key: cord-1050754-5yney7dh
authors: Allgaier, Katharina; Schmid, Johanna; Hollmann, Karsten; Reusch, Pauline A.; Conzelmann, Annette; Renner, Tobias J.
title: Times are changing: digitalisation in child and adolescent psychotherapy
date: 2020-07-31
journal: Eur Child Adolesc Psychiatry
DOI: 10.1007/s00787-020-01610-8
sha: 639c6af66be023c0c687e1d4858899fd30aa3ce9
doc_id: 1050754
cord_uid: 5yney7dh

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Hollis and colleagues [1] summarized 21 former meta-analyses and reviews from the beginning of the development of DHI in the 1990s until the end of 2015 in their meta-review and additionally updated a systematic review analysing 30 randomized controlled trials (RCT) using DHI. Their review represents an outstanding comprehensive approach and has recently been complemented by a systematic literature search of our own work group [2] , strictly following the criteria established in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.

The work by Hollis and colleagues and our own search revealed that most robust evidence exists for interventions for anxiety disorders and mild to moderate depression (especially computerized cognitive behavioural therapy (cCBT) approaches).

RCT for ADHD in children and adolescents revealed rather heterogeneous results which might be explained by their highly heterogeneous approaches. The studies ranged from neurofeedback trainings to executive functioning trainings and interventions targeting everyday organization and planning skills. They show comparable (inconsistent) effects to nonpharmacological face-to-face therapy [1, 2] .

Increasing evidence emerges for DHI targeting autism spectrum disorders which include DHI for children from preschool age to adolescence and their parents [1, 2] . DHI for children and adolescents with ASD involve parents more frequently than DHI for other diagnoses.

Studies investigating DHI for other diagnoses such as eating disorders, psychosis, obsessive compulsive disorders, dyslexia, coordination disorders, conduct disorders with disruptive behaviour, tic disorders, insomnia or trichotillomania in children and adolescents are rather scarce. But the few available studies show promising results, though more high-quality studies are needed for a profound evaluation of DHI for those disorders.

Looking at the technical aspects, most studies use personal computers, which offer the broadest range of applications, ranging from psychoeducation in serious games or in video or written modules over training of cognitive functions to video sessions [1, 2] . Smartphone usage is on the rise, allowing ambulatory assessment of mood or experience in everyday life [1, 2] . Tablets are mainly used for trainings to improve attention or social and communicative skills via apps [1, 2] .

Most published DHI studies were conducted in the Western Hemisphere and Asia, with only few studies from South American and African countries [2] . Due to the advantages of DHI in providing treatment over extensive distances and an increasingly evolving IT-infrastructure for example in African countries, more use of DHI can be expected worldwide.

Implementing DHI in clinical practice requires careful consideration of a variety of prerequisites and precautions [3] . Table 1 gives an overview of practical prerequisites, ranging from personal aspects over data security and regional legal frameworks to the relevance of instable therapeutic situations including suicidality. DHI provide unique benefits, as proven during the SARS-CoV2-19 lock-down, but also bring potential pitfalls. Table 2 gives an overview on aspects regarding accessibility, the implementation of interventions itself, the evidence regarding interventions as well as economic aspects [4] .

In summary, DHI are promising therapeutic interventions for children and adolescents with psychiatric disorders, with already robust data regarding depression and anxiety disorders. SARS-CoV2-19 catalyses the integration of DHI into the standard repertoire of child and adolescent psychiatry and psychotherapy. Nevertheless, for using DHI in daily therapeutic work there are still challenges to overcome, ranging from technical aspects, e.g. general availability of the technical prerequisites, to the most demanding therapeutic tasks like the stabilisation of patients in acute crises. Blended treatment formats using a combination of traditional face-to-face sessions with e.g. intermittent video conferences might be the silver bullet in integrating DHI and taking advantage of their strengths.

Fortunately, at least one partner in therapy, the children and adolescents, are often accustomed to and sometimes highly trained in digitally delivered communication. So, it Increase of the frequency of synchronous communication e.g. via video conferencing as a tool to deliver support during vulnerable episodes At least one parent has to be present in the house during video therapy sessions Therapist needs patient's/parents' contact information at hand to be able to initiate emergency services when needed Cooperation with local professionals (paediatrician, psychiatrists) for emergency support is up to us to use our profound expertise in traditional psychotherapy to create the digital pathways for reaching out to them. Times are changing. Let's go.

Acknowledgements Open Access funding provided by Projekt DEAL.

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Annual research review: digital health interventions for children and young people with mental health problems-a systematic and meta-review

The effects of human interaction on the outcomes of digital health interventions for children and adolescents with mental disorders: a systematic review and meta-analyses

Joint Task Force for the Development of Telepsychology Guidelines for Psychologists (2013) Guidelines for the practice of telepsychology

Ethical issues in online psychotherapy: a narrative review