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EmpiricallySupportedTreatmentsfor Children and Adolescents
What is Evidence Based Practice and Empirically Supported Treatments?
Evidence based practice (EBP) is an approach to patient care that encourages clinicians to
consider and synthesize empirical evidence, clinical expertise, and patient values in
implementing treatments. Empirically-supported treatments (ESTs) are treatments
whose demonstrated efficacy meets a standard of empirical investigation as determined
by various methodological criteria.
Why is Evidence Based Practice Important?
There are a number of reasons for why it is important to use Evidence Based Practice. First APA
has adopted a policy statement on EBP as a preferred approach to psychological treatment for
young people. Second, it is our ethical responsibility to discuss EBPs with a family because
provision of therapy that is not based on empirical evidence is associated with greater treatment
failure. Finally, insurance companies increasingly demand evidence for the empirical basis for
an assessment or treatment approach before reimbursing for services.
There are many interventions that have shown efficacy for youth and their families. The list and
descriptions provided below are just a sample of some empirically supported treatments for
child and adolescent populations.
How Are Empirically Supported Treatments Rated by Division 53?
Division 53 has given each EST a rating based on the empirical support for that EST in the
literature. There are three ratings: Well-Established, Probably Efficacious, and Possibly
Well-Established- There must be at least two good group-design experiments that
are conducted in at least two independent research settings and by independent
investigatory teams. Efficacy must be demonstrated by showing the treatment to
be: a) statistically significantly superior to pill or psychological placebo or to
another treatment OR b) equivalent (or not significantly different) to an already
established treatment in experiments with statistical power being sufficient to
detect moderate differences AND a) treatment manuals or logical equivalent
were used for the treatment
b) conducted with a specified population, for whom inclusion criteria have been
delineated in a reliable, valid manner c) reliable and valid outcome
assessment measures, at minimum taping the problems targeted for change
d) appropriate data analyses.
Probably Efficacious- There must be at least two good experiments showing that
the treatment is superior (statistically significantly) to a wait-list control group
OR one or more good experiments meeting the Well-Established Criteria with
the one exception of having been conducted in at least two independent research
settings and by independent investigatory teams.
Possibly Efficacious- There must be at least one good study showing the
treatment to be efficacious in the absence of conflicting evidence.
General Empirically Supported Treatments
Cognitive Behavioral Therapy (CBT) for Anxiety is a short-term integrative approach
based on the assumption that both cognitive and behavioral processes can cause and maintain
anxiety. Most CBT protocols aim to teach children and adolescents new approach behaviors,
concrete problem-solving skills, and strategies for challenging maladaptive or unrealistic
thoughts and beliefs. CBT can also provide behavioral parent training. CBT for anxiety is
rated as Probably Efficacious by Division 53.
Cognitive Behavioral Therapy (CBT) for Depression is based on the assumption that
emotions and depressed feelings are influenced by thoughts and behaviors and that it is possible
to change negative emotions by changing the way children and adolescents think and act in
response to stressful situations. Group CBT for adolescents, children and parents is rated as
Well-Established by Divisions 53.
Cognitive Behavioral Therapy (CBT) for Pediatric Bipolar Disorder (PBD) may differ
in emphasis and prioritization of specific methods, but commonly incorporates
psychoeducation, affect regulatory strategies, cognitive restructuring techniques, behavioral
management strategies, problem-solving skills training, and social skills training. CBT for PBD
has shown promising results when used as an adjunct to pharmacotherapy. CBT for PBD is
rated as Possibly Efficacious by Division 53.
Cognitive Behavioral Therapy (CBT) for Substance Abuse aims to help adolescents
replace their drinking or drug use with less risky behavior by recognizing and avoiding
antecedents of their use, as well as by learning how to cope more effectively with problems that
lead to increased use. Group CBT for adolescent substance abuse is rated as Well-Established by
Interpersonal Psychotherapy (IPT) is a brief treatment focusing on the quality of
interpersonal relationships for adolescents with depression. Problem areas area identified and
addressed in therapy through education and enhancement of various skills including problem-
solving and communication. IPT has also been adapted for use with other disorders, such as
bipolar disorder and eating disorders. IPT is rated as Well-Established for adolescent depression
by Division 53. Please see http://www.interpersonalpsychotherapy.org/ for more information.
