Jour 1993 nal of Consulting and Clinical Psychology i. Vol. 61. No. 2. 235-247 Copyright 1993 by the American Psychological Association, Inc. 0022-006X/93/$3.00 Cognitive-Behavioral Therapies With Youth: Guiding Theory, Current Status, and Emerging Developments Philip C. Kendall 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. Central to a successful completion of childhood is the child's development of a confident sense of mastery, of appropriate social behavior, and of an ability to engage in self-control. As children enter and pass through school and become more inde- pendently involved in social relationships, there is a new empha- sis toward carrying through on activities and accomplishing goals. The child must work to strike a balance between compli- ance with adult rules and the assertion of independent compe- tence. Industrious work in school and social interactions are the testing ground for children to compare themselves with others, to gain a sense of self, and to acquire the skills needed to adjust to the demands of the environment. Adjusting and coping with these developmental challenges can be a struggle for children, and not all manage the task successfully. Indeed, current estimates of the amount of psycho- pathology in children in the United States are alarming. Recent epidemiological data suggest that between 15% and 22% of the nation's approximately 63 million youth have mental health problems severe enough to warrant treatment (Costello, 1990; National Advisory Mental Health Council, 1990). Yet, as Tuma (1989) noted, of those in need of mental health care, less than 20% received the appropriate services. These data are probably representative of a concern that is worldwide. Indeed, psycho- logical maladjustment in youth is a major problem confronting today's society. All children face developmental challenges, yet not all of these children are prepared, and not all of the challenges are met. Thus, the issue facing clinical child psychology is how to best intervene to reduce or remediate the cognitive, behavioral, and emotional difficulties in childhood that are associated with present psychological distress and later psychopathology. Guiding Theory Those involved in designing interventions for youth have ap- proached their task from various perspectives. Some have Preparation of this article was facilitated by National Institute of Mental Health Grant 44042. Correspondence concerning this article should be addressed to Philip C. Kendall, Weiss Hall, Department of Psychology, Temple Uni- versity, Philadelphia, Pennsylvania 19122. sought to have a preventive influence, intervening to reduce problems in youth at risk for later maladjustment (e.g., Weiss- berg, Caplan, & Harwood, 1991), whereas others have taken a therapeutic approach, providing therapy for youth with identi- fied psychopathology (e.g., Kendall, 199la). Some applications have followed more behavioral guidelines (see Barkley, 1990); others have been influenced by rational-emotive therapy (Ber- nard & Joyce, 1984). Some have sought to intervene at the level of the family (e.g., Robin & Foster, 1989), the school (e.g., Elias, 1989), or the community (e.g., Glenwick & Jason, 1984), whereas others work directly with youth (e.g., Kendall & Bras- well, 1985). Cognitive-behavioral approaches can be defined as a ratio- nal amalgam: a purposeful attempt to preserve the demon- strated positive effects of behavioral therapy within a less doc- trinaire context and to incorporate the cognitive activities of the client into the efforts to produce therapeutic change. Accord- ingly, cognitive-behavioral strategies with children and adoles- cents use enactive, performance-based procedures as well as cognitive interventions to produce changes in thinking, feeling, and behavior (Kendall, 199 Ib). The cognitive-behavioral analy- ses of child and adolescent disorders and adjustment problems, as well as related analyses of treatment-produced gains, include considerations of the child's internal and external environment, and represent an integratoonist perspective (Meichenbaum, 1977). The model places the greatest emphasis on the learning process and the influence of the contingencies and models in the environment while underscoring the centrality of the indi- vidual's mediating-information-processing style in the develop- ment and remediation of psychological distress (Kendall, 1985). Cognitive-behavioral therapies do not insult the role of affect and the social context. Rather, they integrate cognitive, behavioral, affective, social, and contextual strategies for change. The cognitive-behavioral model includes the relation- ships of cognition and behavior to the affective state of the organism and the functioning of the organism in the larger social context. Therapy With Youth: The Cognitive-Behavioral Posture The "posture" (used here to refer to one's mental attitude) of the cognitive-behavioral therapist working with youth can be 235