Disruptive Behavior Problems Research Articles

Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care Trial.

Pediatric primary care providers (PCPs) are increasingly expected to deliver behavioral health (BH) services, yet PCP characteristics that facilitate or hinder BH service delivery are poorly understood. This study examined how PCP characteristics and collaborative care participation influenced changes in BH-related effort and competency over time. Pediatric PCPs (N=74) participating in a cluster randomized trial (8 practices) of a collaborative care intervention for disruptive behavior problems completed self-report measures at 0, 6, 12, and 18 months. Latent growth curve models tested the impact of PCP characteristics (ie, age, gender, negative BH beliefs, BH burden, BH competency) on changes in identification/treatment of disruptive behavior disorders and competency over the course of the trial. Participation in collaborative care was associated with increases in identification/treatment, with no evidence that PCP characteristics moderated changes in identification/treatment. For competency, however, older PCPs (>50 years) in collaborative care exhibited steep increases over time, while older PCPs in the comparison condition exhibited steep decreases, suggesting differential benefits of collaborative care participation by PCP age. In both conditions, PCPs with more negative BH beliefs reported less identification/treatment over time. Baseline competency was positively associated with identification/treatment and associations weakened over time. Gender and perceived burden had little impact. PCP characteristics are associated with changes in PCPs' BH-related effort and competency over time. Participation in a collaborative care model appears to be especially beneficial for older PCPs. Implementation of collaborative care can promote growth in BH-related effort and competency for PCPs.

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.

Improving Parent Emotion Socialization Practices: Piloting Tuning in to Kids in Iran for Children With Disruptive Behavior Problems

ObjectiveTo evaluate Tuning in to Kids (TIK), an emotion‐focused parenting program for mothers and preschool children with disruptive behavior problems in Iran.BackgroundDisruptive behaviors occur in approximately 23% of Iranian children and are associated with poorer emotional competence. The TIK parenting program was used to improve children's emotion competence and behavior by focusing on parent emotion socialization practices and emotion‐coaching skills.MethodFifty‐four children (3–6 years of age) were screened for behavior problems and randomly assigned to intervention or waitlist control conditions. Mothers in the intervention condition attended a six‐session version of the TIK program with two booster sessions at 2‐month intervals. Mothers completed questionnaires assessing children's behavior and emotional competence as well as parents' emotional socialization and emotion regulation at preintervention, postintervention, and 3‐month follow‐up.ResultsCompared with those in the control condition, mothers in the intervention condition reported statistically lower emotion dismissive parenting, child behavior problems, and emotion lability, as well as more emotion coaching.ConclusionTIK shows promise as a way of enhancing parent emotion socialization resulting in improved child behavior and emotional competence in children with disruptive behavior problems.ImplicationsThe findings suggest the program is a useful addition to existing parenting programs used in Iran.

Beyond “what works”: A mixed‐methods study of intervention effect modifiers in the Good Behavior Game

AbstractThis mixed‐methods study examines two moderators of the impact of the Good Behavior Game—implementation variability, participant risk status, and the interaction between them—as predictors of behavioral and academic outcomes. Quantitative data from 38 primary schools were utilized, with outcome data collected at baseline and 2‐year follow‐up. Behavior (disruptive behavior, prosocial behavior, and concentration problems) was assessed via the Teacher Observation of Classroom Adaptation Checklist. Reading attainment was assessed via national teacher assessment scores, and the Hodder Group Reading Test. Implementation fidelity/quality data were collected via independent observations. Participant risk status was modeled using a cumulative risk index. Multilevel modeling revealed that higher levels of fidelity/quality were associated with improved overall reading scores (d = 0.203–225), but worsening disruptive behavior among high‐risk students (d = 0.560). Thematic analysis of qualitative interview data collected from 20 teachers identified six groups of at‐risk students who were perceived to experience differential effects, and five key mechanisms underpinning these.