Behavior Therapy for ADHD is a comprehensive psychosocial intervention for youth with
ADHD, which may be used in combination with medication.Behavior Therapy includes
components of parenting training, teacher consultation/school interventions, and child-focused
treatments such as peer interaction. Behavior Therapy is rated as Well-Established for child and
adolescent ADHD by Division 53. In fact, the literature suggests that Behavioral Therapy is the
only psychosocial treatment that is effective for ADHD.
Multisystemic Therapy (MST) is an intensive family-based treatment for youth with
disruptive behavior problems, delinquency, and substance abuse. MST is based on a social-
ecological model and offers treatment in collaboration with the youth and their family in natural
settings (e.g., home, school, community). MST focuses on enhancing natural strengths and
resources, as well as on removing barriers to service access. MST is rated as Probably Efficacious
for ODD and CD by Division 53. Please see http://www.mstservices.com/ for more information.
Family Therapy for Eating Disorders is a family-based treatment for adolescents with an
eating disorder. The family is viewed not as the cause of the problem, but as a resource to assist
recovery. The treatment consists of first putting parents charge of what, when, and how much
the adolescent eats. When the adolescent is becoming healthier, he/she is put back in charge of
developmentally appropriate tasks. Family Therapy is rated as Well-Established for Anorexia
Nervosa and as Possibly Efficacious for Bulimia Nervosa by Division 53.
Specific, Manualized ESTs
The Coping Cat is a program for children aged 6-13. There is also an adolescent program (i.e.,
the C.A.T. Project). Both programs are cognitive-behavioral treatments that focus on unwanted
and distressing anxiety. Youth learntheir own cues for when they are becoming anxious, as well
as how to use these cues to initiate the implementation of coping skills. The Coping Cat is rated
as Probably Efficacious for general anxiety symptoms and social phobia by Division 53.
Social Effectiveness Training for Children (SET-C)
is a multi-component treatment program that helps
children and adolescents aged 7-17 decrease their social
anxiety, increase their interpersonal skills, and expand
their range of enjoyable social activities. SET-C combines
group social skills training, structured peer generalization
sessions, and individualized behavioral exposure treatment
to help children eliminate their social anxiety. SET-C is
rated as Probably Efficacious for Social Phobia by Division
Penn Prevention Program (PPP) is a small-group curriculum designed to promote
resilience and prevent symptoms of depression in youth aged 10-14. PPP is based on CBT and
problem-solving interventions. The cognitive component teaches participants to identify their
self-talk and to think more flexibly about the problems they encounter. The problem-solving
component teaches skills to help youth cope with day-to-day stressors. PPP is rated as Probably
Efficacious by Division 53. Please see http://www.ppc.sas.upenn.edu/prpsum.htm for more
Adolescents Coping with Depression (CWD-A) is a group CBT program for depressed
adolescents aged 12-18. The therapy typically occurs twice a week for 8weeks. CWD-A
emphasizes monitoring mood, increasing pleasant activities, decreasing anxiety, and challenging
unrealistic thinking that contributes to depression. It also addresses interpersonal skills, such
as conflict resolution and communication. CWD-A is rated as Probably Efficacious by Division
IPT for Depressed Adolescents (IPT-A) is a brief psychosocial intervention with the
objective to decrease depressive symptoms and improve social functioning within the context of
the adolescent’s significant relationships. IPT-A has been developed to address developmental
issues most common to adolescents, such as separation from parents, development of dyadic
interpersonal relationships with members of the opposite sex, and peer pressure. IPT-A is rated
as Probably Efficacious by Division 53.
