Developmental factors in the treatment of adolescents

Parental Involvement in Adolescent Psychological Interventions: A Meta-analysis

Psychological interventions for adolescents have shown mixed efficacy, and including parents in interventions may be an important avenue to improve treatment outcomes. Evidence from meta-analyses examining the role of parents in interventions for youth is inconsistent and has typically combined findings for both children and adolescents together. No prior meta-analysis has examined the specific role of parents in adolescent interventions as compared with interventions focused solely on adolescents across several disorders. To address this gap, systematic literature reviews were conducted utilizing a combination of searches among keywords including (parent * OR family) AND (intervention OR therap * OR treatment OR prevent*) AND (adolescen*). Inclusion criteria were (1) a randomized controlled trial of an individual psychological intervention compared to the same intervention with a parental component, and (2) adolescents must have at least current symptoms or risk to be included. Literature searches identified 20 trials (N = 1251). Summary statistics suggested that interventions involving parents in treatment have a significantly greater impact on adolescent psychopathology when compared to interventions that targeted adolescents alone (g = - 0.18, p < .01, 95% CI [- 0.30, - 0.07]). Examination with symptom type (internalizing or externalizing) as a moderator found that the significant difference remained for externalizing (g = - 0.20, p = .01, 95% CI [- 0.35, - 0.05]) but not internalizing psychopathology (p = .11). Findings provide evidence of the importance of including parents in adolescent therapy, particularly for externalizing problems.

Integrating equifinality and multifinality into the of prevention programs in early childhood: The conceptual case for use of tiered models

Introduced in the context of developmental psychopathology by Cicchetti and Rogosh in the Journal, the current paper incorporates the principles of equifinality and multifinality to support the use of tiered models to prevent the development of emerging child psychopathology and promote school readiness in early childhood. We use the principles of equifinality and multifinality to describe the limitations of applying one intervention model to address all children presenting with different types of risk for early problem behavior. We then describe the potential benefits of applying a tiered model for having impacts at the population level and two initial applications of this approach during early childhood. The first of these tiered models, Smart Beginnings, integrates the use of two evidenced-based preventive interventions, Video Interaction Project, a universal parenting program, and Family Check-Up, a selective parenting program. Building on the strengths of Smart Beginnings, the second trial, The Pittsburgh Study includes Video Interaction Project and Family Check-Up, and other more and less-intensive programs to address the spectrum of challenges facing parents of young children. Findings from these two projects are discussed with their implications for developing tiered models to support children's early development and mental health.

Improving the Scope of Child Mental Health Interventions in Our Modern World

Twenty years ago, an important systematic review showed that the empirical research evidence for interventions available for children and young people with mental health problems were rarely developed with their specific developmental needs in mind [...].

Brief Educational Workshops in Secondary Schools Trial (BESST): protocol for a school-based cluster randomised controlled trial of open-access psychological workshop programme for 16–18-year-olds

Anxiety and depression are increasingly prevalent in adolescents, often causing daily distress and negative long-term outcomes. Despite the significant and growing burden, less than 25% of those with probable diagnosis of anxiety and depression are receiving help in England. Significant barriers to help-seeking exist in this population, with a scarcity of easily accessible, effective, and cost-effective interventions tailored specially for this age group. One intervention that has been shown to be feasible to deliver and with the promise of reducing stress in this age group is a school-based stress workshop programme for 16–18-year-olds (herein called DISCOVER). The next step is to rigorously assess the effectiveness, and cost-effectiveness, of the DISCOVER intervention in a fully powered cluster randomised controlled trial (cRCT). If found to be clinically and cost-effective, DISCOVER could be scaled up as a service model UK-wide and have a meaningful impact on the mental health of adolescents across the country.

Trial registration: ISRCTN registry ISRCTN90912799. Registered with ISRCTN 28 May 2020.

Experiencing Violence among Children and Adolescents with Depression in the Aspect of Polish Law

Violence is not uncommon in the contemporary world. The consequences of harmful experiences in childhood are often educational problems, difficult behavior, failure to cope in adulthood, duplication of learned, negative behavior patterns and disorders in various spheres/areas of life. The experience of childhood violence is associated with the occurrence of about half of mental disorders with onset in childhood and one third of disorders that appear later in life. Various emotional and behavioral disorders are mentioned among the psychological effects of violence against a child, including depressive disorders. Regarding experiences of violence, there is strong evidence that exposure to sexual or physical violence is a predictor of depressive episodes and depressive symptoms in adolescents. Among adolescents, the impact of violence on depression has been shown to be sustained. Accordingly, evidence suggests that elevated depressive symptoms and episodes of depression may even persist for up to two years after experiencing cases of violence. Due to the destructive consequences of such behavior, international and national law devote much attention to the protection of children's rights. Under Polish law, there are regulations describing measures of reaction within the family, as well as provisions sanctioning violent behavior. Therefore, the study discusses the family and criminal law aspects of violence against minors. The whole study is imbued with considerations of the so-called the obligation to denounce, i.e., to notify about the disclosure of a prohibited act committed to the detriment of minors. This issue was presented in the context of medical secrets and its type-psychiatric discretion.

Therapeutic Alliance: A Comparison Study between Adolescent Patients and Their Therapists

The aim of this study was to examine the congruence of adolescent- and therapist-rated therapeutic alliance, and to explore which rating or combination of ratings would predict treatment outcome or premature termination. We also studied whether the alliance changes over the course of treatment and if the change is related to the outcome or dropout. This study comprised 58 adolescents clinically referred for psychotherapeutic interventions. The alliance (Working Alliance Inventory, patient/therapist ratings) and treatment outcomes (Beck Depression Inventory, Clinical Outcomes in Routine Evaluation—Outcome Measure) were measured at baseline and at 3-, 6-, and 12-month follow-ups. The alliance did not change significantly over the course of therapy, but adolescent and therapist ratings did not correlate. Low values in the early assessment of adolescent-rated alliance and discrepancy between the ratings were significant predictors of undesirable treatment outcome. Weak adolescent- or therapist-rated alliance later in treatment and change for the worse in adolescent-rated alliance was associated with treatment dropout. As adolescent-rated alliance predicts treatment outcome better than therapist-rated alliance, therapists should frequently use assessments of therapeutic relationship within the therapy and pay attention if the adolescent feels the alliance is weakening or his/her evaluation is contrary to the therapist’s.

