Treatment enigma for disturbed kids.

In many health-care programs, clinicians who treat children's emotional and behavioral problems face mounting pressures to specify how much therapy kids really need.

Scant research has tracked youngsters receiving mental-health treatment outside university-based programs. Two new studies, both published in the February JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, venture into the real world of child mental-health services.

However, their clashing conclusions about what to expect from such treatment are sure to frustrate health-care insurers.

One investigation, directed by psychiatrist Adrian Angold of Duke University Medical Center in Durham, N.C., finds that seriously disturbed kids who attend at least eight sessions of psychotherapy or other mental-health care improve markedly and continue to progress as they get more treatment. The other study, led by psychologist Ana Regina Andrade of Vanderbilt University in Nashville, reveals comparable improvement in groups of children receiving either little or lots of psychotherapy.

Over 4 years, Angold's group conducted interviews and surveys with 1,422 children, ages 9 to 16, and their parents. Participants came from rural, largely low-income areas of North Carolina. As a large part of their sample, the researchers included children who, according to their parents, had behavior problems.

During the study, 365 children received some form of mental-health treatment. Most sought private psychotherapy or services at public mental-health centers. Kids who got such help had previously displayed more anxiety, depression, and problems in social and home life than untreated youngsters had. Symptoms had been worsening before they or their parents sought help. Eight or more treatment sessions lessened anxiety and depression, although many of the kids' other problems remained. Symptoms continued to recede as youngsters received more treatment. Those who attended fewer than eight sessions showed no improvement or, in some cases, got worse.

Andrade's team studied 568 youngsters who were having social and behavioral problems. These kids, ages 5 to 17, came from middle-class, military families. Each child was assessed at one of three military mental-health centers, where 531 kids then received at least one session of psychotherapy.

Most of the 568 children improved over the 1-year study. No differences emerged between those who received little or no psychotherapy and those who attended eight or more sessions.

Contrasts between the two studies--in kids' backgrounds and definitions of clinical improvement, for instance--virtually ensured different findings, says psychologist Kimberly Hoagwood of the National Institute of Mental Health in Bethesda, Md., in a comment published in the same journal.

Neither project tried to illuminate how specific therapeutic approaches worked for certain children, Hoagwood adds. This critical issue merits intensive research, in her view.