Clinically Significant and Reliable Change: Comparing an Evidence-based Intervention to Usual Care

Multiple Family Groups (MFG) is an evidence-based behavioral parent training developed with a specific focus on increasing engagement and decreasing treatment barriers for families of children with disruptive behavior problems within high-risk communities. Previous studies have demonstrated the effectiveness of MFG in improving oppositional behavior at the group-level compared to services as usual (SAU). However, information is lacking regarding intervention effectiveness on an individual-level (i.e., clinical significance). The reliable change index and clinical cutoff score method was utilized to determine whether MFG produced clinically meaningful changes compared to SAU for both child- and parent-level outcomes in a sample of 320 youth aged 7 to 11-years-old. A significantly greater percentage of children in the MFG group experienced clinically meaningful change in problem behaviors compared to the SAU group, (p = 0.003, 95% [CI]: 1.610–18.481). A significantly greater number of parents in MFG also demonstrated clinically meaningful change in parental experience of stress compared to SAU, (p = 0.01, 95% [CI]: 1.255–14.704). Findings suggested clinically significant and reliable improvements in child problem behaviors and decreases in parental perceived stress for families in MFG compared to SAU. Nevertheless, analyses demonstrated that both MFG and SAU resulted in few families obtaining clinically significant or reliable change in their functioning. Ongoing assessments and deeper understanding of intervention effect are needed to better service families in need. Both group- and individual-level comparisons should be considered when examining the effects of a treatment as they may provide a nuanced understanding of evidence-based interventions.

Direct-to-Consumer Marketing for Parent-Child Interaction Therapy: Impact of Language and Messenger.

Parent-Child Interaction Therapy (PCIT) is an effective therapy to treat early onset disruptive behavior problems and child physical maltreatment. In order to support the successful implementation and sustainment of PCIT, strategies are needed to recruit parents into care, especially for racial and ethnic minority families, who often have lower rates of access and utilization of mental health services. This study investigated the impact of direct-to-consumer advertisements on parents' attitudes towards PCIT. Advertisements were delivered in Spanish and English, with either a parent testimony or therapist explaining the treatment. Participants were parents of children between the ages of 2 and 7, who were recruited through Amazon Mechanical Turk. Participants (N = 204) were 38.2% female and 49.5% Spanish speaking. There were no main effects for language or messenger related to PCIT Help-Seeking Intentions, Attitudes, or Stigmatization. However, there was an interaction effect for language and messenger for PCIT Help-Seeking Intentions. Specifically, Spanish-speaking participants had higher intentions when the messenger was a therapist rather than a parent, and had lower intentions than English-speaking parents when the messenger was a parent. These findings are promising for direct-to-consumer advertising strategies that may help recruit more Spanish-speaking families into PCIT, which could help address disparities in access to mental health services.

Maternal Elaborative Language in Shared Emotion Talk with ODD Children: Relationship to Child Emotion Competencies.

While maternal elaborative reminiscing has been found to be positively connected to children's emotion competencies, little is known about how the quality of maternal talk during mother-child talk about shared emotion events relates to emotional competencies in children with disruptive behavioural disorders. In this study of 68 four to eight year-olds with oppositional defiant disorder and 34 children without a diagnosis there was no evidence of differences between mothers of oppositional defiant disorder (ODD) children and mothers of non-ODD children in their use of emotion descriptors and open-ended questions when discussing emotion events with their child. After controlling for child age, gender, expressive verbal abilities and number of conversational turns, the more the mothers used these devices the poorer child's ability to generate causes for emotions and the lower the child's emotion regulation ability. The association for child emotion regulation was moderated by child's diagnostic status with a notable relationship for ODD mother-child dyads but not for the other group. The implications of the findings for the conceptualisation of mother-child talk and its relationship to the development of emotion competencies in children with disruptive behavioural problems are discussed.

A Meta-Analysis of Program Characteristics for Youth with Disruptive Behavior Problems: The Moderating Role of Program Format and Youth Gender.

