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Frick PJ. The Influence of Parenting on Callous-Unemotional Traits and the Implications for the Causes and Treatment of Conduct Disorder. Am J Psychiatry 2024; 181:265-268. [PMID: 38557142 DOI: 10.1176/appi.ajp.20240096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Paul J Frick
- Department of Psychology, Louisiana State University, Baton Rouge
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Stadler C, Freitag CM, Popma A, Nauta-Jansen L, Konrad K, Unternaehrer E, Ackermann K, Bernhard A, Martinelli A, Oldenhof H, Gundlach M, Kohls G, Prätzlich M, Kieser M, Limprecht R, Raschle NM, Vriends N, Trestman RL, Kirchner M, Kersten L. START NOW: a cognitive behavioral skills training for adolescent girls with conduct or oppositional defiant disorder - a randomized clinical trial. J Child Psychol Psychiatry 2024; 65:316-327. [PMID: 37814906 DOI: 10.1111/jcpp.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Conduct disorder (CD) and oppositional defiant disorder (ODD) both convey a high risk for maladjustment later in life and are understudied in girls. Here, we aimed at confirming the efficacy of START NOW, a cognitive-behavioral, dialectical behavior therapy-oriented skills training program aiming to enhance emotion regulation skills, interpersonal and psychosocial adjustment, adapted for female adolescents with CD or ODD. METHODS A total of 127 girls were included in this prospective, cluster randomized, multi-center, parallel group, quasi-randomized, controlled phase III trial, which tested the efficacy of START NOW (n = 72) compared with standard care (treatment as usual, TAU, n = 55). All female adolescents had a clinical diagnosis of CD or ODD, were 15.6 (±1.5) years on average (range: 12-20 years), and were institutionalized in youth welfare institutions. The two primary endpoints were the change in number of CD/ODD symptoms between (1) baseline (T1) and post-treatment (T3), and (2) between T1 and 12-week follow-up (T4). RESULTS Both treatment groups showed reduced CD/ODD symptoms at T3 compared with T1 (95% CI: START NOW = -4.87, -2.49; TAU = -4.94, -2.30). There was no significant mean difference in CD/ODD symptom reduction from T1 to T3 between START NOW and TAU (-0.056; 95% CI = -1.860, 1.749; Hedge's g = -0.011). However, the START NOW group showed greater mean symptom reduction from T1 to T4 (-2.326; 95% CI = -4.274, -0.378; Hedge's g = -0.563). Additionally, secondary endpoint results revealed a reduction in staff reported aggression and parent-reported irritability at post assessment. CONCLUSIONS Although START NOW did not result in greater symptom reduction from baseline to post-treatment compared with TAU, the START NOW group showed greater symptom reduction from baseline to follow-up with a medium effect size, which indicates a clinically meaningful delayed treatment effect.
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Affiliation(s)
- Christina Stadler
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Arne Popma
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lucres Nauta-Jansen
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, RWTH Aachen & Research Centre Juelich, Juelich, Germany
| | - Eva Unternaehrer
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Katharina Ackermann
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anka Bernhard
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Anne Martinelli
- Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Helena Oldenhof
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Malou Gundlach
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany
| | - Gregor Kohls
- Department of Child and Adolescent Psychiatry, Medical Faculty, TU Dresden, Dresden, Germany
| | - Martin Prätzlich
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
| | - Meinhard Kieser
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Ronald Limprecht
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Nora M Raschle
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | | | | | - Marietta Kirchner
- Institute of Medical Biometry (IMBI), University of Heidelberg, Heidelberg, Germany
| | - Linda Kersten
- University Psychiatric Clinics, University of Basel, Basel, Switzerland
- Department of Forensic Psychiatry, LVR-Klinik Viersen, Viersen, Germany
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Böttinger BW, Aggensteiner PM, Hohmann S, Heintz S, Ruf M, Glennon J, Holz NE, Banaschewski T, Brandeis D, Baumeister S. Exploring real-time functional magnetic resonance imaging neurofeedback in adolescents with disruptive behavior disorder and callous unemotional traits. J Affect Disord 2024; 345:32-42. [PMID: 37852585 DOI: 10.1016/j.jad.2023.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Adolescents with increased callous unemotional traits (CU traits) in the context of disruptive behavior disorder (DBD) show a persistent pattern of antisocial behavior with shallow affect and a lack of empathy or remorse. The amygdala and insula as regions commonly associated with emotion processing, empathy and arousal are implicated in DBD with high CU traits. While behavioral therapies for DBD provide significant but small effects, individualized treatments targeting the implicated brain regions are missing. METHODS In this explorative randomized controlled trial we randomly assigned twenty-seven adolescents with DBD to individualized real-time functional magnetic resonance neurofeedback (rtfMRI-NF) or behavioral treatment as usual (TAU). Visual feedback of either amygdala or insula activity was provided during rtfMRI-NF by gauges and included a simple and concurrent video run plus a transfer run. A linear mixed model (LMM) was applied to determine improvement of self-regulation. Specificity was assessed by correlating individual self-regulation improvement with clinical outcomes. RESULTS The rtfMRI-NF (n = 11) and TAU (n = 10) completers showed comparable and significant clinical improvement indicating neither superiority nor inferiority of rtfMRI-NF. The exploratory LMM revealed successful learning of self-regulation along the course of training for participants who received feedback from the amygdala. A significant exploratory correlation between individual target region activity in the simple run and clinical improvement was found for one dimension of DBD. CONCLUSIONS This exploratory study demonstrated feasibility and suggests clinical efficacy of individualized rtfMRI-NF comparable to active TAU for adolescents with DBD and increased CU traits. Further studies are needed to confirm efficacy, specificity and to clarify underlying learning mechanisms.
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Affiliation(s)
- Boris W Böttinger
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal-M Aggensteiner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Sarah Hohmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Heintz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Matthias Ruf
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jeffrey Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Center, Nijmegen, the Netherlands; Conway Institute of Biomolecular and Biomedical Research, School of Medicine, University College Dublin, Dublin, Ireland
| | - Nathalie E Holz
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Donders Center for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, the Netherlands; Department for Cognitive Neuroscience, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands; Institute of Medical Psychology and Medical Sociology, University Medical Center Schleswig Holstein, Kiel University, Kiel, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Daniel Brandeis
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH, Zurich, Zurich, Switzerland
| | - Sarah Baumeister
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
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Levine RS, Smith K, Wagner NJ. The Impact of Callous-Unemotional Traits on Achievement, Behaviors, and Relationships in School: A Systematic Review. Child Psychiatry Hum Dev 2023; 54:1546-1566. [PMID: 35438469 DOI: 10.1007/s10578-022-01344-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 02/16/2022] [Accepted: 02/27/2022] [Indexed: 11/03/2022]
Abstract
Disruptive behavior disorders (DBDs) are associated with significant academic, behavioral, and relationship challenges in the school setting. Children with co-occurring DBDs and callous-unemotional (CU) traits show a distinct pattern of early starting, chronic, and aggressive disruptive behavior and are resistant to traditional DBD interventions. There is growing evidence that CU traits have important consequences for children's school functioning. The purpose of this systematic review is to synthesize research on CU traits in school with a focus on academics, relationships, and behavior. We searched PsycINFO, PubMed, and Education Full-Text to identify 37 empirical studies that met inclusionary criteria. Findings suggest that CU traits are associated with poor academic performance, high levels of aggression and conduct problems, and difficulty forming relationships at school, often above and beyond the impact of DBDs alone. Findings and future directions are discussed including how the current study can support key stakeholders in promoting the success of students with elevated CU traits.
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Affiliation(s)
- Rebecca S Levine
- Education Studies, University of California, San Diego, La Jolla, Oakland, California, USA
| | - Kelly Smith
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, Massachusetts, USA
| | - Nicholas J Wagner
- Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, Massachusetts, USA.
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Hauschild S, Kasper L, Volkert J, Sobanski E, Taubner S. Mentalization-based treatment for adolescents with conduct disorder (MBT-CD): a feasibility study. Eur Child Adolesc Psychiatry 2023; 32:2611-2622. [PMID: 36434148 PMCID: PMC9702655 DOI: 10.1007/s00787-022-02113-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/16/2022] [Indexed: 11/26/2022]
Abstract
Conduct disorder (CD) is a common psychiatric disorder in youth characterized by persisting norm-violating or aggressive behavior. Considering high individual and societal burden, feasible and effective psychotherapeutic treatment is desirable. Yet, treatments and research in this patient group are scarce. This study investigates the feasibility of mentalization-based treatment for adolescents with CD (MBT-CD) in terms of acceptability of MBT-CD and scientific assessments by participants as well as necessary organizational resources to conduct a consecutive randomized controlled trial (RCT). Recruitment, adherence and treatment session numbers were descriptively analyzed. Treatment evaluation interviews were qualitatively analyzed. A subset of sessions of therapists without prior MBT experience was rated for MBT adherence. Quantitative data were used to plan a consecutive RCT. Pre to post treatment changes in diagnosis and self-reported aggression, mentalizing and personality functioning were preliminarily analyzed. N = 45 adolescents with CD were recruited. 43% dropped out. Acceptance of scientific assessments was somewhat lower than therapy adherence (questionnaires filled out by ~ 80% of adolescents in treatment), and low at follow-up (25% of treatment completers). Mean session number was 30.3. Most treatment completers were satisfied with MBT-CD. Referrals mainly came from child and youth services and psychiatry. Nine of 16 sessions rated for MBT adherence were adherent. A priori sample size estimation for a prospective RCT with a drop-out rate of 43% yielded a sample of N = 158 to detect an effect f = .15 with 80% power in a repeated measures ANOVA. Pre-post analyses revealed diagnostic improvement in 68%. Of self-reported data, empathy pathology improved. Findings provide a sound basis for a consecutive feasibility and pilot RCT. TRIAL REGISTRATION: Clinicaltrials.gov, registration number NCT02988453, November 30, 2016, https://clinicaltrials.gov/ct2/show/NCT02988453.
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Affiliation(s)
- Sophie Hauschild
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany.
- Psychological Institute, University of Heidelberg, Heidelberg, Germany.
| | - Lea Kasper
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
- Psychological Institute, University of Heidelberg, Heidelberg, Germany
| | - Jana Volkert
- Department of Psychology, Medical School Berlin, Berlin, Germany
| | - Esther Sobanski
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, University Hospital Heidelberg, Heidelberg, Germany
- Department of Child and Youth Psychiatry, Lucerne Psychiatry, Lucerne, Switzerland
| | - Svenja Taubner
- Institute for Psychosocial Prevention, University Hospital Heidelberg, Heidelberg, Germany
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O' Brien S, Sethi A, Blair J, Viding E, Beyh A, Mehta MA, Dallyn R, Ecker C, Petrinovic MM, Doolan M, Blackwood N, Catani M, Murphy DGM, Scott S, Craig MC. Rapid white matter changes in children with conduct problems during a parenting intervention. Transl Psychiatry 2023; 13:339. [PMID: 37925439 PMCID: PMC10625622 DOI: 10.1038/s41398-023-02635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/27/2023] [Accepted: 10/23/2023] [Indexed: 11/06/2023] Open
Abstract
Studies report that the microstructural integrity of the uncinate fasciculus (UF; connecting the anterior temporal lobe to the orbitofrontal cortex) is abnormal in adults with psychopathy and children with conduct problems (CP), especially those with high callous-unemotional (CU) traits. However, it is unknown if these abnormalities are 'fixed' or 'reversible'. Therefore, we tested the hypothesis that a reduction in CP symptoms, following a parenting intervention, would be associated with altered microstructural integrity in the UF. Using diffusion tensor imaging tractography we studied microstructural differences (mean diffusivity (MD) and radial diffusivity (RD)) in the UF of 43 typically developing (TD) and 67 boys with CP before and after a 14-week parenting intervention. We also assessed whether clinical response in CP symptoms or CU traits explained changes in microstructure following the intervention. Prior to intervention, measures of MD and RD in the UF were increased in CP compared to TD boys. Following intervention, we found that the CP group had a significant reduction in RD and MD. Further, these microstructural changes were driven by the group of children whose CU traits improved (but not CP symptoms as hypothesized). No significant microstructural changes were observed in the TD group. Our findings suggest, for the first time, that microstructural abnormalities in the brains of children with CP may be reversible following parenting intervention.
