A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age X Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study.Over the past decade, applications of the technique known as meta-analysis (see Cooper & Hedges, 1994;Mann, 1990;Smith, Glass, & Miller, 1980) have enriched our understanding of the impact of psychotherapy with children and adolescents (herein referred to collectively as "children"). At least three general meta-analyses encompassing diverse treatment methods and diverse child problems have indicated that the overall impact of child psychotherapy is positive, with effect sizes averaging not far below Cohen's (1988) threshold of 0.80 for a "large" effect. Casey and Herman (1985) reported a mean effect size of 0.71 for a collection of treatment outcome studies with children 12 years of age and younger (studies published from . Weisz, Weiss, Alicke, and Klotz (1987) We are grateful to Danika Kauneckis and Julie Mosk for their help with various phases of the project. We also thank the outcome study authors who provided us with information needed to calculate effectsize values for this meta-analysis.

Evidence-based prevention and intervention programs are increasingly being implemented in schools and it therefore is becoming increasingly important to understand the complexities of program implementation under real-world conditions. Much research has focused on the contextual factors that influence program implementation but less work has attempted to provide an integrated understanding of mechanisms (e.g., teacher-training processes) that affect teachers' program implementation. In this paper, we review literature on factors related to teachers' implementation of school-based prevention and intervention programs, then from this review abstract what we believe are four basic ingredients that characterize potentially sustainable teacher-implemented classroom programs. Finally, we present a sequential model, based on these ingredients, of the naturalistic processes underlying sustainability of teachers' program implementation and describe how this sustainability can be enhanced through provision of teacher training and performance feedback from a classroom consultant.

How effective is psychotherapy with children and adolescents? The question was addressed by metaanalysis of 108 well-designed outcome studies with 4-18-year-old participants. Across various outcome measures, the average treated youngster was better adjusted after treatment than 79% of those not treated. Therapy proved rnore effective for children than for adolescents, particularly when the therapists were paraprofessionals (e.g., parents, teachers) or graduate students. Professionals (with doctor's or master's degrees) were especially effective in treating overcontrolled problems (e.g., phobias, shyness) but were not more effective than other therapists in treating undercontrolled problems (e.g., aggression, impulsivity). Behavioral treatments proved more effective than nonbehavioral treatments regardless of client age, therapist experience, or treated problem. Overall, the findings revealed significant, durable effects of treatment that differed somewhat with client age and treatment method but were reliably greater than zero for most groups, most problems, and most methods. In the late 1970s and early 1980s, experts raised diverse concerns about child and adolescent psychotherapy research. Some complained of insufficient information about therapy outcomes (e.g., Achenbach, 1982). Others suggested that outcome studies revealed few or no effects of therapy (e.g., Gelfand, Jenson, & Drew, 1982). Still others (e.g., Barrett, Hampe, & Miller, 1978) argued that researchers were too preoccupied with the global question of psychotherapy effects per se and should instead study outcomes as a function of treatment approach, type of child, and therapist characteristics. In recent years, the prospects for addressing these concerns have improved considerably. With the development of meta-analytic techniques (Smith, Glass, & Miller, 1980), it is now possible to aggregate findings across multiple studies and to systematically compare findings across dimensions such as treatment approach and client characteristics. The basis for analysis is the effect size, which is computed separately for the treatment group versus control group comparisons of interest. The effect size is an estimate of the magnitude of the treatment effect (treatment group versus control group scores on measures of psychological functioning) adjusted for sample variability. Meta-analyses of adult outcome studies (Shapiro & Shapiro, This project was facilitated by support from the North Carolina Division of Mental Health, Mental Retardation, and Substance Abuse Services (Department of Human Resources) and by National Institute of Mental Health Grant R01 MH 38240-01. We are grateful to David Langmeyer for his support and suggestions, to Gary Bornstein, Larry Crum, and Lynn Fisher for their assistance in data collection and computation, and to Thomas Achenbach for his thoughtful review of an earlier draft of this article.

