Faculty Bibliography

In the December 2000 issue of the Journal of Abnormal Child Psychology, we published a set of papers presenting secondary analyses of the Multimodal Treatment Study of ADHD (MTA), and R. A. Barkley (2000) provided a commentary. A critique of the design of the study (MTA Cooperative Group, 1999) was presented based on a theoretical perspective of a 'behavioral inhibition' deficit that has been hypothesized as the core deficit of ADHD (R. A. Barkley, 1997). The commentary questioned the design and analysis of the MTA in terms of (1) the empirical criteria for selection of components of behavioral (Beh) intervention, (2) the effectiveness of the Beh intervention, (3) the methods for analyses at the group and individual level, (4) implications of the MTA findings for clinical practice, (5) the role of genetics in response to treatment, and (6) the lack of a nontreatment control group. In this response, we relate the content of the papers to the commentary, (1) by reviewing the selection criteria for the Beh treatment, as outlined by K. C. Wells, W. E. Pelham, et al. (2000), (2) by addressing the myth that the MTA Beh treatment was ineffective (Pelham, 1999), (3) by describing the use of analyses at the level of the individual participant, as presented by J. S. March et al. (2000) and W. E. Pelham et al. (2000) as well as elsewhere by J. M. Swanson et al. (2001) and C. K. Conners et al. (2001), (4) by relating some of the suggestions from the secondary analyses about clinically relevant factors such as comorbidity (as presented by J. S. March et al., 2000) and family and parental characteristics (as presented by B. Hoza et al., 2000, S. P. Hinshaw et al., 2000, and K. C. Wells, J. N. Epstein, et al., 2000), (5) by discussing the statistical concept of heritability and the lack of a significant difference in the presence of ADHD symptoms in parents of the MTA families compared to parents in the classmate-control families (as presented by J. N. Epstein, et al., 2000), and (6) by acknowledging that an ethically necessary weakness of the MTA design is that it did not include a no-treatment control group. We discuss the use of secondary analyses to suggest how, when, and for what subgroups effectiveness of the Beh treatment may have been manifested. Finally, we invite others to use the large and rich data set that will soon be available in the public domain, to perform secondary analyses to mine the meaning of the MTA and to evaluate theories of ADHD and response to treatments

The National Institute of Mental Health established a special subgroup of its National Advisory Mental Health Council to review major research findings on child and adolescent psychiatric disorders over the past decade and to recommend research priorities for the next decade. This Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment published its report, titled Blueprint for Change: Research on Child and Adolescent Mental Health, in August 2001, and several new research announcements reflecting these new directions have been issued since that time. This article summarizes the rationale for and background to the report, its major conclusions, and the reasons why interdisciplinary and translational approaches to research questions in child and adolescent mental health will help to maximize scientific advances.

OBJECTIVE: To examine the characteristics associated with barriers to children's mental health services, focusing on the effect of children's psychosocial problems on parents. METHOD: Data come from a first-grade, prevention-intervention project conducted in Baltimore, Maryland. Analyses were restricted to 116 families who participated in seventh-grade interviews and indicated the index child needed services. The Services Assessment for Children and Adolescents was used to measure barriers to children's mental health services. RESULTS: More than 35% of parents reported a barrier to mental health services. Types of barriers included those related to structural constraints, perceptions of mental health, and perceptions of services (20.7%, 23.3%, and 25.9%, respectively). Although parenting difficulties were associated with all barriers (structural: OR = 10.63, 95% CI: 2.37, 47.64; mental health: OR = 8.31, 95% CI: 1.99, 34.79; services: OR = 5.22, 95% CI: 1.56, 17.51), additional responsibilities related to attendance at meetings was associated only with structural barriers (OR = 5.49, 95% CI: 1.22, 24.59). CONCLUSIONS: Researchers and policymakers interested in increasing children's access to mental health services should consider strategies to reduce barriers related to perceptions about mental health problems and services, in addition to structural barriers. Particular attention should be given to programs that focus on the needs of families who are most affected by their child's psychosocial problems.

The Surgeon General's National Action Agenda highlighted key issues that challenge the public health system in appropriately meeting the mental health needs of children and their families. Among these issues included the need for screening and early identification, improving access to appropriate mental health care, strengthening the infrastructure, and expanding training for providers. Two key gate-keeping systems identified as critical in this reform of mental health care for children and their families are education and primary care. This paper focuses on these two systems to illustrate problems related to these issues. Central to the Surgeon General's call for reform is also the pressing public health responsibility to improve and use the science base by strengthening the connection between what we know from the scientific evidence base and what we do in practice. The implications of this reform for specialty mental health are discussed.

Comments on the article by B. F. Chorpita et al (see record 2002-13168-005) which examined the statewide implementation of empirically based treatments for children. The present author discusses scientific conundrums that surround that transportability of research-based interventions, including issues of definition (e.g., differences among treatments, preventive interventions, services); diagnostic reification and the absence of markers; the value and status of combination treatments (including pharmacologic) for conceptualizing the evidence base; and differences between evidence-based practices and evidence-based treatments. Suggestions are made for a disciplined approach to advancing a yoked research and policy agenda for children's mental health.

The authors review the status, strength, and quality of evidence-based practice in child and adolescent mental health services. The definitional criteria that have been applied to the evidence base differ considerably across treatments, and these definitions circumscribe the range, depth, and extensionality of the evidence. The authors describe major dimensions that differentiate evidence-based practices for children from those for adults and summarize the status of the scientific literature on a range of service practices. The readiness of the child and adolescent evidence base for large-scale dissemination should be viewed with healthy skepticism until studies of the fit between empirically based treatments and the context of service delivery have been undertaken. Acceleration of the pace at which evidence-based practices can be more readily disseminated will require new models of development of clinical services that consider the practice setting in which the service is ultimately to be delivered.