New and highly promising research is beginning to point the way toward a future in child and adolescent mental health treatment based on a personalized model.
“Adaptive intervention” models are designed to provide mental health professionals with a guide to help them make timely, evidence-based adjustments in treatment plans for their patients.
Children and adolescents in treatment for emotional and behavioral problems are vastly different! Not only do they differ when they first start treatment, they also vary in how they respond to, engage in or adhere to treatment.
Additionally, because many mental health conditions are chronic or recurrent, it is common for children to relapse, even after showing a promising early response to treatment. Traditional treatment models have not always taken into account this diversity in baseline presentation and treatment response.
For treating child and adolescent mental health disorders such as ADHD, depression, anxiety, obsessive-compulsive disorder or autism, adaptive interventions would help develop roadmaps for monitoring children for signs of response/non-response or adherence/non-adherence and guide decisions on making necessary adjustments to treatment.
Currently, there is much interest in the development and evaluation of adaptive interventions by child and adolescent mental health researchers. A recent study published in the Journal of Clinical Child and Adolescent Psychology by Pelham et al. was aimed at developing an adaptive intervention for improving the behavior of children with ADHD, in and out of the classroom.
Researchers in this study uncovered an effective model that involves both low-dose medication and behavioral modification. Specifically, they found that an adaptive intervention that begins treatment with behavior modification and adds low-dose medication to children’s treatment plan who show signs of insufficient response, or stays the course with behavioral modification for children showing sufficient response, improved outcomes more than other treatment strategies.
This study used a novel sequential multiple assignment randomized trial (SMART) design, an approach scientists use to study adaptive interventions. SMART designs allow participants to move through multiple stages of treatment and help researchers answer multiple, open scientific questions within one trial to maximize participant recruitment, while providing richer data to researchers.
Another recent study by Pettit et al. (2015) suggests that healthcare providers do not need to wait 16 weeks to determine if a patient with an anxiety disorder is responding to cognitive behavioral therapy (CBT).
The researchers found that mid-treatment status was accurate for predicting results at the end of CBT. For example, 95-97 percent of youth classified as Early Responders to CBT, responded fully to treatment at the end of the sessions. Using this model, providers can evaluate a patient’s response at mid-point to individualize a treatment plan moving forward.
There is much to learn about adaptive interventions and how best to tailor evidence-based psychological approaches to each individual child or adolescent. The two studies described above are part of a special issue in the Journal of Clinical Child and Adolescent Psychology devoted to the science of adaptive interventions in child and adolescent mental health. The special issue covers a variety of first-of-their-kind studies, across child and adolescent mental health disorders, all seeking to improve the science of adaptive interventions.
This kind of research will undoubtedly lead to more effective approaches for treating behavioral and mental health disorders and can provide a blueprint for personalized treatment in child and adolescent mental health.
As a result, children and adolescents will receive higher-quality mental health care to meet their unique needs. The ultimate goal of this research is to improve the lives of a greater number of children and adolescents with mental health disorders by understanding how best to move away from a one-size-fits-all approach to treatment.
Daniel Almirall, Ph.D is an assistant professor in the Survey Research Center at the University of Michigan’s Institute for Social Research; and Andrea Chronis-Tuscano, Ph.D is a professor and director of clinical training at the University of Maryland. Both are members of the Society of Clinical Child and Adolescent Psychology.