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Objective: Meta-analyze the literature on posttraumatic stress (PTS) symptoms in youths post-disaster. Method: Meta-analytic synthesis of the literature (k = 96 studies; [N.sub.total] = 74,154) summarizing the magnitude of associations between disasters and youth PTS, and key factors associated with variations in the magnitude of these associations. We included peer-reviewed studies published prior to 1/1/2009 that quantitatively examined youth PTS ([less than or equal to] 18 years at event) after a distinct and identifiable disaster. Results: Despite variability across studies, disasters had a significant effect on youth PTS (small-to-medium magnitude; [r.sup.pooled] = .19, [SE.sub.r] = .03; d = 0.4). Female gender ([r.sup.pooled] = .14), higher death toll (disasters of death toll [less than or equal to] 25: [r.sup.pooled] = .09; VS. disasters with [greater than or equal to] 1,000 deaths: [r.sub.pooled] = .22), child proximity ([r.sup.pooled] = .33), personal loss ([r.sub.pooled] = .16), perceived threat ([r.sub.pooled] = .34), and distress ([r.sub.pooled] = .38) at time of event were each associated with increased PTS. Studies conducted within 1 year post-disaster, studies that used established measures, and studies that relied on child-report data identified a significant effect. Conclusion: Youths are vulnerable to appreciable PTS after disaster, with preexisting child characteristics, aspects of the disaster experience, and study methodology each associated with variations in the effect magnitude. Findings underscore the importance of measurement considerations in post-disaster research. Areas in need of research include the long-term impact of disasters, disaster-related media exposure, prior trauma and psychopathology, social support, ethnicity/race, prejudice, parental psychopathology, and the effects of disasters in developing regions of the world. Policy and clinical implications are discussed. Keywords: disasters, posttraumatic stress, child, PTSD, trauma Supplemental materials: http://dx.doi.org/10.1037/a0021482.supp DOI: 10.1037/a0021482

Objective: This study examined the feasibility, acceptability, and effects of Camp Cope-A-Lot (CCAL), a computer-assisted cognitive behavioral therapy (CBT) for anxiety in youth. Method: Children (49; 33 males) ages 7-13 (M = 10.1 [+ or -] 1.6: 83.7% Caucasian, 14.2% African American, 2% Hispanic) with a principal anxiety disorder were randomly assigned to (a) CCAL, (b) individual CBT (ICBT), or (c) a computer-assisted education, support, and attention (CESA) condition. All therapists were from the community (school or counseling psychologists, clinical psychologist) or were PsyD or PhD trainees with no experience or training in CBT for child anxiety. Independent diagnostic interviews and self-report measures were completed at pre- and posttreatment and 3-month follow-up. Results: At posttreatment, ICBT or CCAL children showed significantly better gains than CESA children; 70%, 81%, and 19%, respectively, no longer met criteria for their principal anxiety diagnosis. Gains were maintained at follow-up, with no significant differences between ICBT and CCAL. Parents and children rated all treatments acceptable, with CCAL and ICBT children rating higher satisfaction than CESA children. Conclusions: Findings support the feasibility, acceptability and beneficial effects of CCAL for anxious youth. Discussion considers the potential of computer-assisted treatments in the dissemination of empirically supported treatments. Keywords: child anxiety, cognitive behavioral therapy, computer, computer-based treatment DOI: 10.1037/a0019739

Data from a randomized clinical trial comparing the relative efficacy of individual cognitive--behavioral therapy (ICBT), family CBT (FCBT), and a family-based education/support/attention control (FESA) condition were used to examine associations between in-session therapeutic techniques related to parent training (PT) and treatment outcomes. This study explored the extent to which therapists' use of PT techniques, specifically (a) parental anxiety management, (b) transfer of control from therapist to parent to child over child's coping, (c) communication skills training, and (d) contingency management training, contributed to treatment outcome in family-based CBT. Children (N = 53; 31 males; 7.8-13.8 years of age; M = 10.1 years, SD = 2.3; 85% Caucasian, 9% African American, 4% Asian, 2% 'other' background) with a principal anxiety disorder completed 16 sessions of CBT with their parents. The relative contributions of PT components on treatment outcome were evaluated. As hypothesized, both transfer-of-control and parental anxiety management techniques significantly contributed to improvement on clinician and parent ratings of child global functioning within FCBT. PT did not significantly contribute to improvement on measures of child anxiety. These preliminary findings suggest that when FCBT is conducted for child anxiety, PT (i.e., transfer-of-control and parental anxiety management techniques) may contribute to improvements in the child's global functioning. Keywords: child/adolescent, anxiety, parent training, cognitive-behavioral therapy

