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Specific Aims of Project

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Specific Aims of Project

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  1. The Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders,and Posttraumatic Stress DisorderBarbara J. Burns, Ph.D.Scott N. Compton, Ph.D.Helen L. Egger, M.D.Elizabeth M. Z. Farmer, Ph.D.Duke University Medical Center

  2. Specific Aims of Project I .To identify efficacious/effective interventions for the treatment of childhood mental disorders which could reduce the risk for substance use problems in adolescence and later; II. To identify mental health intervention studies in which substance use outcomes could be examined in adolescence and later.

  3. Inclusion Criteria for Literature Search • Study on one of five childhood disorders or related symptom group • Utilized a controlled design • Targeted children in 6-12 age range • Published 1985-1999 (except interventions studied earlier and not repeated later) • Focused on outpatient treatment

  4. Search Results Clinical References References Meeting Condition Identified Inclusion Criteria ADHD 132 31* Depression 28 19 Disruptive Behavior 314 30* Disorders Anxiety 75 37 Disorders Posttraumatic 58 5 Stress Disorder *Studies with N < 30 were excluded

  5. Descriptors in Matrices Study design and description Target population Demographic characteristics (Age, gender, race/ethnicity) Outcomes Comments

  6. Types of Interventions with Positive Findings by Clinical Condition • PSYCHOSOCIAL • PSYCHOPHARMACOLOGICAL • ADJUNCTIVE (combined treatments)

  7. Interventions with Positive Findings forAttention-Deficit/Hyperactivity Disorder Psychosocial Psychopharmacological Adjunctive cognitive behavior methylphenidate; slight evidence therapy; desipramine; for psychosocial pindolol; in 2 of 8 studies social skills training; buproprion; for combined amphetamine sulfate treatment; biofeedback drugs superior to psychosocial treatment in 6 of 8 studies

  8. Interventions with Positive Findings forDepression Psychosocial Psychopharmacological Adjunctive cognitive behavior fluoxetine none therapy; self-control training

  9. Interventions with Positive Findings forDisruptive Behavior Disorders Psychosocial Psychopharmacological Adjunctive parent training; lithium; none multisystemic therapy; methylphenidate case management; anger-coping; problem-solving skills PATHS; Project LIFT; First Step; Fast Track

  10. Interventions with Positive Findings forAnxiety Disorders Psychosocial Psychopharmacological Adjunctive systematic sertraline none desensitization; (for obsessive compulsive modeling; disorder only) reinforced practice; cognitive behavior therapy; contingency management; cognitive self-control; educational support

  11. Interventions with Positive Findings forPosttraumatic Stress Disorder Psychosocial Psychopharmacological Adjunctive stress inoculation; none none gradual exposure; cognitive behavior therapy (for parent and child)

  12. Specific Aims of Project I .to identify efficacious/effective interventions for the treatment of childhood mental disorders which could reduce the risk for substance use problems in adolescence and later; -- EFFICACY --

  13. Response to Aim I. -- EFFICACY -- Efficacious interventions exist for all disorders examined Strength of psychopharmacological evidence varies by disorder Availability of efficacious interventions in clinical practice is unknown, but suspected to be low Increasing efficacious interventions through training and quality monitoring is warranted

  14. Specific Aims of Project II. to identify mental health intervention studies in which substance use outcomes could be examined in adolescence and later. -- FOLLOW-UP STUDIES --

  15. Response to Aim II.-- FOLLOW-UP STUDIES -- To select follow-up studies from existing studies, decisions are needed relative to: (1) the standard for evidence-based interventions (2) current age of previously studied samples (3) adequacy of the methods (4) risk of samples (i.e., disorders, ethnic diversity) for substance problems Prospective studies needed with substance assessment and follow-up incorporated to: (1) replicate older efficacious treatments (2) develop psychosocial treatments (especially for PTSD) and medications (except ADHD)

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