Читать книгу Introduction to Abnormal Child and Adolescent Psychology - Robert Weis - Страница 56

Imagine that you experience unusual pain in your stomach that does not go away with the help of over-the-counter medicine. You schedule an appointment with your physician in the hope that she might be able to identify the cause of your ailment and prescribe an effective treatment. You would hope that your physician’s assessment, diagnostic, and treatment strategies are evidence based—that is, that they reflect the scientific research and best available practice (Rousseau & Gunia, 2016).

Psychologists and other mental health professionals who work with children and families also strive for evidence-based practice. According to the American Psychological Association (APA), evidence-based practice is “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA Presidential Task Force, 2006, p. 273). The purpose of evidence-based practice is to deliver the highest-quality mental health services to children, adolescents, and families and to promote mental health in the community (J. Hamilton, Daleiden, & Youngstrom, 2015).

Clinicians who adopt an evidence-based approach to their practice consider the following three factors when helping children and families in need:

Scientific research: According to the research literature, what methods of assessment and forms of treatment work best for children with this particular problem?

Clinical expertise: According to my own professional experience and judgment, what is the best way for me to assess and treat this child?

Patient characteristics: How might the child’s age, gender, and social–cultural background, or the family’s expectations and preferences for treatment, affect the way I help them?

Evidence-based practice, therefore, begins with consideration of the scientific research literature. If parents request treatment for their son with ADHD, which form of treatment is most likely to be helpful? Fortunately, professional organizations have identified evidence-based treatments—that is, psychotherapies and medications that have been shown in research studies to reduce children’s symptoms and improve their functioning. For example, the Society of Clinical Child and Adolescent Psychology (2020) maintains an excellent website, effectivechildtherapy.org, that describes the most empirically supported psychosocial treatments for childhood disorders. Similarly, the American Academy of Child and Adolescent Psychiatry (2020) issues guidelines to help physicians identify medications and psychosocial treatments that are effective for childhood disorders.

Evidence-based treatments are typically categorized into one of five levels, depending on how well they are supported by research (Figure 1.4). For example, a type of behavior therapy called “parent training” is considered a well-established treatment for children with ADHD because several high-quality experimental studies, conducted by independent teams of researchers, have shown that it reduces children’s ADHD symptoms. Consequently, behavior parent training, in which parents learn to monitor their children’s behavior and reinforce appropriate actions, is considered a first-line psychosocial treatment. Neurofeedback training, on the other hand, is considered possibly efficacious because it has less empirical support. Although one well-designed study suggests that this treatment can help children regulate brain activity and behavior, the study needs to be replicated before it can be considered a first-line treatment. In contrast, social skills training has questionable efficacy for treating ADHD. Most children with ADHD already have adequate social skills and know how to behave in social situations; their main problem is inhibiting their behavior long enough to implement this knowledge (Evans, Owens, & Bunford, 2014).

Evidence-based practice does not simply mean using evidence-based treatments. Clinicians must also apply their knowledge and experience to tailor interventions to meet the social–emotional needs of children and families. Imagine that a mother brings her son with ADHD to their first therapy session. The therapist might initially decide to use behavior parent training. However, the therapist soon senses that the mother needs time in the initial session to describe her own frustration with her son’s behavior and her ex-husband’s lack of interest in sharing caregiving responsibilities. The skillful therapist knows that evidence-based treatments must be modified to meet the immediate needs of families. Consequently, the therapist might see her initial goal as providing empathy and building an alliance with a mother who feels powerless or isolated as a caregiver (Rajwan, Chacko, Wymbs, & Wymbs, 2014).

Figure 1.4 ■ Levels of Evidence-Based Treatments

Note: Treatments can be organized hierarchically based on their level of empirical support. Well-established treatments are supported by multiple, well-conducted experiments showing that the treatment is more effective than placebo (Southam-Gerow & Prinstein, 2014).

Finally, evidence-based practice requires clinicians to consider the characteristics and sociodemographic backgrounds of the children and families they serve (Gonzales, Lau, Murray, Pina, & Barrera, 2016). For example, therapists sometimes have difficulty engaging fathers in parent training. Consequently, researchers have modified traditional parent training to better address the interests of fathers. A treatment called COACHES (Coaching Our Acting-Out Children: Heightening Essential Skills) allows fathers to practice parent management techniques as they play soccer with their children (Image 1.3). Several studies show that the COACHES program not only engages fathers who might otherwise avoid therapy but also improves children’s behavior on the playing field and at home (Isaacs, Webb, Jerome, & Fabiano, 2015).

Review

 Evidence-based practice refers to the integration of high-quality research and clinical expertise to promote the welfare of children and families. It considers the child and family’s strengths and challenges, their cultural identities and backgrounds, and their preferences for treatment.

 Evidence-based treatments have been shown to reduce children’s behavior problems and/or improve their functioning in high-quality, research studies.

 Evidence-based practice is important because it increases the likelihood that clinicians will help their clients and reduces the risk of harm.