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Treatment-as-usual therapy targets for comorbid youth disproportionately focus on externalizing problems
Matthew Milette-Winfree1, Charles W Mueller1
1Department of Psychology, University of Hawai'i at Manoa.
Psychological Services
|May 19, 2017
Summary
Community therapists often prioritize externalizing behaviors over internalizing ones when treating youth with comorbid disorders. This focus on externalizing problems is more pronounced when externalizing disorders are primary or secondary.
Area of Science:
- Child and Adolescent Psychology
- Clinical Psychology
- Mental Health Services Research
Background:
- Comorbid externalizing and internalizing disorders are common in youth seeking mental health services.
- Understanding treatment target prioritization is crucial for effective intervention in youth mental health.
Purpose of the Study:
- To investigate whether psychological treatment for youth with comorbid externalizing and internalizing disorders prioritizes externalizing over internalizing pathology.
- To analyze how diagnostic profiles influence the selection of treatment targets in a real-world community mental health setting.
Main Methods:
- Therapist-reported treatment targets were analyzed for 679 youth across four diagnostic groups: internalizing-only, externalizing-only, primary internalizing with secondary externalizing, and primary externalizing with secondary internalizing.
- A proportional measure of externalizing targets was calculated and analyzed across groups, controlling for client and treatment characteristics.
Main Results:
- Youth with externalizing-only diagnoses received the highest proportion of externalizing treatment targets, while those with internalizing-only diagnoses received the least.
- The presence of a secondary externalizing disorder significantly increased the focus on externalizing targets, even with a primary internalizing diagnosis.
- A primary externalizing diagnosis with a secondary internalizing disorder led to a smaller decrease in externalizing target focus.
Conclusions:
- Community therapists tend to prioritize externalizing problems over internalizing problems in youth with comorbid conditions.
- Clinical practice may need adjustment to ensure balanced treatment of both externalizing and internalizing pathologies in comorbid youth.
- Findings have implications for clinical training, treatment protocol development, and dissemination efforts in youth mental health.
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