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Effective Psychosocial Treatments of Conduct-Disordered Children and Adolescents: 29 Years, 82 Studies, and 5,272 Kids
Abstract
Reviews psychosocial interventions for child and adolescent conduct problems, including oppositional defiant disorder and conduct disorder, to identify empirically supported treatments. Eighty-two controlled research studies were evaluated using the criteria developed by the Division 12 (Clinical Psychology) Task Force on Promotion and Dissemination of Psychological Procedures. The 82 studies were also examined for specific participant, treatment, and methodological characteristics to describe the treatment literature for child and adolescent conduct problems. Two interventions were identified that met the stringent criteria for well-established treatments: videotape modeling parent training program (Spaccarelli, Cotler, & Penman, 1992; Webster-Stratton, 1984, 1994) and parent-training programs based on Patterson and Gullion's (1968) manual Living With Children (Alexander & Parsons, 1973; Bernal, Klinnert, & Schultz, 1980; Wiltz & Patterson, 1974). Twenty of the 82 studies were identified as supporting the efficacy of probably efficacious treatments.
... PCIT is an evidence-based BPT intervention for child behavior problems [45,46]. Treatment includes approximately 14 weekly (1-2 h) sessions, divided into two phases. ...
Background/Objectives: Evidence supports the efficacy of Behavioral Parent Training (BPT) interventions such as Parent–Child Interaction Therapy (PCIT) for treating child behavior problems; however, treatment engagement and outcomes vary across ethnic groups. Risk for poor treatment engagement and outcomes may be attributed in part to misalignment between parent explanatory model components (PEMs) and the traditional BPT model, including treatment expectations, etiological explanations, parenting styles, and family support for treatment. The present study aims to examine whether personalized treatment adaptations addressing these PEM–BPT misalignments reduce risk for poor treatment engagement and outcomes. Methods: The authors previously utilized the PersIn framework to develop a personalized version of PCIT (MY PCIT) that assesses these PEMs in order to identify families at risk for poor treatment engagement and outcomes. Families were identified as high risk (due to PEM–BPT misalignment) and low risk (meaning those without identified PEM–BPT misalignment) for specific PEMs. Families at elevated risk then received tailored treatment materials designed to improve alignment between the parental explanatory model and the PCIT treatment explanatory model. A recent pilot trial of MY PCIT demonstrated positive treatment outcomes; however, the extent to which adaptations were successful in reducing the underlying risk factors has not yet been examined. Results: Findings demonstrate that the personalization approach was effective in reducing indicators of risk, and that families who were initially at high and low risk during pre-treatment reported similar levels of treatment engagement and outcomes by post-treatment. Conclusions: The findings suggest that this personalized approach has the potential to reduce risk associated with poor treatment engagement and outcomes for culturally diverse families.
... Three decades of research have shown that coparenting is one of the central relational processes at work within families. Early studies found that the parenting alliance (i.e., coparenting), in comparison with the quality of the couple's romantic relationship, shows stronger associations with parenting practices, as well as child outcomes (Abidin & Brunner, 1995;Brestan & Eyberg, 1998). The spillover hypothesis suggests that conflict in the collaboration between two parents regarding rearing their child (i.e., coparenting) will not only have a negative impact on their marital relationship but will also negatively impact other subsystems in the family, such as the parent-child relationship (Katz & Gottman, 1996). ...
The purpose of this study was to assess the factor structure and the measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries based on the seven-factor coparenting model (i.e., Coparenting Agreement, Coparenting Closeness, Exposure to Conflict, Coparenting Support, Endorsement of Partner’s Parenting; Division of Labor) proposed by Feinberg (2003). The results of research on coparenting from numerous countries have documented its foundational importance for parent mental health, family relationship quality, child development, and psychopathology. Yet, a cross-country perspective is still lacking. Such a perspective can provide insight into which dimensions of coparenting are universally recognized and which are especially prone to variation. A unique multinational data set, comprised of 15 individual studies collected across 10 countries (Belgium, Brazil, China, Israel, Italy, Japan, Portugal, Switzerland, Turkey, USA) in nine languages was established (N = 9,292; 51.1% mothers). Measurement invariance analyses were conducted. A six-factor structure (original seven factors minus Division of Labor) of the measure was consistent across the different contexts and measurement invariance was achieved at the configural level. There was no support for metric or scalar invariance. These findings provide a basis for the CRS to be used across countries and should inspire future quantitative and qualitative research in cross-country coparenting research to understand what aspects are universal and what aspects of coparenting are linked to specific material, relational, or ideational conditions that underlie high-quality coparenting.
... Ideally, treatment should prevent this escalation of problems, reduce the need for long and intensive treatments, and lower societal costs [5]. Behavioral parent training is the first psychosocial treatment of choice for reducing behavioral difficulties in preschool and school aged children [6][7][8][9][10][11][12]. However, its use in clinical practice is limited by a scarcity of certified therapists, long waiting lists, and the typically long and sometimes perceived as rigid nature of behavioral parent training programs, which may lead to parents not starting or finishing behavioral parent training [13][14][15]. ...
Background
The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties.