Therapy process research helps delineate common and specific elements essential to positive outcomes as well as develop best practice training protocols. Child involvement and therapist flexibility were rated in 63 anxious youth (ages 8-14) who received cognitive--behavioral therapy. Therapist flexibility, defined as therapist attempts to adapt treatment to a child's needs, was hypothesized to act as an engagement strategy that serves to increase child involvement during therapy. Flexibility was significantly related to increases in later child engagement, which subsequently predicted improvement in post-treatment diagnosis and impairment. Therapist flexibility was not associated with earlier measures of child engagement, so a mediation model could not be supported. It was also hypothesized that the impact of flexibility would be greatest for cases who began treatment highly disengaged (i.e., early involvement would moderate the effect of flexibility). Basic descriptive data supported this model, but formal analyses failed to confirm. Further descriptive analyses suggest therapists employ a range of adaptations and a profile of flexible applications within a manual-based treatment is provided. Treatment, measurement, and dissemination issues are discussed. Keywords: child; anxiety; psychotherapy process; therapist flexibility; client involvement

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive-behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention (FESA; N = 39). Children in FCBT engaged in exposure tasks in Sessions 9-16, whereas FESA participants did not. Alliance growth curves of FCBT and FESA youths were compared to examine the impact of exposure tasks on the shape of the alliance (between-subjects). Within FCBT, the shape of alliance prior to exposure tasks was compared with the shape of alliance following exposure tasks (within-subjects). Therapist, child, mother, and father alliance ratings indicated significant growth in the alliance across treatment sessions. Initial alliance growth was steep and subsequently slowed over time, regardless of the use of exposure tasks. Data did not indicate a rapture in the therapeutic alliance following the introduction of in-session exposures. Results are discussed in relation to the processes, mediators, and ingredients of efficacious interventions as well as in terms of the dissemination of empirically supported treatments. Keywords: alliance, cognitive-behavioral therapy (CBT), anxiety disorders, child, growth curve modeling

The authors address concerns regarding manual-based treatments, highlighting the role of flexibility and creativity. A cognitive-behavioral therapy for youth anxiety called the Coping Cat program demonstrates the flexible application of manuals and emphasizes the importance of a child-centered, personalized approach that involves the child in the treatment process.

This study examined associations between televised news regarding risk for future terrorism and youth outcomes and investigated the effects of training mothers in an empirically based approach to addressing such news with children. This approach--Coping and Media Literacy (CML)--emphasized modeling, media literacy, and contingent reinforcement and was compared via randomized design to Discussion as Usual (DAU). Ninety community youth (aged 7-13 years) and their mothers viewed a televised news clip about the risk of future terrorism, and threat perceptions and state anxiety were assessed preclip, postclip, and postdiscussion. Children responded to the clip with elevated threat perceptions and anxiety. Children of CML-trained mothers exhibited lower threat perceptions than DAU youth at postclip and at postdiscussion. Additionally, CML-trained mothers exhibited lower threat perceptions and state anxiety at postclip and postdiscussion than did DAU mothers. Moreover, older youth responded to the clip with greater societal threat perception than did younger youth. Findings document associations between terrorism-related news, threat perceptions, and anxiety and support the utility of providing parents with strategies for addressing news with children. Implications and research suggestions are discussed. Keywords: terrorism, anxiety, threat, media, children

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and l-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed. Keywords: anxiety, children, treatment, cognitive-behavioral therapy, family therapy

