Early Disruptive Behavior Research Articles

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.

Examining the Efficacy of Online Administration of a Time-Limited School Readiness Intervention in the Face of COVID-19

Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the feasibility, acceptability, and efficacy of a telemedicine delivery of the School Readiness Parenting Program (SRPP), an integrative adaptation of PCIT designed to address the behavioral and academic domains of school readiness. The present study takes the first step towards validating an online administration of the SRPP as a treatment for early childhood disruptive behavior. Data were collected for 64 children ages 2–6 years (Mage = 4.63, SD = 0.86; 78.1% Hispanic/Latinx) and their families, who received either in-person administration of time-limited PCIT (PCIT-TL; n=30) or online administration of SRPP (n=34). A series of repeated measures ANOVAS were conducted to examine within and between group effects. Results revealed that both SRPP and PCIT-TL significantly reduced inattention (d’s = −0.54 to −0.88), aggression (d’s = −0.55 to −1.06), and behavioral symptomology (d’s = −0.55 to −0.85) and produced significant gains in parental skills (d’s = −1.47 to 2.99). Notably, online SRPP demonstrated greater improvement in positive parental verbalization, whereas PCIT-TL demonstrated greater reductions in parental stress. Overall, findings support the utility of online SRPP for addressing behavioral school readiness concerns.

Outcomes Accountability Systems for Early Childhood Disruptive Behaviors: A Scoping Review of Availability.

Early childhood disruptive behaviors are common mental health problems among American youth, and if poorly-managed, pose costly psychological and societal burdens. Outcomes accountability systems in clinical practice are vital opportunities to optimize early intervention for common mental health problems; however, such systems seem rare. A scoping review was conducted to summarize the current availability of outcomes accountability systems in clinical programs addressing early childhood disruptive behaviors, particularly in the US. We used PsycINFO to identify peer-reviewed literature published in English from 2005 to 2021, from which we selected 23 publications from the US, UK, and Netherlands on outcomes accountability systems within clinical programs treating common childhood mental health problems. Only 3 out of 23 publications described outcomes accountability efforts specifically for early childhood problems. Within the 3 studies, only one UK-based study specifically targeted early childhood disruptive behaviors. We did not find publications specifically describing outcomes accountability efforts in US-based clinical programs to treat early childhood disruptive behaviors. There are multi-level challenges preventing changes to the prevalent US model of paying a fee for each unit of child mental healthcare, with little regard for patient outcomes. However, opportunities exist to improve US-based accountability efforts; from top-down expansion of financial incentives, accountability initiatives, and PDT evidence-based practices to an iterative, bottom-up development of meaningful outcomes measurement by providers. Greater adoption of outcomes monitoring in US clinical practice for common mental health problems can optimize management of early childhood disruptive behaviors and mitigate long-term societal and economic burdens.

The Impact of Callous-Unemotional Traits on Achievement, Behaviors, and Relationships in School: A Systematic Review.

Disruptive behavior disorders (DBDs) are associated with significant academic, behavioral, and relationship challenges in the school setting. Children with co-occurring DBDs and callous-unemotional (CU) traits show a distinct pattern of early starting, chronic, and aggressive disruptive behavior and are resistant to traditional DBD interventions. There is growing evidence that CU traits have important consequences for children's school functioning. The purpose of this systematic review is to synthesize research on CU traits in school with a focus on academics, relationships, and behavior. We searched PsycINFO, PubMed, and Education Full-Text to identify 37 empirical studies that met inclusionary criteria. Findings suggest that CU traits are associated with poor academic performance, high levels of aggression and conduct problems, and difficulty forming relationships at school, often above and beyond the impact of DBDs alone. Findings and future directions are discussed including how the current study can support key stakeholders in promoting the success of students with elevated CU traits.

Video feedback combined with coordination meetings in school to reduce early disruptive behaviour problems (DBP)-A 1-year follow-up randomised controlled trial.

To compare long-term effects of a systemic school-based intervention, Marte Meo and Coordination Meetings (MAC), targeting 3- to 12-year-old children displaying disruptive behaviour problems (DBP) in preschool or school, and service as usual (SAU). In addition, to examine whether social status (SS) affected the outcomes. In a randomised controlled design, teachers' and parents' ratings of 99 children's DBPs and mental health were collected before intervention and 1year after post-test. A significant time effect in school was found in both interventions, notably larger than at post-test in an earlier study. There was no difference between groups, SAU catching up with MAC. From teachers' reports, 53-70% of the children showed a positive change. SS did not affect the outcomes. School provides an already established setting to detect and intervene when young children begin to display DBP. Even if a long-term positive change in MAC did show more rapidly than in SAU, both interventions were equivalent for children from diverse social backgrounds.

