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Youth with unusual experiences, or psychosis, often meet the diagnostic criteria for one of the schizophrenia spectrum diagnoses. Interventions with the best available research support include cognitive-behavioral therapy for psychosis (CBTp) and family intervention for psychosis (FIp). Components of these treatments include facilitating identity development, psychoeducation to reduce stigma, facilitating cognitive development, operationalizing emotion language, promoting engagement , developing a shared formulation, behavioral change techniques, identifying cognitive biases, cognitive change methods, and relapse prevention.
Although many evidence-based treatments have been developed for youth facing mental health issues and related behaviors, most youth are not receiving these evidence-based approaches. This chapter discusses the problem of the research-to-practice gap and efforts to close the gap. The future of psychotherapy with youth will hopefully build upon current efforts to promote dissemination, improve implementation, and identify effective components for youth and their parents.
In this chapter, we review common components of evidence-based treatments for depression in children and adolescents. We begin with a brief overview of the etiology and theoretical underpinnings of treatments for depression, followed by a summary of evidence-based treatments. We then discuss the most common components of evidence-based treatments for depression: psychoeducation, cognitive restructuring, activity scheduling, problem solving, self-monitoring, and maintenance/relapse prevention. We also highlight the importance of suicide risk assessment and safety planning when working with children and adolescents who are depressed. We conclude with a discussion of the role of parents and other variables (assessment, comorbidity, demographics, medication) that may influence treatment.
Anxiety disorders are the most frequently diagnosed group of psychological disorders in children and may cause significant impairment in a child’s daily functioning (Higa-McMillan et al., 2016). The Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychological Association, 2013) has defined seven anxiety disorders that may develop in childhood: Separation Anxiety Disorder, Specific Phobia, Social Anxiety Disorder, Panic Disorder, Agoraphobia, Selective Mutism, and Generalized Anxiety Disorder. This chapter reviews the etiology and theoretical underpinnings of treatments for these disorders, and provides an overview of evidence-based treatments for child anxiety. The components of those treatments are detailed, including exposure techniques, cognitive techniques, relaxation techniques, and modeling. The role of parents in the treatment of childhood anxiety is also examined. Additional variables of assessment, comorbidity, child demographics, and medication are considered in regards to their influence on treatment. Recommendations and future directions for treatment also are discussed.
Pediatric feeding disorders involve the failure of a child to feed in an age- or developmentally-appropriate manner. This includes food refusal, food selectivity, and difficulty using utensils or open cups to feed oneself. Behavioral treatments for pediatric feeding disorders often include multiple components that manipulate the antecedents and consequences for feeding-related behavior to increase the acceptance of new foods, increase the amount of food or liquid consumed, and teach feeding-related skills (e.g., chewing foods). The treatment of pediatric feeding disorders often starts with more intensive treatments with the ultimate goal being the child feeding themselves at home, school, and in the community. The chapter includes other factors influencing pediatric feeding disorders (e.g., medical and physiological conditions) as well as the role of interdisciplinary treatment teams.
Youth with disruptive behaviors often meet the diagnostic criteria for oppositional defiant disorder or conduct disorder. Evidence-based approaches involve both youth-focused interventions and parent-focused interventions. Youth-focused interventions include education about emotions, anger management, perspective taking/cognitive restructuring, and problem solving skill building. Parent-focused interventions include improving the parent-child relationship, teaching social learning concepts, consistent discipline, stress management, improving family communication, and minimizing problematic peer influences.
This chapter describes the components of evidence-based treatment for youth who have been exposed to traumatic events. These traumatic events may include child maltreatment, witnessing violence, peer victimization, natural disasters, traumatic death, medical trauma, and accidents. The chapter briefly reviews symptomatology commonly exhibited by youth who have experienced traumatic events, particularly symptoms of post-traumatic stress or attachment disorders. The chapter outlines the three forms of cognitive-behavioral therapy for traumatic stress that have been identified as well-established treatments and outlines the core components that are present in each. These components include psychoeducation, anxiety management strategies, imaginal exposure, in vivo exposure, cognitive coping, safety planning, and social problem solving. Next, the chapter discusses the role of parents in treatment and other factors which may influence treatment outcomes, including comorbidity, demographic variables, medication, treatment duration, and expressed dysfunctional cognitions.
This chapter reviews evidence-based treatment components for tics including disorders such as Tourette’s disorder and persistent motor/vocal tic disorder. Treatment packages include habit reversal training, comprehensive behavioral intervention for tics, and exposure and response prevention. Specific components include increasing tic awareness, teaching and reinforcing tic inhibition, function-based assessment, relaxation training, reward programs, psychoeducation, and relapse prevention.
Unlike the other chapters that center discussion on specific behaviors and diagnoses, this chapter cuts across the covered topics to focus on relational elements within the therapeutic relationship. In particular, therapeutic alliance is an evidence-based element of therapy across several disorders. Alliance is discussed in relation to individual therapy as well as family therapy. The level of client involvement in therapy also appears to be an important factor in therapy outcomes.
