This study evaluated the effects of problem-solving skills training (PSST) and parent management training (PMT) on children (JV = 97, ages 7-13 years) referred for severe antisocial behavior. Children and families were assigned randomly to 1 of 3 conditions: PSST, PMT, or PSST and PMT combined. It was predicted that (a) each treatment would improve child functioning (reduce overall deviance and aggressive, antisocial, and delinquent behavior, and increase prosocial competence); and (b) PSST and PMT combined would lead to more marked, pervasive, and durable changes in child functioning and greater changes in parent functioning (parental stress, depression, and overall symptoms). Expectations were supported by results at posttreatment and 1-year follow-up. PSST and PMT combined led to more marked changes in child and parent functioning and placed a greater proportion of youth within the range of nonclinic (normative) levels of functioning. Antisocial child behavior includes aggressive acts, theft, vandalism, fire setting, lying, truancy, running away, and other acts that violate major social rules and expectations. A persistent pattern of antisocial behavior, referred to as conduct disorder, affects diverse domains of current functioning and for many youth portends continued dysfunction in adulthood (see Robins, 1981; Rutter & Giller, 1983). Several characteristics underscore the clinical and social significance of conduct disorder. The prevalence rate is relatively high and encompasses 2 to 6% of school-age children (Institute of Medicine [IOM], 1989). In the United States alone, this translates to between 1.3 and 1.8 million cases. In addition, among children and adolescents, conduct disorder and aggressive and antisocial behaviors encompass one half to one third of all clinic referrals and lead the list of dysfunctions seen in clinical practice (see Kazdin, 1987a). Several longitudinal studies indicate that conduct disorder is relatively stable over time, portends diverse problems in adulthood (e.g., criminal behavior, alcoholism, and poor work adjustment), and often continues across generations (see Pepler & Rubin, 1991; Robins & Rutter, 1990). Among the challenges to treatment is the range of dysfunctions that antisocial youth display. In addition to their antisocial symptoms, youth often evince hyperactivity, cognitive deficits and distortions, poor peer relations, and academic dysfunc

The present study evaluated the characteristics of research on child and adolescent psychotherapy. Published studies (N = 223) of psychotherapy from 1970 to 1988 were codified to characterize research, clinical, and methodological characteristics. The major results indicate that (a) treatment research focuses almost exclusively on the impact of treatment techniques with scant attention to influences (child/adolescent, parent, family, therapist) that may moderate outcome and (b) several characteristics of the children/adolescents and methods of treatment delivery and approaches depart markedly from those evident in the practice of treatment. Priorities for treatment research to place clinical practice on firmer empirical footing are discussed.Developing and identifying effective treatments of emotional and behavioral disorders of children and adolescents are high priorities for research. The range of dysfunctions, their relatively high prevalence rates, and direct costs of untreated psychological disorders among youth underscore the need for effective treatments (Institute of Medicine [IOM], 1989). For example, in the United States alone, between 12 and 17% (or approximately 7.5-14 million) of the nation's youth suffer from emotional and behavioral disorders (IOM, 1989; United States Congress, Office of Technology Assessment, 1986). Although psychotherapy cannot be viewed as the means to address all of the mental health problems of children and adolescents, it is also clear that effective treatments, once identified, would have widespread use and value.Recent reviews suggest that alternative forms of psychotherapy for children and adolescents are effective (e.g., Casey & Berman, 1985;Kazdin, 1990;Weisz, Weiss, Alicke, & Klotz, 1987). However, the conclusion has to be heavily qualified because of the restricted quantity, quality, and focus of psychotherapy research. The quantity of the evidence can be lamented on separate counts. At least 230 different forms of therapy are in use for children and adolescents, only a small fraction of which have been evaluated empirically (Kazdin, 1988). Among those treatments that have been investigated, relatively few studies are available. The dearth of studies is particularly evident in rela-

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This study was designed to draw on clinical practice as a way of identifying priority areas for child and adolescent psychotherapy research. 1,162 psychologists and psychiatrists described several features of their clinical work and evaluated the effects of alternative treatment approaches, factors that influence therapeutic change, and the priority of alternative types of research. The majority agreed on (a) the importance of several specific child, parent, and therapist factors that contribute to outcome, (b) the utility and effectiveness of alternative treatment approaches, and (c) the high priority of research on therapeutic processes and matching cases to alternative types of treatments. In general, the factors, treatments, and types of studies identified have rarely been examined empirically. The use of practitioner views to identify lines of research may aid not only in reducing the hiatus between research and practice but also in placing clinical work on a stronger empirical footing.Research on psychotherapy for children and adolescents has lagged greatly behind parallel work on the treatment of adults (Institute of Medicine, 1989;Kazdin, 1990). The underdeveloped status of treatment research is evident in the limited number of controlled studies, their uneven methodological quality, and the restricted range of clinical problems and treatment approaches that they embrace (

Comparative studies of psychotherapy often find few or no differences in the outcomes that alternative treatments produce. Although these findings may well reflect the comparability of alternative treatments, as a rule, studies are often not sufficiently powerful to detect the sorts of effects sizes likely to be found when two or more treatments are contrasted. The present survey evaluated the power of psychotherapy outcome studies to detect differences for contrasts of two or more treatments and treatment versus no-treatment control conditions. Outcome studies (A' = 85) were drawn from nine journals over a 3-year period (1984)(1985)(1986). Data in each article were examined first to provide estimates of effect sizes and then to evaluate statistical power at posttreatment and follow-up. The findings indicate that the power of studies to detect differences between treatment and no treatment is generally quite adequate given the relatively large effect sizes usually evident for this comparison. On the other hand, the power is relatively weak to detect the small-to-medium effect sizes likely to be evident when alternative treatments are contrasted with each other. Thus, the equivalent outcomes that treatments produce (i.e., "no difference") may be due to the relatively weak power of the tests. The implications for interpreting current outcome studies and for designing future comparative studies are highlighted.Completion of this article was facilitated by Research Scientist Development Award MH00353 and by Grant MH35408 from the National Institute of Mental Health. We are extremely grateful to Jacob Cohen, Larry V. Hedges, and Kenneth I. Howard. Special thanks are also extended to Helena C. Kraemer, who provided comments and guidance on prior drafts.