Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review / Chris HOLLIS in Journal of Child Psychology and Psychiatry, 58-4 (April 2017)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 58-4 (April 2017) . - p.474-503 Titre : Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review Type de document : Texte imprimé et/ou numérique Auteurs : Chris HOLLIS, Auteur ; Caroline J. FALCONER, Auteur ; Jennifer L. MARTIN, Auteur ; Craig WHITTINGTON, Auteur ; Sarah STOCKTON, Auteur ; Cris GLAZEBROOK, Auteur ; E. Bethan DAVIES, Auteur Article en page(s) : p.474-503 Langues : Anglais (eng) Mots-clés : Digital health  mental health  eHealth  methodology  randomised controlled trials  prevention Index. décimale : PER Périodiques Résumé : Background Digital health interventions (DHIs), including computer-assisted therapy, smartphone apps and wearable technologies, are heralded as having enormous potential to improve uptake and accessibility, efficiency, clinical effectiveness and personalisation of mental health interventions. It is generally assumed that DHIs will be preferred by children and young people (CYP) given their ubiquitous digital activity. However, it remains uncertain whether: DHIs for CYP are clinically and cost-effective, CYP prefer DHIs to traditional services, DHIs widen access and how they should be evaluated and adopted by mental health services. This review evaluates the evidence-base for DHIs and considers the key research questions and approaches to evaluation and implementation. Methods We conducted a meta-review of scoping, narrative, systematic or meta-analytical reviews investigating the effectiveness of DHIs for mental health problems in CYP. We also updated a systematic review of randomised controlled trials (RCTs) of DHIs for CYP published in the last 3 years. Results Twenty-one reviews were included in the meta-review. The findings provide some support for the clinical benefit of DHIs, particularly computerised cognitive behavioural therapy (cCBT), for depression and anxiety in adolescents and young adults. The systematic review identified 30 new RCTs evaluating DHIs for attention deficit/hyperactivity disorder (ADHD), autism, anxiety, depression, psychosis, eating disorders and PTSD. The benefits of DHIs in managing ADHD, autism, psychosis and eating disorders are uncertain, and evidence is lacking regarding the cost-effectiveness of DHIs. Conclusions Key methodological limitations make it difficult to draw definitive conclusions from existing clinical trials of DHIs. Issues include variable uptake and engagement with DHIs, lack of an agreed typology/taxonomy for DHIs, small sample sizes, lack of blinded outcome assessment, combining different comparators, short-term follow-up and poor specification of the level of human support. Research and practice recommendations are presented that address the key research questions and methodological issues for the evaluation and clinical implementation of DHIs for CYP. En ligne : http://dx.doi.org/10.1111/jcpp.12663 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=305 [article] Annual Research Review: Digital health interventions for children and young people with mental health problems – a systematic and meta-review [Texte imprimé et/ou numérique] / Chris HOLLIS, Auteur ; Caroline J. FALCONER, Auteur ; Jennifer L. MARTIN, Auteur ; Craig WHITTINGTON, Auteur ; Sarah STOCKTON, Auteur ; Cris GLAZEBROOK, Auteur ; E. Bethan DAVIES, Auteur . - p.474-503. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 58-4 (April 2017) . - p.474-503 Mots-clés : Digital health  mental health  eHealth  methodology  randomised controlled trials  prevention Index. décimale : PER Périodiques Résumé : Background Digital health interventions (DHIs), including computer-assisted therapy, smartphone apps and wearable technologies, are heralded as having enormous potential to improve uptake and accessibility, efficiency, clinical effectiveness and personalisation of mental health interventions. It is generally assumed that DHIs will be preferred by children and young people (CYP) given their ubiquitous digital activity. However, it remains uncertain whether: DHIs for CYP are clinically and cost-effective, CYP prefer DHIs to traditional services, DHIs widen access and how they should be evaluated and adopted by mental health services. This review evaluates the evidence-base for DHIs and considers the key research questions and approaches to evaluation and implementation. Methods We conducted a meta-review of scoping, narrative, systematic or meta-analytical reviews investigating the effectiveness of DHIs for mental health problems in CYP. We also updated a systematic review of randomised controlled trials (RCTs) of DHIs for CYP published in the last 3 years. Results Twenty-one reviews were included in the meta-review. The