Methods
Parents of children aged 2–12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent–child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents’ and therapists’ satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1.
Discussion
The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible.
Trial registration
The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.
... There is also evidence that the earlier the onset the worse the prognosis 29 with 50-80% of the boys retaining the disorder for up to 4 years in follow up studies 30,31 and with a higher risk of developing anti-social personality disorder 1,31,32 , aggressive behavior 33 , and higher comorbidity with different psychiatric disorders 5,34-37 including substance use 24,38,39 . All of these comorbidities increase the cost of management 26,[40][41][42] . ...
Little is known about the prevalence of Conduct Disorder (CD) and symptoms of CD in high risk psychosis persons at both clinical and community populations in LMICs and in particular Kenya. This study aimed to document (1) the prevalence of CD diagnosis and symptoms in youth who screened positive for psychosis and (2) the associated mental disorders and substance use in the same cohort in LMIC. The sample size was 536 students who had screened positive on the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) from a population of 9,742 high school, college and university students, but had not converted to a psychotic disorder. We collected data on socio-demographic characteristics and used the following tools: Economic indicators tool; the Diagnostic Interview Schedule (DIS) tool for DSM-5 diagnosis; World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Basic descriptive statistics, chi-square test, Fisher's exact test, Pearson correlation and Poisson regression were conducted. Five percent (5%) of the respondents met the criteria for DSM-5 CD. Indeterminate CD comprised 10.1%. Male gender, all substances except hallucinogens lifetime, obsessive compulsive disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, antisocial personality disorder, oppositional defiant disorder, suicidality, WERCAP screen for bipolar disorder and WERCAP screen for schizophrenia were significantly (p < 0.05) associated with CD. Deceitfulness or theft criteria symptoms showed that CD had no significant gender difference. Criteria symptoms in aggression to people and animals, destruction of property and serious violations of rules were more common among males. Our findings suggest the need to screen for and diagnose CD, mental disorders and substance use in high risk psychosis youths in Kenya. This will inform integrated management.
... Moreover, Parental Behavioural training has been used in this study as an intervention strategy for children with ADHD as well as oppositional defiant disorder (ODD) and conduct disorder (CD) (Pelham et al., 1998;Brestan & Eyberg, 1998), and many internalizing disorders as well. Although there is comorbidity between ADHD and CD/ODD, it is still not clear whether parent training is effective in reducing antisocial behaviour and symptom severity in ADHD children with or without comorbid CD/ODD. ...
Attention deficit hyperactivity disorder, or ADHD is a neuropsychiatric condition affecting preschoolers, children, adolescents, and adults around the world, characterized by a pattern of diminished sustained attention, and increased impulsivity or hyperactivity. It is the most common behavioral disorder which develops in childhood and later becomes apparent in the preschool and early school years (Alizadeh et al., 2015; Cheng & Myers, 2005). Psychosocial treatments for ADHD are generally combined with medication as medication alone cannot address parental concerns around child management issues and behaviour. Parent training is the most commonly prescribed psychological intervention for ADHD. Aim & Method-The aim of the study was to find out the effectiveness of the Parent Management Training (PMT)model by Kazdin in a sample of 30 children and adolescents in the age group of 10 to 18years. The participants were divided into 2 groups-the study group received PMT along with medication while the control group received only medicine. Results indicated that the study group had better improvement as compared to the control group suggesting that the parent management training module by Kazdin is an effective treatment for children with ADHD.
From a team of leading experts comes a comprehensive, multidisciplinary examination of the most current research including the complex issue of violence and violent behavior. The handbook examines a range of theoretical, policy, and research issues and provides a comprehensive overview of aggressive and violent behavior. The breadth of coverage is impressive, ranging from research on biological factors related to violence and behavior-genetics to research on terrrorism and the impact of violence in different cultures. The authors examine violence from international cross-cultural perspectives, with chapters that examine both quantitative and qualitative research. They also look at violence at multiple levels: individual, family, neighborhood, cultural, and across multiple perspectives and systems, including treatment, justice, education, and public health.
From a team of leading experts comes a comprehensive, multidisciplinary examination of the most current research including the complex issue of violence and violent behavior. The handbook examines a range of theoretical, policy, and research issues and provides a comprehensive overview of aggressive and violent behavior. The breadth of coverage is impressive, ranging from research on biological factors related to violence and behavior-genetics to research on terrrorism and the impact of violence in different cultures. The authors examine violence from international cross-cultural perspectives, with chapters that examine both quantitative and qualitative research. They also look at violence at multiple levels: individual, family, neighborhood, cultural, and across multiple perspectives and systems, including treatment, justice, education, and public health.
Background
The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties.
Methods
Parents of children aged 2–12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent-child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents’ and therapists’ satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1.
Discussion
The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible.
Trial registration:
The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.
