Disruptive Behavior Disorders In Children Research Articles

Disruptive behavior disorders in children: a narrative review

Disruptive behavior disorders in children: a narrative review

The longitudinal impact of an evidence-based multiple family group intervention (Amaka Amasanyufu) on family cohesion among children in Uganda: Analysis of the cluster randomized SMART Africa-Uganda scale-up study (2016-2022).

Family functioning plays a critical role in childhood disruptive behavior disorders (The Family Journal, 2003, 11(1), 33-41; Research in Nursing and Health, 2016, 39(4), 229-243). Yet, there is limited research on the impact of evidence-based family strengthening interventions on improving family cohesion as a protective factor among children experiencing behavioral challenges. To address this gap, we analyzed data (N = 636) from the SMART Africa-Uganda study (2016-2022), a cluster randomized clinical trial testing an evidence-based family-strengthening intervention called Amaka Amasanyufu (translated as "Happy Families" in the local language). Children aged 8-13 and their caregivers were recruited from 26 public primary schools that were randomized to: (1) control condition receiving generalized psychosocial literature (10 schools), (2) intervention delivered via parent peers (eight schools), and (3) intervention delivered via community healthcare workers (eight schools). Children completed the family cohesion questionnaire at baseline, 8 weeks, 16 weeks, and 6 months post-intervention completion. The intervention effectiveness was evaluated via a three-level logistic mixed effects model with pairwise comparisons across study conditions within each time point. Participants in the parent-peer intervention group had greater odds of being in the higher family cohesion group than participants in the control group at 8 weeks (OR = 3.24), 16 weeks (OR = 1.88) and 6 months (OR = 2.07). At 8 weeks, 16 weeks, and 6 months, participants in the community health worker group had 3.98, 2.08, and 1.79 times greater odds of being in the higher family cohesion group than participants in the control group, respectively. Our findings strengthen the evidence base for Amaka Amansayufu as an effective intervention that can be utilized in SSA to improve family cohesion in families with children experiencing behavioral challenges.

Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data.

Disruptive behavior disorders (DBDs) are common mental health problems among early childhood American youth that, if poorly managed, pose costly psychological and societal burdens. There is limited real world evidence on how parent management training (PMT) - the evidence-based treatment model of choice - implemented in common practice settings within the United States influences the behavioral progress of early childhood DBDs, and the risk factors associated with poor outcomes. This study used data from a measurement feedback system implemented within a U.S.-based private practice to study how behavioral outcomes change as a function of PMT treatment engagement and associated risk factors for 4-7 year-old children diagnosed with DBDs. Over 50% of patients reached optimal outcomes after 10 appointments. Attending 24-29 appointments provided maximum treatment effect - namely, 75% of patients reaching optimal outcomes by end of treatment. Outcomes attenuate after reaching the maximum effect. Patients also had higher odds of reaching optimal outcomes if they had consistent attendance throughout the treatment course. Notable risk factors associated with lower odds of reaching optimal outcomes included Medicaid insurance-type, greater clinical complexity, and having siblings concurrently in treatment. Increased implementation of systems that monitor and provide feedback on treatment outcomes in U.S.-based practice settings and similar investigations using its data can further enhance 'real world' management of early childhood DBDs among American youth.

Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress.

Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.

Antipsychotics in the Management of Disruptive Behavior Disorders in Children and Adolescents: An Update and Critical Review.