findings provide some support for the clinical benefit of DHIs, particularly computerised cognitive behavioural therapy (cCBT), for depression and anxiety in adolescents and young adults. The systematic review identified 30 new RCTs evaluating DHIs for attention deficit/hyperactivity disorder (ADHD), autism, anxiety, depression, psychosis, eating disorders and PTSD. The benefits of DHIs in managing ADHD, autism, psychosis and eating disorders are uncertain, and evidence is lacking regarding the cost-effectiveness of DHIs. Conclusions Key methodological limitations make it difficult to draw definitive conclusions from existing clinical trials of DHIs. Issues include variable uptake and engagement with DHIs, lack of an agreed typology/taxonomy for DHIs, small sample sizes, lack of blinded outcome assessment, combining different comparators, short-term follow-up and poor specification of the level of human support. Research and practice recommendations are presented that address the key research questions and methodological issues for the evaluation and clinical implementation of DHIs for CYP. En ligne : http://dx.doi.org/10.1111/jcpp.12663 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=305

Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review / Craig WHITTINGTON in Journal of Child Psychology and Psychiatry, 57-9 (September 2016)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Titre : Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review Type de document : Texte imprimé et/ou numérique Auteurs : Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur Article en page(s) : p.988-1004 Langues : Anglais (eng) Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292 [article] Practitioner Review: Treatments for Tourette syndrome in children and young people – a systematic review [Texte imprimé et/ou numérique] / Craig WHITTINGTON, Auteur ; Mary PENNANT, Auteur ; Tim KENDALL, Auteur ; Cristine GLAZEBROOK, Auteur ; Penny TRAYNER, Auteur ; Madeleine GROOM, Auteur ; Tammy HEDDERLY, Auteur ; Isobel HEYMAN, Auteur ; Georgina JACKSON, Auteur ; Stephen JACKSON, Auteur ; Tara MURPHY, Auteur ; Hugh RICKARDS, Auteur ; Mary ROBERTSON, Auteur ; Jeremy STERN, Auteur ; Chris HOLLIS, Auteur . - p.988-1004. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 57-9 (September 2016) . - p.988-1004 Mots-clés : Paediatrics  Tourette syndrome  therapy  tics Index. décimale : PER Périodiques Résumé : Background Tourette syndrome (TS) and chronic tic disorder (CTD) affect 1–2% of children and young people, but the most effective treatment is unclear. To establish the current evidence base, we conducted a systematic review of interventions for children and young people. Methods Databases were searched from inception to 1 October 2014 for placebo-controlled trials of pharmacological, behavioural, physical or alternative interventions for tics in children and young people with TS or CTD. Certainty in the evidence was assessed with the GRADE approach. Results Forty trials were included [pharmacological (32), behavioural (5), physical (2), dietary (1)]. For tics/global score there was evidence favouring the intervention from four trials of ?2-adrenergic receptor agonists [clonidine and guanfacine, standardised mean difference (SMD) = ?0.71; 95% CI ?1.03, ?0.40; N = 164] and two trials of habit reversal training (HRT)/comprehensive behavioural intervention (CBIT) (SMD = ?0.64; 95% CI ?0.99, ?0.29; N = 133). Certainty in the effect estimates was moderate. A post hoc analysis combining oral clonidine/guanfacine trials with a clonidine patch trial continued to demonstrate benefit (SMD = ?0.54; 95% CI ?0.92, ?0.16), but statistical heterogeneity was high. Evidence from four trials suggested that antipsychotic drugs improved tic scores (SMD = ?0.74; 95% CI ?1.08, ?0.40; N = 76), but certainty in the effect estimate was low. The evidence for other interventions was categorised as low or very low quality, or showed no conclusive benefit. Conclusions When medication is considered appropriate for the treatment of tics, the balance of clinical benefits to harm favours ?2-adrenergic receptor agonists (clonidine and guanfacine) as first-line agents. Antipsychotics are likely to be useful but carry the risk of harm and so should be reserved for when ?2-adrenergic receptor agonists are either ineffective or poorly tolerated. There is evidence that HRT/CBIT is effective, but there is no evidence for HRT/CBIT alone relative to combining medication and HRT/CBIT. There is currently no evidence to suggest that the physical and dietary interventions reviewed are sufficiently effective and safe to be considered as treatments. En ligne : http://dx.doi.org/10.1111/jcpp.12556 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=292

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