Psychosocial Treatments for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice

In the last 15 years we have seen a dramatic increase in efforts to develop and evaluate new psychosocial treatments for a variety of child and adolescent psychiatric disorders. The editors of this volume address a serious need, the development, they say, of "a comprehensive document that recapitulates ongoing research of the psychosocial treatments for children and adolescents that examines, in detail, several therapeutic approaches for different disorders and that, at the same time, can be used for teaching, research, and clinical practice." This book is indeed such a document. Most of the chapters are reviews of research projects funded by the National Institute of Mental Health on specific psychosocial interventions.

The editors are eminently qualified to put this volume together. Both are with the child and adolescent research branch of NIMH, Dr. Jensen as branch chief and Dr. Hibbs as head of the psychosocial treatment research, childhood schizophrenia, and eating disorders programs. Besides presenting new models of treatment and evaluations of their effectiveness, this book also tries to address the all-too-common communications gap between clinicians and researchers.

Of the book's six major sections, each of the first five addresses a group of clinical conditions: anxiety disorders, affective and related disorders, attention-deficit hyperactivity disorder, socially disruptive behavior and conduct disorders, and autistic disorders. The sixth deals with treatments not specific to a particular disorder.

Within each section, individual chapters describe specific treatment programs. Each chapter follows a similar format: a description of the clinical problem, followed by a discussion of epidemiology, a well-articulated rationale for the intervention, a detailed discussion of the intervention itself, and an evaluation of the model's efficacy. Each chapter also addresses limitations of the intervention, generalizability, and problems in evaluating efficacy.

The discussions of the clinical problems are remarkably concise summaries of the descriptive diagnosis, the epidemiology, the interventions usually tried, and relevant outcome studies. Chapter 7, in the affective disorders section, includes an exceptionally clear and succinct discussion of the development and rationale for cognitive-behavioral therapies. The descriptions of the treatment interventions vary considerably. Some are cursory and refer readers to other sources for information; others, such as the account of cognitive-behavioral psychotherapy for obsessive-compulsive disorder by John March and Karen Mulle, are quite specific and clear, with brief vignettes describing step-by-step interventions.

Although psychodynamic therapies, including play therapy, are commonly used to treat a wide variety of child and adolescent disorders, most of the interventions described here fall into the cognitive-behavioral category. Contributors place considerable emphasis on teaching patients and families new approaches to problem solving, either didactically or by role modeling. Some interventions are based on relational or psychodynamic therapy, such as the "psychodynamic developmental therapy" for serious developmental disturbances described by Peter Fonagy and Mary Target in chapter 26.

Many of the models would fit nicely within the demands of managed care, using ten to 20 well-defined sessions. Others, although brief in overall time, are very intensive. For instance, in the "course in coping" described in chapter 7, a cognitive-behavioral approach to adolescent depression, the patient attends two-hour group meetings twice a week and the parents participate in a two-hour group session once a week.

An interesting and important side-benefit of these research efforts is the development of new and innovative evaluation instruments and protocols to help define and diagnose the problem, assess progress, and evaluate the effectiveness of the treatment.

Psychosocial Treatments for Child and Adolescent Disorders would be a valuable resource for clinic directors who want to augment their clinical services. Clinical service researchers would also find it a very useful text. The remarkably concise and well-articulated discussions of clinical entities and treatment rationales would be useful for training. The book is an important contribution to the field. One hopes it will be a recurring effort, with a volume summarizing similar research endeavors appearing every three or four years.

Dr. Hanson is clinical professor of psychiatry and pediatrics at the University of California, San Francisco, and director of training in child and adolescent psychiatry at the Langley Porter Psychiatric Institute in San Francisco.