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Affiliation(s)
- Suzanne O' Brien
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. suzanne.o'
| | - Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - James Blair
- Research Unit at Child and Adolescent Mental Health Center Copenhagen, Capital Region of Denmark, Copenhagen, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Ahmad Beyh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mitul A Mehta
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Dallyn
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Christine Ecker
- Department of Child and Adolescent Psychiatry, University Hospital of the Goethe University, Frankfurt am Main, Germany
| | - Marija M Petrinovic
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Moira Doolan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Female Hormone Clinic, Maudsley Hospital, London, UK
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Fleming GE, Neo B, Kaouar S, Kimonis ER. Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits. Res Child Adolesc Psychopathol 2023; 51:1581-1594. [PMID: 37552366 PMCID: PMC10627936 DOI: 10.1007/s10802-023-01112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. METHOD Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. RESULTS Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. CONCLUSIONS Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).
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Affiliation(s)
- Georgette E Fleming
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Bryan Neo
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Silvana Kaouar
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
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Pinchess C, Pauli R, Tully J. Knowledge and attitudes about conduct disorder of professionals working with young people: The influence of occupation and direct and indirect experience. PLoS One 2023; 18:e0292271. [PMID: 37768972 PMCID: PMC10538712 DOI: 10.1371/journal.pone.0292271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Knowledge and attitudes of professionals both pose a potential barrier to diagnosis and treatment of mental disorders. However, knowledge and attitudes about conduct disorder in professionals working with young people are poorly understood. Little is known about the impact of occupation, direct and indirect (training and education) experience, or the interrelationship between knowledge and attitudes. METHODS We conducted an online survey of 58 participants, including Psychology Staff, Teaching Staff, Care Staff, and Other Non-Clinical Staff. A questionnaire comprising three subscales (causes, treatments, and characteristics) measured knowledge. A thermometer scale measured global attitudes. Open-ended response measures were used to measure four attitude components: stereotypic beliefs (about characteristics), symbolic beliefs (about the holder's traditions), affect, and past behaviour. Primary analysis explored the impact of occupation, direct experience, and indirect experience on outcome measures. A secondary exploratory analysis was conducted to explore the relationship between knowledge and attitudes. RESULTS Psychology Staff had significantly more favourable global attitudes (F = 0.49, p = 0.01) and symbolic beliefs (F = 0.57, p = 0.02) towards those with conduct disorder than Teaching Staff; there were no other significant group differences in attitudes. Psychology staff had more knowledge about conduct disorder than other groups, though the differences were not significant. Direct and indirect experience were associated with greater knowledge (direct: d = 0.97, p = 0.002; indirect d = 0.86, p = 0.004) and favourable global attitudes (direct: d = 1.12, p < 0.001; indirect: d = 0.68, p = 0.02). Secondary exploratory analyses revealed significant positive correlations between: all knowledge variables with global attitudes; total knowledge with past behaviour; and affect and knowledge of causes with past behaviour. CONCLUSIONS Psychology-based staff may have more favourable attitudes towards children with conduct disorder than teachers, primarily due to direct and indirect experience with the disorder. Our sample may have been too small to detect overall or within-group effects of knowledge or attitudes, however exploratory analyses showing a positive correlation between knowledge and attitudes suggest education may be critical in supporting teachers and other groups in their approaches to this challenging group of young people.
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Affiliation(s)
- Chloe Pinchess
- Centre for Forensic and Family Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Clayfields House, Nottinghamshire County Council, Nottingham, United Kingdom
| | - Ruth Pauli
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - John Tully
- Academic Unit of Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Nottinghamshire Healthcare NHS Trust, Nottingham, United Kingdom
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Kurzweil S. Involving Parents in Child Mental Health Treatments: Survey of Clinician Practices and Variables in Decision Making. Am J Psychother 2023; 76:107-114. [PMID: 37114350 DOI: 10.1176/appi.psychotherapy.20220025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
OBJECTIVE Child therapy outcomes research has indicated that involving parents in child mental health treatments is generally beneficial. This study aimed to explore clinicians' decisions to involve parents in treatment for childhood disorders and child-, parent-, and clinician-related variables influencing these decisions. METHODS Data on decision making and reported use of parent involvement by 40 therapists with patients ages 6-12 were obtained from a self-report survey. Most clinicians were psychologists, White, and female and worked in community-based clinics. They reported using cognitive-behavioral and family system interventions considerably more than psychodynamic therapy. RESULTS Clinician-reported use of parent involvement was significantly greater for children with oppositional defiant or conduct disorder than for those with attention-deficit hyperactivity disorder, depression, anxiety, or posttraumatic stress disorder or trauma. A child's age and diagnosis (100% of clinicians), parental level of stress (85%), and parent interest in working with the clinician (60%) were frequently reported as being important to clinicians' decisions. Ninety percent of clinicians reported that they believed working with parents was effective, whereas only 25% reported their own training to be influential in decision making. CONCLUSIONS Findings regarding use of parent involvement stratified by common childhood disorder were not surprising, given the behavioral and treatment complexities of oppositional defiant or conduct disorder. Clinicians often reported parents' stress level and interest in working with the clinician as influencing decision making, reflecting the importance of lesser researched decision variables. The relatively limited influence of training on decision making suggests the need for better parent involvement education for clinicians treating children.
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Affiliation(s)
- Sonya Kurzweil
- Department of Clinical Psychology, William James College, and Sonya Kurzweil Developmental Center, Newton, Massachusetts
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Perlstein S, Fair M, Hong E, Waller R. Treatment of childhood disruptive behavior disorders and callous-unemotional traits: a systematic review and two multilevel meta-analyses. J Child Psychol Psychiatry 2023; 64:1372-1387. [PMID: 36859562 PMCID: PMC10471785 DOI: 10.1111/jcpp.13774] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Children with callous-unemotional (CU) traits are at high lifetime risk of antisocial behavior. It is unknown if treatments for disruptive behavior disorders are as effective for children with CU traits (DBD+CU) as those without (DBD-only), nor if treatments directly reduce CU traits. Separate multilevel meta-analyses were conducted to compare treatment effects on DBD symptoms for DBD+CU versus DBD-only children and evaluate direct treatment-related reductions in CU traits, as well as to examine moderating factors for both questions. METHODS We systematically searched PsycINFO, PubMed, Cochran Library (Trials), EMBASE, MEDLINE, APA PsycNet, Scopus, and Web of Science. Eligible studies were randomized controlled trials, controlled trials, and uncontrolled studies evaluating child-focused, parenting-focused, pharmacological, family-focused, or multimodal treatments. RESULTS Sixty studies with 9,405 participants were included (Mage = 10.04, SDage = 3.89 years, 25.09% female, 44.10% racial/ethnic minority). First, treatment was associated with similar reductions in DBD symptoms for DBD+CU (SMD = 1.08, 95% CI = 0.45, 1.72) and DBD-only (SMD = 1.01, 95% CI = 0.38, 1.64). However, DBD+CU started (SMD = 1.18, 95% CI = 0.57, 1.80) and ended (SMD = 0.73, p < .001; 95% CI = 0.43, 1.04) treatment with more DBD symptoms. Second, although there was no overall direct effect of treatment on CU traits (SMD = .09, 95% CI = -0.02, 0.20), there were moderating factors. Significant treatment-related reductions in CU traits were found for studies testing parenting-focused components (SMD = 0.21, 95% CI = 0.06, 0.35), using parent-reported measures (SMD = 0.16, 95% CI = 0.04, 0.28), rated as higher quality (SMD = 0.26, 95% CI = 0.13, 0.39), conducted outside the United States (SMD = 0.19, 95% CI = 0.05, 0.32), and with less than half the sample from a racial/ethnic minority group (SMD = 0.15, 95% CI = 0.002, 0.30). CONCLUSIONS DBD+CU children improve with treatment, but their greater DBD symptom severity requires specialized treatment modules that could be implemented alongside parenting programs. Conclusions are tempered by heterogeneity across studies and scant evidence from randomized controlled trials.
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Affiliation(s)
| | - Maddy Fair
- Department of Psychology, University of Pennsylvania
| | - Emily Hong
- Department of Psychology, University of Pennsylvania
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Giudice TD, Lindenschmidt T, Hellmich M, Hautmann C, Döpfner M, Görtz-Dorten A. Stability of the effects of a social competence training program for children with oppositional defiant disorder/conduct disorder: a 10-month follow-up. Eur Child Adolesc Psychiatry 2023; 32:1599-1608. [PMID: 35279770 PMCID: PMC10460314 DOI: 10.1007/s00787-021-01932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
The stability and effectiveness of the Treatment Program for Children with Aggressive Behavior (THAV) in terms of reducing behavioral problems in children with oppositional defiant disorder (ODD) and conduct disorder (CD) were examined at a 10-month follow-up (FU). A total of 76 families and their children (boys aged 6-12 years), who previously participated in a randomized controlled trial comparing THAV with an active control group, took part in the 10-month FU assessment. Outcome measures were rated by parents and included the evaluation of child aggressive behavior, prosocial behavior, problem-maintaining and problem-moderating factors, and comorbid symptoms. Linear mixed models for repeated measures (MMRM) were conducted. The results revealed that THAV effects remained stable (problem-maintaining and problem-moderating factors; comorbid symptoms) and even partially improved (aggressive behavior; ADHD symptoms) over the FU period. Additionally, the differences between the THAV intervention group and the control group, which were apparent at the end of the treatment (post), mainly also remained at the FU assessment. It can be concluded that THAV is an effective and stable intervention for boys aged 6-12 years with ODD/CD.
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Affiliation(s)
- Teresa Del Giudice
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Timo Lindenschmidt
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christopher Hautmann
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anja Görtz-Dorten
- Faculty of Medicine, School of Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, University of Cologne, Cologne, Germany
- Faculty of Medicine, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Cologne, University of Cologne, Cologne, Germany
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Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother 2023; 23:1277-1296. [PMID: 37853718 DOI: 10.1080/14737175.2023.2271169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Sara Carucci
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Pietro Muratori
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carla Balia
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Gianluca Sesso
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Parent J, Jones DJ, DiMarzio K, Yang Y, Wright KL, Sullivan ADW, Forehand R. The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training. Res Child Adolesc Psychopathol 2023; 51:165-175. [PMID: 36344876 DOI: 10.1007/s10802-022-00979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.
