental stage and understand what therapeutic techniques utilize only the skills the child has acquired. For instance, many traditional social problem-solving techniques, including role-play, rely on the client having developed sophisticated perspective-taking skills. Such techniques would not be appropriate to employ with a young child who has not developed these skills. By considering the various developmental concerns discussed in this chapter, the clinician can be better prepared to offer efficacious assessment and treatment for children and adolescents across ages and developmental levels.

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