Friday, December 22, 2006

Troubled Children - Therapies

Good article on first page of today's New York Times: "Parenting as Therapy for Child's Mental Disorders". It reflects the fact that the causes of mental disorders in children differ from child to child. Both biology and social factors have effects. Therapies, therefore, should tailor themselves to the needs and preferences of individual children, their parents, and family situations.

In recent decades, the article contends that psychiatry moved from blaming parents and family factors for children's mental disorders toward seeing such disorders as rooted in biology. This led to more use of drugs for treatment. However, the article notes that the science behind nondrug treatments is getting stronger. In fact, it stated that: "In a comprehensive review, the American Psychological Association urged in August that for childhood mental disorders, 'in most cases,' nondrug treatment 'be considered first,' including techniques that focus on parents' skills, as well as enlisting teachers' help."

Studies increasingly suggest that "a combination of medication and talk therapy is significantly more effective, and safer, than either alone." At the Hamm Clinic, where I serve on the Board, we adopted, many years ago, a similar perspective regarding mental health treatment for adults: Let's not over-rely on medications; let's use drugs along with psychosocial interventions only as necessary.

The article pointedly illustrates how science continually evolves. Nothing is static. The "evidence-base" for a therapy changes over time. Our pre-conceptions influence how we look for evidence and what evidence we accept. We must remain as open-minded as possible. New research on how to treat attention deficit problems, for example, helps us to understand how drugs and behavior therapy can both be helpful in different ways and in different phases of the treatment process. Research on cognitive behavior therapy will help us to understand its effectiveness in treating depression. If we rigidly limit ourselves to one way of thinking about effective treatment, we will eliminate opportunities to improve the ways we can help troubled children, and we will reduce the number of children whom we help.

This is the last in a series of New York Times articles about "troubled children." Previous articles appear at:

The articles are worth a look, both for better understanding the needs and treatment issues related to troubled children, as well as for understanding how "evidence-based practice" evolves over time.

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