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Affiliation(s)
- Justin Parent
- Department of Psychiatry and Human Behavior, Brown University, Providence, USA.
- Warren Alpert Medical School, Brown University, 1 Hoppin St #204, Providence, RI, USA.
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kat L Wright
- Department of Psychology, University of Kentucky, Lexington, USA
| | | | - Rex Forehand
- Department of Psychological Science, University of Vermont, Burlington, USA
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Fleming GE, Neo B, Briggs NE, Kaouar S, Frick PJ, Kimonis ER. Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial. Behav Ther 2022; 53:1265-1281. [PMID: 36229121 DOI: 10.1016/j.beth.2022.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.
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White BA, Dede B, Heilman M, Revilla R, Lochman J, Hudac CM, Bui C, White SW. Facial Affect Sensitivity Training for Young Children with Emerging CU Traits: An Experimental Therapeutics Approach. J Clin Child Adolesc Psychol 2022; 51:264-276. [PMID: 35486474 PMCID: PMC9531877 DOI: 10.1080/15374416.2022.2056895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
OBJECTIVE This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel "Facial Affect Sensitivity Training" (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior. METHOD We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits. RESULTS In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST. CONCLUSIONS We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.
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Affiliation(s)
- Bradley A. White
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Breanna Dede
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Meagan Heilman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Rebecca Revilla
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - John Lochman
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Caitlin M. Hudac
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
| | - Chuong Bui
- Alabama Life Research Institute, University of Alabama, Tuscaloosa, AL, USA
| | - Susan W. White
- Center for Youth Development and Intervention, University of Alabama, Tuscaloosa, AL, USA
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Bourion-Bédès S, Bisch M, Baumann C. Factors associated with family involvement in a family-centered care program among incarcerated French adolescents with conduct disorder. Int J Prison Health 2022; 19:220-229. [PMID: 35150213 DOI: 10.1108/ijph-09-2021-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This study aims to identify the patient characteristics that may influence family involvement in a family-centered care program during detention. DESIGN/METHODOLOGY/APPROACH Little is known about the needs of incarcerated adolescents and their families. This exploratory study used a cross-sectional design to collect data from incarcerated adolescents with conduct disorder followed in a French outpatient psychiatric department. Logistic regression models were used to identify the sociodemographic, clinical and family characteristics of these incarcerated adolescents that could predict family involvement in their care. FINDINGS Among 44 adolescents with conduct disorder, the probability of family involvement during the adolescent's detention was 9.6 times greater (95% CI 1.2-14.4, p = 0.03) for adolescents with no than for those with cannabis substance use disorder, and family involvement decreased with the age of the adolescent (OR = 0.22, 95% CI 0.1-0.9, p = 0.04). RESEARCH LIMITATIONS/IMPLICATIONS Increased knowledge of the characteristics of these adolescents and their families is needed to develop programs that will increase family interventions by specialty treatment services during detention. ORIGINALITY/VALUE No study has yet been published on French incarcerated adolescents with conduct disorder. As conduct disorder is one of the most important mental health disorders among delinquent adolescents, this study provides knowledge about these adolescents and the need to involve their parents in their care to prevent the further escalation of problem behaviors.
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Affiliation(s)
- Stéphanie Bourion-Bédès
- Centre Hospitalier de Versailles, Le Chesnay, France and EA4360 APEMAC, University of Lorraine, Nancy, France
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Tuck N, Glenn LM. Cultivating conscience: Moral neurohabilitation of adolescents and young adults with conduct and/or antisocial personality disorders. Bioethics 2021; 35:337-347. [PMID: 33609403 PMCID: PMC8247950 DOI: 10.1111/bioe.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 06/12/2023]
Abstract
Individuals diagnosed with conduct disorder (CD) in childhood and adolescence are at risk for increasingly maladaptive and dangerous behaviors, which unchecked, can lead to antisocial personality disorder (ASPD) in adulthood. Children with CD, especially those with the callous unemotional subgroup qualifier ("limited prosocial emotions"/DSM-5), present with a more severe pattern of delinquency, aggression, and antisocial behavior, all markings of prodrome ASPD. Given this recognized diagnostic trajectory, with a pathological course playing out tragically at the individual, familial, and societal level, and lack of effective remediation via current standards of care, we posit an alternate treatment approach; case-specific compulsory moral habilitation aimed at rectifying the undeveloped affective domain of adolescents and young adults suffering from these disorders. We begin with a brief historical overview of response to mental illness, review CD and ASPD diagnostic criteria and treatment limitations, and posit a unique neurohabilitative approach that focuses on the absent affective moral development of these populations. Next, we invoke a public health safety argument to justify case-specific compulsory moral habilitation, discuss neurotechnologies to be considered in treatment, and conclude with ethical considerations and suggestions for further research.
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Affiliation(s)
- Nancy Tuck
- Albany Medical CollegeAlden March Bioethics InstituteAlbanyNew YorkUnited States
- Molloy CollegePhilosophy DepartmentRockville CentreNew YorkUnited States
| | - Linda MacDonald Glenn
- Albany Medical CollegeAlden March Bioethics InstituteAlbanyNew YorkUnited States
- University of California Santa Cruz, Crown CollegeSanta CruzCaliforniaUnited States
- California State University Monterey BaySeasideCaliforniaUnited States
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McKay K, Kennedy E, Senior R, Scott S, Hill J, Doolan M, Woolgar M, Peeren S, Young B. Informing the personalisation of interventions for parents of children with conduct problems: a qualitative study. BMC Psychiatry 2020; 20:513. [PMID: 33081742 PMCID: PMC7576822 DOI: 10.1186/s12888-020-02917-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/13/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Parenting programmes aim to alleviate behavioural problems in children, including conduct disorder. This study was part of a multi-phase mixed-methods project seeking to extend the reach of parenting programmes for the treatment of conduct problems through developing an evidence base to inform a personalised approach. It explored the narratives of parents of children with behavioural and conduct problems about parenting programmes to identify how such programmes could be personalised in order to extend their reach to parents and children who do not currently benefit. METHODS Face-to-face semi-structured interviews with a purposive sample of 42 parents, who had different experiences of parenting programmes. Interviews were conversational and informed by a topic guide. Analysis of transcripts of audio-recorded interviews drew on inductive thematic approaches and was framed largely within a phenomenological perspective. RESULTS Parents' accounts demonstrated three themes: 1) a personalised approach needs to include the child; 2) a supportive school matters; and, 3) the programme needs to feel personal. Parents were more likely to have a positive experience at a parenting programme, and for their child to demonstrate positive behavioural changes, when they felt their concerns were validated within the group and they also felt supported by the child's teachers. Parents whose children had been assessed prior to undertaking the programme were also more likely to perceive the programme to be beneficial, compared to parents who felt their child's individual issues were never considered. CONCLUSIONS Our findings point to the potential for personalised approaches to extend the reach of parenting programmes to parents and children who do not currently benefit from such programmes. Important in personalising parenting programmes is assessing children before parents are referred, to directly work with children as well as parents, and to work collaboratively with parents and children to identify which families are most suited to group support or one-to-one support and how this may change depending on circumstances.
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Affiliation(s)
- Kathy McKay
- University of Liverpool, Liverpool, UK
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
| | - Eilis Kennedy
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
| | - Rob Senior
- Tavistock and Portman NHS Foundation Trust, 120 Belsize Lane, London, NW3 5BA UK
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Michelson D, Malik K, Krishna M, Sharma R, Mathur S, Bhat B, Parikh R, Roy K, Joshi A, Sahu R, Chilhate B, Boustani M, Cuijpers P, Chorpita B, Fairburn CG, Patel V. Development of a transdiagnostic, low-intensity, psychological intervention for common adolescent mental health problems in Indian secondary schools. Behav Res Ther 2020; 130:103439. [PMID: 31466693 PMCID: PMC7322400 DOI: 10.1016/j.brat.2019.103439] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/29/2019] [Accepted: 07/14/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND The PRIDE programme aims to establish a suite of transdiagnostic psychological interventions organised around a stepped care system in Indian secondary schools. This paper describes the development of a low-intensity, first-line component of the PRIDE model. METHOD Contextual and global evidence informed an intervention 'blueprint' with problem solving as the primary practice element. Successive iterations were tested and modified across two pilot cohort studies (N = 45; N = 39). Participants were aged 13-20 years and presenting with elevated mental health symptoms in New Delhi schools. RESULTS The first iteration of the intervention, based on a guided self-help modality, showed promising outcomes and user satisfaction when delivered by psychologists. However, delivery was not feasible within the intended 6-week schedule, and participants struggled to use materials outside 'guidance' sessions. In Pilot 2, a modified counsellor-led problem-solving intervention was implemented by less experienced counsellors over a 3-4 week schedule. Outcomes were maintained, with indications of enhanced feasibility and acceptability. High demand was observed across both pilots, leading to more stringent eligibility criteria and a modified sensitisation plan. DISCUSSION Findings have shaped a first-line intervention for common adolescent mental health problems in low-resource settings. A forthcoming randomised controlled trial will test its effectiveness.
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Affiliation(s)
| | | | | | | | | | | | - Rachana Parikh
- Sangath, Goa and New Delhi, India; Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | | | | | | | | | - Maya Boustani
- Department of Psychology, Loma Linda University, Los Angeles, USA
| | - Pim Cuijpers
- Department of Clinical Psychology, Vrije Universiteit, Amsterdam, Netherlands
| | - Bruce Chorpita
- Department of Psychology, University of California at Los Angeles, Los Angeles, USA
| | | | - Vikram Patel
- Sangath, Goa and New Delhi, India; Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA.
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Glenn AL, Lochman JE, Dishion T, Powell NP, Boxmeyer C, Kassing F, Qu L, Romero D. Toward Tailored Interventions: Sympathetic and Parasympathetic Functioning Predicts Responses to an Intervention for Conduct Problems Delivered in Two Formats. Prev Sci 2020; 20:30-40. [PMID: 29308549 DOI: 10.1007/s11121-017-0859-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Coping Power is an evidence-based preventive intervention for youth with aggressive behavior problems that has traditionally been delivered in small group formats, but because of concerns about potentially diminished effects secondary to aggregation of high-risk youth, an individual format of Coping Power has been developed. The current study examined whether physiological characteristics of the child may provide information about which intervention delivery format works best for that individual. Indicators of sympathetic and parasympathetic nervous system functioning were examined in 360 fourth-grade children (65% male; 76.4% self-reported African-American) who were randomly assigned to Group Coping Power (GCP) or Individual Coping Power (ICP) (Lochman et al. 2015). Longitudinal assessments of teacher- and parent-reported proactive and reactive aggression were collected through a 1-year follow-up. For children with higher initial levels of aggression, those with lower parasympathetic functioning at pre-intervention showed greater reductions in teacher-rated proactive aggression in the ICP condition than the GCP condition. For children with high parasympathetic functioning, there was no differential effect of intervention format. Regardless of intervention format, youth with lower levels of sympathetic functioning at pre-intervention demonstrated greater reductions in teacher-rated proactive aggression. These findings suggest that physiological indicators may be worth considering in future studies examining which youth respond best to specific types of interventions.
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Affiliation(s)
- Andrea L Glenn
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA.