The authors investigated features of self-statements as predictors of anxiety in children with and without anxiety disorder (AD) and as a mediator of treatment of ADs in children. Children (N = 145) between the ages of 9 and 13 years participated (71 AD youth, 84 controls). Self-statements were classified by valence and content. Results indicated that children's anxious, but not positive or depressed, self-statements significantly predicted anxiety in children with and without AD. For children with AD, changes in anxious self-statements mediated treatment gains, replicating a previously reported finding. A states of mind ratio mediated only 1 outcome measure, and positive and depressive cognitions served no mediating role. The impact of anxious self-talk on children's adjustment and implications for cognitive theory of anxiety in children are discussed. Keywords: child, anxiety, treatment, mediators, cognitive change

The utility of parent- and child- reported social fears for reaching a diagnosis of social phobia in youth is evaluated by examining the diagnostic utility of the number of fears and specific feared social situations. Analysis indicates that 4 parent-endorsed social fears optimally distinguish youth with and without social phobia, but child-reported social fears are recorded.

The role and implementation of evidence-based practice and empirically supported treatments has been hotly contested among researchers and practitioners. Using examples of and from various empirically supported treatments the authors offer suggestions for smoothing the pathway for dissemination of evidence-based practice with children and adolescents. The authors underscore that mediational analyses, treatment process studies, and the continued creation of flexible treatment manuals as important components of successful dissemination. Flexibility within fidelity is proposed as the preferred perspective that eases the transition and dissemination of empirically supported treatments from research clinics to service clinics. Keywords: evidence-based practice, empirically supported treatments, children and adolescents, flexibility within fidelity, treatment manuals

The authors C.R. Snyder and T.R. Elliott in their article, 'Twenty-First Century Graduate Education in Clinical Psychology: A Four Level Matrix Model' (this issue, pp. 1033-1054), reflect on the nature of training needed for optimal clinical psychologists, and offer suggestions for such training within a matrix model. Their position is largely consistent with current American Psychological Association preferences and general training guidelines, and has historical precedence. Indeed. the ideas, though not new or radical, are very sound. Amen, the wheel remains round. Keywords: clinical psychology graduate education; integrative training model; positive psychology

Explored the specific behavior of therapist contributing to a child client's perception of a therapeutic alliance with youth (n = 56) who received a manualized cognitive--behavioral treatment for anxiety disorders. The first 3 sessions were coded for 11 therapist behaviors hypothesized to predict ratings of alliance. Child, therapist, and observer alliance ratings were gathered after the 3rd and 7th therapy sessions. 'Collaboration' positively predicted early child ratings of alliance, and 'finding common ground' and 'pushing the child to talk' negatively predicted early child ratings of alliance. Although no coded therapist behaviors predicted early therapist ratings of alliance, 'collaboration' and 'not being overly formal' positively predicted therapist alliance ratings by Session 7. Child, observer, and therapist ratings of alliance were significantly correlated. Results are discussed with regard to the identified behavior of the therapist as a step toward the identification of empirically supported strategies for building a stronger child--therapist alliance.

Ratings of child involvement in manual-based cognitive-behavioral treatment for anxiety were associated with the absence of primary anxiety diagnosis and reductions in impairment ratings at posttreatment for 59 children with anxiety (ages 8-14 years). Good-to-excellent interrater reliability was established for the independent ratings of 237 therapy sessions, and strong psychometrics were established for the involvement measure. Child involvement at midtreatment, just prior to in vivo exposures, was positively associated with treatment gains but earlier involvement was not. Increased involvement during therapy (positive involvement shifts) may provide a useful index of change and may also predict outcomes. Involvement was not associated with client demographics or diagnostic category. Implications for treatment and measurement of psychotherapy process within manual-based treatments are discussed.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self-and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.