Mutual synergies between reactive and active inhibitory systems of temperament in the development of children's disruptive behavior: Two longitudinal studies.

Individual differences in two inhibitory temperament systems have been implicated as key in the development of early disruptive behaviors. The reactive inhibition system, behavioral inhibition (BI) entails fearfulness, shyness, timidity, and caution. The active inhibition system, or effortful control (EC) entails a capacity to deliberately suppress, modify, or regulate a predominant behavior. Lower scores in each system have been associated with more disruptive behaviors. We examined how the two systems interact, and whether one can alleviate or exacerbate risks due to the other. In two community samples (Study 1, N = 112, ages 2.5 to 4, and Study 2, N = 102, ages 2 to 6.5), we assessed early BI and EC, and future disruptive behaviors (observed disregard for rules in Study 1 and parent-rated externalizing problems in Study 2). Robustly replicated interactions revealed that for children with low BI (relatively fearless), better EC was associated with less disruptive behavior; for children with low EC, more BI was associated with less disruptive behavior. This research extends the investigation of Temperament × Temperament interactions in developmental psychology and psychopathology, and it suggests that reactive and active inhibition systems may play mutually compensatory roles. Those effects emerged after age 2.

Pupil Response to Affective Stimuli: a Biomarker of Early Conduct Problems in Young Children

Childhood conduct problems have been associated with reduced autonomic arousal to negative cues indicative of an insensitivity to aversive stimuli, with mixed evidence in response to positive cues. Autonomic arousal to affective stimuli has traditionally been measured through galvanic skin responses and heart-rate, despite evidence that pupillometry is more reliable and practically beneficial (i.e., no wires are attached to the participant). The current study is the first to examine abnormal pupillary responsivity to affective stimuli as a biomarker for childhood conduct problems. We measured pupil reactivity to negative, positive and neutral images in 131 children aged 4–7 years, who were referred by their teachers for being at risk of future psychopathology. We assessed relationships between pupil response to the images and teacher-rated scores on the Strengths and Difficulties Questionnaire (SDQ), which indexed child conduct problems and their overlapping emotional, behavioural and social difficulties. Reduced pupil dilation to negative images was associated with significantly increased conduct, hyperactivity, emotional and peer problems, as well as reduced prosocial behaviour. Composite scores for disruptive behaviour and emotional difficulties both uniquely predicted blunted pupil response to negative threat stimuli; there were no relations with pupil responses to positive images. These findings highlight that blunted pupil responsivity to negative stimuli serves as a biomarker for early disruptive behavioural problems and affective difficulties. Pupillometry offers an inexpensive, fast and non-intrusive measure to help identify children who are showing early disruptive behaviour or experiencing affective difficulties, which can provide opportunities for preventative intervention to avoid further psychopathology.

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.

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.

Talking Tots and the Terrible Twos: Early Language and Disruptive Behavior in Toddlers.

The goal of this article is to investigate the association between the 2 most commonly reported parental concerns about young children-disruptive behavior (e.g., irritable, aggressive, and noncompliant behaviors) and language delay in toddlers. To test for salient subgroup differences, individual differences by the sex of the child and family poverty status were examined. Participants included 1259 mothers of children between 18 and 36 months of age. Mothers completed questions about their child's language development and disruptive behavior. Information regarding poverty status as well as child age and sex were also collected. Stronger language skills were associated with fewer disruptive behaviors for children between 18 and 36 months of age. This negative association was stronger for females than for males (b = -0.243; t[1251] = -3.555; p < 0.001) and stronger for children living in poverty than for those above the poverty line (b = -2.04; t[1251] = -2.531; p = 0.011). Findings from our study suggest a developmental co-occurrence pattern that begins at a very early age. Individual differences suggest that there is substantial heterogeneity in these patterns; longitudinal investigation is needed to uncover causal pathways and underlying mechanisms. Awareness of the association between these 2 developmental domains, about which parents frequently express concerns, is critical to maximizing early detection and intervention.

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.

