Child Disruptive Behavior Problems Research Articles

Collateral effects of Coping Power on caregiver symptoms of depression and long-term changes in child behavior.

A large body of research demonstrates positive impacts of the Coping Power Program as a preventive intervention for youth behavioral outcomes, but potential collateral effects for caregivers is less known. The current study examined whether the youth-focused Coping Power Program can have a secondary impact on caregiver self-reported symptoms of depression and in turn result in longer-term impacts on child disruptive behavior problems including aggression, conduct problems and hyperactivity. Data from 360 youth/caregiver pairs across 8 waves of data (grades 4 through 10) were analyzed. We used two methodological approaches to (a) assess indirect effects in the presence of potential bidirectionality using timepoint-to-timepoint dynamic effects under Autoregressive Latent Trajectory modeling and (b) estimate scale scores in the presence of measurement non-invariance. Results showed that individually delivered Coping Power (ICP) produced greater direct effects on conduct problems and indirect effects on general externalizing and hyperactivity (through reductions in caregiver self-reported symptoms of depression), compared to group Coping Power (GCP). In comparison to GCP, ICP produced similar direct effects on reductions in caregiver depression. Child-focused prevention interventions can have an indirect impact on caregiver depression, which later shows improvements in longer-term reductions for child disruptive problems.

Associations Between Maternal Negative Affectivity and Young Children’s Disruptive Behavior Problems: The Mediating Effect of Callous-Unemotional Traits

The current study examined associations between maternal negative affectivity (NA) and child disruptive behavior problems. The mediating role of child callous-unemotional (CU) traits in these relationships was also investigated. A multilevel mediation modeling approach was adopted using a sample of 100 families with children between 2.5 and 5.5 years of age (N = 201; mean age = 3.8, standard deviation = 1.0). The mediation models showed significant mediating effects of maternal NA through CU traits for ADHD (β = 0.12, p<.01), ODD (β =0.13, p<.01), and aggression (β =0.16, p<.001), and a significant direct effect for aggression (β = 0.12, p<.05). A structural equation modeling analysis was also performed, and overall, the results were consistent with that from mediation models, which suggested that child CU traits were significantly correlated with maternal NA (β = 0.252, p<.001), ADHD (β = 0.504, p<.001), ODD (β = 0.545, p<.001), and aggression (β = 0.686, p<.001). Our results indicated that maternal NA could serve as a potential risk factor for child CU, which, in turn, may contribute to disruptive behavior during early childhood.

Is internet-based parent training for everyone? Predictors and moderators of outcomes in group vs. internet-based parent training for children with disruptive behavior problems

Parent training is an effective treatment for disruptive behavior problems in children. However, as there is limited access to traditional face-to-face treatment, other delivery formats have been evaluated. This study aims to evaluate possible predictors and moderators of outcome, completion and engagement in parent training when delivered in group or through the internet. A recent randomized controlled non-inferiority trial (N = 161) demonstrated equal effectiveness of the parent training program Comet when delivered in group (gComet) and through the internet (iComet). Demographic, clinical and theory-driven variables were studied to find predictors and moderators of treatment effect, completion and engagement. Linear mixed effects models were used to determine predictors and moderators of change in disruptive behavior from baseline to the 3- and 12-month follow-up. Most variables did not have significant predictive or moderating effects. However, there were some variables that predicted or moderated outcomes that may have implications for practice (e.g., comorbid emotional problems, preferred treatment format, and ADHD). This trial can contribute to guiding clinical work with children with disruptive behavior and results indicate that parent training in both treatment formats can be offered regardless of a range of demographic and clinical factors. Taking patients’ treatment preferences into account can increase treatment completion.