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL, 35487, USA.
| | - John E Lochman
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
| | - Thomas Dishion
- Arizona State University, P.O. Box 871104, Tempe, AZ, 85287-1104, USA
| | - Nicole P Powell
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
| | - Caroline Boxmeyer
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
| | - Francesca Kassing
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
| | - Lixin Qu
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
| | - Devon Romero
- Center for the Prevention of Youth Behavior Problems, The University of Alabama, Tuscaloosa, AL, USA
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Hogue A, Bobek M, MacLean A, Porter N, Jensen-Doss A, Henderson CE. Measurement training and feedback system for implementation of evidence-based treatment for adolescent externalizing problems: protocol for a randomized trial of pragmatic clinician training. Trials 2019; 20:700. [PMID: 31822294 PMCID: PMC6905067 DOI: 10.1186/s13063-019-3783-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innovations in clinical training and support that enhance fidelity to evidence-based treatment (EBT) for adolescent behavior problems are sorely needed. This study will develop an online training system to address this gap: Measurement Training and Feedback System for Implementation (MTFS-I). Using procedures intended to be practical and sustainable, MTFS-I is designed to increase two aspects of therapist behavior that are fundamental to boosting EBT fidelity: therapist self-monitoring of EBT delivery, and therapist utilization of core techniques of EBTs in treatment sessions. This version of MTFS-I focuses on two empirically supported treatment approaches for adolescent conduct and substance use problems: family therapy and cognitive behavioral therapy (CBT). METHODS/DESIGN MTFS-I expands on conventional measurement feedback systems for client outcomes by adding training in observational coding to promote EBT self-monitoring and focusing on implementation of EBT treatment techniques. It has two primary components. (1) The training component, delivered weekly in two connected parts, involves self-monitored learning modules containing brief clinical descriptions of core EBT techniques and mock session coding exercises based on 5-8 min video segments that illustrate delivery of core techniques. (2) The feedback component summarizes aggregated therapist-reported data on EBT techniques used with their active caseloads. MTFS-I is hosted online and requires approximately 20 min per week to complete for each treatment approach. This randomized trial will first collect data on existing delivery of family therapy and CBT techniques for youth in outpatient behavioral health sites (Baseline phase). It will then randomize site clinicians to two study conditions (Implementation phase): Training Only versus Training + Feedback + Consultation. Therapists will choose whether to train in family therapy, CBT, or both. Study aims will compare clinician performance across study phase and between study conditions on MTFS-I uptake, reliability and accuracy in EBT self-monitoring, and utilization of EBT techniques in treatment sessions (based on observer coding of audiotapes). DISCUSSION Study contributions to implementation science and considerations of MTFS-I sustainability are discussed. TRIAL REGISTRATION ClinicalTrials.gov, NCT03722654. Registered on 29 October 2018.
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Affiliation(s)
| | | | | | | | | | - Craig E. Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX USA
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22
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Lochman JE, Boxmeyer CL, Kassing FL, Powell NP, Stromeyer SL. Cognitive Behavioral Intervention for Youth at Risk for Conduct Problems: Future Directions. J Clin Child Adolesc Psychol 2019; 48:799-810. [PMID: 30892949 PMCID: PMC6710135 DOI: 10.1080/15374416.2019.1567349] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This article briefly overviews the history of cognitive behavioral intervention (CBI) for children displaying early signs, or actual diagnoses, of conduct disorders. A series of randomized control trials have identified evidence-based CBI programs for children with these behavior problems at various developmental stages from preschool through adolescence. Although it is critically important for the field to disseminate these existing programs as developed, we argue that it is important to also move beyond the existing evidence-based programs. Research should continue to test new comprehensive, multicomponent interventions, fueled by our evolving understanding of active mechanisms that contribute to children's externalizing behavior problems. The future of research in this area can also benefit from a focus on four central issues. First, research can address how single interventions can have meaningful impact on a range of transdiagnostic outcomes because the intervention mechanisms may affect those various outcomes. Second, rooted in implementation science, we are beginning to understand better how evidence-based programs can be disseminated in the real world, examining key issues such as the adequacy of training approaches and the role of therapist and organizational characteristics. Third, a major focus of research can be on how to optimize intervention outcomes, including a focus on microtrials, on tailoring of interventions, on examining rigorously how interventions are delivered, and on the integration of technology and of other approaches such as mindfulness training into CBI. Fourth, research can explore how the therapeutic relationship and the therapists' characteristics can play substantial roles in effective CBI with conduct problem children.
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Affiliation(s)
- John E. Lochman
- The University of Alabama, 348 Gorddon Palmer Hall, Tuscaloosa, Alabama 35487
| | | | | | - Nicole P. Powell
- The University of Alabama, 348 Gorddon Palmer Hall, Tuscaloosa, Alabama 35487
| | - Sara L. Stromeyer
- The University of Alabama, 348 Gorddon Palmer Hall, Tuscaloosa, Alabama 35487
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23
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Glenn AL. Using biological factors to individualize interventions for youth with conduct problems: Current state and ethical issues. Int J Law Psychiatry 2019; 65:101348. [PMID: 29673560 DOI: 10.1016/j.ijlp.2018.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 04/05/2018] [Indexed: 06/08/2023]
Abstract
A growing body of evidence suggests that biological factors such as genes, hormone levels, brain structure, and brain functioning influence the development and trajectory of conduct problems in youth. In addition, biological factors affect how individuals respond to the environment, including how individuals respond to programs designed to prevent or treat conduct problems. Programs designed to reduce behavior problems in youth would have the greatest impact if they were targeted toward youth who need it the most (e.g., who are mostly likely to demonstrate persistent behavior problems) as well as youth who may benefit the most from the program. Biological information may improve our ability to make decisions about which type or level of intervention is best for a particular child, thus maximizing overall effectiveness, but it also raises a number of ethical concerns. These include the idea that we may be providing fewer services to some youth based on biological factors, and that information about biological risk could potentially lead to discrimination or labeling. In this article, I discuss the risks and benefits of using biological information to individualize interventions for youth with conduct problems.
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Affiliation(s)
- Andrea L Glenn
- Center for the Prevention of Youth Behavior Problems, Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487, USA.
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24
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Lindhiem O, Vaughn-Coaxum RA, Higa J, Harris JL, Kolko DJ, Pilkonis PA. Development and validation of the Knowledge of Effective Parenting Test (KEPT) in a nationally representative sample. Psychol Assess 2019; 31:781-792. [PMID: 30742461 PMCID: PMC6527471 DOI: 10.1037/pas0000699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We report on the development and psychometric properties of an instrument for the assessment of knowledge of effective parenting skills specific to conduct problems using an item response theory (IRT) framework. The initial item pool (36 items) for the Knowledge of Effective Parenting Test (KEPT) was administered online to a national sample (N = 1,570) selected to match the U.S. population on key demographic variables. Items with strong psychometric properties and without significant differential item functioning (DIF) by race/ethnicity were retained, resulting in a 21-item version of the KEPT with excellent reliability and validity. We also created a brief 10-item version of the KEPT to reduce respondent burden and to enhance its utility for repeated measurement in longitudinal and intervention research. We report norms and percentiles for both the 21-item version (KEPT-Full) and the 10-item version (KEPT-Brief). (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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25
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Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ. Prevalence and Treatment of Depression, Anxiety, and Conduct Problems in US Children. J Pediatr 2019; 206:256-267.e3. [PMID: 30322701 PMCID: PMC6673640 DOI: 10.1016/j.jpeds.2018.09.021] [Citation(s) in RCA: 498] [Impact Index Per Article: 99.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To use the latest data to estimate the prevalence and correlates of currently diagnosed depression, anxiety problems, and behavioral or conduct problems among children, and the receipt of related mental health treatment. STUDY DESIGN We analyzed data from the 2016 National Survey of Children's Health (NSCH) to report nationally representative prevalence estimates of each condition among children aged 3-17 years and receipt of treatment by a mental health professional. Parents/caregivers reported whether their children had ever been diagnosed with each of the 3 conditions and whether they currently have the condition. Bivariate analyses were used to examine the prevalence of conditions and treatment according to sociodemographic and health-related characteristics. The independent associations of these characteristics with both the current disorder and utilization of treatment were assessed using multivariable logistic regression. RESULTS Among children aged 3-17 years, 7.1% had current anxiety problems, 7.4% had a current behavioral/conduct problem, and 3.2% had current depression. The prevalence of each disorder was higher with older age and poorer child health or parent/caregiver mental/emotional health; condition-specific variations were observed in the association between other characteristics and the likelihood of disorder. Nearly 80% of those with depression received treatment in the previous year, compared with 59.3% of those with anxiety problems and 53.5% of those with behavioral/conduct problems. Model-adjusted effects indicated that condition severity and presence of a comorbid mental disorder were associated with treatment receipt. CONCLUSIONS The latest nationally representative data from the NSCH show that depression, anxiety, and behavioral/conduct problems are prevalent among US children and adolescents. Treatment gaps remain, particularly for anxiety and behavioral/conduct problems.
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Affiliation(s)
- Reem M Ghandour
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD.
| | - Laura J Sherman
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Catherine J Vladutiu
- Maternal and Child Health Bureau, Health Resources and Services Administration, Rockville, MD
| | - Mir M Ali
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Sean E Lynch
- Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Rebecca H Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Stephen J Blumberg
- National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD
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26
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Lillig M. Conduct Disorder: Recognition and Management. Am Fam Physician 2018; 98:584-592. [PMID: 30365289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Conduct disorder is a psychiatric syndrome that most commonly occurs in childhood and adolescence. It is characterized by symptoms of aggression toward people or animals, destruction of property, deceitfulness or theft, and serious violations of rules. Risk factors include male sex, maternal smoking during pregnancy, poverty in childhood, exposure to physical or sexual abuse or domestic violence, and parental substance use disorders or criminal behavior. At least three symptoms should have been present in the past 12 months, with at least one present in the past six months to diagnose conduct disorder. Interventions consist of treating comorbid conditions such as attention-deficit/hyperactivity disorder; supporting clear, direct, and positive communication within the family; and encouraging the family and youth to connect with community resources. There are several evidence-based psychosocial interventions that a psychologist or therapist may implement as part of long-term treatment. Currently, no medications have been approved by the U.S. Food and Drug Administration to treat conduct disorder. Treatment with psychostimulants is highly recommended for patients who have both attention-deficit/hyperactivity disorder and conduct problems. There is some evidence to support the treatment of conduct disorder and aggression with risperidone, but health care professionals should weigh the medication's potential benefits against its adverse metabolic effects.
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Affiliation(s)
- Mathias Lillig
- University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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27
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He Y, Gewirtz AH, Lee S, August G. Do Parent Preferences for Child Conduct Problem Interventions Impact Parenting Outcomes? A Pilot Study in Community Children's Mental Health Settings. J Marital Fam Ther 2018; 44:716-729. [PMID: 29425398 PMCID: PMC6085174 DOI: 10.1111/jmft.12310] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A pilot, doubly randomized preference trial was conducted to investigate the impact of providing parents preferences on parenting outcomes. Families with children having conduct problems were randomly assigned to a choice group in which they received their preferred treatment among the four intervention options or a no-choice group in which they were randomized assigned to one of the four options. Results of mixed-effects models showed that parents in the choice group who selected Parent Management Training-Oregon Model (PMTO) had better parenting outcomes over time compared to parents in the choice group who selected child therapy. It highlights the importance of incorporating parent preferences in the delivery of evidence-based treatments.