This article makes observations about policy implications and offers a combination of commentary and recommendation regarding the special issue on the impact of childhood psychopathology interventions on subsequent substance abuse. The authors mention forward-looking directives to expand the mandate for early intervention, to expand the research agenda for randomized clinical trials, and to develop a policy-oriented evidence base. They also note topics that require consideration and offer recommendations with regard to how to proceed. The special issue, as well as this discussion, will spark thought and action directed toward the evaluation of interventions for youths to assess the degree to which treating mental disorders has beneficial effects on the sequelae of the initial intervention target.

This collection of articles follows prior special issues' on behavioral medicine published in the Journal of Consulting and Clinical Psychology in 1982 and 1992. From the vantage point of the Decade of Behavior, the field has grown in scope, depth of basic science foundations, and evidence of applied utility. Yet many challenges remain--especially in addressing a wide range of health problems across diverse populations and in a health care context characterized by rapid changes in technology and by a growing concern with costs and evidence-based practice.

This article discusses the application of homework tasks in an empirically supported treatment for children (aged 8-13 years) with anxiety disorders. Within this program, homework tasks--through practice and rehearsal in the child's natural environment--are an important ingredient to enable the child to increase his or her mastery of the information/skills covered in each session. The homework tasks also provide an opportunity for the therapist to check the child's grasp of the session content through unassisted application of the material. This article discusses issues that arise in the application of homework tasks with a child population (e.g., compliance). Homework in both child- and family-focused treatment is discussed. The issues addressed regarding homework, although raised in the context of anxious children in a cognitive behavioral treatment program, may be broadly applied to children in psychotherapy. Keywords: child; anxiety disorders; CBT; homework

This article identifies and addresses three methodological domains relevant to the treatment of anxiety disorders in youth: (a) procedural matters, (b) the assessment of anxious distress, and (c) the analysis of treatment-produced change. Procedural topics include the need to manualize treatment, have diversity among participants and comparability of the duration of treatment and control conditions, and control for medication status. Multiple-method measurement issues include child and parent reports, observations, and structured interviewing. Our examination of change issues considers comorbidity, analyzing the intent-to-treat sample, treatment 'spillover,' and clinical as well as statistical significance. Problems are identified and potential ameliorative strategies are offered. KEY WORDS: Anxiety; therapy research methods; child treatment; clinical and statistical significance; anxiety measurement.

This article introduces the special section of the Journal of Consulting and Clinical Psychology on empirically supported psychological therapies. After a discussion of the rationale for the selection of the specific terms in the label, several justifications are considered for conducting and learning from empirical evaluations of psychological therapies. Finally, the process that guided the special section is described.

The present study explored the differences between completers and terminators (including both refusers and dropouts) of an individual cognitive-behavioral treatment for childhood anxiety. Participants were 190 children with anxiety disorders and their parents: 146 completed treatment and 44 terminated. Terminators were more likely to live in a single-parent household, be ethnic minorities, and self-report less anxious symptomatology. Follow-up interviews indicated that identifiable child factors were influential in terminators' decisions to discontinue treatment. Among terminators, differences between refusers and dropouts were also investigated.

Ninety-four children (aged 9-13 years) with anxiety disorders were randomly assigned to cognitive-behavioral treatment or waiting-list control. Outcomes were evaluated using diagnostic status, child self-reports, parent and teacher reports, cognitive assessment and behavioral observation; maintenance was examined using 1-year follow-up data. Analyses of dependent measures indicated significant improvements over time, with the majority indicating greater gains for those receiving treatment. Treatment gains returned cases to within nondeviant limits (i.e., normative comparisons) and were maintained at 1-year follow-up. Client age and comorbid status did not moderate outcomes. A preliminary examination of treatment segments suggested that the enactive exposure (when it follows cognitive-educational training) was an active force in beneficial change. Discussion includes suggestions for future research.

This study investigated the relationship between childhood anxiety disorders, the valence and content of self-statements, and the impact of treatment on the internal dialogue. Participants (151 8- to 13-year-olds) included 71 youth with anxiety disorders and 80 control participants. Positive and negative self-statements and a states-of-mind (SOM) ratio were examined. Results indicated that the negative self-statements and SOM ratio (but not positive self-statements) of children with anxiety disorders significantly predicted anxiety. Results also indicated that negative (but not positive cognition) and SOM ratio predicted improvement in anxiety after treatment and mediated treatment gains. Results of analyses to explore the content specificity hypothesis were mixed. The impact of negative self-talk on children's anxious symptomatology and favorable treatment outcome is discussed.

