THE EFFICACY OF PSYCHOANALYSIS FOR CHILDREN WITH DISRUPTIVE DISORDERS

Objective: This paper describes a chart review of 763 cases of child p sychoanalysis and psychotherapy at the Anna Freud Centre, and illustra tes its usefulness by examining predictors of treatment outcome in chi ldren with disruptive disorders. Method: 135 children and adolescents with a principal diagnosis of disruptive disorder were individually ma tched with others suffering from emotional disorders. Outcome was indi cated by diagnostic change and change in overall adaptation (clinicall y significant improvement or return to normal functioning). Results: i mprovement rates were significantly higher for the emotional than for the disruptive group. Within the disruptive group, significant improve ment was more frequent among children with oppositional defiant disord er (56%) than those with attention deficit hyperactivity disorder (36% ) or conduct disorder (23%). However, 31% of the children terminated t reatment within 1 year. Of those disruptive children who remained in t reatment more than 1 year, 69% were no longer diagnosable on terminati on. Fifty-eight percent of the variance in outcome ratings could be ac counted for within this group. The crucial variables in predicting att rition and symptomatic improvement were found to be quite different in the disruptive and emotional groups. Conclusion: Although the study h as several methodological limitations, it does suggest demographic, cl inical, and diagnostic characteristics of those disruptive children mo st likely to benefit from intensive and nonintensive psychodynamic tre atment.