[Adolescent Drop-Out from Psychodynamic and Cognitive-Behaviour Psychotherapy from the Therapist's Perspective: A Qualitative Interview Study in Germany and Switzerland]

Therapy drop-outs in adolescence remain a prevalent and complex problem with inconsistent research findings: Although a number of possible predictors have been identified, such as difficult family situations and development-related autonomy efforts, the underlying mechanisms and processes are hardly explained. In this qualitative study, 24 interviews were conducted with resident child and youth psychotherapists. The therapists reported a self-chosen drop-out case from their practice. Additionally, they were asked about their views on what they consider typical for adolescent dropouts. The content analysis yielded factors relating to three topics as reasons for dropouts from the therapist's perspective. The area of therapy included themes such as setting variables or disagreement about therapy goals. The family and environment area included reasons concerning the family, e. g., lack of parental support or parents opposing therapy. Finally, reasons such as therapy being too demanding, lack of motivation or loyalty conflicts were assigned to the adolescents. To conclude, a sensitive handling seems to be necessary when trying to balance the adolescent's striving for autonomy and their therapeutic needs as well as finding the right dosage of parental involvement with parents who are often in need of treatment themselves.

Predicting Child-to-Adult Community Mental Health Service Continuation

Serious mental health conditions peak in prevalence and incidence during the transition to adulthood (approximately ages 16-25). Young adults are at high risk for discontinuation of care when no longer eligible for child mental health services. This study uses state administrative data to examine service continuation among those aging out of child system services in Texas (N = 3135). Most (63.5%) did not enroll in adult services following their 18th birthday. Binary logistic regression analyses found that significant predictors of child-to-adult service continuation included (1) a serious primary mental health diagnosis (i.e., schizophrenia, bipolar disorder, major depressive disorder), (2) risks to self and others, and (3) number of prior-year mental health services received. These findings suggest that historical mental health policies and practices may contribute to service disconnection at age 18 in Texas. Implications for mental health policy and system reform locally and nationally are discussed.

Investigating Adolescent Discourse in Critical Thinking: Monologic Responses to Stories Containing a Moral Dilemma

Purpose The adolescent developmental task of establishing autonomy from parents is supported through various aspects of executive functioning, including critical thinking. Our aim was to investigate younger and older adolescent language performance in form, content, and use in response to a moral dilemma task. Method Forty-four typically developing adolescents completed a language sampling task, responding to stories that contained a moral dilemma for one of the characters. Two age groups participated: younger adolescents (n = 24, 12;2-13;11 [years;months]) and older adolescents (n = 20, 16;1-17;11). Participants produced a monologue in response to an open-ended question prompt. Responses were transcribed and analyzed for discourse production on measures of form (verbal productivity and syntactic complexity) and content (semantic diversity and word percentages in three semantic domains: affective, social, and cognitive). Language use was evaluated using a coding system based on Bloom's revised taxonomy of thinking. Results There were no significant group differences in performance on measures of syntactic complexity and semantic diversity. Significant differences were found in adolescents' language using Bloom's revised taxonomy. The younger adolescents demonstrated a significantly higher proportion of utterances at Level 1 (remembering and understanding) compared to older adolescents, while the older age group produced a higher proportion at Level 3 (evaluating and creating). Conclusions The moral dilemma task was effective in demonstrating the growth of adolescent language skills in use of language for critical thinking. The results highlight the clinical utility of the moral dilemma task in engaging adolescents in discourse involving critical thinking, whereas the associated coding scheme, based on Bloom's revised taxonomy of thinking, may differentiate levels of critical thinking and provide direction for intervention.

The Moderating Role of Child Maltreatment in Treatment Efficacy for Adolescent Depression

Adolescent girls are at heightened risk of depression, and because adolescent depression may initiate a negative developmental cascade, intervention early in adolescence has potential for altering a negative developmental trajectory. Identifying risk factors that impact response to intervention may inform decisions about the type of treatment to provide for adolescent girls with depression. Understanding moderators of outcomes in evidence-based treatment is critical to the delivery of timely and effective interventions. Matching patients effectively with optimal intervention will not only expedite the alleviation of patients' distress, but will also reduce unnecessary time and resources spent on less advantageous interventions. The current investigation examines the efficacy of Interpersonal Psychotherapy for Depressed Adolescents (IPT-A) in a racially and ethnically diverse sample of 120 low-income adolescent girls age 13-15 with and without histories of child maltreatment. Adolescent and parent report of depressive symptoms were assessed at the beginning and end of treatment and a diagnosis of subsyndromal symptoms of depression or depression were required for purposes of inclusion. Results indicated that among adolescent girls who had experienced two or more subtypes of maltreatment, IPT-A was found to be more efficacious than Enhanced Community Standard (ECS) treatment. Importantly, when the subtype of maltreatment experienced was further probed, among girls with a history of sexual abuse, we found preliminary evidence that IPT-A was significantly more effective than ECS in reducing depressive symptoms, and the effect size was large. Thus, if a history of maltreatment is present, especially including sexual abuse, specifically addressing the interpersonal context associated with depressive symptoms may be necessary.

Development of a transdiagnostic, low-intensity, psychological intervention for common adolescent mental health problems in Indian secondary schools

BACKGROUND

The PRIDE programme aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. This paper describes the development of a low-intensity, first-line component of the PRIDE model.