This study prospectively assessed the psychological effects of weight loss and regain (i.e., weight cycling) in obese women. Measures of mood, binge eating, restraint, disinhibition, and hunger were obtained from 55 participants at baseline, after 6 months of treatment, and 58 months posttreatment. Women lost 21.1 [+ or -] 8.4 kg after 6 months of treatment but were 3.6 [+ or -] 10.9 kg above baseline weight at the time of the follow-up. Contrary to expectations, after this 21-kg cycle of weight loss and regain, women reported significant improvements in mood and binge eating, as well as reductions in hunger and disinhibition. Restraint was unchanged from baseline to follow-up. These data suggest that weight loss and regain are not associated with long-term adverse psychological effects. The findings also confirm earlier reports of significant weight regain after treatment and underscore the need for research to improve the maintenance of weight loss.

This study examined the long-term effects of a psychosocial treatment for anxiety-disordered youth. Clients (N = 36) who had completed treatment 3.35 years earlier (on average) were reassessed using self- and parent-report instruments as well as structured diagnostic interviews. Results indicated that previously documented treatment gains were maintained. An examination of participants' recalled events within therapy suggested that the therapeutic relationship, games and activities, and discussion of problems were salient treatment components. Theoretically important components of treatment were also recalled by clients, and some were found to be related to long-term positive outcome.

The Positive Automatic Thoughts Questionnaire (ATQ-P) was developed as a tool for measuring the frequency of positive self-relevant thoughts automatically conceived by individuals. It is designed specifically as a positive counterpart to the original ATQ, which measures the frequency of negative self-statements. The ATQ-P is found to have stable reliability and acceptable convergent and discriminate validity.

This article reviews factors working against or in favor of the transportability of manual-based child treatments from research clinics to service practitioners. The review examines client factors, service-clinic therapist factors, and researcher factors that may contribute to the reported gap between research and practice outcomes. As requested for this special section, this article uses work with anxiety-disordered youths as an example of a potentially transportable manual-based treatment. Issues and future directions are discussed.

A developmental-ecological perspective is offered as a framework for prediction and prevention of antisocial behavior in children and adolescents. The primary assumptions of the approach and the advantages of such an approach for relating prediction, prevention, and implementation are highlighted. It is suggested that such an approach facilitates integration of the recent advances in prevention theory and methods, the accumulating knowledge about the causes and effective interventions for antisocial behavior, and the need for careful consideration of context. Six key advances in the field are listed, and important steps are suggested.

Cognitive-behavioral therapy has been applied to a number of different childhood disorders, including aggression, depression, anxiety and attention-deficit hyperactivity disorder. Research findings have generally shown good results from this form of therapy, especially in the treatment of aggression and impulsivity, although more research is needed. Areas needing further attention include family involvement, developmental factors, comorbidity and the clinical significance of change.

In this study a psychosocial treatment for 47 Ss (aged 9-13 years) with anxiety disorders was investigated. A 16-session cognitive- behavioral treatment was compared with a wait-list condition. Outcome was evaluated using child self-report, parent report, teacher report, cognitive assessment, and behavioral observations. Pretreatment-posttreatment changes and maintenance of gains at 1- year follow-up were examined. Results revealed that many treated Ss were found to be without a diagnosis at posttest and at follow-up and to be within normal limits on many measures. The child's perception of the therapeutic relationship and the therapist's perception of parental involvement were measured but were not related to outcome. Discussion focuses on characteristics of effective child therapy and the need for further research on treatment components and alternative treatment methods.

This article begins with a brief description of the guiding theory behind cognitive-behavioral interventions with youth, such as a therapeutic posture, an important cognitive distinction, and a specific treatment goal. Next, on the basis of a review of the literature, the nature of cognitive functioning, the treatments, and the outcome of treatment studies are described and examined for (a) aggression, (b) anxiety, (c) depression, and (d) attention-deficit hyperactivity. Conclusions and emerging developments are provided.