Multisystemic therapy (MST) delivered through a community mental health center was compared with usual services delivered by a Department of Youth Services in the treatment of 84 serious juvenile offenders and their multiproblem families. Offenders were assigned randomly to treatment conditions. Pretreatment and posttreatment assessment batteries evaluating family relations, peer relations, symptomatology, social competence, and self-reported delinquency were completed by the youth and a parent, and archival records were searched at 59 weeks postreferral to obtain data on rearrest and incarceration. In comparison with youths who received usual services, youths who received MST had fewer arrests and self-reported offenses and spent an average of 10 fewer weeks incarcerated. In addition, families in the MST condition reported increased family cohesion and decreased youth aggression in peer relations. The relative effectiveness of MST was neither moderated by demographic characteristics nor mediated by psychosocial variables.
Evaluated generalization of treatment effects from home to school setting in ten 2to 7-year-old children who were referred for treatment of severe conduct problem behaviors occurring both at home and in the classroom. Families received 14 weeks of parent-child interaction therapy. No direct classroom interventions were conducted. The treatment group displayed significantly greater improvements than two control groups on all measures of conduct problem behavior in the classroom. Results in the areas of hyperactivity/distractibility and social behavior were less supportive of generalization. Positive school generalization results contradict previous findings that children's behavior in the classroom either shows minimal improvement or worsens following parent training.
The author addresses the need to develop culture-specific strategies in working with racial–ethnic minorities. Conceptual frameworks providing a rationale for such recommendations have not been well elucidated. A review of the literature revealed 3 major domains from which such justifications can be drawn: (a) culture-bound communications styles, (b) sociopolitical facets of nonverbal communication, and (c) counseling as a subset of communication style or temporary cultures. Implications for counselor practice, training, and research are discussed.
Considers design issues and strategies by comparative outcome studies, including the conceptualization, implementation, and evaluation of alternative treatments; assessment of treatment-specific processes and outcomes; and evaluation of the results. It is argued that addressing these and other issues may increase the yield from comparative outcome studies and may attenuate controversies regarding the adequacy of the demonstrations. (64 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The effectiveness of a time‐out Signal Seat used in conjunction with a self‐instructional parent training manual and audiotape was investigated with parents of behavior problem children between the ages of 2 and 7 years. Twenty‐seven parent‐child pairs were randomly assigned to one of three conditions: Parent‐administered Treatment plus Signal Seat (PAT‐SS), Parent‐administered Treatment plus Seat (PAT‐S), or Wait‐list Control (WLC). Parents reported daily rates of child compliance, the intensity and problematic nature of frequently occurring child behavior problems, and perceptions of the target child during separate baseline, treatment, and 2‐month follow‐up periods. A post‐treatment questionnaire assessed specific aspects of the program at the conclusion of the treatment phase. When the Signal Seat was used with the self‐instructional materials, results indicated that: (a) parental report of the number and intensity of child behavior problems decreased, (b) perceptions of the target child became more p...
This study examines the specific effects of adding a broader based, videotape treatment component (ADVANCE) to a basic videotape parent skills training program (GDVM). ADVANCE treatment trains parents to cope with interpersonal distress through improved communication, problem solving, and self-control skills. Seventy-eight families with a child diagnosed as oppositional-defiant or conduct-disordered were randomly assigned to either GDVM alone or GDVM plus ADVANCE. Parent reports of child adjustment and parent distress, assessment of child's knowledge of social skills, as well as independent observations of mother-and father-child interactions and communication and of problem solving between parents were obtained at pre- and post-GDVM and at post-ADVANCE. Both groups significantly improved at short-term follow-up. ADVANCE produced additional significant improvements in parents' communication, problem-solving skills, and consumer satisfaction, as well as children's increased knowledge of prosocial solutions. The clinical significance of these findings is discussed.
The purpose of the present study was to assess the effectiveness of a parent training program designed to alter interactions of parents and their noncompliant children. Mother-child pairs were assigned to either a treatment or a waiting list control group. Parent training was conducted in a controlled learning environment. The following pre- and posttreatment measures were collected: clinic observational data, home observational data, and parent verbal report measures. The results indicated that both parents and children in the treatment group demonstrated multiple behavior changes in the clinic and home, whereas the control group did not change over the waiting period. Both treatment and control group mothers demonstrated positive changes on most of the parent verbal report measures.
The effectiveness of a time‐out Signal Seat used in conjunction with a self‐instructional parent training manual and audiotape was investigated with parents of behavior problem children between the ages of 2 and 7 years. Twenty‐seven parent‐child pairs were randomly assigned to one of three conditions: Parent‐administered Treatment plus Signal Seat (PAT‐SS), Parent‐administered Treatment plus Seat (PAT‐S), or Wait‐list Control (WLC). Parents reported daily rates of child compliance, the intensity and problematic nature of frequently occurring child behavior problems, and perceptions of the target child during separate baseline, treatment, and 2‐month follow‐up periods. A post‐treatment questionnaire assessed specific aspects of the program at the conclusion of the treatment phase. When the Signal Seat was used with the self‐instructional materials, results indicated that: (a) parental report of the number and intensity of child behavior problems decreased, (b) perceptions of the target child became more positive, and (c) reported rates of child compliance to parental commands increased. Results are discussed in relation to the practical implications of the Signal Seat and the need for more cost‐effective methods in behavioral parent training programs.