METHOD

Contextual and global evidence informed an intervention 'blueprint' with problem solving as the primary practice element. Successive iterations were tested and modified across two pilot cohort studies (N = 45; N = 39). Participants were aged 13-20 years and presenting with elevated mental health symptoms in New Delhi schools.

RESULTS

The first iteration of the intervention, based on a guided self-help modality, showed promising outcomes and user satisfaction when delivered by psychologists. However, delivery was not feasible within the intended 6-week schedule, and participants struggled to use materials outside 'guidance' sessions. In Pilot 2, a modified counsellor-led problem-solving intervention was implemented by less experienced counsellors over a 3-4 week schedule. Outcomes were maintained, with indications of enhanced feasibility and acceptability. High demand was observed across both pilots, leading to more stringent eligibility criteria and a modified sensitisation plan.

DISCUSSION

Findings have shaped a first-line intervention for common adolescent mental health problems in low-resource settings. A forthcoming randomised controlled trial will test its effectiveness.

School-based early intervention for anxiety and depression in older adolescents: A feasibility randomised controlled trial of a self-referral stress management workshop programme ("DISCOVER")

INTRODUCTION

Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years.

METHODS

A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility.

RESULTS

155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up.

CONCLUSIONS

Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606).

Recovery schools for improving behavioral and academic outcomes among students in recovery from substance use disorders: a systematic review

This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding. Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders. This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses. This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.

Plain language summary

There is insufficient evidence to know whether recovery high schools and collegiate recovery communities are effective: Evidence that recovery high schools (RHSs) may improve academic and substance use outcomes is based on the findings from a single study with a serious risk of bias.The review in brief: Very limited evidence addresses the effectiveness of recovery high schools (RHSs). There is no rigorous evidence on the effectiveness of collegiate recovery communities (CRCs).It is unclear whether CRCs are effective in promoting academic success and reducing substance use among college students.What is the aim of this review?: This Campbell systematic review examines the effects of recovery schools on student behavioral and academic outcomes, compared to the effects of non-recovery schools. The review summarizes evidence from one quasi-experimental study (with a total of 194 participants) that had potential serious risk of bias due to confounding.What are the main findings of this review?: Sizable portions of youth are in recovery from substance use disorders, and many youth will return to use after receiving substance use treatment. Youth spend most of their waking hours at school, and thus schools are important social environments for youth in recovery from substance use disorders. Recovery schools have been identified as educational programs that may help support youth in recovery from substance use disorders.This review focused on two types of recovery schools: RHSs, which are schools that award secondary school diplomas and offer a range of therapeutic services in addition to standard educational curricula; and CRCs, which offer therapeutic and sober support services on college campuses.This review looked at whether recovery schools (RHSs or CRCs) affect academic success and substance use outcomes among students, compared to similar students who are not enrolled in recovery schools.What studies are included?: The included study of recovery high schools used a controlled quasi-experimental pretest-posttest design and reported on the following outcomes: grade point average, truancy, school absenteeism, alcohol use, marijuana use, other drug use, and abstinence from alcohol/drugs. The included study focused on a sample of U.S. high school students. There were no eligible studies of CRCs.What do the findings of this review mean?: Findings from this review indicate insufficient evidence on the effects of recovery schools on student well-being. Although there is some indication RHSs may improve academic and substance use outcomes, this is based on the findings from a single study. There is no available evidence on the effects of CRCs.No strong conclusions can be drawn at this time, given the lack of available evidence on RHSs and CRCs, and the serious risk of bias in the one RHS study included in the review. The evidence from this review suggests there is a clear need for additional rigorous evaluations of recovery school effects prior to widespread implementation.How up-to-date is this review?: The review authors searched for studies until September 2018. This Campbell systematic review was published in 2018.

