The modular approach outperformed usual care and standard evidence-based treatments on multiple clinical outcome measures. The modular approach may be a promising way to build on the strengths of evidence-based treatments, improving their utility and effectiveness with referred youths in clinical practice settings. Trial Registration  clinicaltrials.gov Identifier: NCT01178554.

Background Children with autism spectrum disorders often present with comorbid anxiety disorders that cause significant functional impairment. This study tested a modular cognitive behavioral therapy (CBT) program for children with this profile. A standard CBT program was augmented with multiple treatment components designed to accommodate or remediate the social and adaptive skill deficits of children with ASD that could pose barriers to anxiety reduction. Method Forty children (7–11 years old) were randomly assigned to 16 sessions of CBT or a 3-month waitlist (36 completed treatment or waitlist). Therapists worked with individual families. The CBT model emphasized behavioral experimentation, parent-training, and school consultation. Independent evaluators blind to treatment condition conducted structured diagnostic interviews and parents and children completed anxiety symptom checklists at baseline and posttreatment/postwaitlist. Results In intent-to-treat analyses, 78.5% of the CBT group met Clinical Global Impressions-Improvement scale criteria for positive treatment response at posttreatment, as compared to only 8.7% of the waitlist group. CBT also out-performed the waitlist on diagnostic outcomes and parent reports of child anxiety, but not children's self-reports. Treatment gains were maintained at 3-month follow-up. Conclusions The CBT manual employed in this study is one of the first adaptations of an evidence-based treatment for children with autism spectrum disorders. Remission of anxiety disorders appears to be an achievable goal among high-functioning children with autism.

Objective: To complement standardized measurement of symptoms, we developed and tested an efficient strategy for identifying (before treatment) and repeatedly assessing (during treatment) the problems identified as most important by caregivers and youths in psychotherapy. Method: A total of 178 outpatient-referred youths, 7–13 years of age, and their caregivers separately identified the 3 problems of greatest concern to them at pretreatment and then rated the severity of those problems weekly during treatment. The Top Problems measure thus formed was evaluated for (a) whether it added to the information obtained through empirically derived standardized measures (e.g., the Child Behavior Checklist [CBCL; Achenbach & Rescorla, 2001] and the Youth Self-Report [YSR; Achenbach & Rescorla, 2001]) and (b) whether it met conventional psychometric standards. Results: The problems identified were significant and clinically relevant; most matched CBCL/YSR items while adding specificity. The top problems also complemented the information yield of the CBCL/YSR; for example, for 41% of caregivers and 79% of youths, the identified top problems did not correspond to any items of any narrowband scales in the clinical range. Evidence on test–retest reliability, convergent and discriminant validity, sensitivity to change, slope reliability, and the association of Top Problems slopes with standardized measure slopes supported the psychometric strength of the measure. Conclusions: The Top Problems measure appears to be a psychometrically sound, client-guided approach that complements empirically derived standardized assessment; the approach can help focus attention and treatment planning on the problems that youths and caregivers consider most important and can generate evidence on trajectories of change in those problems during treatment.

Community clinic therapists were randomized to (a) brief training and supervision in CBT for youth depression or (b) usual care (UC). The therapists treated 57 youths (56% girls), aged 8-15, 33% Caucasian, 26% African-American, and 26% Latino; most youths were from low-income families; all had DSM-IV depressive disorders (plus multiple comorbiditities). All youths were randomized to CBT or UC and treated until normal termination. Session coding showed more use of CBT by CBT therapists, more psychodynamic and family approaches by UC therapists. At Address inquiries to John Weisz, Department of Psychology, Harvard University, William James Hall, 33 Kirkland Street, Cambridge, MA 02138, or via to jweisz@jbcc.harvard.edu. 5 When group variances differed significantly (p < .05) and violated the equal variance assumption of the standard t-test, we used the relatively robust Welch statistic and its associated degrees of freedom (Welch, 1951;Blalock, 1972). Publisher's Disclaimer:The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access Author Manuscript J Consult Clin Psychol. Author manuscript; available in PMC 2010 December 24. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript post-treatment, depression symptom measures were at sub-clinical levels, and 75% of youths had no remaining depressive disorder, but CBT and UC groups did not differ on these outcomes. However, compared to UC, CBT was (a) briefer (24 vs. 39 weeks), (b) superior in parent-rated therapeutic alliance, (c) less likely to require additional services [including all psychotropics combined and depression medication in particular], and (d) less costly. The findings showed advantages for CBT in parent engagement, reduced use of medication and other services, overall cost, and possibly speed of improvement-an hypothesis that warrants testing in future research. Keywordsdepression; children; adolescents; youth; cognitive-behavioral therapy; community clinicAdvocates for evidence-based treatments (EBTs; e.g., National Advisory Mental Health Council Workgroup, 2001; Office of the Surgeon General, 1999General, , 2004 President's New Freedom Commission, 2003) have made a case for transporting these treatments to a broad array of everyday practice contexts. This perspective may make sense, in principle. However, before major resources are devoted to large-scale dissemination, it may be wise to study the implementation process, to learn what steps are needed to transport these treatments effectively.As several researchers have suggested...

The role of psychological interpretations in the relationship between low socioeconomic status (SES) and physiological responses was tested. One hundred high school students (ages 15-19) watched videos of ambiguous and negative life situations, and were interviewed about their interpretations. Lower SES was associated with greater threat interpretations during ambiguous (but not negative) situations and with greater diastolic blood pressure and heart rate reactivity. Threat interpretations partially mediated relationships between SES and reactivity. General life events (e.g., lack of positive life events), rather than specific life events (e.g., exposure to violence), partially explained the relationship between low SES and threat interpretations. Results suggest that the larger social environment helps explain how adolescents approach new social situations, which in turn has implications for adolescent physical health.

Parenting stress is relevant to the development, maintenance, and amelioration of youth mental, emotional, and behavioral health issues. This Evidence Base Update evaluates the empirical literature on the measurement of parenting stress to guide future research and inform clinical decision-making. After a comprehensive literature search, we identified eight well-studied measures of parenting stress, to which we applied the criteria put forth by Hunsley and Mash (2008) and extended by Youngstrom et al. (2017) to evaluate the evidence base for norms, validity, and utility. All measures were rated adequate, good, excellent, or no evidence on 11 psychometric categories (e.g., internal consistency, treatment sensitivity). Overall, the ability of identified measures to accurately and reliably assess parenting stress was strong. Although the psychometrics vary across measures, the aggregated findings support the existence of a parenting stress construct and further confirm the relevance of parenting stress to family functioning, youth psychopathology, and mental health interventions.

This study tests a model of reciprocal influences between absenteeism and youth psychopathology using three longitudinal datasets (Ns= 20745, 2311, and 671). Participants in 1st through 12th grades were interviewed annually or bi-annually. Measures of psychopathology include self-, parent-, and teacher-report questionnaires. Structural cross-lagged regression models were tested. In a nationally representative dataset (Add Health), middle school students with relatively greater absenteeism at study year 1 tended towards increased depression and conduct problems in study year 2, over and above the effects of autoregressive associations and demographic covariates. The opposite direction of effects was found for both middle and high school students. Analyses with two regionally representative datasets were also partially supportive. Longitudinal links were more evident in adolescence than in childhood.

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