There is high variability in efficacy for interventions for youth with disruptive behavior problems (DBP). Despite evidence of the unique correlates and critical consequences of girls' DBP, there is a dearth of research examining treatment efficacy for girls. This meta-analysis of 167 unique effect sizes from 29 studies (28,483 youth, 50% female; median age: 14) suggests that existing treatments have a medium positive effect on DBP (g=.33). For both boys and girls, the most effective interventions included (a) multimodal or group format, (b) cognitive skills or family systems interventions, and (c) length-intensive programs for (d) younger children. Boys demonstrated significantly greater treatment gains from group format interventions compared to girls, which is particularly important given that the group program format was the most prevalent format for boys and girls, with 14 studies involving 10,433 youth encompassing this category. This is the first meta-analysis to examine the effect of program characteristics in a sample of programs selected to be specifically inclusive of girls. Given that girls are underrepresented in intervention research on DBP, findings are discussed in terms of gender-responsive considerations and elucidating how key aspects of program structure can support more effective intervention outcomes for youth.

The Subjective Experience of Children with Disruptive Behavior Problems as Reflected in “Person Picking an Apple from a Tree” Drawings

ABSTRACTThis study administered the “Person Picking an Apple from a Tree” drawing task to inquire into the subjective experience of children with Disruptive Behavior Problems. A total of 40 4th-6th grade students from an elementary school in Crete participated: 20 children showed signs of Disruptive Behavior Problems according to their teacher’s reports, and the other 20 did not. The drawings and verbal narratives were analyzed using a qualitative method. Findings present differences in two central themes: the environment as a context was duller, and self-agency representations showed less agency and subjectivity in the first group. The discussion deals with the findings in terms of object relations and agency theories. Therapeutic implications, study limitations, and future research are also discussed.

Parent mental health problems and motivation as predictors of their engagement in community-based child mental health services

Parent or caregiver engagement in child mental health treatment is an important element of treatment effectiveness, particularly for children with disruptive behavior problems. Parent or caregiver characteristics, such as their mental health and/or motivation to participate in treatment, may impact engagement and subsequent treatment outcomes. However, a lack of empirical research exists examining these potential links, particularly in community-based treatment settings. The current pilot study: 1) examines whether parent mental health problems and/or early parent motivation to participate in treatment predict three indicators of parent engagement in child treatment, controlling for the other predictor; and 2) examines and compares the differential influence of parent mental health and parent motivation on each parent engagement indicator. Participants in this study include 19 dyads from 18 therapists who were recruited from community mental health clinics. Results indicated a significant association between parent mental health and session attendance, and a marginally significant association between parent mental health and therapist-rated parent engagement. Parent mental health predicted outcomes above and beyond parent motivation. These findings preliminarily suggest that parent mental health problems early in child mental health treatment may be important to consider as an impactful target to promote parent treatment engagement, in addition to focusing on parent motivation to participate in treatment.

Self-views and aggression in boys referred for disruptive behavior problems: self-esteem, narcissism, and their interaction

How do children with aggressive behavior problems view themselves? The present research seeks to answer this question by examining the self-views (i.e., self-esteem and narcissism) of boys referred for disruptive behavior problems. In Study 1 (N = 85, Mage= 10.8 years), we examined relations between self-views and self-reported and parent-reported aggression; in Study 2 (N = 73, Mage= 11.8 years), we examined relations between self-views and teacher-reported aggression. We found narcissism to be related with self-reported aggression, but not with parent- and teacher-rated aggression. Children with narcissistic traits were more aggressive according to themselves, and these links were independent of children’s level of self-esteem. Self-esteem was not significantly associated with aggression according to children themselves, their parents, nor their teachers. We encourage scholars to explore the possibility that interventions that target characteristics of narcissistic self-views (e.g., perceived superiority, sensitivity to negative feedback) can effectively reduce aggressive behavior in boys referred for behavior problems.

Early childhood child care and disruptive behavior problems during adolescence: a 17-year population-based propensity score study.