Disruptive Behavior Problems
Rational-Emotive Mental Health Program (REMH) is a school-based intervention based
on cognitive-behavioral principles for high-risk 11th and 12th graders with disruptive behavior
problems. Students participate in daily small group sessions that include activities such as
cognitive restructuring through adaptive rational appraisal, in vivo role playing, group-directed
discussion, and therapy "homework" assignments. REMH is rated as Probably Efficacious by
Helping the Noncompliant Child is a parent skills-training program aimed at teaching
parents how to obtain compliance in their children to reduce conduct problems and prevent
subsequent juvenile delinquency and other problem behaviors. The parent(s) and child attend
sessions in a playroom setting, and parenting skills are taught using active teaching methods
(e.g., role play). The program is rated as Probably Efficacious by Division 53.
Triple P (Positive Parenting Program) is a multi-level system of parenting and family
support interventions delivered through varying formats (e.g., individual, group). Although the
core programming focuses on parents of children aged 1 to 12 years, Triple P also extends to
parents of teenagers. Triple P draws on empirical literatures related to child development,
applied behavior analysis, social learning, cognitive functioning, and family dynamics. Triple P
is rated as Probably Efficacious by Division 53.
Incredible Years Training Series (IY) is a set of three comprehensive, multifaceted, and
developmentally-based curricula for parents, teachers, and children aimed at treating disruptive
behavior problems in youth. Overall, IY is designed to promote emotional, social, and problem-
solving competence, as well as to prevent, reduce, and treat aggression and emotional problems
in children. The IY is rated as Probably Efficacious by Division 53.
Reaching Educators, Children, and Parents (RECAP) is a school-based, cognitive-
behavioral and social skills training program for elementary school children with co-occurring
externalizing and internalizing problems. RECAP focuses on the development of socio-
emotional and problem-solving skills and positive behavior management. It heavily emphasizes
teacher training and ongoing consultative support for the classroom teacher. RECAP is rated as
Possibly Efficacious by Division 53.
First Step to Success Program is a joint home and school-based intervention for
kindergartners who either display, or are at risk for, antisocial behavior patterns. The program
teaches children social skills and appropriate classroom and schoolwork habits. Often, parents
are enlisted as partners with teachers and school staff. First Step is rated as Possibly Efficacious
by Division 53.
Self-Administered Treatment, plus Signal Seat is designed to improve misbehavior in
children aged 2-7 by using behavioral management techniques. This is accomplished by
supplementing traditional "time-out" punishment with the Signal Seat, a time-out chair which
sounds an alarm whenever the child leaves the chair without permission. The Self-Administered
Treatment, plus Signal Seat is rated as Possibly Efficacious by Division 53.
Multidimensional Family Therapy (MDFT) is a comprehensive family-based intervention
for youth ages 11-18with antisocial behavior and substance abuse. MDFT is a theoretically-
multicomponent treatment incorporating comprehensive assessment, an
integrated treatment approach, and specialized engagement and retention
protocols. MDFT is rated as Well-Established for adolescent substance
abuse by Division 53. See http://www.med.miami.edu/ctrada for
Functional Family Therapy (FFT) is a short-term family-based
intervention that integrates both systemic and cognitive-behavioral
components to treat youth with conduct problems and/or substance abuse.
FFT was developed specifically for difficult to treat youth ages 10-18, who
may have few resources, multiple diagnoses, and a history of resistance
(i.e., lack of engagement). FFT is rated as Well-Established for adolescent substance abuse by
Division 53. Please see http://www.fftinc.com/ for more information.
Brief Strategic Family Therapy (BSFT) is a short-term family-based intervention for youth
(ages 8-17) presenting with a variety of behavioral problems, risky behaviors or mild substance
abuse. The goal is to increase the youth's psychosocial functioning by improving family
interactions. BDFT has been used primarily with inner-city Hispanic and African American
families. BSFT is rated as Probably Efficacious for adolescent substance abuse by Division 53.
Please see http://www.abct.org/sccap/docs/pro_BSFT_Manual.pdf for more information.
Strength Oriented Family Therapy (SOFT) is a family-based therapy program for
adolescents with substance abuse disorders. Key features include motivational interviewing
during the pre-treatment phase, a strengths and resources assessment, solution-focused
language and techniques, family relapse prevention planning, and family communication skills
training. SOFT is rated as Possibly Efficacious for adolescent substance abuse by Division 53.
Minnesota Model 12 Step is a program for adolescents with substance abuse including
components of individual and group therapy, family education, and aftercare planning. The
program integrates behavioral strategies with the 12 spiritual steps used in Alcoholics
Anonymous. This program can also be adapted to treat other addictions, including gambling and
sexual compulsion. The program is rated as Possibly Efficacious for adolescent substance abuse
by Division 53. See http://archives.drugabuse.gov/adac/ADAC11.html for more information.
Psychoanalytic Therapy for Anorexia Nervosa is a treatment program for adolescents
based on “self psychology”, a modern version of psychoanalysis. In this model, it is believed that
adolescents develop eating disorders because they are unable to rely to people for emotional
support. Adolescents are taught to turn to people instead of food. Psychoanalytic Therapy is
rated as Possibly Efficacious for adolescent AN by Division 53.
Cash's Body Image Therapy, plus Virtual Reality is a treatment for adolescents with body
image problems that combine cognitive-behavioral therapy with Virtual Reality (VR)
components. In addition to traditional cognitive-behavioral components, VR is used for
repeated exposure to the adolescent’s body in a variety of stressful situations. The program is
rated as Possibly Efficacious for adolescent anorexia nervosa by Division 53. Please see
http://www.abct.org/sccap/docs/pro_POP_VirtualBody_english.pdf for more information.
Family-Focused Treatment for Adolescents (FFT-A) is conducted with bipolar children
or adolescents, one or more of their parents, and siblings. The treatment focuses on assessment,
psychoeducation, communication enhancement skills training, and problem-solving skills
training. The treatment is commonly used in conjunction with medication, and canimprove
medication adherence. The program is rated as Probably Efficacious for child and adolescent
bipolar disorder by Division 53.
Multi-Family Psychoeducation is an intervention for children
and adolescents with a mood disorder, including bipolar disorder.
The biopsychosocial intervention integrates psychoeducation,
support, and skill-building based on cognitive-behavioral and
family systems principles. The psychoeducational psychotherapy
can be delivered in a multi-family or individual family format. The
program is rated as Probably Efficacious for child and adolescent
bipolar disorder by Division 53.
Dialectical Behavior Therapy (DBT) was initially developed for adults with borderline
personality disorder, but has been adapted to suicidal adolescents and adolescents with bipolar
disorder. DBT for adolescents with bipolar disorder consists of Family Skills Training in
combination with Individual DBT Therapy. DBT is a cognitive-behavioral treatment that uses a
skills-based approach targeting emotion dysregulation, suicidal behavior, interpersonal deficits,
and treatment resistance. DBT is rated as Possibly Efficacious by Division 53. Please see
http://depts.washington.edu/brtc/about/dbt for more information.
Lovaas' Model of Applied Behavior Analysis is an intervention for children with autism,
based on principles from Applied Behavior Analysis. Lovaas is adapted to fit each individual
child’s need and developmental level. Skills taught through various behavioral strategies are
related to communication, relationships, academic readiness, self help, and independent leisure
time. Lovaas is rated as Well-Established by Division 53. See
http://www.lovaas.com/resources.php for more information.
PTSD, Abuse, and Complex Trauma
Attachment, Self-Regulation, and Competence (ARC) is a guideline for individuals
working with traumatized children in the community. Interventions focus on building secure
attachments, enhancing self regulatory capabilities, and increasing competencies across
multiple domains. ARC targets children who have experienced chronic trauma such as sexual
abuse, physical abuse, neglect, domestic violence, and community violence. ARC is rated as a
Promising Practice by the NCTSN.
Child-Parent Psychotherapy (CPP) integrates a focus on the way the trauma has affected
the parent-child relationship and the family’s connection to their culture and cultural beliefs,
spirituality, intergenerational transmission of trauma, historical trauma, immigration
experiences, parenting practices, and traditional cultural values. It is a dyadic attachment-based
treatment for young children exposed to interpersonal violence. CPP is rated as a Promising
Practice by the NCTSN.