Meta-analyses of laboratory outcome studies reveal beneficial effects of psychotherapy with children and adolescents. However, the research therapy in most of those lab studies differs from everyday clinic therapy in several ways, and the 9 studies of clinic therapy the authors have found show markedly poorer outcomes than research therapy studies. These findings suggest a need to bridge the long-standing gap between outcome researchers and clinicians. Three kinds of bridging research are proposed and illustrated: (a) enriching the research data base on treatment effects by practitioners in clinical settings-including private practice and health maintenance organizations, (b) identifying features of research therapy that account for positive outcomes and applying those features to clinical practice, and (c) exporting lab-tested treatments to clinics and assessing their effects with referred youths. If these bridging strategies were widely adopted, despite the numerous obstacles described herein, real progress might be made toward more effective treatment in clinical practice. The gulf that divides clinical practice and clinical research is now accepted as a fact of life by many in the mental health professions and in academia. For years, practicing clinicians have maintained that psychotherapy research is of little value to them (

Although a number of studies have reported a relation between abusive parental behavior and later aggressive behavior in the victim, many of these investigations have had methodological limitations that make precise interpretation of their results problematic. In the present study, we attempted to determine whether harsh parental discipline occurring early in life was associated with later aggression and internalizing behavior in children, using a prospective design with randomly selected samples to avoid some of these methodological difficulties. Structural equation modeling indicated a consistent relation between harsh discipline and aggression in 2 separate cohorts of children. This relation did not appear to be due to possible confounding factors such as child temperament, SES, and marital violence, although there was some indication in our data that the latter variables were related to child aggression. In addition, our analyses suggested that the effect of harsh discipline on child aggression may be mediated at least in part by maladaptive social information processing patterns that develop in response to the harsh discipline.

Four recent meta-analyses, involving more than 200 controlled outcome studies, have shown consistent evidence of beneficial therapy effects with children and adolescents. However, most of the studies involved experimental procedures, nonreferred subjects, specially trained therapists with small caseloads, and other features that may not represent conventional clinic therapy. Research focused on more representative treatment of referred clients in clinics has shown more modest effects; in fact, most clinic studies have not shown significant effects. Interpretation studies have not shown significant effects. Interpretation of these findings requires caution; such studies are few and most could profit from improved methodology. The clinic studies do raise questions as to whether the positive lab findings can be generalized to the clinics where most therapy occurs; however, the lab interventions that have worked so well may point the way to enhanced therapy effects in clinics.

This study examines the psychometric properties of the Children's Attributional Style Questionnaire-Revised (CASQ-R; N. J. Kaslow & S. Nolen-Hoeksema, 1991), a 24-item shortened measure derived from the 48-item CASQ designed to assess children's causal explanations for positive and negative events. The data for this study come from 1,086 children, 9 to 12 yean* old, with equal representation of boys and girls and African American and Caucasian children. Approximately one half (n = 475) of the youths also completed the CASQ-R 6 months later. Results revealed that although the CASQ-R was somewhat less reliable than the original CASQ, with moderate internal consistency reliability and fair test-retesl reliability, it demonstrated equivalent criterion-related validity with self-reported depressive symptoms. Psychometric properties of the CASQ-R showed some variation by race, such that the overall composite demonstrated better internal consistency and criterion-related validity among Caucasian youths than among African American youths. The Children's Attributional Style Questionnaire (CASQ; Seligman et al., 1984), also referred to as the K ASTAN-CASQ, is the main measure of attributional style for children. The CASQ was designed to test the attributional reformulation of the learned helplessness model of depression in children (Abramson, Seligman, & Teasdale, 1978). A meta-analysis examining children's self-reported depressive symptoms (assessed by one of four standard self-reported depression measures) and attributional patterns for positive and negative events as measured by the CASQ revealed that youths who make more internal-stable-global attributions for negative events and more external-unstable-specific attributions for positive events report more depressive symptoms than do their peers with the reverse attributional style (r -.50;Gladstone & Kaslow, 1995). In other words, youths who report more depressive symptoms lend to blame themselves for negative events (internal) and view the causes of these events as consistent over time (stable) and generalizable across situations (global), r = .38 for depressive symptoms and negative events composite. Conversely, these

Although a number of studies have reported a relation between abusive parental behavior and later aggressive behavior in the victim, many of these investigations have had methodological limitations that make precise interpretation of their results problematic. In the present study, we attempted to determine whether harsh parental discipline occurring early in life was associated with later aggression and internalizing behavior in children, using a prospective design with randomly selected samples to avoid some of these methodological difficulties. Structural equation modeling indicated a consistent relation between harsh discipline and aggression in 2 separate cohorts of children. This relation did not appear to be due to possible confounding factors such as child temperament, SES, and marital violence, although there was some indication in our data that the latter variables were related to child aggression. In addition, our analyses suggested that the effect of harsh discipline on child aggression may be mediated at least in part by maladaptive social information processing patterns that develop in response to the harsh discipline.