Parent Training via Internet or in Group for Disruptive Behaviors: A Randomized Clinical Noninferiority Trial

To evaluate if an internet-delivered parent training program is noninferior to its group-delivered counterpart in reducing child disruptive behavior problems (DBP). This noninferiority randomized clinical trial enrolled families seeking treatment in primary care in Stockholm, Sweden, for DBP in a child 3-11 years of age. Participants were randomized to internet-delivered (iComet) or group-delivered (gComet) parent training. The primary outcome was parent-rated DBP. Assessments were made at baseline and 3, 6, and 12 months. Secondary outcomes included child and parent behaviors and well-being and treatment satisfaction. The noninferiority analysis was determined by a one-sided 95% CI of the mean difference between gComet and iComet using multilevel modeling. This trial included 161 children (mean age 8.0); 102 (63%) were boys. In both intention-to-treat and per-protocol analyses, iComet was noninferior to gComet. There were small differences in between-group effect sizes (d=-0.02 to 0.13) on the primary outcome with the upper limit of the one-sided 95% CI below the noninferiority margin at 3-, 6-, and 12-month follow-up. Parents were more satisfied with gComet (d= 0.49, 95% CI [0.26, 0.71]). At 3-month follow-up, there were also significant differences in treatment effect on attention-deficit/hyperactivity disorder symptoms (d= 0.34, 95% CI [0.07, 0.61]) and parenting behavior (d= 0.41, 95% CI [0.17, 0.65]) favoring gComet. At 12-month follow-up, there were no differences in any outcomes. Internet-delivered parent training was noninferior to group-delivered parent training in reducing child DBP. The results were maintained at 12-month follow-up. This study supports internet-delivered parent training being used as an alternative to group-delivered parent training in clinical settings. Randomized Controlled Trial of Comet via the Internet or in Group Format; https://www. gov/; NCT03465384.

Online-Delivered Over Staff-Delivered Parenting Intervention for Young Children With Disruptive Behavior Problems: Cost-Minimization Analysis.

BackgroundHigh-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality.ObjectiveThis study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers.MethodsA cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches.ResultsFor the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P<.001), family costs (t185=9.2; P<.001), and total costs (t171=19.1; P<.001) compared to the staff-delivered intervention. The mean incremental cost difference between the interventions was $1164 total costs per case. The same pattern of significant differences was confirmed in the per-protocol analysis based on the families who completed their respective intervention, with a mean incremental cost difference of $1483 per case. All costs were valued or adjusted in 2017 US dollars.ConclusionsThe online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal.Trial RegistrationClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

The Effects of Emotion Regulation Treatment on Disruptive Behavior Problems in Children: A Randomized Controlled Trial

Disruptive behavior problems are a frequent reason for children’s referrals to psychological services and can have negative effects on social and academic functioning. Most treatment programs involve parents as recipients and implementation of intervention programs in school is low. Deficits in emotion regulation have recently been implicated in the development of disruptive behavior disorders, making child directed early intervention programs focusing on increasing emotion regulation skills feasible. The purpose of this study was to assess the effects of Tuning Your Temper, a brief cognitive behavioral program for children with disruptive behavior problems, in a randomized controlled trial. A total of 125 children with disruptive behavior problems at school, aged 6–11 years old were randomized to either intervention or wait-list control condition. Treatment was conducted at school. Assessments included teacher and parent ratings on the Strengths and Difficulties Questionnaire (SDQ) and the Disruptive Behavior Rating Scale (DBRS) pre- and post-treatment and at 6-month follow-up. Results showed a significant reduction in behavior problems for the treatment condition on both measures and effects were maintained at 6-month follow-up. Results were more robust for teacher ratings, with medium to large effect sizes. Tuning Your Temper appears to be a promising early intervention program for children with disruptive behavior problems at school.

Establishing norms on the Japanese version of the Eyberg Child Behavior Inventory.

The Eyberg Child Behavior Inventory (ECBI) is one of the standardized parent rating scales used to identify disruptive behavior problems in children in Western countries. This study aimed to determine norms for the Japanese version of the ECBI, including clinical cutoff scores among the general population in Japan. This study established norms for the Japanese version of the ECBI using a sample of 1,992 parents of children aged 2-7, living in Japan. The research evaluates the validity and the reliability of the ECBI scores for the Intensity Scale and the Problem Scale. After validation, a clinical cutoff value of the ECBI scores was calculated, setting the cutoff to above the +1 standard deviation (SD) level based on the population distribution. The means of the Intensity and Problem Scale scores were 100.07 and 6.57, respectively. Cronbach's α for both the Intensity and the Problem scores was 0.91. At this point, we propose cutoff scores of 125 for the Intensity Scale and 14 for the Problem Scale. Our results suggest that the Japanese version of the ECBI is highly reliable and may be useful as a tool for assessing behavior problems in children.

Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020).

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.

Home-Based Parent-Child Interaction Therapy to Prevent Child Maltreatment: A Randomized Controlled Trial.

High treatment attrition and limited reach of mental health services for at-risk families remains an important problem in order to effectively address the global concern of child maltreatment and child disruptive behavior problems. This study evaluated the effectiveness of a home-based and time-limited adaptation of Parent–Child Interaction Therapy (PCIT). Twenty families with children (70% boys) aged between three and seven years were randomly assigned to an immediate treatment group (IT, n = 10) or a waitlist control group (WL, n = 10). After receiving treatment and compared to mothers in the WL group, mothers in the IT group reported fewer child behavior problems and more improved parenting skills. Although initial analyses revealed no significant differences, additional analyses showed a significant decrease in the primary outcome of the study, namely child abuse potential, between the baseline and follow-up assessment for the total treated sample. A low treatment attrition rate (15%) was found, indicating higher accessibility of treatment for families. Findings suggest that the brief home-based PCIT is a potentially effective intervention to prevent child maltreatment and disruptive behavior problems in at-risk families. Results also reinforce the importance of addressing the specific needs of these families to increase treatment effectiveness.

Online-delivered parenting intervention for young children with disruptive behavior problems: a noninferiority trial focused on child and parent outcomes.

This study evaluated whether an evidence-based parenting intervention, when delivered online, could effectively address disruptive behavior problems in young children and yield outcomes comparable to in-person delivery of the same intervention. Families (n = 334) of children (3-7 years; 63% White, 22% African American, 15% other races; 63% male) with disruptive behavior problems were randomized to online-delivered intervention (ODI) or staff-delivered intervention (SDI), resulting in baseline and demographic equivalence. Primary outcome measures for child disruptive behavior (independent observation, parent report) and secondary outcome measures of parenting and family impact were assessed at baseline, postintervention, and follow-up. Conducted using intent-to-treat (ITT) as well as per-protocol (PP) methods, noninferiority analyses, which drew on an HLM framework with repeat measures across three timepoints and on REML to provide unbiased estimates of model parameters, tested whether the outcome-difference CI did not exceed the a priori noninferiority margin. For ITT and PP analyses, the ODI was found to be noninferior to the SDI on the primary outcome: independently observed child disruptive behavior and parent-reported child behavior problems. The pattern for secondary outcomes was more varied: (a) noninferiority for observed positive and aversive parenting; (b) noninferiority for observed quality of parent-child relationship at post but not follow-up assessment; (c) noninferiority for parent-reported inappropriate/inconsistent discipline for PP but not ITT analyses; and (d) noninferiority not confirmed for parenting daily hassles and adverse family quality of life, despite large effect sizes for the ODI (Cohen's d .75-1.07). Finally, ODI noninferiority was found for teacher-reported child disruptive behavior. The tested online-delivered parenting intervention demonstrated clear noninferiority with the corresponding staff-delivered parenting intervention on the primary outcome, child disruptive behavior problems, and reflected substantial though nonuniform noninferiority and meaningful effect sizes for secondary outcomes related to parenting and family. Future research will guide optimization of online interventions.

Understanding Differential Effectiveness of Behavioral Parent Training from a Family Systems Perspective: Families Are Greater than “Some of Their Parts”

AbstractBehavioral parent training (BPT) is a theory‐driven, evidence‐based, and widely used intervention strategy for preventing and decreasing children's disruptive behavior problems, indirectly via improved parenting behavior. However, not all families benefit equally from BPT. To date, our knowledge of who benefits (and who does not) and our understanding of why some families benefit more than others is limited. An important challenge for research and practice is finding ways to tailor interventions to the needs of an individual family and increase their effectiveness. We put forwardfamily systems theoryas a tool to gain more insight into which families (do not) benefit from BPT and why. We synthesize the theoretical foundations and empirical support for the putative mechanisms through which the functioning of family systems may explain BPT effectiveness and propose ways in which family systems theory can help strengthen the design, implementation, and evaluation of BPT programs.

