Disruptive Behavior In Young Children Research Articles

Behavior Management in Young Children Exposed to Trauma: A Case Study of Three Evidence-Based Treatments.

Young children are particularly vulnerable to traumatic events and the development of posttraumatic stress symptoms, including comorbid disruptive behaviors. Fortunately, several evidence-based interventions have been shown to be effective at decreasing both posttraumatic stress symptoms and disruptive behaviors in young children. This paper provides an overview of three such interventions-Child-Parent Psychotherapy (CPP), Parent-Child Interaction Therapy (PCIT), and Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). An illustrative case study is used to compare how each intervention addresses disruptive behaviors, with a focus on theoretical underpinnings, model similarities, and model differences. The models each have empirical evidence for the treatment of disruptive behavior in young children, and therefore, may be appropriate for treating children with a history of trauma exposure and comorbid disruptive behaviors. Child, caregiver, and environmental factors are essential to consider when identifying an evidence-based intervention for this population.

Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism.

Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parenting program for disruptive behavior and has been shown to also be effective for children with autism spectrum disorder (ASD). Telehealth delivery of PCIT (Tele-PCIT) is also supported, but no trials have focused on children with ASD. The purpose of the study was to examine the initial efficacy of a time limited version of Tele-PCIT within an ASD sample. Participants included parents of 20 children (ages 2-6) with ASD who received 10 sessions of Tele-PCIT. Parents reported on their parenting stress, parenting practices, and child behavior. A play observation was coded for parent use of treatment skills and for child compliance. 80% of participants completed treatment (n = 16) and results revealed significant improvements across parenting and child outcomes. Parents reported decreases in parenting stress from pre-to-post-treatment, which were maintained at a 3-month follow-up, along with decreases in negative parenting practices (i.e., Laxness and Overactivity) from pre-to-post treatment that were also maintained at follow-up. Significant increases in parent use of positive parenting skills (i.e., "Do" Skills) during child-led play and decreases in negative parenting skills (i.e., "Don't" Skills) were observed. Results also revealed significant reductions in parent rated child externalizing behavior problems from pre-to-post-treatment that were also maintained at follow-up. Results of the current study support the initial efficacy of Tele-PCIT for treating disruptive behavior in young children with ASD. Findings from this pilot will inform larger examinations of Tele-PCIT for youth with ASD.

68.2 TREATMENT GUIDELINES FOR PHARMACOLOGICAL MANAGEMENT OF DISRUPTIVE BEHAVIORS AND ADHD

There is a high comorbidity between ADHD and disruptive behavior problems in young children. The AAP recommends behavioral parent training and/or behavioral therapy as a first-line treatment of preschool-aged children with ADHD. Based on literature review, behavioral therapy in young children is the most efficacious in the treatment of ADHD symptomatology, particularly when it is comorbid with disruptive behaviors; however, if it fails or is inadequate in managing symptomatology, stimulant medications are considered. Dextroamphetamine is FDA approved for the treatment of ADHD in children aged 3 years and older, vs methylphenidate, which has a warning to not be used in children younger than 6 years old. Data on medication use in this patient population are limited and risk assessment is complex due to lack of full appreciation of potential long-term side effects and consequences on the developing brain. It is also unclear which children would respond better to therapy and which ones would respond better to medication management. There are also no guidelines regarding combined treatment, medication plus therapy, for children with severe symptomatology. This presentation will focus on a literature review of studies discussing various treatment modalities for disruptive behaviors in young children with ADHD. We will discuss challenges of combined treatment: psychotherapy and medication management. We will focus on available literature on the use of psychotropic medications in children aged 2 to 7 years. We will review available treatment guidelines and offer provisional guidelines, based on available literature on when to use behavior treatment alone vs in combination with medication. Participants will learn treatment recommendations for young children with ADHD and disruptive behaviors. They will gain an understanding of the pros and cons of using medications in this patient population. They will have an opportunity to present their challenging cases and ask questions. First-line treatment of disruptive behaviors in kids with ADHD is with behavioral therapies. Data on medication use are very limited in this patient population.

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.

