This scholarly book is the timeliest addition to our understanding of evidence-based therapies for childhood mental disorders.
The use of the term “evidence based therapies” (EBT) has become quite common. However, after reading this book I was struck how most clinicians (myself included) may be using this term in an overly simplistic manner.
The book contains 13 methodically constructed chapters that introduce the reader to the aspects of outcomes methodology, epidemiology and terminology thus grounding the knowledge of the reader who will then better appreciate discussion about individual disorders.
Interestingly, the appendices were also quite informative. For example, in Appendix 2, the authors clarified which search items were used to match up with related clinical terms. Some were surprising but educative. For example: ‘Bullying’ as a search term picked up conduct disorder and ODD! I tried out these search items and they worked as stated!
Our knowledge of therapeutic modalities for children has been taking a quantum leap and that makes one wonder if the discussion regarding current EBT will hold even two to three years from now. Even then, the first two chapters were so powerfully written that they will always be the guideposts for further discussion on the EBT in children. Those chapters are the heart and soul of this book and I will spend some time describing them for the benefit of busy clinicians.
The first chapter addressed the importance of outcome measurements in practicing EBT and the emphasis on EBT itself. Quality of care is not the only driving force behind the movement towards EBT. Behind quality of care is the accountability of professionals to the funders and purchasers of health care. “Governments and health funders are attracted to the notion of allocating health resources on the basis of evidence.”
Using a classification system proposed by Hoagwood and Jensen five levels of outcome were described:
The symptomatic or diagnostic level,
Adaptation to the psychosocial environment,
The mechanisms (such as the cognitive and emotional capacities),
The transactional aspects of development,
The level of service utilization and satisfaction with services.
The authors then gave a rich appraisal of the limitations of treatment outcomes in psychosocial treatment research. I found the use of RCT (randomized controlled trials) especially relevant. Can RCTs be considered as a gold standard of evaluation research when applied to childhood treatment outcomes? The authors concluded that at present, the results from RCTs should be considered as the best option for clinicians who wish to base their practice on scientific data
The second chapter described epidemiological aspects of childhood disorders including prevalence, natural history, risk factors and the stability of disorders. The latter topic was very important since the evidence they presented suggested that child psychiatric disorders are not likely to remit spontaneously. Indeed, since they can become resistant to treatment with time, the use of the earliest possible intervention was emphasized
The rest of the book reviewed different childhood disorders, current EBT and the implications of EBT. These disorders included: anxiety disorders, depressive disorders, disturbance of conduct, attention deficit hyperactivity disorder, Tourette’s disorder, psychotic disorders, pervasive developmental disorders, self harming disorders, children with physical disorders and children with specific developmental disorders. There was a comprehensive review of the evidence for the effectiveness of psychopharmacologic, cognitive behavioural (problem solving, skills training and social skills training), psychodynamic and multi-modal treatments
There were definite variations in the level of discussion for these disorders. For example, the chapter on conduct disorders was the most comprehensive and could have stood on its own. The chapter on specific developmental disorders, on the other hand, covered mostly speech language and cognitive disorder treatments and was designed for a North American audience
In their conclusions, the authors stated 11 points that characterized treatment research in the field of child and adolescent mental health. Many of these included much common sense such as the use of a framework incorporating the transactional, family and societal influences on the child’s disorder.
This book has to be read in the order that it is written and in that hierarchical manner, I found it enjoyable. The concluding chapter made the best sense after following the logic of accepting or refuting the evidence for successful treatments in earlier chapters. There was no subjective bias in the book to lead the reader in a particular direction and full acknowledgement was given to clinicians and to their clinical judgment.
This book should be in the department library. It is not a clinician’s handbook, but it is a good tool for clinician teachers who want to teach good evidence based medicine. My rating: 7/10