Inattention and hyperactivity, symptom domains that characterize attention-deficit/hyperactivity disorder (ADHD), can lead to impairments in both academic and social functioning throughout childhood and adolescence. This chapter provides an overview of the components of evidence-based psychosocial treatments (EBTs) for children and adolescents with ADHD. These EBTs include both behavioral interventions (i.e., behavioral classroom management, behavioral parent training, behavioral peer interventions) and training interventions (e.g., organizational skills training). EBTS for ADHD rely on both antecedent-based strategies such as rules, commands, and routines as well as consequence-based strategies such as positive reinforcement (e.g., praise, tangible rewards) and response cost (e.g., time out, privilege removal). Further, the role of parental involvement in the treatment of ADHD and the resulting influence of inter-parental conflict and psychopathology on treatment are discussed. Lastly, the chapter describes how other variables such as assessment, comorbidity, demographic information, and stimulant medications can influence the delivery of evidence-based treatments for ADHD.
This chapter reviews the literature to date on evidence-based treatment approaches for bipolar spectrum disorders in children and adolescents. Psychosocial interventions for pediatric bipolar spectrum disorders address the range of cognitive, social, and interpersonal impairments that are typical of these disorders and aim to provide children and their families with a set of skills to bolster them against the negative impact of symptoms and improve their quality of life. Diagnosis and etiology of pediatric bipolar spectrum disorders is briefly reviewed to provide the theoretical underpinnings for existing treatment approaches. In addition, an overview of existing empirically-supported treatment packages is provided. The key components of treatment across approaches are discussed, as well as the literature supporting the efficacy and utility of such components. The components reviewed include psychoeducation, affect regulation and coping skills, communication skills, problem-solving, and parent self-care. The role families can play in effective treatment for bipolar spectrum disorders is highlighted.
Specific learning disorders include academic subjects that include reading, mathematics, and written expression. Interventions typically take place in schools and often include the response to intervention (RTI) model. Specific components discussed in the chapter include the identification of a well-defined academic skill response, setting modifications, stimulus control, providing more opportunities to respond, positive reinforcement, corrective feedback, progress monitoring, and behavioral skills training. The role of parents and special education are also discussed.
This chapter focuses on evidence based treatment for adolescent substance use disorders. The chapter provides information on the etiology of substance use disorders among adolescents and the theoretical basis for effective treatment. Evidence based treatments are described, including an overview of the components of cognitive-behavioral therapy (establishing a working relationship, drug monitoring and harm reduction, behavioral skills training, cognitive therapy techniques, and increasing prosocial behavior). The components of family therapy are also described (family engagement, relational reframing, family restructuring, and family behavior change). Other factors influencing treatment, including assessment, demographics, and comorbitidy are discussed, as well as medication for adolescent substance use disorder and the emerging problem and research area of adolescent problematic gambling.
This chapter discusses evidence-based treatments and practices for child and adolescent eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding and eating disorders (OSFED). The chapter begins with a brief description of the diagnostic criteria for eating disorder diagnoses with an emphasis on unique presentation characteristics among children and adolescents. The primary treatments discussed are family based therapy (FBT) and cognitive-behavioral therapy (CBT). Specifically, this chapter focuses on the theoretical underpinnings and evidence-based treatment components of each modality. Overlapping treatment components discussed in this chapter include medical evaluation and consultation, addressing ambivalence and motivation to change in treatment, psychoeducation, weight restoration and stabilization, self-monitoring, maintenance factors, and relapse prevention. Other variables that may influence treatment are also discussed, including assessment issues, complications due to comorbidity, patient demographics, medication use, patient weight status, and the presence of suicidal ideation and/or self-injurious behavior.
This chapter examines components of successful early interventions for autism spectrum disorder (ASD). It focuses on applied behavior analysis (ABA), the treatment for ASD with the most robust evidence of producing developmental acceleration, and assisting children to begin catching up to same-aged typically developing children. Research demonstrates ABA approaches often result in meaningful long term improvements in areas including adaptive, cognitive, and social functioning. After a brief review of theoretical underpinnings and the current body of research supporting ABA approaches, the majority of the chapter is devoted to reviewing the individual components that make ABA a successful intervention including the importance of creating developmentally-appropriate treatment targets across multiple areas and successful teaching strategies (e.g., differential reinforcement, prompting and fading, direct instruction, and generalization). The important role of parents and families in treatment is discussed along with other variables that can influence whether treatment is successful, such as comorbid conditions, age at the start of intervention, severity of symptoms, and ability to access treatment.
Intellectual Disability (ID) is characterized by lifelong impairments of cognitive and adaptive functioning that first become evident during early development. Individuals with ID have difficulty learning and often require support services across residential, educational, and vocational settings. Maladaptive behavior is common for youth with ID and can include tantrums, aggression, self-injurious behavior, and other forms of disruptive behavior. Evidence-based treatment for ID focuses on systematic remedial teaching and modifying maladaptive behavior. This chapter reviews behavioral components of evidence-based treatment including prevention, antecedent-based (environmental control, behavioral momentum, providing choices, addressing setting events, prompting, and using auditory and visual cues), and consequence-based (differential reinforcement, token-reinforcement, and time-out) strategies. Other factors that influence treatment such as the role of parents, characterization of behavior and the function of behavior, comorbidities, demographics, and medication are also discussed.