Ollendick Thomas H, Jarrett Matthew A, Grills-Taquechel Amie E, Hovey Laura D, Wolff Jennifer C
Department of Psychology, Child Study Center, Virginia Polytechnic Institute and State University, Blacksburg, VA 24060, United States.
Clin Psychol Rev. 2008 Dec;28(8):1447-71. doi: 10.1016/j.cpr.2008.09.003. Epub 2008 Sep 17.
In the present review, we examine one of the critical issues that have been raised about evidence-based treatments and their portability to real-world clinical settings: namely, the presence of comorbidity in the participants who have been treated in these studies and whether the presence of comorbidity predicts or moderates treatment outcomes. In doing so, we examine treatment outcomes for the four most commonly occurring childhood psychiatric disorders: Anxiety disorders, affective disorders, attention deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD)/conduct disorder (CD). For each of these disorders, we first review briefly the prevalence of comorbidity in epidemiological and clinical samples and then highlight the evidence-based treatments for these disorders. We next determine the effects of comorbidity on treatment outcomes for these disorders. For the most part, comorbidity in the treated samples is the rule, not the exception. However, the majority of studies have not explored whether comorbidity predicts or moderates treatment outcomes. For the not insignificant number of studies that have examined this issue, comorbidity has not been found to affect treatment outcomes. Notable exceptions are highlighted and recommendations for future research are presented.
在本综述中，我们探讨了关于循证治疗及其在现实临床环境中的适用性所引发的一个关键问题：即在这些研究中接受治疗的参与者中合并症的存在情况，以及合并症的存在是否预测或调节治疗结果。在此过程中，我们研究了四种最常见的儿童精神疾病的治疗结果：焦虑症、情感障碍、注意力缺陷多动障碍（ADHD）和对立违抗障碍（ODD）/品行障碍（CD）。对于每种疾病，我们首先简要回顾流行病学和临床样本中合并症的患病率，然后重点介绍这些疾病的循证治疗方法。接下来，我们确定合并症对这些疾病治疗结果的影响。在很大程度上，接受治疗样本中的合并症是常态，而非例外。然而，大多数研究并未探讨合并症是否预测或调节治疗结果。对于已研究此问题的数量可观的研究而言，尚未发现合并症会影响治疗结果。文中突出了显著的例外情况，并提出了未来研究的建议。