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Affiliation(s)
- Yaliu He
- The Family Institute at Northwestern University
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28
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Fuhrman AM, Greer BD, Zangrillo AN, Fisher WW. Evaluating competing activities to enhance functional communication training during reinforcement schedule thinning. J Appl Behav Anal 2018; 51:931-942. [PMID: 29959773 PMCID: PMC6188798 DOI: 10.1002/jaba.486] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/06/2017] [Indexed: 01/10/2023]
Abstract
Arranging periods in which requests for reinforcement are denied in a multiple schedule may result in increased destructive behavior during these periods for individuals who receive functional communication training (FCT) as treatment for severe destructive behavior. Providing access to competing activities during periods of reinforcer unavailability has been shown to minimize destructive behavior. We evaluated methods to identify effective competing activities for use when thinning reinforcement availability in a multiple schedule and compared competing activities embedded within the multiple schedule using an alternating-treatments design. Results suggested at least one competing activity facilitated favorable treatment outcomes for each participant. We discuss building on this empirical approach to identify effective competing activities for use during reinforcement schedule thinning.
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Affiliation(s)
| | - Brian D Greer
- University of Nebraska Medical Center's Munroe-Meyer Institute
| | | | - Wayne W Fisher
- University of Nebraska Medical Center's Munroe-Meyer Institute
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29
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Ghaderi A, Kadesjö C, Björnsdotter A, Enebrink P. Randomized effectiveness Trial of the Family Check-Up versus Internet-delivered Parent Training (iComet) for Families of Children with Conduct Problems. Sci Rep 2018; 8:11486. [PMID: 30065246 PMCID: PMC6068169 DOI: 10.1038/s41598-018-29550-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 07/09/2018] [Indexed: 12/04/2022] Open
Abstract
We investigated the effectiveness of the Family Check-Up (FCU) and an Internet-based parent-training program (iComet), along with moderators and mediators of outcome. Families (N = 231) with a child with conduct problems were randomized to one of the conditions for 10 weeks of treatment. The drop-out rate was significantly higher in the iComet (39%) compared to FCU (23%). At post-treatment, both conditions resulted in significant improvement, based on parent-report, but no significant interaction between time and condition, with the exception of conduct problem subscale of the Strengths and Difficulties Questionnaire, slightly favoring the FCU. Neither child, nor teacher reports indicated any significant changes on any of the investigated variables. At 1-, and 2-years follow-up, the gains from the treatment were maintained in both conditions, with basically no significant time X condition interactions. A significantly larger proportion of children in the FCU recovered at post-treatment with regard to opposition defiant behavior, inattention, and conduct problems, compared to the iComet, but almost none of these differences remained significant at 1-, and 2-years follow-up. None of the moderators (child age, parental income or education, or pre-treatment level of motivation) or mediators (limit setting, and appropriate or harsh parenting) of outcome turned out to be significant.
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Affiliation(s)
- Ata Ghaderi
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden.
| | - Christina Kadesjö
- University of Gothenburg, Sahlgrenska Academy, Gillberg Neuropsychiatry Centre, Gothenburg, Sweden
| | | | - Pia Enebrink
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
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30
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Sampaio F, Barendregt JJ, Feldman I, Lee YY, Sawyer MG, Dadds MR, Scott JG, Mihalopoulos C. Population cost-effectiveness of the Triple P parenting programme for the treatment of conduct disorder: an economic modelling study. Eur Child Adolesc Psychiatry 2018; 27:933-944. [PMID: 29288334 PMCID: PMC6013530 DOI: 10.1007/s00787-017-1100-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 12/16/2017] [Indexed: 01/30/2023]
Abstract
Parenting programmes are the recommended treatments of conduct disorders (CD) in children, but little is known about their longer term cost-effectiveness. This study aimed to evaluate the population cost-effectiveness of one of the most researched evidence-based parenting programmes, the Triple P-Positive Parenting Programme, delivered in a group and individual format, for the treatment of CD in children. A population-based multiple cohort decision analytic model was developed to estimate the cost per disability-adjusted life year (DALY) averted of Triple P compared with a 'no intervention' scenario, using a health sector perspective. The model targeted a cohort of 5-9-year-old children with CD in Australia currently seeking treatment, and followed them until they reached adulthood (i.e., 18 years). Multivariate probabilistic and univariate sensitivity analyses were conducted to incorporate uncertainty in the model parameters. Triple P was cost-effective compared to no intervention at a threshold of AU$50,000 per DALY averted when delivered in a group format [incremental cost-effectiveness ratio (ICER) = $1013 per DALY averted; 95% uncertainty interval (UI) 471-1956] and in an individual format (ICER = $20,498 per DALY averted; 95% UI 11,146-39,470). Evidence-based parenting programmes, such as the Triple P, for the treatment of CD among children appear to represent good value for money, when delivered in a group or an individual face-to-face format, with the group format being the most cost-effective option. The current model can be used for economic evaluations of other interventions targeting CD and in other settings.
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Affiliation(s)
- Filipa Sampaio
- Department of Public Health and Caring Sciences (IFV), Uppsala University, BMC, Husargatan 3, 751 22 Uppsala, Sweden
| | - Jan J. Barendregt
- Epigear International, Sunrise Beach, QLD Australia
- School of Public Health, The University of Queensland, Herston, QLD Australia
| | - Inna Feldman
- Department of Public Health and Caring Sciences (IFV), Uppsala University, BMC, Husargatan 3, 751 22 Uppsala, Sweden
| | - Yong Yi Lee
- School of Public Health, The University of Queensland, Herston, QLD Australia
- Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD Australia
| | - Michael G. Sawyer
- School of Medicine, University of Adelaide, Adelaide, SA Australia
- Research and Evaluation Unit, Women’s and Children’s Health Network, Adelaide, SA Australia
| | - Mark R. Dadds
- Child Behaviour Research Clinic, University of Sydney, Sydney, Australia
| | - James G. Scott
- Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Wacol, QLD Australia
- The University of Queensland Centre for Clinical Research, Herston, QLD Australia
- Metro North Mental Health, Royal Brisbane and Women’s Hospital, Herston, QLD Australia
| | - Cathrine Mihalopoulos
- School of Health and Social Development, Deakin Health Economics, Deakin University, Melbourne, Australia
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31
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Elizur Y, Somech LY. Callous-Unemotional Traits and Effortful Control Mediate the Effect of Parenting Intervention on Preschool Conduct Problems. J Abnorm Child Psychol 2018; 46:1631-1642. [PMID: 29478120 DOI: 10.1007/s10802-018-0412-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Parenting intervention (PI) is an effective treatment for children's conduct problems (CP) that has been shown to be mediated by improved parenting practices and parenting self-efficacy. Recently, Hitkashrut's randomized controlled trial demonstrated that ineffective parenting (IP) mediated effects on callous-unemotional (CU) traits and effortful control (EC), while controlling for more general treatment effects on CP. These temperament and personality-based features predict the formation of early-onset antisocial trajectories with poor long-term prognosis. The objective of this study was to use Hitkashrut's 3-wave dataset to test posttreatment EC and CU mediation of treatment effect on 1-year follow-up CP, and to determine whether mediation by each child-level potential mediator remains significant when tested concurrently with the parenting mediator. Parents of 209 3-5 year-old preschoolers (163 boys; 46 girls), with subclinical-clinical range CP were assigned to 14-session co-parent training groups (n = 140 couples), or to minimal intervention control groups (n = 69 couples). Assessments were based on both parents' questionnaires. An intent-to-treat analysis showed that EC and CU traits simultaneously mediated treatment effects on CP in one EC/CU mediational model. The concurrent testing of child- and parent-level mediators showed mediation by IP and CU traits in the CU/IP model, and IP mediation in the EC/IP model. Similar results were obtained in mediational analyses that controlled for the shared variance between the mediators and CP at T2. Overall, the findings support an intervention model of coaching parents of high-CP children to promote moral self-regulatory competencies while concurrently applying behavioral methods that directly target CP.
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Affiliation(s)
- Yoel Elizur
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Mount Scopus, 9190501, Jerusalem, Israel.
| | - Lior Y Somech
- The Seymour Fox School of Education, The Hebrew University of Jerusalem, Mount Scopus, 9190501, Jerusalem, Israel
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32
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Fonagy P, Butler S, Cottrell D, Scott S, Pilling S, Eisler I, Fuggle P, Kraam A, Byford S, Wason J, Ellison R, Simes E, Ganguli P, Allison E, Goodyer IM. Multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour (START): a pragmatic, randomised controlled, superiority trial. Lancet Psychiatry 2018; 5:119-133. [PMID: 29307527 PMCID: PMC6697182 DOI: 10.1016/s2215-0366(18)30001-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 11/16/2017] [Accepted: 11/16/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Adolescent antisocial behaviour is a major health and social problem. Studies in the USA have shown that multisystemic therapy reduces such behaviour and the number of criminal offences committed by this group. However, findings outside the USA are equivocal. We aimed to assess the effectiveness and cost-effectiveness of multisystemic therapy versus management as usual in the treatment of adolescent antisocial behaviour. METHODS We did an 18 month, multisite, pragmatic, randomised controlled, superiority trial in England. Eligible participants aged 11-17 years with moderate-to-severe antisocial behaviour had at least three severity criteria indicating past difficulties across several settings and one of five general inclusion criteria for antisocial behaviour. We randomly assigned families (1:1) using stochastic minimisation, stratifying for treatment centre, sex, age at enrolment to study, and age at onset of antisocial behaviour, to receive either management as usual or 3-5 months of multisystemic therapy followed by management as usual. Research assistants and investigators were masked to treatment allocation; the participants could not be masked. The primary outcome was out-of-home placement at 18 months. The primary analysis included all randomised participants for whom data were available. This trial is registered, number ISRCTN77132214. Follow-up of the trial is still ongoing. FINDINGS Between Feb 4, 2010, and Sept 1, 2012, 1076 families were referred to nine multi-agency panels, 684 of whom were assigned to management as usual (n=342) or multisystemic therapy followed by management as usual (n=342). At 18 months, the proportion of participants in out-of-home placement was not significantly different between the groups (13% [43/340] in the multisystemic therapy group vs 11% [36/335] in the management-as-usual group; odds ratio 1·25, 95% CI 0·77-2·05; p=0·37). INTERPRETATION The findings do not support that multisystemic therapy should be used over management as usual as the intervention of choice for adolescents with moderate-to-severe antisocial behaviour. FUNDING Department for Children, Schools and Families, Department of Health.