Executive Summary/Abstract

BACKGROUND: Substance use disorders (SUDs) among youth are a major public health problem. In the United States, for example, the incidence of SUDs increases steadily after age 12 and peaks among youth ages 18-23 (White, Evans, Ali, Achara-Abrahams, & King, 2009). Although not every youth who experiments with alcohol or illicit drugs is diagnosed with an SUD, approximately 7-9% of 12-24 year olds in the United States were admitted for public SUD treatment in 2013 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2016). Recovery from an SUD involves reduction or complete abstinence of use, defined broadly as "voluntarily sustained control over substance use, which maximises health and wellbeing and participation in the rights, roles and responsibilities of society" (UK Drug Policy Commission, 2008). However, SUDs are often experienced as chronic conditions; among youth who successfully complete substance use treatment, approximately 45-70% return to substance use within months of treatment discharge (Anderson, Ramo, Schulte, Cummins, & Brown, 2007; Brown, D'Amico, McCarthy, & Tapert, 2001; Ramo, Prince, Roesch, & Brown, 2012; White et al., 2004). Thus, multiple treatment episodes and ongoing recovery supports after treatment are often necessary to assist with the recovery process (Brown et al., 2001; Ramo et al., 2012; White et al., 2004).Success and engagement at school and in postsecondary education are critical to healthy youth development. For youth in recovery from SUDs, school attendance, engagement, and achievement build human capital by motivating personal growth, creating new opportunities and social networks, and increasing life satisfaction and meaning (Keane, 2011; Terrion, 2012; 2014). Upon discharge from formal substance use treatment settings, schools become one of the most important social environments in the lives of youth with SUDs. Healthy school peer environments can enable youth to replace substance use behaviors and norms with healthy activities and prosocial, sober peers. Conversely, many school environments may be risky for youth in recovery from SUDs due to perceived substance use among peers, availability of drugs or alcohol, and substance-approving norms on campus (Centers for Disease Control [CDC], 2011; Spear & Skala, 1995; Wambeam, Canen, Linkenbach, & Otto, 2014).Given the many social and environmental challenges faced by youth in recovery from substance use, recovery-specific institutional supports are increasingly being linked to educational settings. The two primary types of education-based continuing care supports for youth in recovery, defined under the umbrella term of "recovery schools" for this review, are recovery high schools (RHSs) and collegiate recovery communities (CRCs). RHSs are secondary schools that provide standard high school education and award secondary school diplomas, but also include therapeutic programming aimed at promoting recovery (e.g., group check-ins, community service, counseling sessions). CRCs also provide recovery oriented support services (e.g., self-help groups, counseling sessions, sober dorms) for students, but are embedded within larger college or university settings. The primary aims of RHSs and CRCs are to promote abstinence and prevent relapse among students, and thus ultimately improve students' academic success.OBJECTIVES: This review summarized and synthesized the available research evidence on the effects of recovery schools for improving academic success and behavioural outcomes among high school and college students who are in recovery from substance use. The specific research questions that guided the review are as follows: 1. What effect does recovery school attendance (versus attending a non-recovery or traditional school setting) have on academic outcomes for students in recovery from substance use? Specifically (by program type): a. For recovery high schools: what are the effects on measures of academic achievement, high school completion, and college enrolment?b. For collegiate recovery communities: what are the effects on measures of academic achievement and college completion?2. What effect does recovery school attendance have on substance use outcomes for students in recovery from substance use? Specifically, what are the effects on alcohol, marijuana, cocaine, or other substance use?3. Do the effects of recovery schools on students' outcomes vary according to the race/ethnicity, gender, or socioeconomic status of the students?4. Do the effects of recovery schools on students' outcomes vary according to existing mental health comorbidity status or juvenile justice involvement of the students? SEARCH METHODS: We aimed to identify all published and unpublished literature on recovery schools by using a comprehensive and systematic literature search. We searched multiple electronic databases, research registers, grey literature sources, and reference lists from prior reviews; and contacted experts in the field.SELECTION CRITERIA: Studies were included in the review if they met the following criteria:Types of studies: Randomized controlled trial (RCT), quasi-randomized controlled trial (QRCT), or controlled quasi-experimental design (QED).Types of participants: Students in recovery from substance use who were enrolled part-time or full-time in secondary (high school) or postsecondary (college or university) educational institutions.Types of interventions: Recovery schools broadly defined as educational institutions, or programs at educational institutions, developed specifically for students in recovery and that address recovery needs in addition to academic development.Types of comparisons: Traditional educational programs or services that did not explicitly have a substance use recovery focus.Types of outcome measures: The review focused on primary outcomes in the following two domains: academic performance (e.g., achievement test scores, grade-point average, high school completion, school attendance, college enrolment, college completion) and substance use (alcohol, marijuana, cocaine, heroin, stimulant, mixed drug use, or other illicit drug use). Studies that met all other eligibility criteria were considered eligible for the narrative review portion of this review even if they did not report outcomes in one of the primary outcome domains.Other criteria: Studies must have been reported between 1978 and 2016. The search was not restricted by geography, language, publication status, or any other study characteristic.DATA COLLECTION AND ANALYSIS: Two reviewers independently screened all titles and abstracts of records identified in the systematic search. Records that were clearly ineligible or irrelevant were excluded at the title/abstract phase; all other records were retrieved in full-text and screened for eligibility by two independent reviewers. Any discrepancies in eligibility assessments were discussed and resolved via consensus. Studies that met the inclusion criteria were coded by two independent reviewers using a structured data extraction form; any disagreements in coding were resolved via discussion and consensus. If members of the review team had conducted any of the primary studies eligible for the review, external and independent data collectors extracted data from those studies. Risk of bias was assessed using the ROBINS-I tool for non-randomized study designs (Sterne, Higgins, & Reeves, 2016).Inverse variance weighted random effects meta-analyses were planned to synthesize effect sizes across studies, as well as heterogeneity analysis, subgroup analysis, sensitivity analysis, and publication bias analysis. However, these synthesis methods were not used given that only one study met the inclusion criteria for the review. Instead, effect sizes (and their corresponding 95% confidence intervals) were reported for all eligible outcomes reported in the study.RESULTS: Only one study met criteria for inclusion in the review. This study used a QED to examine the effects of RHSs on high school students' academic and substance use outcomes. No eligible studies examining CRCs were identified in the search.The results from the one eligible RHS study indicated that after adjusting for pretest values, students in the RHS condition reported levels of grade point averages (= 0.26, 95% CI [-0.04, 0.56]), truancy (= 0.01, 95% CI [-0.29, 0.31]), and alcohol use (= 0.23, 95% CI [-0.07, 0.53]) similar to participants in the comparison condition. However, students in the RHS condition reported improvements in absenteeism (= 0.56, 95% CI [0.25, 0.87]), abstinence from alcohol/drugs (OR = 4.36, 95% CI [1.19, 15.98]), marijuana use (= 0.51, 95% CI [0.20, 0.82]), and other drug use (= 0.45, 95% CI [0.14, 0.76]).Overall, there was a serious risk of bias in the one included study. The study had a serious risk of bias due to confounding, low risk of bias due to selection of participants into the study, moderate risk of bias due to classification of interventions, inconclusive risk of bias due to deviations from intended interventions, inconclusive risk of bias due to missing data, moderate risk of bias in measurement of outcomes, and low risk of bias in selection of reported results.AUTHORS' CONCLUSIONS: There is insufficient evidence regarding the effectiveness of RHSs and CRCs for improving academic and substance use outcomes among students in recovery from SUDs. Only one identified study examined the effectiveness of RHSs. Although the study reported some beneficial effects, the results must be interpreted with caution given the study's potential risk of bias due to confounding and limited external validity. No identified studies examined the effectiveness of CRCs across the outcomes of interest in this review, so it is unclear what effects these programs may have on students' academic and behavioral outcomes.The paucity of evidence on the effectiveness of recovery schools, as documented in this review, thus suggest the need for caution in the widespread adoption of recovery schools for students in recovery from SUDs. Given the lack of empirical support for these recovery schools, additional rigorous evaluation studies are needed to replicate the findings from the one study included in the review. Furthermore, additional research examining the costs of recovery schools may be needed, to help school administrators determine the potential cost-benefits associated with recovery schools.