Disruptive behaviour disorders (DBDs) in childhood include conduct disorder (CD) and oppositional defiant disorder (ODD). Though psychological therapies are considered to be the first-line treatment for DBDs, many patients require adjunctive pharmacotherapy for the control of specific symptoms, such as aggression. Three prior systematic reviews have examined the evidence for the use of antipsychotics in DBDs and have concluded that their efficacy is marginal and limited by adverse effects. This paper has two objectives: (i) to summarize the findings of existing systematic reviews of antipsychotics for the management of DBDs in children and adolescents (2012-2017), and (ii) to provide an update to these reviews by examining recent clinical trials of antipsychotics in this population, published in the period from 2 January 2017 to 10 October 2022. The PubMed, Scopus and ScienceDirect databases were searched for relevant citations using the search terms "disruptive behaviour disorder", "oppositional defiant disorder", "conduct disorder" and their variants, along with "antipsychotic", "atypical antipsychotic" and the generic names of all currently approved atypical antipsychotics. Six relevant trials were identified during this period, including five randomized controlled trials and one naturalistic open-label trial. These trials were critically evaluated in terms of outcome measures, efficacy and safety. Overall, the data from these trials suggests that of all available antipsychotics, risperidone appears to be effective in the short-term management of DBDs. All available antipsychotics are associated with significant metabolic adverse effects in this population. These results are discussed in the light of global trends towards increasing off-label prescription of antipsychotic medication in children and adolescents and of recent literature on the neuropharmacology of aggression in this patient population. The need for rational, short-term use of these drugs is highlighted, as well as the importance of post-marketing surveillance for long-term or severe adverse events.

We do know that multiple dimensions of psychopathy can contribute to research on and diagnosis of conduct disorder: The question is how

In a critique of a review by Frick (2022), Salekin (2022) perpetuates several misinterpretations of the research extending the construct of psychopathy to research and diagnostic classification of children with Conduct Disorder Specifically, he proposes that the existing research, including the research reviewed by Frick, does not support limiting the extension to a single construct and proposes that the diagnostic criteria should consider more dimensions than just the callous-unemotional (CU) dimension. My response shows that these concerns are misleading and divert attention from several critical issues. That is, contrary to Salekin's assertion, the focus of my review was not on whether multiple dimensions of psychopathy should inform research and diagnosis of Conduct Disorder but on how this should be done based on available research. Further, contrary to Salekin's assertion, multiple dimensions of psychopathy are already integrated into diagnostic classification for childhood disruptive behavior disorders. The focus of my review was whether the available research currently supports a different method of integrating them. Unfortunately, by trying to promote a false narrative, Salekin's response could limit research to address these critical issues and lead to harmful consequences for children with disruptive behavior disorders.

Some critical comments on the paper titled “Some critical considerations in applying the construct of psychopathy to research and classification of childhood disruptive behavior disorders”

Frick (2022) presented a narrative review of some literature and made several critical comments regarding the extension of the full psychopathy construct to research and classification of childhood disruptive behavior disorders (DBDs). His arguments cautioned against the use of the multicomponent concept of psychopathy for specification of DBDs for several reasons including definitional issues, symptom sequencing, specifier versus risk factor considerations, potential overlap with other disorders and criteria (e.g., ADHD), and concerns regarding harm. While I agree with Frick (2022) that we need to be cautious when extending personality constructs to the DBDs, the remaining arguments in his paper fall short of calling for the exclusion of psychopathy components in the examination of DBDs. Rather, the counterpoints in this paper further convince that the multidimensional model of psychopathy, when applied to the DBDs, could better facilitate understanding of the etiology and mechanisms for Conduct Disorder (CD), and, it may help us to predict the prognosis and treatment outcomes of children with various forms of DBDs such as CD and Oppositional Defiant Disorder (ODD). To have the most informative designs, future research should examine the broad construct to glean a better understanding of psychopathy and the DBDs. Further, research should continue to examine sequencing and external correlates at the component level and to test the incremental value of the multicomponent model of psychopathy to help us better comprehend how each component may facilitate our understanding of the types and severity of conduct problems exhibited by youth with DBDs (i.e., CD, ODD).

Contemporary screen time modalities and disruptive behavior disorders in children: a prospective cohort study.