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Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
| | - Stephen Butler
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Stephen Scott
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Stephen Pilling
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Peter Fuggle
- Anna Freud National Centre for Children and Families, London, UK
| | - Abdullah Kraam
- University of Leeds and South West Yorkshire Partnership NHS Foundation Trust, Leeds, UK
| | - Sarah Byford
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - James Wason
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Rachel Ellison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Elizabeth Simes
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Poushali Ganguli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Elizabeth Allison
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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33
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Muratori P, Milone A, Manfredi A, Polidori L, Ruglioni L, Lambruschi F, Masi G, Lochman JE. Evaluation of Improvement in Externalizing Behaviors and Callous-Unemotional Traits in Children with Disruptive Behavior Disorder: A 1-Year Follow Up Clinic-Based Study. Adm Policy Ment Health 2018; 44:452-462. [PMID: 26008901 DOI: 10.1007/s10488-015-0660-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multi-component interventions based on cognitive behavioral principles and practices have been found effective in reducing behavioral problems in children with disruptive behavior disorders (oppositional defiant disorder and conduct disorder). However, it is still unclear if these interventions can affect children's callous-unemotional traits, which are predictive of subsequent antisocial behavior. Furthermore, it could be important to identify empirically supported treatment protocols for specific disorders addressed by child mental health services. The present study aimed to test the following two hypotheses: first, the Coping Power (CP) treatment program is able to reduce externalizing behaviors in children with disruptive behavior disorders treated in a mental health care unit; second, the CP program can reduce children's callous unemotional traits. The sample included 98 Italian children, 33 treated with the CP program; 37 with a less focused multi-component intervention, and 28 with child psychotherapy. The results showed that the CP program was more effective than the other two treatments in reducing aggressive behaviors. Furthermore, only the CP program was associated with a decrease in children's callous unemotional traits. The CP program was also associated with lower rate of referrals to mental health services at one-year follow-up. These findings support the importance of disseminating manualized and focused intervention programs in mental health services.
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Affiliation(s)
- Pietro Muratori
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy.
| | - Annarita Milone
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy
| | - Azzurra Manfredi
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy
| | - Lisa Polidori
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy
| | - Laura Ruglioni
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy
| | | | - Gabriele Masi
- Scientific Institute of Child Neurology and Psychiatry, IRCCS Fondazione Stella Maris, Viale del Tirreno 331, Calambrone, 56018, Pisa, Italy
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Oruche UM, Robb SL, Aalsma M, Pescosolido B, Brown-Podgorski B, Draucker CB. Developing a Multiple Caregiver Group for Caregivers of Adolescents With Disruptive Behaviors. Arch Psychiatr Nurs 2017; 31:596-601. [PMID: 29179827 DOI: 10.1016/j.apnu.2017.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/13/2017] [Accepted: 08/18/2017] [Indexed: 11/18/2022]
Abstract
This article describes the development of a 6-week multiple caregiver group intervention for primary caregivers of adolescents diagnosed with Oppositional Defiant Disorder or Conduct Disorder in low-income African American families. The intervention is aimed at increasing the primary caregivers' self-efficacy in managing interactions within the family and especially with child serving educational, mental health, juvenile justice, and child welfare systems. Development of the intervention involved seven iterative activities performed in a collaborative effort between an interdisciplinary academic team, community engagement specialists, members of the targeted population, and clinical partners from a large public mental health system. The intervention development process described in this article can provide guidance for teams that aim to develop new mental health interventions that target specific outcomes in populations with unique needs.
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Affiliation(s)
- Ukamaka M Oruche
- School of Nursing, Indiana University-Purdue University Indianapolis, United States.
| | - Sheri L Robb
- School of Nursing, Indiana University-Purdue University Indianapolis, United States
| | - Matt Aalsma
- Section of Adolescents Health and Medicine, School of Medicine, Indiana University, United States
| | | | - Brittany Brown-Podgorski
- Richard M. Fairbanks School of Public Health, Indiana University-Purdue University Indianapolis, United States
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Edginton E, Walwyn R, Burton K, Cicero R, Graham L, Reed S, Tubeuf S, Twiddy M, Wright-Hughes A, Ellis L, Evans D, Hughes T, Midgley N, Wallis P, Cottrell D. TIGA-CUB - manualised psychoanalytic child psychotherapy versus treatment as usual for children aged 5-11 years with treatment-resistant conduct disorders and their primary carers: study protocol for a randomised controlled feasibility trial. Trials 2017; 18:431. [PMID: 28915904 PMCID: PMC5602865 DOI: 10.1186/s13063-017-2166-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/30/2017] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The National Institute for Health and Care Excellence (NICE) recommends evidence-based parenting programmes as a first-line intervention for conduct disorders (CD) in children aged 5-11 years. As these are not effective in 25-33% of cases, NICE has requested research into second-line interventions. Child and Adolescent Psychotherapists (CAPTs) address highly complex problems where first-line treatments have failed and there have been small-scale studies of Psychoanalytic Child Psychotherapy (PCP) for CD. A feasibility trial is needed to determine whether a confirmatory trial of manualised PCP (mPCP) versus Treatment as Usual (TaU) for CD is practicable or needs refinement. The aim of this paper is to publish the abridged protocol of this feasibility trial. METHODS AND DESIGN TIGA-CUB (Trial on improving Inter-Generational Attachment for Children Undergoing Behaviour problems) is a two-arm, pragmatic, parallel-group, multicentre, individually randomised (1:1) controlled feasibility trial (target n = 60) with blinded outcome assessment (at 4 and 8 months), which aims to develop an optimum practicable protocol for a confirmatory, pragmatic, randomised controlled trial (RCT) (primary outcome: child's behaviour; secondary outcomes: parental reflective functioning and mental health, child and parent quality of life), comparing mPCP and TaU as second-line treatments for children aged 5-11 years with treatment-resistant CD and inter-generational attachment difficulties, and for their primary carers. Child-primary carer dyads will be recruited following a referral to, or re-referral within, National Health Service (NHS) Child and Adolescent Mental Health Services (CAMHS) after an unsuccessful first-line parenting intervention. PCP will be delivered by qualified CAPTs working in routine NHS clinical practice, using a trial-specific PCP manual (a brief version of established PCP clinical practice). Outcomes are: (1) feasibility of recruitment methods, (2) uptake and follow-up rates, (3) therapeutic delivery, treatment retention and attendance, intervention adherence rates, (4) follow-up data collection, and (5) statistical, health economics, process evaluation, and qualitative outcomes. DISCUSSION TIGA-CUB will provide important information on the feasibility and potential challenges of undertaking a confirmatory RCT to evaluate the effectiveness and cost-effectiveness of mPCP. TRIAL REGISTRATION Current Controlled Trials, ID: ISRCTN86725795 . Registered on 31 May 2016.
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Affiliation(s)
- Elizabeth Edginton
- Child Oriented Mental health Interventions Centre (COMIC), Leeds and York Partnership NHS Foundation Trust, University of York, IT Building, Innovation Way, York, YO10 5NP UK
| | - Rebecca Walwyn
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Kayleigh Burton
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Robert Cicero
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Liz Graham
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Sadie Reed
- Leeds Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Sandy Tubeuf
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Lynda Ellis
- Northern School of Child and Adolescent Psychotherapy (NSCAP), Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | | | - Tom Hughes
- General Adult Psychiatry, Leeds and York Partnership NHS Foundation Trust, Leeds, UK
| | - Nick Midgley
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, UK
| | - Paul Wallis
- The Winnicott Centre, CAMHS Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Cottrell
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Lochman JE, Boxmeyer CL, Jones S, Qu L, Ewoldsen D, Nelson WM. Testing the feasibility of a briefer school-based preventive intervention with aggressive children: A hybrid intervention with face-to-face and internet components. J Sch Psychol 2017; 62:33-50. [PMID: 28646974 PMCID: PMC5492991 DOI: 10.1016/j.jsp.2017.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 07/30/2016] [Accepted: 03/30/2017] [Indexed: 10/19/2022]
Abstract
This study describes the results from a feasibility study of an innovative indicated prevention intervention with hybrid face-to-face and web-based components for preadolescent youth. This intervention includes a considerably briefer set of face-to-face sessions from the evidence-based Coping Power program and a carefully integrated internet component with practice and teaching activities and cartoon videos for children and for parents. The Coping Power - Internet Enhanced (CP-IE) program introduces a set of cognitive-behavioral skills in 12 small group sessions for children delivered during the school day and 7 group sessions for parents. Eight elementary schools were randomly assigned to CP-IE or to Control, and six children at each school were identified each year based on 4th grade teacher ratings of aggressive behavior. Path analyses of teacher-rated disruptive behavior outcomes for 91 fifth grade children, across two annual cohorts, indicated Control children had significantly greater increases in conduct problem behaviors across the 5th grade year than did CP-IE children. This much briefer version of Coping Power provided beneficial preventive effects on children's behavior in the school setting similar to the effects of the longer version of Coping Power. The website materials appeared to successfully engage children, and parents' use of the website predicted children's changes in conduct problems across the year.
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Affiliation(s)
| | | | | | - Lixin Qu
- The University of Alabama, United States
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Hogue A, Henderson CE, Schmidt AT. Multidimensional Predictors of Treatment Outcome in Usual Care for Adolescent Conduct Problems and Substance Use. Adm Policy Ment Health 2017; 44:380-394. [PMID: 26884380 PMCID: PMC4987263 DOI: 10.1007/s10488-016-0724-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study investigated baseline client characteristics that predicted long-term treatment outcomes among adolescents referred from school and community sources and enrolled in usual care for conduct and substance use problems. Predictor effects for multiple demographic (age, sex, race/ethnicity), clinical (baseline symptom severity, comorbidity, family discord), and developmental psychopathology (behavioral dysregulation, depression, peer delinquency) characteristics were examined. Participants were 205 adolescents (52 % male; mean age 15.7 years) from diverse backgrounds (59 % Hispanic American, 21 % African American, 15 % multiracial, 6 % other) residing in a large inner-city area. As expected, characteristics from all three predictor categories were related to various aspects of change in externalizing problems, delinquent acts, and substance use at one-year follow-up. The strongest predictive effect was found for baseline symptom severity: Youth with greater severity showed greater clinical gains. Higher levels of co-occurring developmental psychopathology characteristics likewise predicted better outcomes. Exploratory analyses showed that change over time in developmental psychopathology characteristics (peer delinquency, depression) was related to change in delinquent acts and substance use. Implications for serving multiproblem adolescents and tailoring treatment plans in routine care are discussed.
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Affiliation(s)
- Aaron Hogue
- The National Center on Addiction and Substance Abuse, 633 Third Avenue, 19th floor, New York, NY, 10017, USA.
| | - Craig E Henderson
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
| | - Adam T Schmidt
- Department of Psychology, Sam Houston State University, Huntsville, TX, USA
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Caye A, Swanson J, Thapar A, Sibley M, Arseneault L, Hechtman L, Arnold LE, Niclasen J, Moffitt T, Rohde LA. Life Span Studies of ADHD-Conceptual Challenges and Predictors of Persistence and Outcome. Curr Psychiatry Rep 2016; 18:111. [PMID: 27783340 PMCID: PMC5919196 DOI: 10.1007/s11920-016-0750-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
There is a renewed interest in better conceptualizing trajectories of attention-deficit/hyperactivity disorder (ADHD) from childhood to adulthood, driven by an increased recognition of long-term impairment and potential persistence beyond childhood and adolescence. This review addresses the following major issues relevant to the course of ADHD in light of current evidence from longitudinal studies: (1) conceptual and methodological issues related to measurement of persistence of ADHD, (2) estimates of persistence rate from childhood to adulthood and its predictors, (3) long-term negative outcomes of childhood ADHD and their early predictors, and (4) the recently proposed new adult-onset ADHD. Estimates of persistence vary widely in the literature, and diagnostic criteria, sample characteristics, and information source are the most important factors explaining variability among studies. Evidence indicates that ADHD severity, comorbid conduct disorder and major depressive disorder, and treatment for ADHD are the main predictors of ADHD persistence from childhood to adulthood. Comorbid conduct disorder and ADHD severity in childhood are the most important predictors of adverse outcomes in adulthood among children with ADHD. Three recent population studies suggested the existence of a significant proportion of individuals who report onset of ADHD symptoms and impairments after childhood. Finally, we highlight areas for improvement to increase our understanding of ADHD across the life span.