Theoretical and empirical foundations of a novel online social networking intervention for youth suicide prevention: A conceptual review

Suicide is a major public health problem and is the second leading cause of death in young people worldwide. Indicating a lack of adequate treatment approaches, recent data suggest a rising suicide rate. Current approaches to suicide prevention do not sufficiently account for the specific needs of young people or the ways in which they engage with the health system, nor are they adequately theory-driven. In this paper, we review an empirically-supported theoretical model of suicide together with the latest evidence in treating young people who are at risk. We discuss the potential efficacy of social-media-based online interventions, with a particular focus on how they may be uniquely placed to target interpersonal risk factors for suicide. We highlight the risks associated with such interventions, including the potential for contagion to occur. Based on prominent theoretical models and gaps in existing treatment approaches, we propose a newly-developed, theory-driven, online social-networking-based intervention for suicide prevention in young people.

Shared Decision-Making in Youth Mental Health Care: Using the Evidence to Plan Treatments Collaboratively

The shared decision-making (SDM) model is one in which providers and consumers of health care come together as collaborators in determining the course of care. The model is especially relevant to youth mental health care, when planning a treatment frequently entails coordinating both youth and parent perspectives, preferences, and goals. The present article first provides the historical context of the SDM model and the rationale for increasing our field's use of SDM when planning psychosocial treatments for youth and families. Having established the potential utility of SDM, the article then discusses how to apply the SDM model to treatment planning for youth psychotherapy, proposing a set of steps consistent with the model and considerations when conducting SDM with youth and families.

A phenomenographic study of factors leading to variation in the experience of a school-based wilderness experiential programme

Adventure programming provides an exemplar for interventions through which adolescents may experience holistic development, interdependence, competence, and learn to model pro-social values. This study used a phenomenographic methodology to investigate the different ways in which a sample of 37 adolescents experienced a 27-day school-based wilderness adventure programme and identify aspects of the programme that were critical to variation in programme outcomes. The analysis revealed four conceptions of the programme: (a) long gruelling school hike, (b) school initiation/rite of passage programme, (c) once-in-a-lifetime group adventure, and (d) multifaceted learning and development opportunity. These categories of description are structured hierarchically, relate directly to programme outcomes, and evolve from different levels of awareness in six critical dimensions of variation, including: (a) programme characterisation, (b) the nature of group processes and interactions, (c) the nature and level of connection and interactions with adult group leaders, (d) the depth of engagement in various components of the programme, (e) the personal relevance that experiences had for participants, and (f) the type of growth and learning that was perceived to have accrued from these experiences. These findings and their implications for both adventure programming design and implementation, and for research on psychological interventions are discussed.

Delivering Parent-Teen Therapy for ADHD through Videoconferencing: A Preliminary Investigation

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N=20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.

Addressing critical gaps in the treatment of eating disorders

Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.

Psychotherapy with a 3-Year-Old Child: The Role of Play in the Unfolding Process

Few studies have investigated the outcomes and process of psychodynamic psychotherapies with children. Among the limited number of studies, some only paid attention to play and verbal production, as they are fundamental aspects in assessing the psychotherapy process. This paper focuses on an empirical investigation of a 3-year, once-a-week psychodynamic psychotherapy carried out with a 3-year-old girl. A process-outcome design was implemented to evaluate play and verbal discourse in in the initial, middle, and final parts of 30 psychotherapy sessions. Repeated measurements of standardized play categories (the Play Category System and the Affect in Play Scale-Preschool version) and verbal discourse (Verbal Production) were analyzed. To increase the clinical validity of the study, data from the assessment phase and vignettes from the sessions were reported to deepen the patient's picture during the unfolding therapy process. Parent reports before and after the therapy were also included. Empirically measured changes in play and verbal production were fundamental in evaluating the young patient's psychotherapy process. Verbal production and discourse ability progressively increased and took the place of play, which instead became more symbolic. Developmental issues as well as psychotherapy's influence on the patient's change, were discussed in relation to the role of play in enhancing the development of verbal dialog and the expression of the child's emotions, needs, and desires.

Parent-teen behavior therapy + motivational interviewing for adolescents with ADHD

OBJECTIVE

This study evaluates a parent-teen skills-based therapy for attention deficit/hyperactivity disorder (ADHD) blended with motivational interviewing (MI) to enhance family engagement. Supporting Teens' Autonomy Daily (STAND) is an adolescent-specific treatment for ADHD that targets empirically identified adolescent (i.e., organization, time management, and planning, or OTP skills) and parent-based (i.e., monitoring and contingency management) mechanisms of long-term outcome through individual parent-teen sessions.

METHOD

The current randomized trial (N = 128) evaluates efficacy at posttreatment and 6-month follow-up. Participants were ethnically diverse teens (7.7% non-Hispanic White, 10.8% African American, 78.5% Hispanic, 3.0% other) randomly assigned to STAND or Treatment As Usual (TAU).

RESULTS

Primary findings were that (1) STAND was delivered in an MI-adherent fashion and most families fully engaged in treatment (85% completed); (2) STAND produced a range of significant acute effects on ADHD symptoms, OTP skills, homework behavior, parent-teen contracting, implementation of home privileges, parenting stress, and daily homework recording; and (3) 6 months after treatment ceased, effects on ADHD symptom severity, OTP skills, and parenting stress maintained, while parent use of contracting and privilege implementation strategies, as well as teen daily homework recording and homework behavior gains, were not maintained.

