This randomized clinical trial evaluated individual cognitive-behavioral therapy (CBT), family therapy, combined individual and family therapy, and a group intervention for 114 substance-abusing adolescents. Outcomes were percentage of days marijuana was used and percentage of youths achieving minimal use. Each intervention demonstrated some efficacy, although differences occurred for outcome measured, speed of change, and maintenance of change. From pretreatment to 4 months, significantly fewer days of use were found for the family therapy alone and the combined interventions. Significantly more youths had achieved minimal use levels in the family and combined conditions and in CBT. From pretreatment to 7 months, reductions in percentage of days of use were significant for the combined and group interventions, and changes in minimal use levels were significant for the family, combined, and group interventions.

Purpose-Much has been written about conceptual concern for voluntary assent with children and adolescents. However, little empirical data exists examining the frequency with which, or context in which, adolescents and parents disagree on research participation decisions. The purpose of this study was to compare parent and adolescent willingness to participate in minimal and above minimal risk pediatric asthma research protocols.Method-36 adolescents diagnosed with asthma and one of their parents independently rated their willingness to participate in 9 pediatric asthma research protocol vignettes. The selected protocols were chosen by an expert panel as representative of typical minimal and above minimal risk pediatric asthma studies.Results-Parents and adolescents were significantly less likely to agree to enroll in above minimal risk studies. However, this was qualified by a finding that adolescents were significantly more willing than parents to enroll in above minimal risk research. Across all 9 studies, parents and adolescents held concordant views on participation decisions approximately 60% of the time. Perception of potential study benefit was the most frequent reason provided for participation decisions by both parents and adolescents.Conclusion-Parents and their adolescents report a consistent 40% discordance in their views about participating in asthma research across a variety of asthma research protocols, with adolescents more willing than their parents to enroll in above minimal risk studies. These differences of opinion highlight the need to carefully consider the process by which families are offered the option of adolescent research participation. The role of the adolescent in research participation decision-making is ambiguous. While federal regulations give parents legal responsibility for providing permission, consensus standards view adolescent assent as a moral and ethical imperative [1][2][3][4], with an adolescent's desire to dissent generally considered binding, particularly for non-therapeutic research. KeywordsSeveral models for adolescent participation in research and treatment decision-making have been proposed [5][6][7][8]. Inherent in the formulation of these models are differing views on the best way to protect the rights and interests of children and adolescents. Autonomy focused models [6,9] propose that adolescents should be approached alone after parental permission has been granted. This procedure highlights concern that adolescents exercise decision-making independently of their parents and treatment providers. Proponents of this model argue there may be competing interests between parents and adolescents in participation decision-making that result in different choices [10][11][12] Recent interview studies of parents and adolescents involved in research find that parents see their role as ensuring their child's best interest is upheld and protecting them from harm [6,17]. Factors that appear salient to parents' attitudes on what constitutes the child's best interest...

Given hypothetical protocols with variable design elements, schizophrenia patients and psychiatrists made meaningful and discerning harm assessments and participation decisions. These findings suggest that schizophrenia patients may have strengths in the research consent process that may not be fully recognized. The impact of outside influences upon research enrollment decisions remains uncertain. While psychiatrists were often accurate in predicting patient responses, data suggest the importance of clarifying views of individual patients regarding specific protocols.

This study helps to characterize previously neglected attitudes of psychiatric patients and clinicians toward ethically important aspects of biomedical research participation. Schizophrenia patients offered highly discerning views, and interesting similarities and differences emerged in comparing responses of patients and psychiatrists.

This study examined treatment outcomes of 86 highly acculturated Hispanic and Anglo substance-abusing adolescents in functional family therapy, testing the hypothesis that ethnic matching of therapist and client is related to better treatment outcomes for clients. Adolescents reported on their substance use pre- and posttreatment on a timeline follow-back interview. Ethnically matched Hispanic adolescents demonstrated greater decreases in their substance use compared with Hispanic adolescents with Anglo therapists. Ethnic match status was not related to treatment outcome for Anglo clients. Thus, the matching hypothesis was supported for Hispanic clients only. The results underscore the importance of greater ethnic diversity among therapists and better cultural competency training for Anglo therapists. More research is needed on individual differences in the effects of ethnic matching.