What five decades of research tells us about the effects of youth psychological therapy: A multilevel meta-analysis and implications for science and practice.

Abstract

Across five decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, ADHD) disorders and problems. Since the last broad-based youth meta-analysis, in 1995, the number of trials has almost tripled, and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths) synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects, using multilevel modeling to address ES dependency that is common, but typically not modeled in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multi-problem treatment (0.15). ESs differed across control conditions, with "usual care" emerging as a potent comparison condition, and across informants, highlighting the need to obtain, and integrate, multiple perspectives on outcome.Effects of therapy type varied by informant; only youth-focused behavioral therapies (including CBT) showed similar and robust effects across youth, parent, and teacher reports.Therapy effects did not improve over the years. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science.Keywords: children, adolescents, youth, psychological therapy, treatment outcome, metaanalysis YOUTH PSYCHOLOGICAL THERAPY: FIVE DECADES OF RESEARCH What Five Decades of Research Tells Us about the Effects of Youth Psychological Therapy:A Multilevel Meta-Analysis and Implications for Science and Practice Mental health problems are both prevalent and disabling in children and adolescents (herein "youths"). At any one time, about one in six will meet criteria for a disorder, and at least one in three will have a disorder by age 16 (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). A recent Lancet report (Gore et al., 2011) ranked neuropsychiatric disorders as the most prominent cause of the global burden of disease in young people, expressed in "years lost because of disability" (p. 2093). For many of these conditions, psychological therapy has been identified as the primary resource, highlighted as a path to promoting and protecting youth mental health, and advocated in government policy documents (US Department of Health & Human Services, 2003; US Public Health Service, 2000;Weisz, Sandler, Durlak, & Anton, 2005). Indeed, psychological therapy is often recommended as the first-line treatment of choice for young people, even within the practice guidelin...

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