CONCLUSION

Skills-based behavior therapy blended with MI is an acutely efficacious treatment for adolescents with ADHD although more work is needed to establish the nature of long-term effects. (PsycINFO Database Record

Treating Emetophobia and Panic Symptoms in an Adolescent Female

Emetophobia is an understudied specific phobia, especially during the developmental stage of adolescence. Adult and child literatures suggest that a combined approach of psychopharmacological and cognitive-behavioral interventions may be an efficacious treatment for emetophobia. Despite evidence supporting the success of this therapeutic approach, research assessing treatment outcomes of adolescent populations with the disorder remains limited. The current study presents a case study of the successful use of combined treatment for emetophobia in an adolescent female. Therapy included psychoeducation, cognitive restructuring, and exposure therapy in tandem with Sertraline 50 mg. Upon termination of therapeutic services, symptoms of emetophobia were significantly reduced, panic attacks had remitted, and the continued use of psychotropic medication was no longer indicated. Findings in the present case study suggest that cognitive-behavioral therapy (CBT) including exposure-based therapy effectively reduced emetophobia symptoms and panic attacks for the patient. The implications for these findings in treating adolescents with emetophobia are discussed.

Developmental Demands of Cognitive Behavioral Therapy for Depression in Children and Adolescents: Cognitive, Social, and Emotional Processes

Although some treatments for depression in children and adolescents have been found to be efficacious, the effects sizes have tended to be modest. Thus, there is considerable room to improve upon existing depression treatments. Some children may respond poorly because they do not yet have the cognitive, social, or emotional maturity needed to understand and apply the skills being taught in therapy. Therefore, treatments for depression may need to be tailored to match children's ability to both comprehend and implement the therapeutic techniques. This review outlines the steps needed for such developmental tailoring: (a) Specify the skills being taught in depression treatments; (b) identify what cognitive, social, and emotional developmental abilities are needed to attain these skills; (c) describe the normative developmental course of these skills and how to determine a child's developmental level; and (d) use this information to design an individualized treatment plan. Possible approaches to intervening include: alter the therapy to meet the child's level of development, train the child on the skills needed to engage in the therapy, or apply a dynamic assessment approach that integrates evaluation into treatment and measures children's current abilities as well as their potential.

Doing Anger Differently: A Group Percussion Therapy for Angry Adolescent Boys

This paper describes Doing Anger Differently (DAD), a group treatment for young adolescent boys with high levels of anger. The approach is school-based, 10 weeks long, and utilizes music in the form of percussion to engage this difficult to treat population into treatment and to represent the experience of anger. A tri-level intervention is described: the experience of anger and its influence on action; the formation of meaning and identity resulting from anger and aggression; and the emphasis on group work and the interpersonal basis of anger. Techniques used throughout the group are discussed and illustrative case vignettes are provided.

Adapting and implementing an evidence-based treatment with justice-involved adolescents: the example of multidimensional family therapy

For over four decades family therapy research and family centered evidence-based therapies for justice-involved youths have played influential roles in changing policies and services for these young people and their families. But research always reveals challenges as well as advances. To be sure, demonstration that an evidence-based therapy yields better outcomes than comparison treatments or services as usual is an accomplishment. But the extraordinary complexity embedded in that assertion feels tiny relative to what we are now learning about the so-called transfer of evidence-based treatments to real world practice settings. Today's family therapy studies continue to assess outcome with diverse samples and presenting problems, but research and funding priorities also include studying particular treatments in nonresearch settings. Does an evidence-based intervention work as well in a community clinic, with clinic personnel? How much of a treatment has to change to be accepted and implemented in a community clinic? Perhaps it is the setting and existing procedures that have to change? And, in those cases, do accommodations to the context compromise outcomes? Thankfully, technology transfer notions gave way to more systemic, dynamic, and frankly, more family therapy-like conceptions of the needed process. Implementation science became the more sensible, as well as the theoretically and empirically stronger overarching framework within which the evidence-based family based therapies now operate. Using the example of Multidimensional Family Therapy, this article discusses treatment development, refinement, and implementation of that adapted approach in a particular clinical context-a sector of the juvenile justice system-juvenile detention.

Prevalence rates and risk factors for mental health difficulties in adolescents aged 16 and 17 years living in rural Ireland

OBJECTIVE

This study sought to ascertain the prevalence rates and risk factors for a range of mental health difficulties, including suicidal ideation/self-harm among 16 and 17-year-old rural Irish adolescents, a vulnerable group in transition from childhood to adulthood.

METHOD

Adolescents (n=237) took part in this cross-sectional study. Participants completed a questionnaire compendium consisting of generic questions on demographic information, use of mental health services and four normed questionnaires: The Youth Self-Report, the Children's Depression Inventory, the Coping Inventory for Stressful Situations-Adolescent and The Family Assessment Device.

RESULTS

We found that 16.9% of adolescents reported clinically significant mental health difficulties. Significant gender differences were found on internalising and externalising difficulties. There were no gender differences in suicidal ideation or self-harm. Only 3.4% of adolescents were receiving professional help for mental health difficulties. Multiple regression analyses revealed that family dysfunction, emotion-focussed coping and poor academic competence were significant predictors of poorer mental health difficulties in both genders. Family dysfunction was the strongest predictor of mental health difficulties in males. Among females, emotion-focussed coping was the strongest predictor of internalising difficulties and depression. Social diversion (social support) was predictive of less internalising difficulties and depression for females.

CONCLUSION

The study shows that a significant number of Irish 16 and 17 year olds have mental health difficulties, yet very few are receiving treatment. Emotion-focussed coping, family dysfunction, poor academic competence and less social support were important predictors of mental health difficulties. A new finding is the stronger association that family dysfunction has with poorer mental health in males than females, when controlling for academic competence and coping skills. The findings may have implications for psychological interventions.