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Affiliation(s)
- Arthur Caye
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - James Swanson
- Department of Pediatrics, University of California, Irvine, CA, USA
| | - Anita Thapar
- MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Margaret Sibley
- Department of Psychiatry and Behavioral Health at the Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Louise Arseneault
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lily Hechtman
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - L Eugene Arnold
- Department of Psychiatry, Nisonger Center, Ohio State University, Columbus, OH, USA
| | - Janni Niclasen
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Centre for Collaborative Health, Aarhus University, Aarhus, Denmark
| | - Terrie Moffitt
- Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Luis Augusto Rohde
- ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
- National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.
- Serviço de Psiquiatria da Infância e Adolescência, Hospital de Clinicas de Porto Alegre, 4o andar, Rua Ramiro Barcelos 2350, Porto Alegre, 90035-003, Brazil.
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Sampaio F, Enebrink P, Mihalopoulos C, Feldman I. Cost-Effectiveness of Four Parenting Programs and Bibliotherapy for Parents of Children with Conduct Problems. J Ment Health Policy Econ 2016; 19:201-212. [PMID: 27991419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 08/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Parenting programs and self-help parenting interventions employing written materials are effective in reducing child conduct problems (CP) in the short-term compared to control groups, however evidence on the cost-effectiveness of such interventions is insufficient. Few studies have looked at the differences in effects between interventions in the same study design. AIM This study aimed to determine the cost-effectiveness of four parenting programs: Comet, Incredible Years (IY), Cope and Connect, and bibliotherapy, compared to a waitlist control (WC), with a time horizon of 4 months, targeting CP in children aged 3-12 years. METHODS This economic evaluation was conducted alongside an RCT of the four parenting interventions and bibliotherapy compared to a WC. The study sample consisted of 961 parents of 3-12 year-old children with CP. CP was measured by the Eyberg Child Behavior Inventory. Effectiveness was expressed as the proportion of "recovered" cases of CP. The time horizon of the study was four months with a limited health sector perspective, including parents' time costs. We performed an initial comparative cost analysis for interventions whose outcomes differed significantly from the WC, and later a cost-effectiveness analysis of interventions whose outcomes differed significantly from both the WC and each other. Secondary analyses were performed: (i) joint outcome "recovered and improved", (ii) intervention completers, (iii) exclusion of parents' time costs, (iv) exclusion of training costs. RESULTS All interventions apart from Connect significantly reduced CP compared to the WC. Of the other interventions Comet resulted in a significantly higher proportion of recovered cases compared to bibliotherapy. A comparative cost analysis of the effective interventions rendered an average cost per recovered case for bibliotherapy of USD 483, Cope USD 1972, Comet USD 3741, and IY USD 6668. Furthermore, Comet had an ICER of USD 8375 compared to bibliotherapy. Secondary analyses of "recovered and improved" and of intervention completers held Cope as the cheapest alternative. Exclusion of parents' time and training costs did not change the cost-effectiveness results. DISCUSSION The time horizon for this evaluation is very short. This study also had a limited costing perspective. Results may be interpreted with caution when considering decision-making about value for money. The inclusion of a multi-attribute utility instrument sensitive to domains of quality-of-life impacted by CP in children would be valuable so that pragmatic value for money estimations can be made. IMPLICATIONS FOR FUTURE RESEARCH Further studies are needed with longer follow-up periods to ascertain on the sustainability of the effects, and fuller economic evaluations and economic modeling to provide insights on longer-term cost-effectiveness. These results also raise the need to investigate the cost-effectiveness of the provision of these interventions as a "stepped care" approach. CONCLUSIONS The results suggest the delivery of different programs according to budget constraints and the outcome desired. In the absence of a WTP threshold, bibliotherapy could be a cheap and effective option to initially target CP within a limited budget, whereas Comet could be offered to achieve greater effects based on decision-makers' willingness to make larger investments. In its turn, Cope could be offered when targeting broader outcomes, such as symptom improvement, rather than clinical caseness.
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Affiliation(s)
- Filipa Sampaio
- Department of Women's and Children's Health, Uppsala University, CHAP (Muninhuset), Islandsgatan 2, Plan 3, 751 85 Uppsala, Sweden,
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Bjørseth Å, Wichstrøm L. Effectiveness of Parent-Child Interaction Therapy (PCIT) in the Treatment of Young Children's Behavior Problems. A Randomized Controlled Study. PLoS One 2016; 11:e0159845. [PMID: 27622458 PMCID: PMC5021353 DOI: 10.1371/journal.pone.0159845] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 07/08/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the present investigation was to compare the effectiveness of Parent-Child Interaction Therapy (PCIT) with treatment as usual (TAU) in young children who were referred to regular child and adolescent mental health clinics for behavior problems. METHOD Eighty-one Norwegian families with two- to seven-year-old children (52 boys) who had scored ≥ 120 on the Eyberg Child Behavior Inventory (ECBI) were randomly assigned to receive either PCIT or TAU. The families were assessed 6 and 18 months after beginning treatment. Parenting skills were measured using the Dyadic Parent-Child Interaction Coding System (DPICS), and child behavior problems were measured using the ECBI and the Child Behavior Checklist (CBCL). RESULTS Linear growth curve analyses revealed that the behavior problems of children receiving PCIT improved more compared with children receiving TAU according to mother reports (ECBI d = .64, CBCL d = .61, both p < .05) but not according to father report. Parents also improved with regard to Do and Don't skills (d = 2.58, d = 1.46, respectively, both p ≤ .001). At the 6-month assessment, which often occurred before treatment was finished, children who had received PCIT had lower father-rated ECBI and mother-rated CBCL-scores (p = .06) compared with those who had received TAU. At the 18-month follow-up, the children who had received PCIT showed fewer behavior problems compared with TAU according to mother (d = .37) and father (d = .56) reports on the ECBI and mother reports on the CBCL regarding externalizing problems (d = .39). Parents receiving PCIT developed more favorable Do Skills (6-month d = 1.81; 18-month d = 1.91) and Don't Skills (6-month d = 1.46; 18-month d = 1.42) according to observer ratings on the DPICS compared with those receiving TAU. CONCLUSION Children receiving PCIT in regular clinical practice exhibited a greater reduction in behavior problems compared with children receiving TAU, and their parents' parenting skills improved to a greater degree compared with those receiving TAU. TRIAL REGISTRATION ClinicalTrials.gov NTC01085305.
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Affiliation(s)
- Åse Bjørseth
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Nord-Trøndelag, Norway
- Department of Psychology, Norwegian University of Science and Technology, Sør-Trøndelag, Trondheim, Norway
| | - Lars Wichstrøm
- Department of Psychology, Norwegian University of Science and Technology, Sør-Trøndelag, Trondheim, Norway
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Abstract
Multisystemic therapy (MST) is an evidence-based treatment originally developed for youth with serious antisocial behavior who are at high risk for out-of-home placement and their families; and subsequently adapted to address other challenging clinical problems experience by youths and their families. The social-ecological theoretical framework of MST is presented as well as its home-based model of treatment delivery, defining clinical intervention strategies, and ongoing quality assurance/quality improvement system. With more than 100 peer-reviewed outcome and implementation journal articles published as of January 2016, the majority by independent investigators, MST is one of the most extensively evaluated family based treatments. Outcome research has yielded almost uniformly favorable results for youths and families, and implementation research has demonstrated the importance of treatment and program fidelity in achieving such outcomes.
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Affiliation(s)
- Scott W Henggeler
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC.
| | - Cindy M Schaeffer
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
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Folk JB, Disabato DJ, Daylor JM, Tangney JP, Barboza S, Wilson JS, Bonieskie L, Holwager J. Effectiveness of a self-administered intervention for criminal thinking: Taking a Chance on Change. Psychol Serv 2016; 13:272-282. [PMID: 27243111 PMCID: PMC4980178 DOI: 10.1037/ser0000079] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The current study tested the effectiveness of a self-administered, cognitive-behavioral intervention targeting criminal thinking for inmates in segregated housing: Taking a Chance on Change (TCC). Participants included 273 inmates in segregated housing at state correctional institutions. Reductions in criminal thinking, as assessed by the Psychological Inventory of Criminal Styles-Simplified Version, were found in the general criminal thinking score as well as the proactive and reactive composite scores. Examination of demographic predictors of change (i.e., age, years of education, length of sentence) revealed older and more educated participants decreased in criminal thinking more than younger and less educated participants. For a subset of 48 inmates, completion of TCC was associated with significant reduction of disciplinary infractions. Reductions in reactive criminal thinking predicted reductions in disciplinary infractions. Although further research is needed to determine the effectiveness of TCC in reducing recidivism, the reductions in criminal thinking and disordered conduct suggest this is a promising intervention and mode of treatment delivery. By utilizing self-directed study at an accessible reading level, the intervention is uniquely suited to a correctional setting where staff and monetary resources are limited and security and operational issues limit the feasibility of traditional cognitive-behavioral group treatment. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | - Lynda Bonieskie
- Department of Mental Health, Maryland Department of Public Safety and Correctional Services
| | - James Holwager
- Department of Mental Health, Maryland Department of Public Safety and Correctional Services
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Niec LN, Barnett ML, Prewett MS, Shanley Chatham JR. Group parent-child interaction therapy: A randomized control trial for the treatment of conduct problems in young children. J Consult Clin Psychol 2016; 84:682-698. [PMID: 27018531 PMCID: PMC5325686 DOI: 10.1037/a0040218] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although efficacious interventions exist for childhood conduct problems, a majority of families in need of services do not receive them. To address problems of treatment access and adherence, innovative adaptations of current interventions are needed. This randomized control trial investigated the relative efficacy of a novel format of parent-child interaction therapy (PCIT), a treatment for young children with conduct problems. METHOD Eighty-one families with 3- to 6-year-old children (71.6% boys, 85.2% White) with diagnoses of oppositional defiant or conduct disorder were randomized to individual PCIT (n = 42) or the novel format, Group PCIT. Parents completed standardized measures of children's conduct problems, parenting stress, and social support at intake, posttreatment, and 6-month follow-up. Therapist ratings, parent attendance, and homework completion provided measures of treatment adherence. Throughout treatment, parenting skills were assessed using the Dyadic Parent-Child Interaction Coding System. RESULTS Parents in both group and individual PCIT reported significant improvements from intake to posttreatment and follow-up in their children's conduct problems and adaptive functioning, as well as significant decreases in parenting stress. Parents in both treatment conditions also showed significant improvements in their parenting skills. There were no interactions between time and treatment format. Contrary to expectation, parents in Group PCIT did not experience greater social support or treatment adherence. CONCLUSIONS Group PCIT was not inferior to individual PCIT and may be a valuable format to reach more families in need of services. Future work should explore the efficiency and sustainability of Group PCIT in community settings. (PsycINFO Database Record
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Affiliation(s)
- Larissa N Niec
- Center for Children, Families, and Communities, Central Michigan University
| | - Miya L Barnett
- Department of Psychology, University of California, Los Angeles
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Abstract
Out-of-home treatment for youth with conduct problems is increasing rapidly in this country. Most programs for these youth deliver treatment in a group format and commonly employ some version of a token economy. Despite widespread evidence of effectiveness, a substantial minority of treated youth fail to respond. Participants for this study were 3 youth who were nonresponsive to treatment provided in a family-style residential care program with a comprehensive token economy. Our approach to the “nonresponse” of these youth involved modifications of the frequency and immediacy of their access to the backup rewards earned with tokens. We evaluated the effects of the modifications with a treatment-withdrawal experimental design. Dependent measures included two indices of youth response to treatment: intense behavioral episodes and backup rewards earned. Results showed substantial improvement among these indices during treatment conditions.