Child-care services during early childhood provide opportunities for social interactions that may facilitate children's learning of acceptable social behaviors. Furthermore, they may reduce exposure to family adversity for some children. The aim of this study was to determine whether intensity of exposure to child-care services prior to age 5years has a beneficial effect on disruptive behavior problems during adolescence, and whether the effect is more pronounced for children from low socioeconomic families. N=1,588 participants from the Québec Longitudinal Study of Child Development were assessed 14 times from 5months to 17years. Intensity of child-care exposure was measured from 5months to 5years of age. Main outcomes were self-reported physical aggression and opposition from age 12 to 17years. Family socioeconomic status (SES) was measured at 5months. Factors explaining differences in child-care use were controlled using propensity score weights (PSW). Children exposed to moderate-intensity child-care services (part-time child-care services before 1½ years and full time afterward) reported lower levels of physical aggression (d=-.11, p=.056) and opposition (d=-.14, p=.029) during adolescence compared to children exposed to low-intensity child-care services. A significant child care by SES interaction (p=.017) for physical aggression indicated that the moderate-intensity child-care effect was specific to children from low SES families (d=-.36, p=.002). No interaction with socioeconomic status was found for opposition. Moderate-intensity child-care services from infancy to school entry may prevent disruptive behavior during adolescence, especially for disadvantaged children.

Web-Based Parent Training Intervention With Telephone Coaching for Disruptive Behavior in 4-Year-Old Children in Real-World Practice: Implementation Study.

BackgroundParent training is the most effective approach to the psychosocial treatment of disruptive behavioral problems in childhood. However, no studies exist on how well Web-based training programs work when they make the transition from the research setting to implementation in primary health care.ObjectiveThe study aimed to examine how the randomized controlled trial (RCT) and implementation study groups of the Strongest Families Smart Website (SFSW) intervention differed in child psychopathology, family demographics and treatment-related factors, such as therapeutic alliance and parents’ satisfaction rates. The intervention was conducted in the pediatric primary health care in Finland.MethodsThe study focused on 232 parents who had taken part in the SFSW intervention, which formed part of a 2-arm RCT study, and 882 families that would participate in the subsequent SFSW implementation study group. Both groups comprised parents whose children displayed high levels of parent-reported disruptive behavioral problems when they were screened in child health clinics at 4 years of age. Parents in both groups were provided with the SFSW intervention, which consisted of a Web-based training program with 11 weekly themes and associated telephone sessions.ResultsDemographic factors or duration of behavioral problems did not differ statistically or clinically between the RCT and implementation groups. Overall, 42.0% (362/862) of children in the implementation group and 35.4% (80/226) in the RCT intervention group had suffered from behavioral difficulties more than 1 year before the screening phase (χ12=3.2; P=.07). The mean duration of telephone coaching calls was very similar in the implementation and RCT intervention groups, that is, 38 and 37 min per call, respectively (t279.5=0.26; P=.79). The total time spent on the website of the program was 451 min in the implementation group and 431 min in the RCT intervention group (t318.8=1.38; P=.17). In the RCT intervention group, 52 of the 232 participants (22.4%) discontinued the program before the tenth week, whereas in the implementation group, 109 of the 882 participants (12.4%; odds ratio 2.05, 95% CI 1.4-3.0; P<.001) discontinued. Parents in both the implementation (77.1% to 98.5%, 498/742 to 731/742, respectively) and the RCT (64.8% to 98.2%, N=105/162- to 159/162, respectively) groups reported qualitatively similar and high level of posttreatment satisfaction rates in improved parenting skills, expectations, and stress relief. Parents in both groups reported a high level of satisfaction in skills and professionalism of the telephone coaches.ConclusionsThe implementation of population-based screening of Web-based parent training intervention with telephone coaching resulted in good feasibility, fidelity, accessibility, and similar satisfaction level post treatment when compared with intervention in RCT research setting. The discontinuation of treatment in the implementation group was exceptionally low.

Parents' Spontaneous Attributions about their Problem Child: Associations with Parental Mental Health and Child Conduct Problems.

Parents' attributions about their child's personality and behaviour are known to predict the quality of parent-child interactions and outcomes for the child, including those from parenting interventions. Nothing is known, however, about the quantity and quality of attributions parents use during free speech about their children referred for treatment of behavioural and emotional problems. We tested hypotheses about the types of attributions and associations among parental attributions, parental psychopathology and child conduct problems, using 504 five-minute speech samples (FMSS) coded using the Parent Attribution Speech Sample (PASS) coding system. Both mothers and fathers talked about their thoughts and feelings regarding their children with disruptive behaviour problems (N = 295; 74% male; 3-8years old). The assessment of spontaneous parental attributions via the PASS coding system was shown to be valid and reliable. Mothers made more negative, dispositional attributions than fathers, however, parents of either gender made, on average, more positive than negative attributions about their children. Parents' natural attributions about these children with emotional and behavioural problems were rather independent from parents' own mental health, but were consistently related to child factors. Specifically, across parent gender and across all attribution dimensions, levels of callous-unemotional traits were associated with spontaneous parental attributions above and beyond other child and parent factors. Overall, the results show that parents' spontaneous speech about referred children contains important information about their causal attributions, and that these are associated with child temperament rather than specific referral symptoms.

Two Drawing Tasks to Illuminate Self-Agency Representations of Children With Disruptive Behavior Problems

This article discusses the clinical benefit of comparing and integrating responses to 2 drawing tasks based on a small study that explored self-agency representations in children with disruptive behavior problems. Qualitative analysis of the children’s free drawing and a Person Picking an Apple from a Tree (PPAT) task, as well as comparison of their verbal stories about both drawings, revealed differences in self-agency representation that could enrich clinical thinking. Because the study’s free drawings contained figures with self-agency to a greater degree than was found in the PPAT, along with more frequent self-references in the corresponding verbal narratives, future research with larger samples and greater rigor is recommended to further explore these and other findings.

Multisystemic Therapy for Disruptive Behavior Problems in Youths with Autism Spectrum Disorder: Results from a Small Randomized Clinical Trial

ABSTRACTYouths with autism spectrum disorder (ASD) often display disruptive behaviors, yet few of the available treatments for such behaviors have been effective with this clinical population. In the present study, the authors examined outcomes for youths with ASD who participated in a randomized clinical trial of multisystemic therapy (MST), a treatment that has previously been adapted for a variety of complex problem behaviors in youths. Participants were youths with an ASD diagnosis and comorbid disruptive behaviors (N = 15) who were randomized to MST or usual community services. Measures of youth-, parent-, and family-level outcomes were obtained at 6 and 12 months postrecruitment. Findings indicated that MST was more effective that usual community services in improving family functioning and ameliorating youth problem behaviors. The present study represents the first clinical trial of MST for youths with ASD and comorbid disruptive behaviors. The results suggest that intensive family-based treatments such as MST hold considerable promise with this clinical population. The implications of these findings for the continued development and evaluation of effective treatments for ASD are discussed.

Marte Meo and Coordination Meetings (MAC): A Systemic School-Based Video Feedback Intervention\u2014A Randomised Controlled Trial

Children displaying early disruptive behaviour problems (DBP) in school are at risk for severe long-term problems. This study evaluated and compared a systemic school-based intervention, Marte Meo and Coordination meetings (MAC) with service as usual (SAU) in a randomised controlled trial. The teachers’ and parents’ ratings were collected before and after intervention. Target group were children aged 3–12 years that displayed DBPs in school (N = 99). MAC programme was more effective than SAU in reducing DBPs among school children based on teachers’ reports (dppc2 .30–.38), whereas the effect was equal according to parents’ reports. It is possible to achieve changes in children’s DBPs in a school setting. Advantages of MAC might be explained by a clear target for change enhancing children’s development in school, but might also be explained by shortcomings in SAU, which seems to generate more services and personnel.

Associations Between Disruptive Behavior Problems, Parenting Factors, and Sleep Problems Among Young Children.