Psychological distress and mental health service contact of unaccompanied asylum-seeking children

BACKGROUND

Evidence is emerging that psychological problems, particularly symptoms of depression and post-traumatic stress disorder, are more prevalent in unaccompanied asylum-seeking children (UASC) than their accompanied peers. However, little is known about help seeking and mental health service (MHS) utilization in this group, and how this relates to their psychological needs. This study aims to describe the level of psychological distress among a group of UASC and the pattern of MHS contact.

METHOD

Socio-demographic data on 71 UASC residing in London was obtained and self-report questionnaires were completed regarding trauma events (Harvard Trauma Questionnaire), general psychological distress [Strengths and Difficulties Questionnaire (SDQ)], post-traumatic stress symptoms (Impact of Event Scale), depressive symptoms (Birleson Depression Self-Rating Scale for Children) and contact with MHS (Attitudes to Health and Services Questionnaire).

RESULTS

UASC were mainly male (n = 48, 67.6%), Black African (n = 39, 54.9%) and their median age was 17 years (interquartile range = 15; 17). They had been living in the UK for a median of 18 months. Eight (11.3%) scored on the SDQ borderline/abnormal range for total symptoms, but this was 21 (29.6%) using the SDQ emotional subscale. Forty-seven (66.2%) were at high risk for post-traumatic stress disorder and nine (12.7%) at high risk for depressive disorder. Only 12 (17%) had MHS contact. Predictors of MHS contact were depressive symptoms and duration of time in the UK.

CONCLUSIONS

UASC had a high level of emotional symptoms, especially post-traumatic stress symptoms. However, only a small proportion of UASC were in contact with MHS. This suggests a high level of MHS under-utilization, and reasons for this are discussed.

Gender differences in the social functioning of adolescents with inflammatory bowel disease

Inflammatory bowel disease (IBD) has been associated with social difficulties. Boys with IBD may have increased risk for social problems due to delayed growth and puberty, but gender differences in social functioning have not been investigated. This study examined gender differences in multiple areas of social functioning for adolescents with IBD compared to healthy adolescents. Participants were 92 adolescents 11-17 years (50 with IBD, 42 healthy) and parents who completed questionnaires assessing social functioning. IBD was associated with poorer social functioning in the areas of social competence and social problems. Boys with IBD had worse social competence, with no gender differences for social problems. Gender predicted the use of social contact as a coping strategy, but no significant group differences were found for other areas of social functioning. Adolescents with IBD experience significant social difficulties in some areas, and boys are at risk for poor social competence. However, previously reported social difficulties may not extend to all areas of social functioning.

The characteristics of serious suicide attempters in Japanese adolescents--comparison study between adolescents and adults

BACKGROUND

Suicide is the leading cause of death among Japanese adolescents, and they may commit suicide differently from adults. However, there are few studies in medical-based data concerning adolescent patients seriously attempting suicide. We aimed to explore the characteristics of serious suicide attempts in Japanese adolescents, comparing them with those in adults.

METHODS

We investigated adolescents who seriously attempted suicide and were treated at the Critical Care Medical Center (CCMC) of Nippon Medical School Hospital between 2000 and 2010, and we compared them with adult suicide attempters treated during 2009. We retrospectively studied medical records and collected clinical data and socio-demographic factors, including age, sex, psychiatric symptoms or diagnosis, methods of suicide attempt, motives for suicide attempt, previous deliberate self-harm, previous psychiatric history, parent loss experience, and previous psychiatric history in the family.

RESULTS

Adolescent attempters were 15 males and 44 females, 13 to 18 years old (mean 16.39). Adult attempters were 37 males and 65 females, 19 to 79 years old (mean 39.45). In comparison to adult attempters, adolescent attempters were more frequently diagnosed with Borderline Personality Disorder (BPD), had more school problems and parent loss experience, but they had less financial problems. Gender differences between adolescents and adults were examined, and male adolescent attempters were found to be more frequently diagnosed with schizophrenia and had less financial problems than their adult counterparts, while female adolescent attempters were more frequently diagnosed with BPD, had more school problems and parent loss, but they had less previous psychiatric history than their adult counterparts.

CONCLUSIONS

Our findings indicated that adolescent attempters were more frequently diagnosed with BPD and had more school problems and parent loss experience but had less financial problems. Additionally, in male adolescent attempters, identifying patients with schizophrenia seemed important, as it was their most frequent psychiatric diagnosis. For female adolescents, adequately assessing family function and interpersonal conflicts seemed important, as they were more often diagnosed with BPD and had more school and family problems.

The complex role of sleep in adolescent depression

Psychological and pharmacologic treatments for youth depression yield post-acute response and remission rates that are modest at best. Improving these outcomes is an important long-term goal. The authors examine the possibility that a youth cognitive behavioral therapy insomnia intervention may be an adjunct to traditional depression-focused treatment with the aim of improving depression outcomes. This “indirect route” to improving youth depression treatment outcomes is based on research indicating that the risk of depression is increased by primary insomnia and that sleep problems interfere with depression treatment success and on emerging adult depression randomized controlled trial results. The authors describe the protocol they developed.

Risk for arrest: the role of social bonds in protecting foster youth making the transition to adulthood

This study examines a sample of foster youth at the onset of the transition to adulthood and explores how social bonds are related to the risk of arrest during adulthood. Drawing from official arrest records, event history models are used to examine the time to arrest. Because individuals may be at risk for different types of crime, competing risk regression models are used to distinguish among arrests for drug-related, nonviolent, or violent crimes. Between the ages of 17-18 and 24, 46% of former foster youth experience an arrest. Arrests were evenly distributed across drug, nonviolent, and violent crimes columns. Although findings fail to support the significance of social bonds to interpersonal domains, bonds to employment and education are associated with a lower risk for arrest. Child welfare policy and practice implications for building connections and protections around foster youth are discussed.

