DEVELOPMENTALLY APPROPRIATE INTERVENTIONS

FOR CHILDREN AND ADOLESCENTS

A LITERATURE REVIEW BY MATT BROSCH

WHAT IS A DEVELOPMENTALLY APPROPRIATE

INTERVENTION?• I’m glad you asked!

• Developmentally appropriate interventions are therapeutic modalities that are effective in treating the maladaptive or distressing components of a client’s life

• Take into account not only the client’s age, but the developmental milestones they may or may not have reached

• Developmentally appropriate interventions for minors are specifically used with children or adolescents, or are modified to suit the developmental needs of children or adolescents

• There are myriad therapeutic interventions that can be implemented in a developmentally appropriate manner

• Umm….like what?

EXAMPLES OF DEVELOPMENTALLY APPROPRIATE

INTERVENTIONS• Cognitive Behavioral Therapy

• Intergrates Cognitive and Behavioral interventions

• Dialectical Behavior Therapy

• Modifies CBT with the psycho-social aspects of Interpersonal Therapy

• Child-Parent Interaction Therapy

• Emphasizes improving parent-child relationship as means of helping child

• Play Therapy

• Self guided play that can be used as therapy or as a diagnostic tool

• Neurofeedback Therapy

• Trains children to be cognizant of their brain patterns in an attempt to affect them

COGNITIVE BEHAVIORAL THERAPY• Therapy that is focused on challenging maladaptive thoughts/beliefs and modifying maladaptive

behavior

• Cognitive aspects are downplayed when intervention is used on children younger than 12

• This is due to lack of formal operational thinking, which is a necessary component of cognitive-focused interventions

• Behavior becomes focus of treatment and modification

• Typically used in children over 12 years old due to importance of cognitive component

• Limited research has shown it to be effective with children as young as 5 years old

• This variety includes parental training and interaction

• Limited number of studies makes it difficult to draw a conclusion on CBT for children this young

DIALECTICAL BEHAVIOR THERAPY

• Therapeutic method that uses components of CBT combined with Interpersonal Therapy

• Interpersonal components focus on how the child interacts with adults and peers across a variety of environs and contexts

• Typically used with children 12 years and older due to emphasis on CBT component

• Was originally designed to treat Borderline Personality Disorder in women, but has recently been adopted for use in child-centered inpatient clinical settings

• Usually incorporates weekly group therapy as part of Interpersonal component

• Is one main advantage cited over CBT in clinical settings

• As a newer form of treatment, the research available is underwhelming

• Study in juvenile center resulted in inconclusive results, calling effectiveness of DBT into question

CHILD-PARENT INTERACTION THERAPY

• Form of therapy that focuses on improving quality of child-parent interactions

• Helps overcome early maladaptive attachment styles

• Useful when considering how maladaptive attachment affects subsequent development

• Typically used in children aged 2-7 years

• One of the few empirically supported treatment modalities available for children this young

• Treatment is more effective when mothers are emotionally stable

• Depressed mothers reported more severe child behaviors, but also reported greater reductions in behavioral problems after treatment

PLAY THERAPY

• Involves allowing child to play with toys while therapist evaluates play style/ communication methods

• Can be used as a form of treatment, or as a diagnostic tool in evaluating development

• Toys are specifically chosen by therapist to attain specific treatment goals

• Commonly used with children from 3-11 years old

• 11 may be too old for this form of therapy, but it will depend on developmental needs of child in question

• Has been shown to be especially effective when used in conjunction with Head Start programs at preschool and elementary levels

NEUROFEEDBACK THERAPY• Involves using electrodes to measure real-time brain activity via EEG, HEG, and fMRI

• Graphs are displayed for children to see and child attempts to alter pattern of brain activity

• Attempts to correct for poor self-regulation and lack of control over arousal

• Most commonly used to treat ADD and ADHD

• Typically used with children who are 11 years or older

• Requires concrete operational functioning/ abstract thinking

• Has been used in children as young as 5, although empirical support for this practice is nonexistent

• Treatment has been shown to be more effective when used with children who have histories of neglect or abuse

• It has not been empirically demonstrated why it is more effective with this population

OVERVIEW – DEVELOPMENTALLY APPROPRIATE

INTERVENTIONS• Play Therapy – Structured play therapy and diagnostic tool. Best when used with children younger than 11 years old or

those who have not yet developed sufficient cognitive capacity to engage in other forms of empirical treatment (CBT, DBT, etc.).

• Child-Parent Interaction Therapy – Designed to improve parent-child relationships. Best when used with children between 2 and 7 years old who haven’t developed a well adapted attachment style with one or more parents/caregivers.

• Neurofeedback Therapy – Self-regulation training construct. Best when utilized with children 11 and over who have developed the cognitive capacity to think abstractly. Conflicting empirical evidence on its efficacy.

• Dialectical Behavior Therapy – Combination of Interpersonal and CBT therapies that is best used with children 12 years and older. Evidence based intervention that includes individual and group components.

• Cognitive Behavioral Therapy – Challenges maladaptive thoughts and modifies behavior. Best used with children 12 years and older who have developed capacity for formal operational thinking. Most empirically supported form of developmentally appropriate interventions.

REFERENCES• Minde, K., Roy, J., & Hashemi, A. (2010). Effectiveness of CBT in 3-7 Year Old Anxious Children. Journal of

the Canadian Academy of Child and Adolescent Psychiatry, vol. 5, p. 109-115.

• Langer, D., Chiu, A., McLeod, B., Har, K., Drahota, A., Galla, B., Jacobs, J., Ifekwunigwe, M., & Wood, J. (2013). Effectiveness of Modular CBT for Child Anxiety in Elementary Schools. School Psychology Quarterly, vol. 28 (no. 2), p. 141-153.

• Trupin, E., Stewart, D., Beach, B., &Boesky, L. (2002). Effectiveness of a Dialectical Behavior Therapy Program for Incarcerated Female Juvenile Offenders. Child and Adolescent Mental Health, vol. 7 (no. 3), p. 121-127.

• Timmer, S., Ho, L., Uriquiza, A, Zebell, N., Garcia, E., & Boys, D. (2011). The Effectiveness of Parent-Child Interaction Therapy with Depressive Mothers: The Changing Relationship as the Agent of Individual Change. Child Psychiatry and Human Development, vol. 42, p. 406-423.

• Huang-Storms, L. (2013). QEEG-guided Neurofeedback for Children with Histories of Abuse and Neglect: Neurodevelopmental Rationale and Pilot Study. Journal of Neurotherapy, vol. 10 (no. 4), p. 3-16.

• Bratton, S., Ceballos, P., Sheely-Moore, A., Meany-Walen, K., Pronchenko, Y., & Jones, L. (2013). Head Start Early Mental Health Intervention: Effects of Child-Centered Play Therapy on Disruptive Behaviors. International Journal of Play Therapy, vol. 22, p. 28-42.