Peer influence on disruptive classroom behavior depends on teachers' instructional practice

This study investigated whether early adolescents' disruptive classroom behavior is predicted by descriptive classroom norms for such behavior (i.e., mean level of classmates' disruptive behaviors). We further examined whether classmates' influence on a student's disruptive behavior varies based on teacher's instructional practice. Participants were 701 adolescents (M = 13.12 years; 48.8% girls) who were followed across six measurement points from Grades 7 through 9. Multilevel analyses showed that subsequent individual disruptive behavior was predicted by earlier levels of disruptive behavior in the classroom. Peer influence on disruptive behavior was lower when students perceived that their teacher's instruction was more supportive and interesting. When students reported that their teacher used more ability differentiation (e.g., ability grouping), peer influence on disruptive behavior was higher.

Understanding Banking Time Implementation in a Sample of Preschool Children Who Display Early Disruptive Behaviors

The development of a warm and supportive relationship with their teacher is protective for preschool children, and particularly beneficial for children who display early disruptive behaviors. Banking Time is a dyadic, short-term intervention to improve the quality of teacher–child interactions between a teacher and a specific child, building a more positive teacher–child relationship. During Banking Time sessions, both teacher and child interact toward an activity chosen by the child. This study used variable- and person-centered approaches to examine Banking Time implementation in a sample of diverse preschool teachers (N = 120) and children (N = 319) randomly selected to participate in the intervention. Results indicated that the majority of teachers implemented expected practices (i.e., observe and narrate the child’s actions, allow the child to lead) as intended. However, although teachers were instructed to limit teacher-directed practices (i.e., ask questions, give praise, and use commands), teachers’ use of these practices was not as limited as ideally expected. Three different implementation patterns were evident: (1) High Fidelity, in which the teachers engaged in the child’s activity while ensuring that the child led the session; (2) Low Engaged, in which the child led the session, but the teacher was not engaged in the child’s activity; and (3) Teacher-Led, in which the teacher was engaged in the child’s activity but also directing the session instead of ensuring the child’s lead. These implementation patterns were linked to changes in the quality of teacher–child interactions. Implementation findings from this study can inform interventions to improve the quality of teacher–child interactions.

Clinical and Environmental Risk Factors for Bipolar Disorder: Review of Prospective Studies.

After participating in this activity, learners should be better able to:• Evaluate factors that have been identified in prospective studies as predicting the onset of bipolar disorder ABSTRACT: The prodromal phase of bipolar disorder (BD) remains incompletely characterized, limiting early detection of BD and delaying interventions that might limit future morbidity and disability. Retrospective and family-risk studies have consistently found evidence of prodromal psychopathology in subjects later diagnosed with BD. Here, we review prospective studies of clinical risk factors and exposures identified before diagnosis of BD: our findings are consistent with those from retrospective and family-risk studies. Affective psychopathology often precedes diagnosis to suggest a homotypic trajectory in developing BD. Early non-affective (heterotypic) psychopathological disturbances, including anxiety and disruptive behavior disorders, as well as environmental factors and exposures, have been found in prospective studies to increase the risk of BD, but tend to lack specificity in predicting BD. Findings from prospective studies are encouragingly similar to those of retrospective and family-risk studies.

Children's Early Disruptive Behavior Predicts Later Coercive Behavior and Binge Drinking by Mothers

PurposeWe examined the prospective influence of early child problematic behavior on later coercive interactions and binge drinking by mothers. Design and methodsCanadian participants are from the Quebec Longitudinal Study of Child Development, born between spring 1997 and 1998, which allowed a longitudinal birth cohort design. At the 41months, 628 parents reported on children's oppositional, aggressive, turbulent, and inattentive/hyperactive behavior. Mothers then reported on their own coercive and binge drinking behavior at the 60month follow-up. ResultsWe estimated a series of ordinary least-squares regressions to examine the relationship between early child behavior problems and later parental coercion and binge drinking, above and beyond many key pre-existing/concurrent confounding factors including prior parenting stress and binge alcohol use. Oppositional, aggressive, and turbulent child behaviors at 41months predicted harsh, negative parenting at 60months. Early inattentive/hyperactive child behavior also forecasted later binge alcohol use by mothers within the same time frame. ConclusionNegative preschool behavior predicted harsh, negative maternal behavior kindergarten entry. Early inattentive/hyperactive behavior also forecasted later binge alcohol use by mothers. Coercive parenting and alcohol use are clinically signs of adult distress. Such parents might use alcohol excessively because of its perceived stress-dampening effects and mental evasion from their life difficulties and frustration experiences. Practice implicationsProblematic preschool behavior can lead to less effective child-rearing and unhealthy parental behavior. Such at-risk mothers would benefit from professional caring practices. Practitioners can inspire change, especially using interaction interventions which encourage positive parent-child relations that, in turn, diminish parental distress.