Which fearful toddlers should we worry about? Context, fear regulation, and anxiety risk

In the current study, the author tested a model of risk for anxiety in fearful toddlers characterized by the toddlers' regulation of the intensity of withdrawal behavior across a variety of contexts. Participants included low-risk 24-month-old toddlers (N = 111) followed longitudinally each year through the fall of their kindergarten year. The key hypothesis was that being fearful in situations that are relatively low in threat (i.e., are predictable and controllable and in which children have many coping resources) is an early precursor to risk for anxiety development as measured by parental and teacher reports of children's anxious behaviors in kindergarten. Results supported the prediction such that it is not how much fear is expressed but when and how the fear is expressed that is important for characterizing adaptive behavior. Implications are discussed for a model of risk that includes the regulation of fear, the role of eliciting context, social wariness, and the importance of examining developmental transitions, such as the start of formal schooling. These findings have implications for the methods used to identify fearful children who may be at risk for developing anxiety-related problems.

School refusal and anxiety in adolescence: non-randomized trial of a developmentally sensitive cognitive behavioral therapy

The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social anxiety disorder was the most common disorder among adolescents still meeting anxiety disorder criteria at follow-up. Treatment modifications to improve efficacy for school-refusing adolescents presenting with social anxiety disorder are suggested.

The causal impact of childhood-limited maltreatment and adolescent maltreatment on early adult adjustment

PURPOSE

We use full-matching propensity score models to test whether developmentally specific measures of maltreatment, in particular childhood-limited maltreatment versus adolescent maltreatment, are causally related to involvement in crime, substance use, health-risking sex behaviors, and internalizing problems during early adulthood.

METHODS

Our design includes 907 participants (72% male) in the Rochester Youth Development Study, a community sample followed from age 14 to age 31 with 14 assessments, including complete maltreatment histories from Child Protective Services records.

RESULTS

After balancing the data sets, childhood-limited maltreatment is significantly related to drug use, problem drug use, depressive symptoms, and suicidal thoughts. Maltreatment during adolescence has a significant effect on a broader range of outcomes: official arrest or incarceration, self-reported criminal offending, violent crime, alcohol use, problem alcohol use, drug use, problem drug use, risky sex behaviors, self-reported sexually transmitted disease diagnosis, and suicidal thoughts.

CONCLUSIONS

The causal effect of childhood-limited maltreatment is focused on internalizing problems, whereas adolescent maltreatment has a stronger and more pervasive effect on later adjustment. Increased vigilance by mandated reporters, especially for adolescent victims of maltreatment, along with provision of appropriate services, may prevent a wide range of subsequent adjustment problems.

Cognitive behavior therapy for anxious adolescents: developmental influences on treatment design and delivery

Anxiety disorders in adolescence are common and disruptive, pointing to a need for effective treatments for this age group. Cognitive behavior therapy (CBT) is one of the most popular interventions for adolescent anxiety, and there is empirical support for its application. However, a significant proportion of adolescent clients continue to report anxiety symptoms post-treatment. This paper underscores the need to attend to the unique developmental characteristics of the adolescent period when designing and delivering treatment, in an effort to enhance treatment effectiveness. Informed by the literature from developmental psychology, developmental psychopathology, and clinical child and adolescent psychology, we review the 'why' and the 'how' of developmentally appropriate CBT for anxious adolescents. 'Why' it is important to consider developmental factors in designing and delivering CBT for anxious adolescents is addressed by examining the age-related findings of treatment outcome studies and exploring the influence of developmental factors, including cognitive capacities, on engagement in CBT. 'How' clinicians can developmentally tailor CBT for anxious adolescents in six key domains of treatment design and delivery is illustrated with suggestions drawn from both clinically and research-oriented literature. Finally, recommendations are made for research into developmentally appropriate CBT for anxious adolescents.

Interventions for suicidal youth: a review of the literature and developmental considerations

Suicidal behavior is developmentally mediated, but the degree to which interventions for suicidal behaviors have been developmentally tailored has varied widely. Published controlled studies of psychosocial treatment interventions for reducing adolescent suicidal behavior are reviewed, with a particular emphasis on the developmental nuances of these interventions. In addition, developmental considerations important in the treatment of suicidal adolescents are discussed. There are insufficient data available from controlled trials to recommend one intervention over another for the treatment of suicidal youth, but interventions that are sensitive to the multiple developmental contexts have potential for greater effectiveness in reducing adolescent suicidal behavior.

The hidden crisis in mental health and education: the gap between student needs and existing supports

The authors provide a selected review of mental health and educational concerns evident in U.S. middle schools and describes promising and important strategies to ameliorate the high rates of students with mental health and academic difficulties. Despite some promising and important strategies, service systems are fragmented, and comprehensive systems of supports are still in development. Furthermore, there remains a lack of integrated developmental considerations in practice. The RALLY approach systematically introduces development and caring adult relationships into preventive practice and combines mental health, education, and youth development to promote students' resiliency and academic potential.

Family-based treatment for adolescent substance abuse: controlled trials and new horizons in services research

This article provides an overview of controlled trials research on treatment processes and outcomes in family-based approaches for adolescent substance abuse. Outcome research on engagement and retention in therapy, clinical impacts in multiple domains of adolescent and family functioning, and durability and moderators of treatment effects is reviewed. Treatment process research on therapeutic alliance, treatment fidelity and core family therapy techniques, and change in family processes is described. Several important research issues are presented for the next generation of family-based treatment studies focusing on delivery of evidence-based treatments in routine practice settings.

Cognitive behavioral approaches in adolescent anorexia and bulimia nervosa

This article starts with what is known about cognitive behavior therapy (CBT) in adults with eating disorders and with some developmental considerations about CBT in children and adolescents. It then considers how CBT might be adapted for adolescents with eating disorders and reviews the current knowledge base on CBT in adolescents. The article finishes with some thoughts on future developments in this area.