Family sociodemographic resources moderate the path from toddlers' hard-to-manage temperament to parental control to disruptive behavior in middle childhood.

Research inspired by ecological perspectives has amply documented broad effects of the family's sociodemographic resources on children's outcomes, with parents' young age, low education, and low income considered risk factors. Typically, sociodemographic characteristics have been studied as influencing child outcomes either directly or indirectly through parenting. We tested a more nuanced longitudinal model in a community sample of 102 infants, mothers, and fathers. We conceptualized family sociodemographic resources, measured as a composite of parents' ages, education, and income, as moderating developmental cascades from children's hard-to-manage temperament to parental power-assertive control to children's disruptive behavior problems. Children's temperament measures encompassed proneness to anger and inability to delay, observed at 2 and 3 years in standard laboratory episodes. We observed parents' control at 4.5 and 5.5 years in lengthy naturalistic prohibition paradigms, and obtained parental ratings of children's disruptive behavior at 6.5 and 8 years. As expected, moderated mediation analyses, covarying stability of children's difficulty and parental control, revealed that the cascade from hard-to-manage temperament to child behavior problems, mediated by parental power-assertive control, was present in families with relatively more disadvantaged sociodemographic characteristics, or fewer resources, but absent in families with more advantageous sociodemographic features, or more resources. The findings were parallel for mother- and father-child dyads.

Parent-Child Interaction Therapy: current perspectives.

Parent–Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006–2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher–child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed.

What Doesn't Work for Whom? Exploring Heterogeneity in Responsiveness to the Family Check-Up in Early Childhood Using a Mixture Model Approach.

This study applied latent class analysis to a family-centered prevention trial in early childhood to identify subgroups of families with differential responsiveness to the Family Check-Up (FCU) intervention. The sample included 731 families with 2-year-olds randomized to the FCU or control condition and followed through age 5 with yearly follow-up assessments. A two-step mixture model was used to examine whether specific constellations of family characteristics at age 2 (baseline) were related to intervention response across ages 3, 4, and 5. The first step empirically identified latent classes of families based on several family risk and adjustment variables selected on the basis of previous research. The second step modeled the effect of the FCU on longitudinal change in children's problem behavior in each of the empirically derived latent classes. Results suggested a five-class solution, where a significant intervention effect of moderate to large size was observed in one of the five classes-the class characterized by child neglect, legal problems, and parental mental health issues. Pairwise comparisons revealed that the intervention effect was significantly greater in this class of families than in two other classes that were generally less at risk for the development of child disruptive behavior problems, albeit still low-income. Thus, findings suggest that (a) the FCU is most successful in reducing child problem behavior in more highly distressed, low-income families, and (b) the FCU may have little impact for relatively low-risk, low-income families. Future directions include the development of a brief screening process that can triage low-income families into groups that should be targeted for intervention, redirected to other services, monitored prospectively, or left alone.

Parasympathetic reactivity and disruptive behavior problems in young children during interactions with their mothers and other adults: A preliminary investigation.

Parasympathetic nervous system influences on cardiac functions-commonly indexed via respiratory sinus arrhythmia (RSA)-are central to self-regulation. RSA suppression during challenging emotional and cognitive tasks is often associated with better emotional and behavioral functioning in preschoolers. However, the links between RSA suppression and child behavior across various challenging interpersonal contexts remains unclear. The present study experimentally evaluated the relationship between child RSA reactivity to adult (mother vs. study staff) direction and disruptive behavior problems in children ages 3-8 with varying levels of disruptive behavior problems (N = 43). Reduced RSA suppression in the context of mothers' play-based direction was associated with more severe child behavior problems. In contrast, RSA suppression in the context of staff play-based direction was not associated with behavior problems. Findings suggest that the association between RSA suppression and child behavior problems may vary by social context (i.e., mother vs. other adult direction-givers). Findings are discussed in regard to RSA as an indicator of autonomic self-regulation that has relevance to child disruptive behavior problems.