Cross-sectional studies have demonstrated associations between screen time and disruptive behavior disorders (conduct disorder and oppositional defiant disorder); however, prospective associations remain unknown. This study's objective was to determine the prospective associations of contemporary screen time modalities with conduct and oppositional defiant disorder in a national cohort of 9-11-year-old children. We analyzed data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 11,875). Modified Poisson regression analyses were conducted to estimate the associations between baseline child-reported screen time (total and by modality) and parent-reported conduct or oppositional defiant disorder based on the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS-5) at 1-year follow-up, adjusting for potential confounders. Participants reported an average of 4 hr of total screen time per day at baseline. Each hour of total screen time per day was prospectively associated with a 7% higher prevalence of conduct disorder (95% CI 1.03-1.11) and a 5% higher prevalence of oppositional defiant disorder (95% CI 1.03-1.08) at 1-year follow-up. Each hour of social media per day was associated with a 62% higher prevalence of conduct disorder (95% CI 1.39-1.87). Each hour of video chat (prevalence ratio [PR] 1.21, 95% CI 1.06-1.37), texting (PR 1.19, 95% CI 1.07-1.33), television/movies (PR 1.17, 95% CI 1.10-1.25), and video games (PR 1.14, 95% CI 1.07-1.21) per day was associated with a higher prevalence of the oppositional defiant disorder. When examining thresholds, exposure to >4 hr of total screen time per day was associated with a higher prevalence of conduct disorder (69%) and oppositional defiant disorder (46%). Higher screen time was prospectively associated with a higher prevalence of new-onset disruptive behavior disorders. The strongest association was between social media and conduct disorder, indicating that future research and interventions may focus on social media platforms to prevent conduct disorder.

Male Caregivers and Engagement in a Family Strengthening Program for Child Disruptive Behavior Disorders.

Awareness and interest in involving male caregivers in child mental health treatment has grown, especially for youth with disruptive behavior disorders like oppositional defiant disorder (ODD). The purpose of this study was to examine the relationship between male caregiver involvement and treatment engagement for child ODD. Children (n=122) ages 7-11 and their caregivers participated in the 4 Rs 2 Ss Strengthening Families Program for child-onset ODD. Families were compared based on male caregiver presence. Families with a male caregiver were significantly more resourced with respect to income, educational status, and food security. Additionally, they were over three times less likely to drop out of the program than those without a male caregiver. The presence of a male caregiver was associated with increased resources and higher rates of engagement in services than single, female-headed families. Future research is needed to discern the underlying mechanisms of this association.

Multimodal Ensemble Deep Learning to Predict Disruptive Behavior Disorders in Children

Oppositional defiant disorder and conduct disorder, collectively referred to as disruptive behavior disorders (DBDs), are prevalent psychiatric disorders in children. Early diagnosis of DBDs is crucial because they can increase the risks of other mental health and substance use disorders without appropriate psychosocial interventions and treatment. However, diagnosing DBDs is challenging as they are often comorbid with other disorders, such as attention-deficit/hyperactivity disorder, anxiety, and depression. In this study, a multimodal ensemble three-dimensional convolutional neural network (3D CNN) deep learning model was used to classify children with DBDs and typically developing children. The study participants included 419 females and 681 males, aged 108–131 months who were enrolled in the Adolescent Brain Cognitive Development Study. Children were grouped based on the presence of DBDs (n = 550) and typically developing (n = 550); assessments were based on the scores from the Child Behavior Checklist and on the Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime version for DSM-5. The diffusion, structural, and resting-state functional magnetic resonance imaging (rs-fMRI) data were used as input data to the 3D CNN. The model achieved 72% accuracy in classifying children with DBDs with 70% sensitivity, 72% specificity, and an F1-score of 70. In addition, the discriminative power of the classifier was investigated by identifying the cortical and subcortical regions primarily involved in the prediction of DBDs using a gradient-weighted class activation mapping method. The classification results were compared with those obtained using the three neuroimaging modalities individually, and a connectome-based graph CNN and a multi-scale recurrent neural network using only the rs-fMRI data.