This summary blends the commentaries from the 6 articles in the special section on comorbidity Included is a discussion of various definitions of comorbidity, the merits and demerits of a hierarchical diagnostic system, and consideration of the extent, patterning, and nature of comorbidity Directive comments with reference to future intervention planning mention both assessment (distinguishing overlapping constructs) and treatment (sequencing and treatment manuals) issues., A summary of the special section on comorbidity is presnted, blending the commentaries of previous articles. A discussion of various definitions of comorbidity, the advantages and disadvantages of a hierarchical diagnostic system and the extent, patterning and nature of comorbidity is presented. Comments on future intervention planning focus on both assessment (distinguishing, overlapping constructs) and treatment (sequencing and treatment manual) issues.

Reviews the empirical literature on the comorbidity of anxiety and depressive disorders in youth, emphasizing prevalence of comorbidity, difficulties in assessment and measurement, familial factors, and developmental differences. The nature of anxiety and of depression in youth is examined (e.g., differentiating cognitive deficiencies from cognitive distortions), and treatment recommendations are presented from a cognitive-behavioral framework. Components of the treatment include affective education, enactive programming, addressing reinforcement difficulties, correcting cognitive distortions, and enhancing problem-solving skills. Peer and familial factors are discussed. Successful treatment of comorbid children relies on a flexible application of these strategies with consideration of the developmental level and particular symptom constellation of the individual child., Several theoretical and definitional issues concerning comorbidity are discussed and a review of literature on the comorbidity of anxiety and depression in children and adolescents is provided. Specific attention is directed to the treatment of anxiety, depression and comorbidity anxiety and depression. Treatment strategies that cover the overlapping and distinctive features of the disorders as well as familial and developmental factors that may affect treatment results are also examined.

Anxiety and depression in children and adolescents are reviewed, including differential diagnosis, assessment of symptoms, family history data, developmental features, and clinical correlates. Find indicate that 15.9% of 61.9% of children identified as anxious or depressed have comorbid anxiety and depressive disorders and that measures of anxiety and depression are highly correlated. Family history data are inconclusive. Differences emerged among children with anxiety, depression, or both disorders. Anxious children were distinguishable from the other 2 groups in that they showed less depressive symptomatology and tended to be younger. The concurrently depressed and anxious group tended to be older and more symptomatic. In this group, the anxiety symptoms tended to predate the depressive symptoms. Findings are discussed in the context of a proposed developmental sequence.

Healthy thinking involves cognitive information processing. Features of cognitive functioning (i.e., content, process, product, structure), with reference to behavioral and emotional adjustment, are described and discussed. Within these cognitive features specific differentiations are proposed and related research examined. An important content differentiation concerns positive versus negative thinking, and a principal processing differentiation concerns deficient information processing versus distorted processing. Both dysfunctional and functional cognitive distortion are examined. Areas in need of research attention are identified., Thinking is aform of cognitive functioning whose relationship to behavior remains an unresolved question. To elucidate this process and its role in behavior adjustment, cognition has been categorized into four features, namely, cognitive content, process, product and structure. This categorization has allowed an analysis of the literature by a process of differentiation within the features. Such an approach may significantly clarify the data in this field allowing a more scientific understanding of the psychologically healthy approaches to cognitive information processing.

When children or adolescents are clients in receipt of psychological treatment, there are specific issues that require attention. With regard to assessment and diagnosis, researchers and clinicians alike must pay attention to variations across sources of assessment data, the comorbidity of diagnoses, and the potential utility of a 'family' (as opposed to child) diagnosis. Considerations of 'Who is the client?' and the role of the therapeutic relationship in child therapy are discussed. Specific methodological recommendations regarding randomized clinical trials, control groups, the selection of dependent variables, the manualization of treatments, and the use of tests of clinical and statistical significance are presented. Specific topics for research are recommended.