Intervention: First Principles 305long-term outcome. Other plausible interventions have also been shown
to have little or no effect. Thus, conventional tricyclic antidepressants seem
ineffective for depressed children and adolescents. There is also contro-
versy about the effectiveness of the newer selective serotonin reuptake
inhibitors (SSRIs), though on balance it does seem likely that at least one,
fluoexetine, does work with adolescents (see Chapter 10). Similarly, many
of the psychological treatments for children administered in everyday
clinical settings are ineffective, or almost so.
On the positive side, treatment trials, and meta-analyses based on these
trials, have shown that an increasing range of specific treatments for child
psychiatric disorders are effective (see Box 36.1 for examples). But how
effective are they? It is not enough to know that a particular treatment
makes a statistically significant difference; it is also essential to know
whether the size of this difference is large enough to be clinically signifi-
cant. A tiny effect that is of no clinical relevance could still be statistically
Box 36.1Examples of effective and ineffective treatments
There is extensive and sound evidence for the effectiveness of:
Stimulant medication for ADHD.
Parent training for disruptive behavioural disorders.
Behavioural methods for soiling and enuresis.
Family therapy for anorexia.
Cognitive behavioural therapy for a number of anxiety disorders and
post-traumatic stress disorder.
Behaviourally-based video feedback for infants with insecure attachment
patterns.
There is reasonably sound evidence for:
Fluoxetine medication, cognitive behavioural therapy and interpersonal
therapy for adolescent depression.
Cognitive behavioural therapy and clomipramine medication for obsessive
compulsive disorder.
Behavioural approaches for school refusal.
Home visiting schemes for physical maltreatment.
Teacher classroom management techniques for child antisocial behaviour in
school.
There is evidence that the following have little or no effect, or are harmful:
Unfocused family work for disruptive behavioural disorders.
Anger management for disruptive behavioural disorders.
Medication for disruptive behavioural disorders (in the absence of
hyperactivity).
Social skills therapy given in clinic settings for peer relationship problems.
Social work and general support for delinquency.
Tricyclic medication for adolescent depression.
Intensive behavioural approaches for the core symptoms of autism.
Intensive treatments based on ‘breaking through defences’ or ‘rebirthing’ for
children with attachment disorders.