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Interventions benefit disruptive behavior in children: review

Oct. 29, 2015, 9:08 AM

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Children with disruptive behavior disorders (DBDs), such as conduct disorder, are most likely to benefit from psychosocial interventions that include a parental component alone or in combination with other interventions, according to a newly published systematic review by Vanderbilt researchers.

Approximately 3.5 percent of children between the ages of 3 and 17 in the United States have been diagnosed with DBDs.

Children with DBDs may be aggressive, defiant and struggle to get along with peers or siblings, but symptoms vary significantly among children and over time. Children with DBDs may be at greater risk for problems in adolescence such as substance abuse or delinquency.

Recent data trends for treatment of children with the disorder suggest a move toward a reduction in behavioral interventions/therapies and an increase in the use of psychotropic medications, such as antipsychotics, mood stabilizers and stimulants.

Researchers with the Vanderbilt Evidence-Based Practice Center (EPC), one of 13 centers in the United States and Canada funded by the Agency for Healthcare Research and Quality (AHRQ), reviewed evidence from previous studies to examine the effectiveness of various interventions alone and in combination.

Melissa McPheeters, Ph.D., MPH

The Vanderbilt EPC, directed by Melissa McPheeters, Ph.D., MPH, in the Department of Health Policy, is responsible for reviewing the evidence on important clinical questions across the health care spectrum.

The report is available to the public at the AHRQ website and published in the journal Pediatrics online and in print.

“We hope that understanding the important role of the family and parents in supporting positive changes for children who are at substantial risk can help guide clinical practice and policy and support continued development of family-oriented treatment approaches,” said Richard Epstein, Ph.D., MPH, a psychologist and first author on the Pediatrics paper.

For the review, the Vanderbilt EPC team identified 84 unique studies published between January 1994 and June 2014 that addressed one or more key questions.

Of these, 66 studies assessed psychosocial interventions and 13 assessed pharmacologic interventions. The team looked at studies that included children between ages 5 and 12 who received treatment in a health care setting.

Examples of the most common named psychosocial interventions included Parent-Child Interaction Therapy, Incredible Years programs and Positive Parenting Program.

The assessment of the studies showed moderate strength of evidence supporting the effectiveness of multicomponent interventions and interventions with only a parent component. There was insufficient evidence to support interventions only involving the child, namely because there were few well-designed studies to assess that component.

“Clearly much more work needs to be done in this area, with very few studies available to assess interventions focused solely on children. Disruptive behavior disorders put children at significant risk of poor future outcomes, and are tremendously stressful for families. This is certainly an area worthy of further review,” McPheeters said.

Vanderbilt authors on the publication, from multiple disciplines, included McPheeters, Epstein, Christopher Fonnesbeck, Ph.D., Shannon Potter, MLIS, and Katherine H. Rizzone, M.D., MPH.

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