Across five decades, hundreds of randomized trials have tested psychological therapies for youth internalizing (anxiety, depression) and externalizing (misconduct, ADHD) disorders and problems. Since the last broad-based youth meta-analysis, in 1995, the number of trials has almost tripled, and data-analytic methods have been refined. We applied these methods to the expanded study pool (447 studies; 30,431 youths) synthesizing 50 years of findings and identifying implications for research and practice. We assessed overall effect size (ES) and moderator effects, using multilevel modeling to address ES dependency that is common, but typically not modeled in meta-analyses. Mean posttreatment ES was 0.46; the probability that a youth in the treatment condition would fare better than a youth in the control condition was 63%. Effects varied according to multiple moderators, including the problem targeted in treatment: mean ES at posttreatment was strongest for anxiety (0.61), weakest for depression (0.29), and nonsignificant for multi-problem treatment (0.15). ESs differed across control conditions, with "usual care" emerging as a potent comparison condition, and across informants, highlighting the need to obtain, and integrate, multiple perspectives on outcome.Effects of therapy type varied by informant; only youth-focused behavioral therapies (including CBT) showed similar and robust effects across youth, parent, and teacher reports.Therapy effects did not improve over the years. Effects did not differ for Caucasian versus minority samples, but more diverse samples are needed. The findings underscore the benefits of psychological treatments as well as the need for improved therapies and more representative, informative, and rigorous intervention science.Keywords: children, adolescents, youth, psychological therapy, treatment outcome, metaanalysis YOUTH PSYCHOLOGICAL THERAPY: FIVE DECADES OF RESEARCH What Five Decades of Research Tells Us about the Effects of Youth Psychological Therapy:A Multilevel Meta-Analysis and Implications for Science and Practice Mental health problems are both prevalent and disabling in children and adolescents (herein "youths"). At any one time, about one in six will meet criteria for a disorder, and at least one in three will have a disorder by age 16 (Costello, Mustillo, Erkanli, Keeler, & Angold, 2003). A recent Lancet report (Gore et al., 2011) ranked neuropsychiatric disorders as the most prominent cause of the global burden of disease in young people, expressed in "years lost because of disability" (p. 2093). For many of these conditions, psychological therapy has been identified as the primary resource, highlighted as a path to promoting and protecting youth mental health, and advocated in government policy documents (US Department of Health & Human Services, 2003; US Public Health Service, 2000;Weisz, Sandler, Durlak, & Anton, 2005). Indeed, psychological therapy is often recommended as the first-line treatment of choice for young people, even within the practice guidelin...

With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963–2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.

Objective: Youth depression is a debilitating condition that constitutes a major public health concern. A 2006 meta-analysis found modest benefits for psychotherapy vs. control. Has 13 more years of research improved that picture? We sought to find out. Method:We searched PubMed, PsychINFO, and Dissertation Abstracts International for 1960-2017, identifying 655 randomized, English-language psychotherapy trials for ages 4-18 years. Of these, 55 assessed psychotherapy versus control for youth depression with outcome measures administered to both treatment and control conditions at post (k=53) and/or follow-up (k=32). Twelve study and outcome characteristics were extracted, and effect sizes were calculated for all psychotherapy vs. control comparisons. Using a threelevel random-effects model, we obtained an overall estimate of the psychotherapy vs. control difference while accounting for the dependency among effect sizes. We then fitted a three-level mixed-effects model to identify moderators that might explain variation in effect size within and between studies.Results: Overall effect size (g) was 0.36 at posttreatment, 0.21 at follow-up (averaging 42 weeks after post-treatment). Three moderator effects were identified: effects were significantly larger for Interpersonal Therapy than CBT, for youth self-reported outcomes than parent-reports, and for comparisons with inactive control conditions (e.g., waitlist) than active controls (e.g., usual care). Effects showed specificity, with significantly smaller effects for anxiety and externalizing behavior outcomes than for depression measures. Conclusion:Youth depression psychotherapy effects are modest, with no significant change over the past 13 years. The findings highlight the need for treatment development Running Head: PSYCHOTHERAPY FOR YOUTH DEPRESSION 3 and research to improve both immediate and longer-term benefits.

Objective.-An emerging trend in youth psychotherapy is measurement-based care (MBC): treatment guided by frequent measurement of client response, with ongoing feedback to the treating clinician. MBC is especially needed for treatment that addresses internalizing and externalizing problems, which are common among treatment-seeking youths. A very brief measure is needed, for frequent administration, generating both youth-and caregiver-reports, meeting psychometric standards, and available at no cost. We developed such a measure to monitor youth response during psychotherapy for internalizing and externalizing problems.Method.-Across 4 studies, we used ethnically diverse, clinically relevant samples of caregivers and youths aged 7-15 to develop and test the Behavior and Feelings Survey (BFS). In Study 1, candidate items identified by outpatient youths and their caregivers were examined via an MTurk survey, with item response theory methods used to eliminate misfitting items. Studies 2-4 used separate clinical samples of youths and their caregivers to finalize the 12-item BFS (6 internalizing and 6 externalizing items), examine its psychometric properties, and assess its performance in monitoring progress during psychotherapy.Results.-The BFS showed robust factor structure, internal consistency, test-retest reliability, convergent and discriminant validity in relation to three well-established symptom measures, and slopes of change indicating efficacy in monitoring treatment progress during therapy.

We report on the development and psychometric properties of an instrument for the assessment of knowledge of effective parenting skills specific to conduct problems using an item response theory (IRT) framework. The initial item pool (36 items) for the Knowledge of Effective Parenting Test (KEPT) was administered online to a national sample (N = 1,570) selected to match the U.S. population on key demographic variables. Items with strong psychometric properties and without significant differential item functioning (DIF) by race/ethnicity were retained, resulting in a 21-item version of the KEPT with excellent reliability and validity. We also created a brief 10-item version of the KEPT to reduce respondent burden and to enhance its utility for repeated measurement in longitudinal and intervention research. We report norms and percentiles for both the 21-item version (KEPT–Full) and the 10-item version (KEPT–Brief).