Treatment and Intervention
What this domain tests
Treatment covers stepped care, evidence-based psychotherapies matched to age and problem, when to add medication, safety planning, and school-based supports.
Matching therapy to problem and age
- Depression: CBT, interpersonal psychotherapy for adolescents, behavioral activation. For moderate to severe depression, SSRI plus CBT outperforms either alone.
- Anxiety: CBT built on graded exposure is first-line; Coping Cat fits roughly ages 7-13. Parent involvement is essential in younger children and should target accommodation, which maintains anxiety when adults keep rescuing the child.
- Disruptive behavior: parent-child interaction therapy for ages 2-7, parent management training, Incredible Years. These are first-line for preschool oppositionality.
- Trauma: trauma-focused CBT for ages 3-18.
- ADHD: for ages 4-5, behavioral parent training and classroom structure come first; methylphenidate is considered if behavior therapy is insufficient. For ages 6 and up, medication plus behavioral treatment is standard.
- Substance use: motivational interviewing, brief interventions, and referral.
Safety and systems
- Safety planning (Stanley-Brown) plus lethal means counseling: firearms locked and stored separately from ammunition, medications locked, and safe storage discussed with caregivers.
- 988 Suicide and Crisis Lifeline for crisis access.
- School supports: a 504 plan provides accommodations; an IEP under IDEA requires a qualifying disability category and need for specialized instruction.
Worked example
A 9-year-old with generalized anxiety worries nightly about parents and seeks repeated reassurance. Reasoning: psychoeducation, CBT with graded exposure, and a caregiver plan to reduce accommodation rather than repeat reassurance. Reassess in 4-6 weeks; medication is considered if impairment persists or exposure work stalls.
Traps that cost marks
- Reaching for medication first in mild anxiety or preschool ADHD.
- Designing a plan that never touches caregiver accommodation or school.
- Writing a safety plan without means restriction.
- Confusing a 504 plan with an IEP.