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The Efficacy of Psychoanalysis for Children with Disruptive Disorders

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ABSTRACT

Objective

This paper describes a chart review of 763 cases of child psychoanalysis and psychotherapy at the Anna Freud Centre, and illustrates its usefulness by examining predictors of treatment outcome in children with disruptive disorders.

Method

135 children and adolescents with a principal diagnosis of disruptive disorder were individually matched with others suffering from emotional disorders. Outcome was indicated by diagnostic change and change in overall adaptation (clinically significant improvement or return to normal functioning).

Results

Improvement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improvement was more frequent among children with oppositional defiant disorder (56%) than those with attention deficit hyperactivity disorder (36%) or conduct disorder (23%). However, 31 % of the children terminated treatment within 1 year. Of those disruptive children who remained in treatment more than 1 year, 69% were no longer diagnosable on termination. Fifty-eight percent of the variance in outcome ratings could be accounted for within this group. The crucial variables in predicting attrition and symptomatic improvement were found to be quite different in the disruptive and emotional groups.

Conclusion

Although the study has several methodological limitations, it does suggest demographic, clinical, and diagnostic characteristics of those disruptive children most likely to benefit from intensive and nonintensive psychodynamic treatment.

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    This paper is dedicated to George Moran, late Director of the Anna Freud Centre, who established this study. We gratefully acknowledge the guidance of Professors Donald Cohen and Alan Kazdin, Yale University; also our research team, especially Maureen Parr and Maria Branagan. Linda Mayes, M.D., William Young, M.D., Alison Westman, M.D., and Anna Higgitt, M.D., provided independent validation of psychiatric diagnoses. James Hampton, Ph.D. advised on the statistical analysis.

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    Copyright © 1994 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.