Adolescence - Parenting in Treatment

Question 1

Reynolds et al (2012)

Answer 1

Meta-analysis indicating no significant difference between child-only and child-parent interventions for ADs in both children and adolescents, but few studies powered to address possible age effects, and where addressed, results inconsistent

Suggests no need to involve parents here, compatible with adolescents’ strive for autonomy, but perhaps within-adolescence differences e.g., earlier adolescence more emotionally volatile (Larson et al., 2002; Steinberg, 2005)

Question 2

Waite et al (2019)

Answer 2

RCT of Internet-delivered CBT for adolescent ADs in routine clinical care with and without parent sessions

Used BRAVE-ONLINE for Teenagers (Spence et al., 2006), assessed by Spence et al (2011) as significantly better outcomes than waitlist at posttreatment, with increases to ~80% remission at 12mo follow-up, comparable to CAMS (Walkup et al., 2008), but this used parent sessions, here having these as key variable

No significant difference posttreatment between immediate treatment and waitlist in remission of primary AD, but similar to Spence et al (2011), showing extension of findings into routine practice from research settings

Parent sessions didn’t significantly improve adolescent outcomes immediately or at 6mo follow-up > but generally some involvement in adolescent’s treatment even if not directly involved such as discussing content, so may not be necessary to dedicate resources for parent-sessions in adolescents (but no health economics measures)

Question 3

Cardy et al (2020)

Answer 3

Reviewed 24 studies of CBT for adolescents with variety of methods of parental involvement (separate sessions, joint sessions, both, or workbook), with content varying but mainly targeting parental understanding of CBT components and teaching skills to manage adolescent anxiety

Concluded CBT with parental involvement effective, but only one study allowed assessment of parent vs parentless, and that was Waite et al (2019)

Only half of studies RCTs

Question 4

Overall Argument

Answer 4

Limited understanding, and future studies need to be RCTs comparing both active and waitlist comparator arms with and without parental involvement, as well as being both in-person and online, and including health economics measures

Inclusion of different age groups within-adolescence would allow fine-grained developmental assessment

May improve only moderate CBT (James et al., 2013, 2020), with mix of evidence of age effects (Bennett et al., 2013; Ginsburg et al., 2011; James et al., 2013, 2020)