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Published on: September 20, 2019
Editorial: Standardizing methods and measures in randomized controlled trials: a necessary catalyst for clinical
1Washington University School of Medicine, St. Louis, MO, USA.
Insights
More randomized controlled trials are needed for childhood mental disorder treatments. Current clinical decisions rely on anecdotal evidence due to limited research translation and data gaps.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychopathology
- Evidence-Based Practice
Background:
- Significant advances in understanding childhood mental disorders have not translated into clinical practice.
- Child mental health treatment decisions are often based on anecdotal experience rather than empirical data.
- Limited availability of empirically supported treatments hinders effective psychotherapeutic interventions.
Discussion:
- A considerable gap exists between clinical practice and the empirical evidence base for treating childhood mental disorders.
- Existing research is often limited by small sample sizes and inconsistent findings.
- Variations in treatment and prescribing practices are observed internationally.
Key Insights:
- There is a pressing need for more randomized controlled trials (RCTs) in pediatric mental health.
- Translational research efforts have lagged, impacting evidence-based treatment delivery.
- Definitive data on psychopharmacologic treatments, including dosing and polypharmacy, are insufficient.
Outlook:
- Future research should focus on generating robust RCT data to inform clinical guidelines.
- Addressing data limitations is crucial for coherent clinical treatment of childhood psychopathology.
- Enhanced translation of research findings is essential for improving child mental health outcomes.
Abstract:
The pressing need for more randomized controlled trials (RCTs) of treatments for childhood mental disorders has been emphasized by researchers and clinicians as well as in recent commentaries in JCPP (e.g. Stringaris, 2014). Despite the significant increase in research on aetiology, course and antecedents of developmental psychopathology more generally, and the numerous important discoveries that have been made in this domain in the last two decades, the translation of these findings into clinical practice has lagged behind (Insel and Gotay, 2014). Currently, based on limitations in the extant literature, treatment decisions by child mental health clinicians are still made largely based on personal anecdotal experience. Consistent with this, wide variation in prescribing practices have been found by region internationally (Steinhausen, 2015). When it comes to psychotherapeutic interventions, these clinical strategies are often driven by the limited availability of empirically supported treatments in any given community. In the case of psychopharmacologic treatments, while some clinical guidelines are now available, much more definitive data are needed to inform indications, optimal dosing and duration of treatment, uses of polypharmacy, as well as more nuanced information about differential developmental effects. Therefore, a significant gap still exists between clinical practice and the empirical database in the treatment of child mental disorders. Further, the available database is also limited by small sample sizes and mixed findings, making it much less straightforward to coherently guide clinical treatment of childhood psychopathology.
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