The ABCs of Evidence-Based Therapies (EBTs) for Children
How to sift through the science and find the best treatment for your child
Posted Mar 22, 2019
This guest post was contributed by Sofia Cardenas, a graduate student in the USC Psychology Department's Clinical Science program.
You’ve read all the parenting blogs and are starting to suspect that your child needs help for a mental health condition. You find yourself online, scrolling through dozens of treatment options. Should you try Play Therapy? Maybe medication could take the edge off of the symptoms? What about something more “natural” like crystals for opening your child’s root chakra and cleansing their aura? The choices are overwhelming, your child needs help, and you will try almost anything at this point as long as it helps!
This article is meant as a guide to arm you with the knowledge to make informed, scientifically supported choices about your child’s mental health future. Remember to consult your trusted family doctor or mental health professional when deciding on a final course of action.
Evidence-Based Treatments (EBTs). What are they?
Mental health professionals (such as psychiatrists, psychologists, social workers, marriage and family therapists) can use very different approaches to assist children and adolescent clients with mental health symptoms. “Evidence-based Treatments” (EBTs) are strategies that have been tested in scientific settings and have been shown to work. Some treatments—like the past life regression therapy offered at your local yoga studio—have not been rigorously tested. Why does this matter? EBTs are treatments that have scientific evidence supporting their effectiveness, which means that they may be more likely to help your child. The American Psychiatric Association and the American Psychological Association list EBTs as ‘preferred’ and ‘best practice’ approaches to mental health treatment.
For a concrete example, check out the work of Drs. Philip Kendall and Muniya Khanna. They created the Child Anxiety Tales program, which is composed of 10 training modules that teach parents strategies for helping their children with anxiety. Child Anxiety Tales is built on several decades of research on child anxiety and has been deemed as useful in a research trial.
Are EBTs one size fits all? Or do different treatments work for different disorders?
EBTs are usually designed to target one specific set of symptoms. The table below lists some examples of EBTs for some common childhood disorders. You might notice a trend— different variations of Cognitive Behavioral Therapies (CBTs) seem to help a variety of disorders. CBT focuses on the idea that thoughts, feelings, and behaviors are highly linked, so changing one of these areas (e.g., behaviors) can often mean improvement in another (e.g., feelings).
For example, CBT tailored to Panic Disorder works to identify, challenge, and modify ideas that are keeping panic symptoms around, for example, a fear of bodily sensations that lead to panic, which then turns into a full-blown attack. One CBT technique to reduce panic symptoms is exposure, in which the child is encouraged (with the support of a mental health professional) to confront the event or bodily symptom that they fear in a real-life situation (e.g., walking alone in a busy mall or raising their hand in class) and physical experiences (e.g., breathing through a straw to create the sensation of hyperventilating, a common physical symptom of panic attacks).
Many children have comorbidities (i.e., having more than one mental health condition). The chart above includes treatment by Dr. John Weisz, a Harvard professor of clinical psychology. Dr. Weisz created the MATCH-ADTC (Modular Approach to Therapy for Children with Anxiety, Depression, Trauma or Conduct Problems). MATCH-ADTC is a psychological intervention designed to treat children with more than one mental health disorder (i.e., disruptive conduct, post-traumatic stress, depression, and anxiety). The treatment has 33 lessons that can be mixed and matched to a child’s specific needs.
How are Evidence-Based Treatments (EBTs) supported by science? Clinical trials!
Before treatment is considered “evidence-based,” individual research studies must be conducted to see if certain treatment approaches are helpful for a given mental health problem. These studies are called “clinical trials,” and they typically involve at least a dozen research participants in each study. These research participants have a similar type of problem, such as clinical levels of chronic irritability, depression, or anxiety. The research participants are “randomly assigned” to receive Treatment X or Treatment Y, which means that they are preselected in a randomized fashion to one treatment versus another. If Treatment Y helps children more than Treatment X, then Treatment Y has received some support or evidence of its efficacy. Over time, more researchers will try to replicate these findings in different clinical trials. By the time treatment is considered an EBT, it has research backing it that suggests that it is helpful for treating a given disorder. If Treatment Y continues to be useful, it might become a “gold standard” treatment, which means it is publicly recognized as the best treatment for a specific mental health condition.