Using Class Pass Intervention to Decrease Disruptive Behavior in Young Children

Previous research has shown that disruptive behavior can impair students’ academic success (Pierce et al. in Remedial Spec Educ 25:175–188, 2004, https://doi.org/10.1177/07419325040250030501 ), as well as increase teacher’s stress level (Westling in Remedial Spec Educ 31:48–63, 2010, https://doi.org/10.1177/0741932508327466 ). The Class Pass Intervention (CPI) is a Tier 2 intervention designed to decrease disruptive behavior and increase academic engagement; however, few studies have evaluated the efficacy of CPI. The purpose of this study was to assess the effects of CPI on disruptive behavior and academic engagement of young students who engage in disruptive behavior. This study used a non-concurrent multiple baseline design to assess experimental control. In the current study, CPI led to a decrease in disruptive behavior and an increase in academic engagement for all three participants and these levels persisted throughout schedule thinning. In addition, results of teacher and student social validity assessments indicated that the intervention was effective and easy to implement and that students preferred the intervention.

Brief Report: What Diagnostic Observation Can Teach Us About Disruptive Behavior in Young Children with Autism.

Objective: Approximately 50% of children with autism exhibit severe tantrums, defiance, and/or aggression. We propose that the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)-a standardized clinical observation modeled after, and complementary to, the Autism Diagnostic Observation Schedule (ADOS)-could enhance earlier identification of disruptive behavior (DB) in autism populations and inform treatment planning. Methods: We adapted the DB-DOS for children with autism based on expert input and preliminary feasibility testing to accommodate varying cognitive and social communication capacities and increase the likelihood of observing DB in this population. Thereafter, we concurrently administered the modified DB-DOS and the ADOS to 12 children with autism aged 36 to 50 months. Results: Overall, children exhibited greater DB, especially behavioral regulation challenges, during the DB-DOS than during the ADOS. Conclusion: The use of a developmentally sensitive standardized observation tool that presses for DB to complement standardized observations such as the ADOS shows promise for enabling more precise research on targeted DB interventions. Such a tool holds promise as a reliable and efficient method of identifying comorbid DB disorders in the autism population.

Associations between early home environment and trajectories of disruptive behavior among preschoolers reared in CPS-referred families

Young children who experience maltreatment are at increased risk for disruptive behavior problems. In high-risk environments, children’s difficulties regulating negative emotions and behavior may be an important precursor to later disruptive behavior problems. This longitudinal study examined associations between early home risk factors and trajectories of disruptive behavior in young children in Child Protective Services–involved families. Standardized observations of disruptive behavior, home environment quality, and parenting risk were measured when children ( N = 142) were 36 and 48 months old. Results of multiple indicator latent change models showed that early childhood anger dysregulation decreased over the early preschool period. Early home and parenting risk factors (increased harsh parenting, reduced organization of the home, and decreased parental involvement and responsiveness) were associated with higher baseline values of anger dysregulation at 36 months, but not with change in anger dysregulation over the preschool period. These findings hold important implications for early prevention and intervention for externalizing problems among children in the child welfare system.

Adapting Internet-Delivered Parent-Child Interaction Therapy to Treat Co-Occurring Disruptive Behavior and Callous-Unemotional Traits: A Case Study

Disruptive behavior disorders (DBD) are highly prevalent, emerge in early childhood, exhibit considerable stability across time, and are associated with profound disability. When DBD co-occur with callous-unemotional (CU) traits (i.e., lack of empathy/guilt), the risk of early-onset, stable, and severe disruptive behavior is even higher, relative to DBD alone. Early intervention is critical, and there is robust empirical support for the efficacy of parent management training (PMT) for reducing disruptive behavior in young children. However, broad access to these interventions is hindered by numerous systemic barriers, including geographic disparities in availability of services. To overcome these barriers and enhance access and quality of care to underserved communities, several PMT programs have been adapted to online delivery formats, including Parent-Child Interaction Therapy (PCIT). PCIT is an evidence-supported treatment that attempts to reduce disruptive child behavior by improving the parent–child relationship and implementing consistent and effective discipline strategies. Comer and colleagues proposed an online adaptation of PCIT (I-PCIT) that is delivered using video teleconferencing (VTC). I-PCIT was implemented with the family of a 5-year-old Australian boy presenting with clinically significant disruptive behavior and CU traits living in a rural community. Findings from this case report (a) document an improvement in disruptive behavior that was maintained to follow-up and (b) provide preliminary support for adapting PCIT to online delivery formats to enhance accessibility of services and improve child and parent outcomes.

Moderators of Parent Training for Disruptive Behaviors in Young Children with Autism Spectrum Disorder.