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Abstract
Juvenile firesetting is a significant cause of morbidity and mortality in the United States. Male gender, substance use, history of maltreatment, interest in fire, and psychiatric illness are commonly reported risk factors. Interventions that have been shown to be effective in juveniles who set fires include cognitive behavior therapy and educational interventions, whereas satiation has not been shown to be an effective intervention. Forensic assessments can assist the legal community in adjudicating youth with effective interventions. Future studies should focus on consistent assessment and outcome measures to create more evidence for directing evaluation and treatment of juvenile firesetters.
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Affiliation(s)
- Brittany Peters
- Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue South, Suite 3023, Nashville, TN 37212, USA
| | - Bradley Freeman
- Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue South, Suite 3023, Nashville, TN 37212, USA.
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Saint-André S, Planche P, Gourbil A, Botbol M. Occupational identity crisis of professionals dealing with difficult adolescents. Psychiatriki 2016; 27:44-50. [PMID: 27110882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study tests the hypothesis of vulnerability in health and social care professionals dealing with difficult adolescents. This vulnerability appears to be underpinned by an occupational identity crisis that seems to diminish the ability of these professionals to recognize the suffering of these adolescents. A questionnaire was developed and then distributed during a network day bringing together members of various institutions and bodies working with difficult adolescents. Ninety-three professionals responded. Occupational identity weaknesses were identified: inadequate basic training, experiences of solitude, feelings of powerlessness and exposure, inadequate personal and institutional resources. Actors involved express their need for inter-institutional and inter-sectoral network but find it uneasy to implement. Some changes can be recommended to reduce this occupational identity crisis: increased efforts towards continuing training, development of possibilities of reflection within institutions, and more structured partnerships and actions.
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Affiliation(s)
- S Saint-André
- Department of Child and Adolescent PSychiatry, Brest University Hospital, Hôpital de Bohars, CHRU Brest, France
| | - P Planche
- CREAD, Research Center for Education, Learning and Teaching University of Western Brittany
| | - A Gourbil
- Department of Child and Adolescent PSychiatry, Brest University Hospital, Hôpital de Bohars, CHRU Brest, France
| | - M Botbol
- Department of Child and Adolescent PSychiatry, Brest University Hospital, Hôpital de Bohars, CHRU Brest, France
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Lucassen MFG, Stasiak K, Crengle S, Weisz JR, Frampton CMA, Bearman SK, Ugueto AM, Herren J, Cribb-Su'a A, Faleafa M, Kingi-'Ulu'ave D, Loy J, Scott RM, Hartdegen M, Merry SN. Modular Approach to Therapy for Anxiety, Depression, Trauma, or Conduct Problems in outpatient child and adolescent mental health services in New Zealand: study protocol for a randomized controlled trial. Trials 2015; 16:457. [PMID: 26458917 PMCID: PMC4603305 DOI: 10.1186/s13063-015-0982-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 09/28/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mental health disorders are common and disabling for young people because of the potential to disrupt key developmental tasks. Implementation of evidence-based psychosocial therapies in New Zealand is limited, owing to the inaccessibility, length, and cost of training in these therapies. Furthermore, most therapies address one problem area at a time, although comorbidity and changing clinical needs commonly occur in practice. A more flexible approach is needed. The Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH-ADTC) is designed to overcome these challenges; it provides a range of treatment modules addressing different problems, within a single training program. A clinical trial of MATCH-ADTC in the USA showed that MATCH-ADTC outperformed usual care and standard evidence-based treatment on several clinical measures. We aim to replicate these findings and evaluate the impact of providing training and supervision in MATCH-ADTC to: (1) improve clinical outcomes for youth attending mental health services; (2) increase the amount of evidence-based therapy content; (3) increase the efficiency of service delivery. METHODS This is an assessor-blinded multi-site effectiveness randomized controlled trial. Randomization occurs at two levels: (1) clinicians (≥60) are randomized to intervention or usual care; (2) youth participants (7-14 years old) accepted for treatment in child and adolescent mental health services (with a primary disorder that includes anxiety, depression, trauma-related symptoms, or disruptive behavior) are randomly allocated to receive MATCH-ADTC or usual care. Youth participants are recruited from 'mainstream', Māori-specific, and Pacific-specific child and adolescent mental health services. We originally planned to recruit 400 youth participants, but this has been revised to 200 participants. Centralized computer randomization ensures allocation concealment. The primary outcome measures are: (i) the difference in trajectory of change of clinical severity between groups (using the parent-rated Brief Problem Monitor); (ii) clinicians' use of evidence-based treatment procedures during therapy sessions; (iii) total time spent by clinicians delivering therapy. DISCUSSION If MATCH-ADTC demonstrates effectiveness it could offer a practical efficient method to increase access to evidence-based therapies, and improve outcomes for youth attending secondary care services. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry ACTRN12614000297628 .
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Affiliation(s)
- Mathijs F G Lucassen
- Department of Health and Social Care, The Open University, Walton Hall, Milton Keynes, MK7 6AA, UK.
- Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Karolina Stasiak
- Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Sue Crengle
- Invercargill Medical Centre, 160 Don Street, Invercargill, New Zealand.
| | - John R Weisz
- Department of Psychology, Harvard University, 1030 William James Hall, 33 Kirkland Street, Cambridge, MA, 02138, USA.
| | - Christopher M A Frampton
- Department of Psychological Medicine, University of Otago (Christchurch), 2 Riccarton Avenue, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, 1912 Speedway, Stop D5800, Austin, TX, 78712-1289, USA.
| | | | - Jennifer Herren
- Department of Psychiatry and Human Behavior, Brown University, Box G-BH, Providence, RI, 02912, USA.
| | - Ainsleigh Cribb-Su'a
- Whirinaki, Counties Manukau District Health Board, PO Box 217198, Botany Junction, Auckland, 2164, New Zealand.
| | - Monique Faleafa
- Le Va, PO Box 76536, Manukau City, Auckland, 2241, New Zealand.
| | | | - Jik Loy
- Infant, Child, and Adolescent Mental Health Services, Waikato District Health Board, Pembroke Street, Private Bag 3200, Hamilton, 3240, New Zealand.
| | - Rebecca M Scott
- Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Morgyn Hartdegen
- Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
| | - Sally N Merry
- Department of Psychological Medicine, School of Medicine, Level 12 Auckland City Hospital Support Building, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand.
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Burkey MD, Hosein M, Purgato M, Adi A, Morton I, Kohrt BA, Tol WA. Psychosocial interventions for disruptive behavioural problems in children living in low- and middle-income countries: study protocol of a systematic review. BMJ Open 2015; 5:e007377. [PMID: 25995239 PMCID: PMC4442205 DOI: 10.1136/bmjopen-2014-007377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Disruptive behaviour disorders (DBDs) are among the most common forms of child psychopathology and have serious long-term academic, social, and mental health consequences worldwide. Psychosocial treatments are the first line of evidence-based treatments for DBDs, yet their effectiveness often varies according to patient sociodemographic characteristics, practice setting, and implementation procedures. While a large majority of the world's children live in low- and middle-income countries (LMIC), most studies have evaluated psychosocial treatments for DBDs in high-income Anglo countries. METHODS AND ANALYSIS The primary objective of this systematic review is to assess the effects of psychosocial treatments for DBDs in children and adolescents (under age 18) diagnosed with oppositional defiant disorder, conduct disorder, or other disruptive behavioural problems living in LMIC. The secondary objectives are to: (1) describe the range and types of psychosocial treatments used to address DBDs in LMIC and (2) identify key dissemination and implementation factors (adaptation processes, training/supervision processes, and financial costs). All controlled trials comparing psychosocial treatments versus waiting list, no treatment, or treatment as usual in children living in LMIC will be included. Studies will be identified using the methods outlined in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines without restrictions on language, publication type, status, or date of publication. The primary outcome measures will be disruptive behavioural problems (eg, oppositionality, defiance, aggression or deceit). Secondary outcomes will be positive mental health outcomes (eg, prosocial behaviour), function impairment, institutionalisation (or hospitalisation), academic outcomes and caregiver outcomes. ETHICS AND DISSEMINATION This study uses data from published studies; therefore ethical review is not required. Findings will be presented in a published manuscript. TRIAL REGISTRATION NUMBER PROSPERO CRD42014015334.
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Affiliation(s)
- Matthew D Burkey
- Division of Child and Adolescent Psychiatry, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Megan Hosein
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marianna Purgato
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA Section of Psychiatry, World Health Organization Collaborating Centre for Research and Training in Mental Health and Service Evaluation, University of Verona, Verona, Italy
| | - Ahmad Adi
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Isabella Morton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Brandon A Kohrt
- Duke University Global Health Institute, Durham, North Carolina, USA
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Hogue A, Dauber S, Lichvar E, Bobek M, Henderson CE. Validity of therapist self-report ratings of fidelity to evidence-based practices for adolescent behavior problems: correspondence between therapists and observers. Adm Policy Ment Health 2015; 42:229-43. [PMID: 24711046 PMCID: PMC4763603 DOI: 10.1007/s10488-014-0548-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Developing therapist-report fidelity tools to support quality delivery of evidence-based practices in usual care is a top priority for implementation science. This study tested the reliability and accuracy of two groups of community therapists who reported on their use of family therapy (FT) and motivational interviewing/cognitive-behavioral therapy (MI/CBT) interventions during routine treatment of inner-city adolescents with conduct and substance use problems. Study cases (n = 45) were randomized into two conditions: (a) Routine Family Therapy (RFT), consisting of a single site that featured family therapy as its standard of care for behavioral treatment; or (b) Treatment As Usual (TAU), consisting of five sites that featured non-family approaches. Therapists and trained observational raters provided FT and MI/CBT adherence ratings on 157 sessions (104 RFT, 53 TAU). Overall therapist reliability was adequate for averaged FT ratings (ICC = .66) but almost non-existent for MI/CBT (ICC = .06); moreover, both RFT and TAU therapists were more reliable in reporting on FT than on MI/CBT. Both groups of therapists overestimated the extent to which they implemented FT and MI/CBT interventions. Results offer support for the feasibility of using existing therapist-report methods to anchor quality assurance procedures for FT interventions in real-world settings, though not for MI/CBT.
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Affiliation(s)
- Aaron Hogue
- Treatment Research Division, The National Center on Addiction and Substance Abuse at Columbia University, 633 Third Avenue, 19th floor, New York, NY, 10017, USA,
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Santin B, Kaups K. The disruptive physician: addressing the issues. Bull Am Coll Surg 2015; 100:20-24. [PMID: 25799767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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