Comparative efficacy and acceptability of psychosocial treatments for disruptive behaviour disorders in children and adolescents: study protocol for a systematic review and network meta-analysis

IntroductionDisruptive behaviour disorders are common among children and adolescents, with negative impacts on the youths, their families and society. Although multiple psychosocial treatments are effective in decreasing the symptoms of...

Implementation and evaluation of a curriculum on the assessment and treatment of disruptive behaviour disorders.

Disruptive behaviour disorders (DBDs)—which can include or be comorbid with disorders such as attention-deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder and disruptive mood dysregulation disorder—are commonly seen in paediatric practice. Given increases in the prescribing of atypical antipsychotics for children and youth, it is imperative that paediatric trainees in Canada receive adequate education on the optimal treatment of DBDs. We describe the development, dissemination, and evaluation of a novel paediatric resident curriculum for the assessment and treatment of DBDs in children and adolescents. Pre–post-evaluation of the curriculum showed improved knowledge in participants.

Risperidone for disruptive behaviour disorders in children and young people with borderline-to-moderate intellectual disability

Risperidone for disruptive behaviour disorders in children and young people with borderline-to-moderate intellectual disability

Less imitation of arbitrary actions is a specific developmental precursor to callous-unemotional traits in early childhood.

Callous-unemotional (CU) traits in early childhood explain heterogeneity within conduct problems and are associated with higher risk for later diagnoses of childhood disruptive behavior disorders and antisocial behavior in adulthood. Emerging research implicates impairments in affiliative processes in the etiology of CU traits. The current study tests whether the imitation of intentional actions with no functional significance -a behavior that supports the acquisition of social conventions and affiliative bonds, is a specific developmental precursor to CU traits in early childhood. Data came from a longitudinal twin study of 628 children (Age 2: 47% females; Age 3: 44.9% females) with observations of arbitrary (i.e., nonfunctional actions) and instrumental (i.e., functional actions) imitation and parent reports of CU traits and oppositional defiant (ODD) behaviors at ages 2 and 3. Lower arbitrary imitation at age 2, but not instrumental imitation, was related to increases in CU traits from ages 2 to 3 (β=-.10, p=.02). These findings establish early social and affiliative processes in the etiology of CU traits, highlighting that novel personalized treatment and intervention strategies for CU traits may benefit from targeting these processes to help reduce CU traits and risk for persistent conduct problems in children.

Exposure to marital conflict: Gender differences in internalizing and externalizing problems among children.

PurposeMarital conflict is integral to children’s psychosocial well-being. Extant research has shown that the effects of marital conflict on children are likely to vary by gender, indicating that gender plays a significant and complex role in the relationship between marital conflict and child adjustment. Focusing on gender, this study investigates the link between specific marital conflict tactics and children’s mental health symptoms in families in which the parents live together.MethodsThis study gathered data from 799 children and their parents in Japan by means of a questionnaire focusing on marital conflict and child behavioral problems. Marital conflict (verbal aggression, physical aggression, stonewalling, avoidance-capitulation, child involvement, and cooperation) was assessed using a Conflict and Problem-Solving Scale. Children’s behavioral problems (externalizing and internalizing symptoms) were assessed using the Strengths and Difficulties Questionnaire.ResultsThe findings highlight the significant impact of specific interparental conflict on children’s behavioral problems, demonstrating that there are differences according to the child’s gender. More specifically, multivariate analyses targeting boys revealed that cooperation was significantly inversely associated with externalizing problems and internalizing problems, while avoidance-capitulation and verbal aggression were significantly positively associated with externalizing problems. In contrast, multivariate analyses targeting girls revealed that cooperation was significantly inversely associated with externalizing problems and internalizing problems, while avoidance-capitulation and stonewalling were significantly positively associated with internalizing problems.ConclusionThis study reveals that interparental conflict is associated with children’s behavioral problems. Constructive marital conflict was significantly inversely associated with externalizing and internalizing problems in both boys and girls. Meanwhile, destructive marital conflict (i.e., avoidance-capitulation and verbal aggression) was significantly positively associated with externalizing problems in boys and significantly positively associated with internalizing problems in girls. These findings contribute to the substantial literature demonstrating the relationship between family processes and the development of disruptive behavior disorders in children.

