Riise Eili N, Wergeland Gro Janne H, Njardvik Urdur, Öst Lars-Göran
Department of Child and Adolescent Psychiatry, District General Hospital of Førde, Førde, Norway.
Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
Clin Psychol Rev. 2021 Feb;83:101954. doi: 10.1016/j.cpr.2020.101954. Epub 2020 Dec 7.
Various Cognitive Behavioral Therapy (CBT) programs for externalizing disorders in children and adolescents are supported by a substantial body of empirical evidence. Most of the research evidence comes from efficacy studies conducted in university settings, but there is less knowledge about the effect of these treatments in routine clinical care. The purpose of this meta-analysis was to investigate the effectiveness of CBT in non-university settings for Attention Deficit Hyperactivity Disorder (ADHD), Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to May 2020. In total, 51 treatment effectiveness studies involving 5295 patients were included. The average within-group effect size at post-treatment was significant (g = 0.91), and there were large effect sizes for both ADHD (g = 0.80) and CD/ODD (g = 0.98). At post treatment, remission rates were 38% for ADHD and 48% for CD/ODD, and the overall attrition rate was 14%. Benchmarking against efficacy studies showed that CBT in routine clinical care yields remission rates, within-group effect sizes and attrition rates that are very similar to those found in university settings. The findings support the transportability of CBT for externalizing disorders from university settings to routine clinical care. PROSPERO registration: CRD42020147524.
大量实证证据支持了针对儿童和青少年外化性障碍的各种认知行为疗法（CBT）项目。大部分研究证据来自于在大学环境中进行的疗效研究，但对于这些治疗方法在常规临床护理中的效果了解较少。这项荟萃分析的目的是调查在非大学环境中，CBT 对注意力缺陷多动障碍（ADHD）、品行障碍（CD）和对立违抗性障碍（ODD）的有效性。我们系统检索了 Embase OVID、Ovid MEDLINE 和 PsycINFO 数据库，以查找截至 2020 年 5 月发表的符合条件的研究。总共纳入了 51 项涉及 5295 名患者的治疗效果研究。治疗后组内平均效应量显著（g = 0.91），ADHD（g = 0.80）和 CD/ODD（g = 0.98）的效应量都很大。治疗后，ADHD 的缓解率为 38%，CD/ODD 的缓解率为 48%，总体脱落率为 14%。与疗效研究进行对比发现，常规临床护理中的 CBT 产生的缓解率、组内效应量和脱落率与大学环境中的非常相似。这些发现支持了 CBT 用于外化性障碍从大学环境到常规临床护理的可移植性。PROSPERO 注册号：CRD42020147524。
