Cognitive Behavioural Therapy for Children and Adolescents

Antonio Muñoz-Solomando; Tim Kendall; Craig J. Whittington

Disclosures

Curr Opin Psychiatry. 2008;21(4):332-337. 

In This Article

Conclusion

From this narrative synthesis of systematic reviews, some undertaken for the development of NICE guidelines and others developed separately, it appears that the best evidence for the potential of CBT in children and adolescents is in the treatment of generalized anxiety disorder. Not only does the treatment have a very positive effect but the evidence upon which this is based is comparatively robust. Our review also suggests that CBT has a similarly positive effect in other anxiety disorders (OCD and PTSD), although the number and size of trials are fewer and smaller, respectively. These findings have further confirmation in independent systematic reviews. Nevertheless, some of the trials included in these systematic reviews compare the active treatment with treatment as usual rather than an alternative form of therapy (such as supportive psychotherapy) - a weaker test of efficacy.

There appears to be moderately good evidence that CBT is effective in the treatment of depression in children and young people, although the evidence upon which this is based is also moderate, in particular that controls are a mixture of waiting lists, nondirective supportive therapy, clinical management or other active treatment. Independent review also confirms this finding.

There is some evidence supporting the use of behavioural and cognitive behavioural approaches to the treatment of children with ADHD, although the best evidence is for preschool children. The evidence to support the potential for media-based CBT for general behavioural problems in children and young people is also moderately good. However, the evidence is inconclusive as to whether CBT has a role in the treatment of antisocial behaviour or drug misuse. There is no evidence from systematic reviews or RCTs regarding the use of CBT in the treatment of psychosis and related disorders, eating disorders, or in the treatment of self-harm among children and adolescents.

In conclusion, on the basis of meta-analysis and systematic reviews undertaken mainly during the development of NICE guidelines, current evidence suggests that CBT has significant potential in the treatment of a number of mental health problems in children and adolescents. The best evidence for the effectiveness of CBT appears to be for emotional disorders, especially those characterized by anxiety, but also for depression. Involving the parents of children with some externalizing disorders, most notably ADHD, appears to be a beneficial strategy, especially for preschool-aged children.

The evidence upon which much of these systematic reviews are based (for example, in terms of the samples recruited, the extent to which they reflect clinical populations, and high attrition rates) is, nevertheless, limited. Moreover, many trials have relatively short follow-up periods and a number use outcome measures that are too varied to meta-analyse. Also, a number of these meta-analyses included a mixture of comparators, including waitlist controls, supportive psychotherapy and treatment as usual. Stronger tests should compare CBT with other active psychological treatments. In addition, the relative use of cognitive and behavioural components for different age groups could be specified more clearly, especially in the treatment of externalizing disorders.

Nevertheless, in the light of the uncertainty surrounding pharmacological treatments resulting from selective publication of industry-sponsored trials, and the consequently disappointing results surrounding the use of SSRIs in children and young people for many, but not necessarily all, purposes, it is important that this modest but important evidence base for the use of cognitive behavioural psychological treatment should be extended by further primary and secondary research.

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