We conducted a 6month, randomized trial of parent training (PT) versus a parent education program (PEP) in 180 young children (158 boys, 22 girls), ages 3-7years, with autism spectrum disorder (ASD). PT was superior to PEP in decreasing disruptive and noncompliant behaviors. In the current study, we assess moderators of treatment response in this trial. Thirteen clinical and demographic variables were evaluated as potential moderators of three outcome variables: the Aberrant Behavior Checklist-Irritability subscale (ABC-I), Home Situations Questionnaire (HSQ), and Clinical Global Impressions-Improvement Scale (CGI-I). We used an intent-to-treat model and random effects regression. Neither IQ nor ASD severity moderated outcome on the selected outcome measures. Severity of Attention Deficit Hyperactivity Disorder (ADHD) and anxiety moderated outcomes on the ABC-I and HSQ. For instance, there was a 6.6 point difference on the ABC-I between high and low ADHD groups (p = .05) and a 5.3 point difference between high and low Anxiety groups (p = .04). Oppositional defiant disorder symptoms and household income moderated outcomes on the HSQ. None of the baseline variables moderated outcome on the CGI-I. That IQ and ASD symptom severity did not moderate outcome suggests that PT is likely to benefit a wide range of children with ASD and disruptive behavior.

Using a Modified Parent-Child Interaction Therapy to Increase Vocalizations in Children With Autism

ABSTRACTParent-Child Interaction Therapy (PCIT) is a manualized behavioral intervention originally developed by Eyberg (1988) to address disruptive behaviors in young children. Although previous research findings support the contention that components of PCIT would positively impact communication, behavior, and adaptive skills (Howard, Sparkman, Cohen, Green, & Stanislaw, 2005; Lovaas, 1987; Remington et al., 2007) in children with developmental disabilities, few studies are shown in the literature. In a modified version of PCIT, caregivers completed two phases of intervention with their child diagnosed with Autism Spectrum Disorder (ASD). During the Child-Directed Interaction (CDI) phase, caregivers were taught to conduct mand training, follow-their child’s lead, provide attention for their child’s positive behaviors, and ignore their child’s negative behaviors. During the Parent-Directed Interaction (PDI) phase, caregivers were taught to give effective commands and follow through with demands. The goal of the current study was to determine whether children’s production of vocalizations increased after participation in a modified PCIT program. Data from two participants diagnosed with autism were included in the study. Outcomes of these two case studies show that both children displayed an increase in the total number of vocalizations emitted in the posttreatment observation relative to baseline. Additionally, caregivers of both participants displayed an increased number of positive behaviors in the posttreatment observation relative to baseline.

Effect of Parent Training on Adaptive Behavior in Children With Autism Spectrum Disorder and Disruptive Behavior: Results of a Randomized Trial

This study examined the impact of parent training on adaptive behavior in children with autism spectrum disorder (ASD) and disruptive behavior. This was a 24-week, 6-site, randomized trial of parent training versus parent education in 180 children with ASD (aged 3-7 years; 158 boys and 22 girls) and moderate or greater behavioral problems. Parent training included specific strategies to manage disruptive behavior over 11 to 13 sessions, 2 telephone boosters, and 2 home visits. Parent education provided useful information about autism but no behavior management strategies over 12 core sessions and 1 home visit. In a previous report, we showed that parent training was superior to parent education in reducing disruptive behavior in young children with ASD. Here, we test whether parent training is superior to parent education in improving daily living skills as measured by the parent-rated Vineland Adaptive Behavior Scales II. The long-term impact of parent training on adaptive functioning is also presented. At week 24, the parent training group showed a 5.7-point improvement from baseline on the Daily Living domain compared to no change in parent education (p=.004; effect size= 0.36). On the Socialization domain, there was a 5.9-point improvement in parent training versus a 3.1-point improvement in parent education (p=.11; effect size= 0.29). Gains in the Communication domain were similar across treatment groups. The gain in Daily Living was greater in children with IQ of >70. However, the interaction of treatment-by-IQ was not significant. Gainsin Daily Living at week 24 were maintained upon re-evaluation at 24 weeks posttreatment. These results support the model that reduction in disruptive behavior can lead to improvement in activities of daily living. By contrast, the expected trajectory for adaptive behavior in children with ASD is often flat and predictably declines in children with intellectual disability. In the parent training group, higher-functioning children achieved significant gains in daily living skills. Children with intellectual disability kept pace with time. Clinical trial registration information-Randomized Trial of Parent Training for Young Children With Autism (RUBI); http://clinicaltrials.gov/; NCT01233414.