Fatigue and physical activity: Potential modifiable contributors to parenting sense of competence.

Parenting sense of competence, as measured by the Parenting Sense of Competence Scale (PSCS), is defined as one's levels of satisfaction and self-efficacy experienced in the parenting role. Previous studies have identified significant associations among PSCS scores and a host of parenting characteristics predictive of child outcomes. Existing approaches to improving parenting sense of competence focus on developing parenting knowledge and skills; however, other modifiable contributing factors to parenting sense of competence may exist. We examined associations among fatigue, physical activity, and parenting sense of competence in a community sample of female primary caregivers of young children (N=137) recruited from a university-based pediatric primary care clinic. Participants completed measures of child disruptive behavior disorders, parent fatigue, and parent physical activity level. Parenting sense of competence was measured with the 16-item PSCS. Participants' mean age was 32 years (SD=8 years), and most were non-Hispanic (87%) and White (70%). Multiple linear regression analyses revealed significant independent associations of fatigue (β=-0.19, p=.02) and physical activity level (β=0.20 and β=0.25, p<.05) with parenting sense of competence, controlling for child disruptive behaviors, child age, and socioeconomic status. In this non-clinical sample of mothers of young children, the significant relationships among fatigue, physical activity level, and parenting sense of competence could suggest potential targets for preventive intervention.

Disseminating parent-child interaction therapy through the learning collaborative model on the adoption and implementation of an evidence-based treatment

Evidence-based treatments (EBTs) for childhood disruptive behavior disorders, such as Parent-Child Interaction Therapy (PCIT), have limited availability in community settings. Recent research highlights the importance of implementation support models to ensure full adoption and sustainability of an EBT. Although other EBT protocols have been disseminated using the learning collaborative (LC) model, these methods are only now being applied to PCIT. This paper will describe the first PCIT learning collaborative conducted in the US. Community clinicians successfully completing the program demonstrated high levels of treatment fidelity and coding reliability, and families who completed treatment through the program reported significant improvements in child internalizing and externalizing behaviors and parenting behaviors and stress. These preliminary results suggest community clinicians are successful in implementing PCIT with the support of the LC.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)

Aim: The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey.Method: A nation-wide, randomly selected, representative population of 5830 children (6–13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently.Results: Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring.Conclusion: This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

Atypical Antipsychotic Drugs for Disruptive Behaviour Disorders in Children and Youths

Atypical Antipsychotic Drugs for Disruptive Behaviour Disorders in Children and Youths

Role of Parenting Style in Children's Behavioral Problems through the Transition from Preschool to Elementary School According to Gender in Japan.

While ineffective discipline can be attributed to authoritarian and permissive parenting styles, little research has examined the role of gender in the association between parenting style and early childhood behavioral problems. Thus, this study aimed to clarify the effects of authoritarian and permissive parenting on children’s externalizing and internalizing behaviors during the preschool-to-elementary-school transition according to gender in Japan. A sample of 1668 Japanese children (853 boys and 815 girls) were followed longitudinally over one-year intervals, and assessed based on parenting styles (the Parenting Scale), children’s behavioral problems (the Strengths and Difficulties Questionnaire), and family characteristics. Multivariate analyses revealed that, when analyzed by gender, authoritarian discipline influenced externalizing problems in boys (β = 0.048, p = 0.047) and girls (β = 0.067, p = 0.023), while permissive discipline influenced externalizing problems in boys only (β = 0.049, p = 0.038). The results document the relationship between family processes and the development of disruptive behavior disorders in children. Support for parents employing such child-rearing styles in early childhood may be effective in reducing school maladjustment.