# Presentation: 290387

##   The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders,and Posttraumatic Stress DisorderBarbara J. Burns, Ph.D.Scott N. Compton, Ph.D.Helen L. Egger, M.D.Elizabeth M. Z. Farmer, Ph.D.Duke University Medical Center

- <date/time>

**  ****The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with ****Attention-Deficit/Hyperactivity Disorder, ****Major Depressive Disorder,**** Disruptive Behavior Disorders,**** Anxiety Disorders,****and Posttraumatic Stress Disorder****Barbara J. Burns, Ph.D.****Scott N. Compton, Ph.D.****Helen L. Egger, M.D.****Elizabeth M. Z. Farmer, Ph.D.****Duke University Medical Center**

## I . 	To identify efficacious/effective interventions  

**I ****.**** ****	****To identify efficacious/effective interventions  **
**	****for the treatment of childhood mental disorders**
**	****which could reduce the risk for substance use**
**	****problems in adolescence and later;**
**I**** ****I****.****	****To identify mental health intervention studies **
**	****in which substance use outcomes could be **
**	****examined in adolescence and later.**

## Inclusion Criteria for Literature Search

- Study on one of ***five childhood disorders*** or related                                                  	symptom group
- Utilized a ***controlled design***
- Targeted children in ***6-12 age range***
- Published ***1985-1999***
- 	 (except interventions studied earlier and not repeated later)
- Focused on ***outpatient*** treatment

## Search Results

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

## 

**Study design and description**
**Target population**
**Demographic characteristics**
**	****  ****(Age, gender, race/ethnicity)**
**Outcomes**
**Comments**

****

## Types of Interventions with Positive Findings by Clinical Condition

**PSYCHOSOCIAL**
**PSYCHOPHARMACOLOGICAL**
**ADJUNCTIVE  **
**	****	****(combined treatments)**

## Interventions with Positive Findings forAttention-Deficit/Hyperactivity Disorder

**Psychosocial****	****Psychopharmacological****	****    Adjunctive**
**cognitive behavior****	****methylphenidate;****	****slight evidence**
**	****therapy;****	****desipramine;****	****	****	****for psychosocial ****	****	****	****pindolol; ****	****	****	****in 2 of 8 studies**
**social skills training;****	****buproprion;  ****	****	****	****for combined**
**	****	****	****amphetamine sulfate ****	****	****treatment;**
**biofeedback**
**	****	****	****	****	****drugs superior to**
**	****	****	**** ****	****	****	****psychosocial**
**	****	****	****	****	****	****treatment in**
**	****	****	****	****	****	****6 of 8 studies**

## Interventions with Positive Findings forDepression

**Psychosocial****	****       Psychopharmacological****	**** ****	**** Adjunctive**
**cognitive behavior****	****	****fluoxetine****	****	****	****     none**
**	****therapy;****	****	**
**self-control training**

## Interventions with Positive Findings forDisruptive Behavior Disorders

**Psychosocial****	****Psychopharmacological****	****  ****	****Adjunctive**
**parent training;****	****lithium;****	****	****	****	****     none**
**multisystemic therapy;****	****methylphenidate****	**
**case management;**
**anger-coping;**
**problem-solving skills**
**PATHS; **
**Project LIFT; **
**First Step; **
**Fast Track**

## Interventions with Positive Findings forAnxiety Disorders

**Psychosocial****	****	****Psychopharmacological****	****	****Adjunctive**
**systematic****	****	****	****sertraline ****	****	****	****    none**
**	****desensitization;****	****	****	****(for obsessive compulsive****	****	****	**
**m****odeling;****	****	****	****	****disorder only)**
**reinforced practice;****	****	****	**
**cognitive behavior**
**	****therapy;**
**contingency **
**	****management;**
**cognitive self-control;**
**educational support**

## Interventions with Positive Findings forPosttraumatic Stress Disorder

**Psychosocial****	****	****Psychopharmacological****	****	****Adjunctive**
**stress****	****inoculation;****	****	****               none****	****	****     none****	**
**gradual exposure;**
**cognitive behavior therapy **
**	****(for parent and child)**

## I . 	to identify efficacious/effective interventions  

**I ****.**** ****	****to identify efficacious/effective interventions  **
**	****for the treatment of childhood mental disorders**
**	****which could reduce the risk for substance use**
**	****problems in adolescence and later;**

***--  EFFICACY --***

##                                         Response to Aim  I.                                                  --  EFFICACY  --

**Efficacious interventions exist for all disorders examined**
**Strength of psychopharmacological evidence **
**varies by disorder**
**Availability of efficacious interventions in clinical practice**
**	****	****is unknown, but suspected to be low**
**Increasing efficacious interventions through training and **
**	****	****quality monitoring is warranted**

## I I.	to identify mental health intervention studies 

**I**** ****I****.****	****to identify mental health intervention studies **
**	****in which substance use outcomes could be **
**	****examined in adolescence and later.**

***--  FOLLOW-UP  STUDIES  --***

##                                                   Response to Aim II.                                                  --  FOLLOW-UP  STUDIES  --

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