Transported Versus Homegrown Parenting Interventions for Reducing Disruptive Child Behavior: A Multilevel Meta-Regression Study

Children's disruptive behavior problems place children at high risk for oppositional defiant disorder and conduct disorder, and carry a high burden for individuals and society. Policy makers and service providers aiming to reduce children's disruptive behavior problems must often choose between importing an intervention developed abroad or instead developing or using a "homegrown" (i.e., local) intervention. No comprehensive comparison of these interventions exists. We performed a multilevel meta-regression of 129 randomized trials (374 effect sizes) of transported andhomegrown parenting interventions. We identified trials by searching the included trials lists of systematic reviews, found through searches in 6 databases (e.g.,MEDLINE, EMBASE). Trials that had not yet been reviewed were found by searching the same databases. Primary outcome was the mean difference in effectiveness between transported and homegrown interventions to reduce disruptive child behavior. We also compared thisdifferential effectiveness for various intervention"brands" (e.g., Incredible Years and Triple P Positive Parenting Program) and geographical regions (e.g.,North America and Europe). Transported and homegrown interventions did not differ in their effectiveness to reduce disruptive child behavior (d= 0.10, not significant). Results were robust across intervention brands and geographical regions. Six trials on transported interventions in Hong Kong, Iran, and Panama suggest promising results for transporting interventions to "nonwestern" countries, whereas one trial in Indonesia does not. Parenting interventions based on the same principles led to similar outcomes, whether transported or homegrown. This finding supports the selection of interventions based on their evidence base rather than on cultural specificity.

Treating Child Disruptive Behavior in High-Risk Families: A Comparative Effectiveness Trial from a Community-Based Implementation.

Parent management training programs have proven the most effective way to treat child behavior problems. This study reports on an effectiveness trial of a community-based implementation of Parent–Child Interaction Therapy (PCIT) in comparison with the Dutch-developed Family Creative Therapy (FCT). Forty-five children (58 % boys) aged between 32 and 102 months (M = 67.7, SD = 15.9) were referred for treatment, and they and their parent(s) were randomly assigned to PCIT or FCT. Treatment effectiveness was measured primarily by the degree of improvement on child behavior problems, using the Eyberg Child Behavior Inventory. Secondary outcomes included parent and teacher report data and independent observations of parenting skills and child behavior. During the trial, randomization was violated by treatment crossovers (from FCT to PCIT). Intention-to-treat analyzes revealed no significant differences in the primary outcome at 6-month follow-up, but interpretation was hampered by the crossovers. Subsequent treatment-received analyzes revealed significant interaction effects between time and treatment condition, with greater improvements in child behavior and parenting skills for PCIT families compared to FCT families. Analyzes on families that fully completed the PCIT protocol also showed higher treatment maintenance at follow-up. The treatment-received analyzes indicated promising results for the effectiveness of PCIT in treating young children’s disruptive behavior problems in a high-risk population. However, caution in generalizing the conclusions is needed in view of the design difficulties in this study. Suggestions are made for enhancing treatment delivery in daily practice, and clinical implications are noted.

Parental Stress, Discipline Strategies, and Child Behavior Problems in Families With Young Children With Autism Spectrum Disorders

The current study investigated the parent–child relationship by examining associations between parent stress, parental discipline strategies, child disruptive behavior problems, and level of autism spectrum disorder (ASD) symptoms. A sample of 130 parents of children with ASD ages 3 to 11 years participated. Parents reported high levels of parent stress and high levels of child disruptive behavior problems. A series of mediation analyses via bootstrapping were used to examine the development of child disruptive behavior. Use of harsh and punitive parental discipline strategies mediated the link between parent stress and child disruptive behavior problems. These findings suggest that parental discipline strategies should be a central target in prevention and treatment interventions for children with ASD to reduce the emergence of child disruptive behavior problems. Reducing challenging behavior in children with ASD may improve the rate of skill acquisition and improve the parent–child relationship. Future directions for research along with clinical implications for families are discussed.

Acceptability of robot-assisted therapy for disruptive behavior problems in children.

Acceptability of robot-assisted therapy for disruptive behavior problems in children.

Supplemental Material for Acceptability of Robot-Assisted Therapy for Disruptive Behavior Problems in Children

Supplemental Material for Acceptability of Robot-Assisted Therapy for Disruptive Behavior Problems in Children