Psychological interventions: overview and critical issues for the field

Abstract

(229 words)Efforts to help young people have ancient historical roots, but "youth psychotherapy" has only been practiced for about a century and studied empirically for 50 years. Nonetheless, hundreds of randomized trials have now accumulated, and many specific treatments have sufficient empirical support that they are classified as evidence-based psychotherapies (EBPs). We examine the strength of that support, highlight specific EBPs for specific forms of youth dysfunction, and consider strategies for understanding how, with which groups, and under what conditions, the treatments produce beneficial effects. We also examine how specific these effects are (e.g., whether benefit is greatest for targeted symptoms), how robust (e.g., whether "blind" informants perceive benefit, whether effects vary with type of control group), and how effective when extended to youths in ethnic minority groups, low-and middle-income countries, war-torn regions, and the criminal justice and child protection systems. We discuss the challenge of disseminating EBPs and implementing them within the everyday practice of youth mental health care. Strategies for improving youth psychotherapies and intervention science are proposed, including making intervention research look more like clinical practice, leveraging the heuristic potential of usual clinical care, conducting more high-risk/high-gain research and finding ways to learn from treatment "failure," restructuring EBPs to fit clinical practice, boosting treatment effectiveness through monitoring and feedback, enriching our understanding of what makes treatments work, and building efficient and accessible delivery methods and models.

Neurodevelopmental disorders

“…Second, the effectiveness of a recommended treatment for the primary condition might be moderated by the presence of other conditions. This has not been widely investigated for child psychopathology although there are some exceptions 20,30 . For example, in the case of ADHD, behavioural interventions appear to be especially helpful for those with anxiety 30 and although stimulants reduce ADHD symptoms in those with intellectual disability or ASD, medication is less well-tolerated 31,32 .…”

“…Also, research participants need to be characterised beyond a single core diagnosis; for example by assessing participants across multiple dimensions of symptoms, functioning and social contexts, regardless of primary diagnosis. A shared measurement tool kit used by different health-care professionals and researchers might be helpful here.Selecting appropriate treatments: First, for clinicians, different problem areas may require different sorts of evidence-based treatments that would not be captured by treatment guidelines for a single neurodevelopmental disorder; for example cognitive behavioural strategies (CBT) for anxiety20 and parenting interventions for behaviour problems21 .Secondly, a i di idual s s pto p ofile a oss ultiple di e sio s a p o ide a useful prognostic index. Co-occurrence rates of problems and disorders are elevated in clinics -so alled Be kso s ias.…”

Neurodevelopmental disorders

“…This has not been widely investigated for child psychopathology although there are some exceptions 20,30 . For example, in the case of ADHD, behavioural interventions appear to be especially helpful for those with anxiety 30 and although stimulants reduce ADHD symptoms in those with intellectual disability or ASD, medication is less well-tolerated 31,32 .…”

“…Selecting appropriate treatments: First, for clinicians, different problem areas may require different sorts of evidence-based treatments that would not be captured by treatment guidelines for a single neurodevelopmental disorder; for example cognitive behavioural strategies (CBT) for anxiety 20 and parenting interventions for behaviour problems 21 .…”

Commentary: Enabling efficient and full application of prevention strategies for population mental health — reflections on Dodge (2020)

“…He argues that the impact on a population can be estimated on the basis of metrics like the expectable effect size, prevalence rates, and the costs associated with various interventions. Most fundamentally what is offered in this rich, complex, and carefully reasoned essay is the reminder of the need to bring population impact front and center in prevention selection, whether the focus of chosen component interventions might be applied to the whole population (universal prevention) or targeted selectively on a segment with elevated risk (Weisz, Ng, & Lau, ). Specifically, Dodge provides a rational framework for determining whether a universal approach or a targeted approach will yield the biggest impact on population health, taking into account available resources and costs and the likely return on investment.…”