To examine within an at-risk/clinical sample of preschool-aged children with externalizing problems: (1) which disruptive behavior and attention disorder symptoms (i.e., inattention, hyperactivity/impulsivity, and oppositionality/aggression) and (2) what aspects of parenting (e.g., discipline practices or stress) are related to children's sleep problems (e.g., sleep habit and night waking problems). The sample consisted of 148 children (meanage = 5.06 years, 82% male) with at-risk/clinically elevated levels of externalizing behavior problems and their primary caregiver. As part of a larger study, parents reported on their stress and parenting practices and their children's behavioral and sleep functioning. Positive and negative parenting behaviors ("do" and "don't" skills, respectively) were also observed during a 15-minute parent-child interaction during play. Oppositionality/aggression was the only disruptive behavior and attention disorder symptom associated with more sleep habit problems. Higher levels of inconsistent discipline and "don't" skills were also associated with more sleep habit problems. Within a combined model, an interaction emerged such that the association between "don't" skills and elevated sleep habit problems was only evident at low levels of inconsistent discipline. In terms of night waking problems, there was only an association with parenting stress, whereas the other parenting factors and disruptive behavior and attention disorder symptoms were unrelated. Although the directionality of our associations cannot be ascertained because of the cross-sectional nature of our study, these findings, nevertheless, highlight the importance of parenting factors (e.g., inconsistent discipline and parenting stress) when considering sleep difficulties in young children with disruptive behavior and attention disorders.

Violence exposure in an urban city: A GxE interaction with aggressive and impulsive behaviors.

Previous research has demonstrated a reciprocal relationship between community violence exposure and disruptive behavior problems among youth. No study to date, however, has explored the potential interaction between violence exposure in early adolescence and genetics. We explore the gene x environment interaction's impact on teacher-rated aggressive and impulsive behaviors. Violence exposure during the middle school years was assessed using self-report. Genetic data collection occurred in emerging adulthood. A polygenic score was created using findings from a conduct disorder symptomatology genome-wide association study. Three longitudinal classes of teacher reported aggressive and impulsive behavior were identified. We found a significant relationship between violence exposure and class membership. There was a significant GxE interaction, such that those with below average levels of the polygenic score and who were exposed to violence were more likely to be in the moderately high aggressive and impulsive class as compared to the no to low class. These findings highlight the influence of genetic risk together with violence exposure on adolescent problem behavior. Although youth may have little control over the environments in which they live, interventions can and should focus on helping all youth.

Structural Brain Connectivity in Childhood Disruptive Behavior Problems: A Multidimensional Approach

BackgroundStudies of white matter connectivity in children with disruptive behavior have yielded inconsistent results, possibly owing to the trait’s heterogeneity, which comprises diverse symptoms like physical aggression, irritability, and delinquency. This study examined associations of global and specific white matter connectivity with childhood disruptive behavior problems, while accounting for their complex multidimensionality. MethodsIn a large cross-sectional population-based study of 10-year-old preadolescents (n = 2567), we assessed four previously described empirically derived dimensions of disruptive behavior problems using the Child Behavior Checklist: physical aggression, irritability, disobedient behavior, and delinquent behavior. Global and specific white matter microstructure was assessed by diffusion tensor imaging. ResultsGlobal fractional anisotropy and mean diffusivity were not associated with broad measures of disruptive behavior, e.g., Child Behavior Checklist externalizing problems scale. Global fractional anisotropy was negatively associated with delinquent behavior (β = −.123, pfalse discovery rate adjusted = .028) and global mean diffusivity was positively associated with delinquent behavior (β = .205, pfalse discovery rate adjusted < 0.001), suggesting reduced white matter microstructure in preadolescents with higher levels of delinquent behavior. Lower white matter microstructure in the inferior longitudinal fasciculus, superior longitudinal fasciculus, cingulum, and uncinate underlie these associations. Global white matter microstructure was not associated with physical aggression, irritability, or disobedient behavior. ConclusionsDelinquent behavior, a severe manifestation of childhood disruptive behavior, was associated with lower white matter microstructure in tracts connecting frontal and temporal lobes. These brain regions are involved in decision making, reward processing, and emotion regulation. This study demonstrated that incorporating the multidimensional nature of childhood disruptive behavior traits shows promise in advancing the search for elucidating neurobiological correlates of disruptive behavior.