Behavioral Therapies Work for Disruptive Behavior in Young Children

An estimated 10% of preschool children exhibit early disruptive behavior problems, including oppositional defiant disorder and conduct disorder. These

A Pilot Study of Parent Training in Young Children with Autism Spectrum Disorders and Disruptive Behavior

Guidance on effective interventions for disruptive behavior in young children with autism spectrum disorders (ASDs) is limited. We present feasibility and initial efficacy data on a structured parent training program for 16 children (ages 3-6) with ASD and disruptive behavior. The 6-month intervention included 11 Core and up to 2 Optional sessions. The program was acceptable to parents as evidenced by an attendance rate of 84 % for Core sessions. Fourteen of 16 families completed the treatment. An independent clinician rated 14 of 16 subjects as much improved or very much improved at Week 24. Using last observation carried forward, the parent-rated Aberrant Behavior Checklist-Irritability subscale decreased 54 % from 16.00 (SD = 9.21) to 7.38 (SD = 6.15).

DEVELOPMENT OF DISRUPTIVE BEHAVIORS IN YOUNG CHILDREN: A PROSPECTIVE POPULATION-BASED COHORT STUDY.

We know relatively little about the development of disruptive behaviors (DBs), and gender differences therein. The objective of this study was to describe the continuity and discontinuity in the degree to which young children in the general population are reported to exhibit specific DBs over time. Data came from the Québec Longitudinal Study of Child Development. First, the results show that relatively few children exhibit DBs on a frequent basis at 41 months of age. Second, the results show that a majority of children who exhibit a particular DB on a frequent basis at 41 months of age did not do so 1 year earlier. In addition, a majority of children who exhibited a particular DB on a frequent basis at 29 months of age no longer do so 1 year later. Third, gender differences in DBs (boys > girls) are either emerging or at least increasing in magnitude between 29 and 41 months of age. Consistent with the canalization of the behavioral development principle, children who exhibited DBs on a frequent basis at 29 months of age are less likely to stop doing so in the following year if they had exhibited the same behaviors at 17 months of age.

Preschool Children's Observed Disruptive Behavior: Variations Across Sex, Interactional Context, and Disruptive Psychopathology

Sex differences in disruptive behavior and sensitivity to social context are documented, but the intersection between them is rarely examined empirically. This report focuses on sex differences in observed disruptive behavior across interactional contexts and diagnostic status. Preschoolers (n = 327) were classified as nondisruptive (51%), clinically at risk (26%), and disruptive (23%) using parent and teacher reports on developmentally validated measures of disruptive behavior and impairment. Observed disruptive behavior was measured with the Disruptive Behavior Diagnostic Observation Schedule, a developmentally sensitive observational paradigm characterizing variation in preschoolers' disruptive behavior across two interactional contexts (parent and examiner). Repeated measures analyses of variance revealed a three-way interaction of child sex by diagnostic status by interactional context (F = 9.81, p < .001). Disruptive boys were the only subgroup whose behavior was not sensitive to interactional context: They displayed comparable levels of disruptive behavior with parents and examiners. In contrast, disruptive girls demonstrated the strongest context effect of any group. Specifically, with the examiner, disruptive girls' behavior was comparable to nondisruptive boys (though still more elevated than nondisruptive girls). However, in interactions with their mothers, disruptive girls displayed the highest rates of disruptive behavior of any subgroup in any context, although the difference between disruptive boys and disruptive girls in this context was not statistically significant. Findings suggest the importance of sex-specific conceptualizations of disruptive behavior in young children that take patterns across social contexts into account.

Inhibitory Control and Harsh Discipline as Predictors of Externalizing Problems in Young Children: A Comparative Study of U.S., Chinese, and Japanese Preschoolers

We examined associations between child inhibitory control, harsh parental discipline and externalizing problems in 120 4 year-old boys and girls in the US, China, and Japan. Individual differences in children's inhibitory control abilities, assessed using behavioral tasks and maternal ratings, were related to child externalizing problems reported by mothers. As predicted, both child inhibitory control and maternal harsh discipline made significant contributions to child externalizing problems in all three countries. Across countries, child inhibitory control and maternal harsh discipline made significant independent contributions to early externalizing problems, suggesting an additive model of association. Our findings supported the cross-cultural generalizability of child inhibitory control and parental harsh punishment as key contributors to disruptive behavior in young children.

Use and Feasibility of Telemedicine Technology in the Dissemination of Parent-Child Interaction Therapy

This brief report discusses the use and feasibility of telemedicine technology in the dissemination of Parent-Child Interaction Therapy (PCIT). PCIT is an empirically supported behavioral parent training program for reducing disruptive behavior in young children and for reducing future rates of child physical abuse. The positive impact PCIT has demonstrated in reducing child maltreatment has galvanized interest in widespread dissemination of the PCIT model into child service systems. PCIT has traditionally been taught in university-based training programs in a mentored cotherapy model. By contrast, in field settings, PCIT training typically consists of workshop training supplemented by a period of telephone consultation (PC). Given concerns with the level of practitioner competency and fidelity yielded by the PC model, PCIT training programs have begun to examine Internet-based telemedicine technology to deliver live, mentored PCIT training to trainees at remote locations (Remote Real-Time or RRT) to better approximate the university-based training model. Challenges of disseminating evidence-based practices are discussed, using PCIT as a model of how these challenges are being addressed by telemedicine technology.

Observational Assessment of Preschool Disruptive Behavior, Part II: Validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)

To examine the validity of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior. A total of 327 behaviorally heterogeneous preschoolers from low-income environments comprised the validation sample. Parent and teacher reports were used to identify children with clinically significant disruptive behavior. The DB-DOS assessed observed disruptive behavior in two domains, problems in Behavioral Regulation and Anger Modulation, across three interactional contexts: Examiner Engaged, Examiner Busy, and Parent. Convergent and divergent validity of the DB-DOS were tested in relation to parent and teacher reports and independently observed behavior. Clinical validity was tested in terms of criterion and incremental validity of the DB-DOS for discriminating disruptive behavior status and impairment, concurrently and longitudinally. DB-DOS scores were significantly associated with reported and independently observed behavior in a theoretically meaningful fashion. Scores from both DB-DOS domains and each of the three DB-DOS contexts contributed uniquely to discrimination of disruptive behavior status, concurrently and predictively. Observed behavior on the DB-DOS also contributed incrementally to prediction of impairment over time, beyond variance explained by meeting DSM-IV disruptive behavior disorder symptom criteria based on parent/teacher report. The multidomain, multicontext approach of the DB-DOS is a valid method for direct assessment of preschool disruptive behavior. This approach shows promise for enhancing accurate identification of clinically significant disruptive behavior in young children and for characterizing subtypes in a manner that can directly inform etiological and intervention research.

Supportive expressive therapy--Parent child version: An exploratory study.

Currently, there are no empirically supported psychodynamic treatments for disruptive behavior in young children. Supportive Expressive Therapy--Parent Child (SET-PC) is a newly developed brief psychodynamic psychotherapy that focuses on a parent's internal representations of self and others, particularly as they manifest in problematic parent-child relationships. It is a manualized dyadic therapy that uses videotaped parent-child play sessions followed by parent-therapist discussions. This exploratory study is the first randomized controlled study of SETPC. SET-PC was compared with the Incredible Years Parenting Program (IYPP; Webster-Stratton, 2001), an empirically supported group parent training intervention for child disruptive behavior. Treatment completers were 37 consecutive referrals of parent- child dyads (children ages 30-72 months) to an outpatient psychiatry clinic. SET-PC produced treatment outcomes that were equivalent to IYPP. Both treatments were associated with large effect sizes for decreases in externalizing behavior and for the positive quality of observed parent- child interactions and small effect sizes for improvements in parents' psychological functioning. Treatment gains were maintained at 1-year follow-up regardless of treatment condition. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Parent—Child Interaction Therapy with an Immigrant Family Exposed to Domestic Violence

Parent—child interaction therapy (PCIT) is an empirically supported treatment to enhance the parent—child relationship and to help parents learn how to effectively manage disruptive behavior in young children. PCIT has been shown to be effective with various populations. However, few reports have documented its use with children exposed to domestic violence in families who have recently immigrated to the United States. A mother and 3-year-old child who immigrated to the United States from Africa were identified as an appropriate family for PCIT. The child had reportedly been exposed to domestic violence and presented with both internalizing and externalizing behaviors and symptoms. Specific challenges and successes related to this case are presented.