If your child or adolescent might be interested in being a part of a clinical trial to potentially receive treatment and to help advance science, you can go onto the website created by the National Library of Medicine to find a comprehensive list of all clinical trials being conducted in the United States and 208 other countries.
Want to look at the data yourself? Learn the basics to examine the science behind a clinical trial
Here are the two necessary steps:
Step 1: Find research papers
This step seems easy, but it’s harder than you might think because papers are published in research journals that are not necessarily open to the public. We suggest that you first try using Google Scholar, a search engine designed specifically for scholarly literature. Then, you can enter a search term relating to your topic of interest, such as “child depression treatments” or “gender dysphoria support,” and you will have a list of scholarly articles relating to your topic. Most of these articles will list the title, authors, and a short description of the paper and its findings. Unfortunately, in many cases, you will not be able to access the full paper through these websites.
Luckily, researchers tend to be pretty open about sharing their research and many post their articles on ResearchGate, essentially the Facebook of science, where researchers can share papers and collaborate. You are welcome to peruse a researcher’s web page and see if they have posted the article for the public or a site that hosts preprints, such as PsyArxiv. You can even contact a researcher directly via their institutional email address to ask if they are willing to share their work with you.
It might seem like a lot of work to find articles, but it is worth it since articles that are published in journals are “peer-reviewed,” meaning another group of scientists reviewed the authors’ work and deemed it rigorous science. These scholars will evaluate all aspects of the research— the design, the statistics used, and even the way the results are discussed—to ensure it is scientifically sound. This whole process can take months to years, but once a study emerges from peer review, you can have more confidence that the results are higher quality science.
Step 2: Read the research papers with an eye for science
Once you have access to a research paper on a given clinical trial, you can begin assessing the quality of the study. Here are a few things you should look for:
1. The number of people in the trial— When evaluating clinical trials, the number of people in the study is significant. Most well-conducted clinical trials will have a large sample size with 50 to 100 people per group. This is crucial to ensure that the results are not due to an extreme case within the group of people in the study.
2. Research Design— It is critical to assess the research design of studies supporting EBTs. The gold standard design of a clinical study is the “randomized controlled double-blind trial.” That term is a mouthful! Let’s break it down.
Randomized—Most clinical trials are randomized. As mentioned above, randomization means that researchers assign patients into different groups, usually the treatment group and a control group or alternative treatment groups. Randomization is essential to ensuring that researchers are not biased, and for example, placing patients in the group in which they think they will do best. Also, randomization allows for researchers to make sure that other factors that might affect how the treatment works— like socioeconomic status, racial background, or gender— are equally distributed across different conditions/groups in the study.
Controlled— Most clinical trials include a comparison group. The comparison group receives a placebo (i.e., no active treatment) or another treatment. This is essential for a study because it allows researchers to look at the outcome of a similar group of children or adolescents who are not receiving treatment under investigation.
Double-Blind— Not many clinical trials are double-blind. But double-blind studies get an extra “gold star” in terms of scientific design. Double-blind means that neither the subjects in the experiment or the experimenter know whether a given treatment participant is in the control group or the treatment group. It’s tricky business to pull off a double-blind study. Even so, double-blind trials help to ensure that the participants’ or researchers’ expectations that a given treatment may or may not work does not potentially bias them during the study.
You are your child’s best advocate, and now you have some basic skills to look at the data yourself. We hope you feel a little more empowered to see if the research is up to your standards!
Where to find updated evidence on EBTs?
Here are some great resources to help you keep tabs on evidence-based therapies: