The Society of Clinical Child and Adolescent Psychology (SCCAP) and the Association of Behavioral and Cognitive Therapies (ABCT) teamed up to launch a website to promote effective, science-based therapies for children. Our mission is to provide parents and clinicians with accurate, up-to-date information on evidence-based psychosocial treatments for children and adolescents.
Outrageous claims regarding the appropriateness of Time Out have no basis in science.
Released September 29, 2014 by the Society of Clinical Child & Adolescent Psychology (SCCAP)
We are writing to express strong concern with the article “‘Time-Outs’ Are Hurting Your Child” by Dan
Siegel and Tina Payne Byrson (9/23/14) which described time-out as “ineffective” and seemingly equated
this practice with “physical abuse”. Based on their selective review of recent neuroscientific findings,
these authors advocate rejecting the use of time-out in favor of an alternative strategy, “time-in” which
they describe a “forging a loving relationship” through sitting or talking with or comforting the child
immediately following the child’s misbehavior.
Unfortunately, none of the authors’ conclusions regarding the rejection of time-out or the use of “time-in”
are directly supported by research evidence, nor do they reflect a clear understanding of correctly
implemented time-out. Decades of carefully controlled studies support the efficacy of time-out when used
correctly with regard to the child’s developmental and emotional status and in the context of a broader
behavioral management program. Time out appropriately used involves explaining to the child during a
non-crisis time how and why the procedure is being used. At the end of the Time Out the child should be
praised and rewarded for following the procedure, a parent hug works well at this point—akin to what
Siegel and Payne Bryson refer to as Time In. While it is possible that “time-in” by itself may be a useful
tool for some children in some circumstances, no evidence is available to support this. Thus, broad
recommendation of “time in” only is premature, and potentially harmful, in the absence of controlled and
replicated research documenting efficacy and safety. It is a disservice to the public to suggest that families
try an unproven approach when one with decades of support is available. This isn’t to say that time-out is
appropriate for every child or in every circumstance, but it is the place to start.
Marc Atkins, Ph.D., Past-President
Anne Marie Albano, Ph.D., Past-President
Mary Fristad, Ph.D., Past-President
Bill Pelham, Ph.D., Past-President
John Piacentini, Ph.D., President-Elect
Dick Abidin, Ph.D.
Kristin Hawley, Ph.D.
Yo Jackson, Ph.D.
Amanda Jensen-Doss, Ph.D.
Tara Peris, Ph.D.
Mitch Prinstein, Ph.D.
Eric Youngstrom, Ph.D.
Society for Clinical Child and Adolescent Psychology
Created on August 5, 2017. Last updated on August 4th, 2017 at 08:54 pm
ABOUT EFFECTIVE CHILD THERAPY – Effective Child Therapy is an initiative of the Society of Clinical Child and Adolescent Psychology (SCCAP). The site aims to provide parents and other caregivers with easy-to-access, comprehensive information on the symptoms and treatments of behavioral and mental health problems in children and adolescents.
About the Society of Clinical Child and Adolescent Psychology
The Society for Clinical Child and Adolescent Psychology (SCCAP) is a clinician-run, non-profit association representing mental health providers with expertise and passion for the use of evidence-based treatments, prevention programs, and techniques for assessing and understanding the behavioral and mental health of children and adolescents. The society’s primary mission is to improve the lives of children, adolescents, young adults, and their families by providing the best possible clinical care.
Created on August 5, 2017. Last updated on August 22nd, 2017 at 02:06 pm
THERAPY OR MEDICATION – Evidence-based therapies have been shown to work for a broad range of mental health disorders, as well as for many life problems not typically classified as disorders in both children and adults. The same can be said, however, for the effectiveness of several psychoactive medications. The information below is intended to help parents/caregivers choose between these two treatment options for their child or adolescent or decide when they should be combined.
Therapy or Medication for Non-psychotic and Psychotic Disorders
Non-psychotic Disorders (e.g., Disorders NOT involving a loss of contact with reality, such as schizophrenic or manic disorders)
As a general rule, findings suggest that Cognitive Behavioral Therapy (CBT) with children and adolescents can do anything that medications can do in the treatment of the nonpsychotic disorders and it can do so without causing problematic side effects.
Research suggests that pediatric medications often work but they do so only IF or for as long as your child keeps taking them. The reason for this is psychiatric medications typically treat the symptoms but do not cure the disorders.
CBT, on the other hand, can address symptoms on a more enduring basis by teaching children and adolescents valuable skills that may reduce the risk for subsequent symptom return long after treatment is over.
Young people with more severe symptoms may benefit from taking psychoactive medications-either alone or in conjunction with CBT treatment-particularly among disorders like depression, obsessive-compulsive disorder, and attention-deficit hyperactivity disorder. For the less severe instances of these disorders, however, the evidence for CBT is at least as strong as that for medications and for some disorders it is even stronger.
Medications tend to work a little faster than CBT (by a matter of weeks) and there are sometimes benefits from using the two in combination or in sequence. Currently, the best research evidence indicates that, for most children and adolescents, some combination of medication and CBT is the “gold standard” treatment for clinical symptoms of anxiety, depression, and attention-deficit hyperactivity disorder.
Findings regarding the effectiveness of child/adolescent psychotherapy as an alternative to medication use are mostly available for CBT therapy. While there are many other approaches to psychotherapy, data indicating whether these other approaches are effective are still emerging.
A different rule applies for the psychotic disorders (those involving a loss of contact with reality, such as schizophrenia or mania). For these disorders, medication treatment has the best empirical support and represents the current standard of treatment.
The parents of young people with psychotic disorders are advised to seek good psychiatric treatment for their children and to keep them on their prescribed medication.
CBT and certain family focused interventions often can play a useful adjunctive role in these disorders but they should not be used instead of medications.
What if my child just has a minor or specific problem?
Many children and adolescents have certain life problems not typically classified as psychiatric disorders which may benefit from CBT.
Young people who have trouble standing up for themselves or who are prone to anger or acting in an aggressive fashion often benefit from CBT.
Children/adolescents who are experiencing difficulties in their relationships with family members, peers, romantic partners, or people at school often benefit from CBT.
There is nothing that medications can do for the everyday problems of childhood or adolescence that could not also be addressed by the skillful application of cognitive and behavioral principles. Often, results from CBT treatment these situations are better and longer-lasting!
When considering how to deal with long-standing child or adolescent difficulties such as temperament or everyday problems in life, it is important to keep in mind that some of the most widely prescribed medications can be addictive and have a number of unwanted or harmful side-effects.
Most children see a pediatrician on a regular basis, whereas few will ever see a psychotherapist. With the advent of newer and safer medications like the selective serotonin reuptake inhibitors (SSRIs), more children and adolescents are getting medicated than ever before for problems like depression and anxiety. On the one hand this may be good, since these problems might be causing a young person significant distress and/or impairment and may have otherwise gone untreated. On the other hand, this could represent a lost opportunity; these drugs do nothing to resolve the underlying tendency for these young people to get anxious or depressed.
Given current trends in medical practice, many children grow up to face a lifetime of more or less continuous reliance on medications when equally effective and longer lasting alternatives are available. It is not that pediatricians or primary care physicians do not want to help – they do – but often the only way that they know how to help is by prescribing medications. Your child’s pediatrician will likely refer you to a psychiatrist if he or she has a more severe disorder but many young people with nonpsychotic disorders or problems (e.g., depression, anxiety, everyday stress, etc.) would benefit as much or more from receiving CBT.
Types of Medications
There are several different types of psychiatric medications:
What are Antipsychotics? Antipsychotics are used in the treatment of schizophrenia and other psychotic disorders like mania. They include the typical antipsychotics like chlorpromazine or haloperidol and the newer atypical antipsychotics like aripiprazole or olanzapine. These are powerful medications that are intended to treat serious disorders and they can sometimes have serious side effects or complications; they typically require close psychiatric management.
What are Mood Stabilizers? Mood stabilizers like lithium and the anticonvulsants are used to reduce the risk for mania and depression in bipolar patients and typically require psychiatric management.
What are Antidepressants? Antidepressants are widely used in the treatment of depression and anxiety. The newer SSRIs are relatively safe and widely prescribed in primary care settings; older types of antidepressants like the tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) work at least as well but are more difficult to manage.
What are Stimulants? Stimulants, like methylphenidate and dextroamphetamine are commonly used in the treatment of attention-deficit disorder (with or without hyperactivity) in children and adolescents and are sometimes used to supplement other medications in the treatment of depression. Stimulants can be addictive and there are ongoing concerns about their effects on growth and development in young people, but they appear to have an important role in the treatment of more severe instances of ADHD (together with careful CBT behavior management strategies).
What are Anxiolytics? Anxiolytics include benzodiazepines like diazepam and chlordiazepoxide and are used to treat anxiety and stress-related disorders. Although widely prescribed and providing very rapid symptom relief, they can be addictive if used for too long (especially the high-potency benzodiazapines like alprazolam). CBT sometimes is used to help children and adolescents withdraw from these medications and many psychiatrists now prefer to treat these disorders with the slower acting but nonaddictive antidepressants.
What are Hypnotics? Hypnotics include medications like zolpidem that are widely used to treat insomnia but also can be addictive if taken for too long. Once again, CBT has been shown to provide comparable and more lasting relief of pediatric insomnia without the risks associated with medication.
Each of these medication classes has its uses and downfalls. To summarize: CBT is commonly added as a treatment to the antipsychotics and mood stabilizers in the treatment of patients with psychotic and bipolar disorders; as well as a viable alternative to the antidepressants and stimulants for less severe nonpsychotic disorders. CBT is best used in combination with medication for more severe nonpsychotic disorders, and generally superior over time to the anxiolytics and hypnotics for anxiety and sleep disorders.
Some Limitations of CBT Include:
It can sometimes be hard to find a good CBT therapist. The Association for Behavioral and Cognitive Therapies (ABCT) maintains a website to help in that regard.
It has become fashionable for therapists to describe themselves as offering CBT even when they do something quite different; it is perfectly appropriate to ask what kind of training your potential therapist has received.
It still may be hard to find a well-trained CBT therapist in some communities. In this case, medications may represent the best available option.
CBT will not work for everyone and if it does not work for your child within a reasonable period of time, then it might be wise to consider adding or switching to medications.
It also may help to add medications if CBT produces some relief but, after a time, does not fully resolve the problems that brought you to first bring your child into treatment.
Some parents, or even the children or adolescents themselves, may prefer medications to CBT, since medications typically work a little faster and may involve less time and effort. That is perfectly alright; it is good to live in an age in which there are multiple efficacious treatment options. But remember- just as adding medications can sometimes help when CBT alone is not enough, adding CBT to medications can often help when drugs alone are not enough.
Created on August 5, 2017. Last updated on August 22nd, 2017 at 02:05 pm
COGNITIVE AND BEHAVIORAL THERAPY – Cognitive and behavioral therapy (CBT) for children and adolescents usually are short-term treatments (i.e., often between six and 20 sessions) that focus on teaching youth and/or their parents specific skills. CBT differs from other therapy approaches by focusing on the ways that a child or adolescent’s thoughts, emotions, and behaviors are interconnected, and how they each affect one another. Because emotions, thoughts, and behaviors are all linked, CBT approaches allow for therapists to intervene at various points in the cycle.
These treatments have been proven to be effective in treating many psychological disorders among children and adolescents, such as anxiety, depression, posttraumatic stress disorder (PTSD), behavior problems, and substance abuse.
The therapist and child or adolescent client develop goals for therapy together, often in close collaboration with parents, and track progress toward goals throughout the course of treatment.
The therapist and client work together with a mutual understanding that the therapist has theoretical and technical expertise, but the client is the expert on him- or herself.
The therapist seeks to help the client discover that he/she is powerful and capable of choosing positive thoughts and behaviors.
Treatment is often short-term. Clients actively participate in treatment in and out of session. Homework assignments often are included in therapy. The skills that are taught in these therapies require practice.
Types of Cognitive Behavioral Therapy
Individual Cognitive Behavioral Therapy focuses solely on the child or adolescent and includes one therapist who teaches the child or adolescent the skills needed to overcome his/her challenges. This form of CBT has been proven effective in the treatment of child and adolescent depression and anxiety disorders, as well as substance abuse in adolescents.
Group CBT Group Cognitive Behavioral Therapy includes not only the child or adolescent and therapist in the therapy sessions, but also others outside of the child or adolescent’s social groups – usually new acquaintances who are also being treated for the same disorder. Those in the group therapy are often dealing with similar behavioral issues and, unlike individual CBT, the group format allows helpful relationships to form, in addition to learning skills needed to change behavior. Group CBT is often less expensive than individual CBT, and more broadly available. It has been proven effective in the treatment of depression and substance abuse in adolescents.
CBT with Parents Cognitive Behavioral Therapy that includes parents in the treatment process has been shown through research to be effective in treating children and adolescents with anxiety disorders. Specifically, CBT that teaches parents techniques to help care for anxious youth, including psychoeducation, individual therapy, caregiver coping, and parent training techniques are especially helpful. In this form of therapy, the parents are involved directly in the treatment of their children and are essentially trained in ways to help them handle their children’s fears at home.
CBT with Medication
Research has shown that pairing Cognitive Behavioral Therapy with psychotropic medications can be effective in treating a child or adolescent’s anxiety symptoms or depression. A child’s care team will be able to prescribe the right medication if he/she believes it to be necessary in your child’s therapy process.
Trauma-Focused CBT Trauma-Focused Cognitive Behavioral Therapy was developed to help children and adolescents affected by trauma. It is effective in treating PTSD but can be effective in treating other trauma-related disorders as well. It is delivered in the same way as Cognitive Behavioral Therapy – usually short-term in six to 20 sessions with the child and his/her parents present. A Trauma-Focused CBT session addresses several factors related to the child’s traumatic experiences, including behavioral and cognitive issues, and depression or anxiety symptoms, and helps improve parenting skills and parents’ interactions with their children to help support and cope with their children’s struggles.
CBT paired with Motivational Enhancement Therapy Motivational Enhancement Therapy (MET) is a type of evidence-based therapy that motivates adolescents internally to change their behavior. When MET is paired with group-based CBT, it is effective in changing an adolescent’s behavior towards drug and alcohol abuse. This therapy uses discussion, coping strategies and motivational interviewing principles to help the youth initiate a plan to change his/her behavior and motivate the youth to follow through. Throughout the sessions, the therapist will guide the youth through their plan to stop using substances and will continue to motivate and encourage his/her progress. Following MET therapy sessions, the adolescent would participate in group-based CBT to see the best results.
CBT paired with Motivational Enhancement Treatment and Family-Based Behavioral Treatment
In Family-Based Behavioral Treatment, parents set examples for their children in changing their own behavior to help their children change their behaviors in the long run. An important component of this type of therapy is the training of parents on child management and problem-solving skills. This integrated therapy has been proven effective in treating adolescent substance abuse.
Charmaine K. Higa-McMillan, Sarah E. Francis, Leslie Rith-Najarian, & Bruce F. Chorpita (2015). Evidence Based Update: 50 Years of Research on Treatment for Children and Adolescent Anxiety. Journal of Clinical Child & Adolescent Psychology. Vol. 45 Issue 2, 91-113. http://www.tandfonline.com/doi/full/10.1080/15374416.2015.1046177
Aaron Hogue, Craig E. Henderson, Timothy J. Ozechowski, & Michael S. Robbins (2014). Evidence Base on Outpatient Behavioral Treatment Adolescent Substance Use: Updates and Recommendations 2007-2013. Journal of Clinical Child & Adolescent Psychology. Vol. 43 Issue 5, 695-720. http://dx.doi.org/10.1080/15374416.2014.915550
Myra Altman & Denise E. Wilfrey (2014). Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents. Journal of Clinical Child & Adolescent Psychology. Vol. 44 Issue 4, 521-537. http://dx.doi.org/10.1080/15374416.2014.963854
Kendall, P.C. (2016). Child and Adolescent Therapy, Fourth Edition. New York: Guilford.