Parent-Child Interaction Therapy (PCIT) is an evidenced-based treatment model with
highly specified, step-by-step, live coached sessions with both the parent/caregiver and the
child. Parents learn skills through PCIT didactic sessions. Using a transmitter and receiver
system, the parent/caregiver is coached in specific skills as he or she interacts in specific play
with the child. Generally, the therapist provides the coaching from behind a one-way mirror.
The emphasis is on changing negative parent/caregiver child patterns. PCIT is rated as a
Promising Practice by the NCTSN.
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) aims to address the
biopsychosocial needs of children with Posttraumatic Stress Disorder (PTSD) or other problems
related to traumatic life experiences, and their parents or primary caregivers. TF-CBT is a model
of psychotherapy that combines trauma-sensitive interventions with cognitive behavioral
therapy. Children and parents are provided knowledge and skills related to processing the
trauma; managing distressing thoughts, feelings, and behaviors; and enhancing safety,
parenting skills, and family communication. TF-CBT is rated as a Promising Practice by the
*There are several other empirically supported treatments and promising practices evaluated by
the National Child Traumatic Stress Network. Please visit http://www.nctsnet.org for more
Concerns and Alternatives
There are some concerns about the definition, identification, and cataloguing of ESTs, most of
which are based on misunderstandings. However, it is should be noted that some concerns are
warranted and that alternatives to ESTs have been proposed by various researchers. For
example, researchers have noted that many ESTs appear to work for similar reasons, and that
"empirically supported principles of change” (e.g., exposure for anxiety) may be a more
parsimonious solution (Rosen & Davison, 2003). Others argue that it would be helpful to map
specific clinical procedures with client or contextual features (Chorpita & Daleiden, 2009).
Finally, the list of ESTs can guide choices about effective treatments, but does not warn against
potentially harmful treatments (Chorpita et al., 2002; Lilienfeld, 2007).
Recommended Reading and Resources
EBP and Identifying ESTs
1. Chambless, D. L., & Ollendick, T. H. (2001). Empirically supported psychological
interventions: Controversies and evidence. Annual Review of Psychology, 52, 685-716.
2. Norcross, J. C., Beutler, L. E., & Levant, R. F. (Eds.). (2005). Evidence-based practices in
mental health: Debate and dialogue on the fundamental questions. Washington, DC: American
3. Westen, D., Novotny, C. M., & Thompson-Brenner, H. (2004). The empirical status of
empirically supported psychotherapies: Assumptions, findings, and reporting in controlled
clinical trials. Psychological Bulletin, 130, 631-663.
Utilizing ESTs and CBT
1. Kazdin, A. E., & Weisz, J. R. (Eds.). (2003). Evidence-based psychotherapies for children and
adolescents. New York: Guilford.
2. Barlow, D. H. (Ed.). (2008). Clinical handbook of psychological disorders: A step-by-step
treatment manual (4th ed.). New York: Guilford.
3. Beck, J. S. (1995). Cognitive therapy: Basics and beyond. New York: Guilford.
4. Nathan, P. E., & Gorman, J. M. (Eds.) (2007). A guide to treatments that work (3rd Ed.).
New York: Oxford University
Division 53: http://www.effectivechildtherapy.com
Evidence Based Mental Health Treatment for Children/Adolescents:
Evidence Based Behavioral Practice: http://www.ebbp.org/
Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) National Registry
for Evidence-Based Practice (NREPP): http://www.nrepp.samhsa.gov/
National Child Traumatic Stress Network: http://nctsn.org
Table of ESTs
Well-established Probably Efficacious Possibly Efficacious
Social Phobia Social Effectiveness
Depression Group CBT Penn Prevention Program*
Adolescents Coping with
IPT for Depressed
Brief Strategic Family
Strength Oriented Family
Minnesota Model 12 Step*
ADHD Behavior Therapy
Helping the Noncompliant
Triple P (Positive Parenting
Incredible Y ears Training
Children & Parents*
First Step to Success*
Treatment + Signal Seat*
Autism Lovaas’ Model of
Family Therapy Psychoanalytic Therapy*
Cash’s Body Image Therapy
+ Virtual Reality*