Dimensional Latent Structure of Early Disruptive Behavior Disorders: A Taxometric Analysis in Preschoolers.

Although disruptive behavior disorders (DBDs) are used as a distinct categorical diagnosis in clinical practice, they have repeatedly been described as having a dimensional structure in taxometric analyses. In the current study the authors analyzed the latent status of disruptive behaviors (DB) in a large sample (N = 2,808) of German preschool children (2-6years old, mean age 53.7months, SD = 13.5, 48.4% girls). The Eyberg Child Behavior Inventory (ECBI) as well as the Strengths and Difficulties Questionnaire (SDQ) were used to compile indicators of the DB core dimensions (Temper Loss, Aggression, Noncompliance, and Low Concern for others). Three widely used taxometric methods (a) MAXEIG, (b) MAMBAC, and (c) L-Mode were applied. Simulation data were created to evaluate the Comparison Curve Fit Index values (CCFIs), which were below 0.45, supporting a dimensional solution. Hence, in the current study the latent structure of DB in preschoolers encompassed differences in degree rather than kind. Researchers and practitioners should be mindful of the dimensional latent status of DB in theory building, assessment, classification, and labeling.

The Neurodevelopmental Basis of Early Childhood Disruptive Behavior: Irritable and Callous Phenotypes as Exemplars.

The arrival of the Journal's 175th anniversary occurs at a time of recent advances in research, providing an ideal opportunity to present a neurodevelopmental roadmap for understanding, preventing, and treating psychiatric disorders. Such a roadmap is particularly relevant for early-childhood-onset neurodevelopmental conditions, which emerge when experience-dependent neuroplasticity is at its peak. Employing a novel developmental specification approach, this review places recent neurodevelopmental research on early childhood disruptive behavior within the historical context of the Journal. The authors highlight irritability and callous behavior as two core exemplars of early disruptive behavior. Both phenotypes can be reliably differentiated from normative variation as early as the first years of life. Both link to discrete pathophysiology: irritability with disruptions in prefrontal regulation of emotion, and callous behavior with abnormal fear processing. Each phenotype also possesses clinical and predictive utility. Based on a nomologic net of evidence, the authors conclude that early disruptive behavior is neurodevelopmental in nature and should be reclassified as an early-childhood-onset neurodevelopmental condition in DSM-5. Rapid translation from neurodevelopmental discovery to clinical application has transformative potential for psychiatric approaches of the millennium. [AJP at 175: Remembering Our Past As We Envision Our Future November 1938: Electroencephalographic Analyses of Behavior Problem Children Herbert Jasper and colleagues found that brain abnormalities revealed by EEG are a potential causal factor in childhood behavioral disorders. (Am J Psychiatry 1938; 95:641-658 )].

A randomized controlled trial evaluating a low-intensity interactive online parenting intervention, Triple P Online Brief, with parents of children with early onset conduct problems

ObjectiveThis randomized controlled trial examined the efficacy of Triple P Online Brief, a low-intensity online positive parenting program for parents of children with early onset disruptive behavior problems. MethodTwo hundred parents with 2–9-year-old children displaying early onset disruptive behavior difficulties were randomly assigned to either the intervention condition (n = 100) or a Waitlist Control group (n = 100). ResultsAt 8-week post-assessment, parents in the intervention group displayed significantly less use of ineffective parenting strategies and significantly more confidence in dealing with a range of behavior concerns. These effects were maintained at 9-month follow-up assessment. A delayed effect was found for child behavior problems, with parents in the intervention group reporting significantly fewer and less frequent child behavior problems at follow-up, but not at post-assessment. All effect sizes were in the small to medium range. There were no significant improvements in observed negative parent and child behavior. No change was seen for parents' adjustment, anger, or conflict over parenting. Consumer satisfaction ratings for the program were high. ConclusionsA brief, low-intensity parenting program delivered via the Internet can bring about significant improvements in parenting and child behavior.

Friend influence on early adolescent disruptive behavior in the classroom: Teacher emotional support matters.

This research investigated how the level of disruptive behavior and friend influence on disruptive behavior varies across classrooms in relation to teacher emotional support. Data were collected from 48 fifth- and sixth-grade classrooms (N = 879 students) and included classroom observations at Wave 1 and student reports of their disruptive behavior and peer nominations of their friends at Waves 1 and 2 (fall and spring of the school year, about 6 months apart). In the fall, there were no differences in the level of disruptive behavior between classes that were low versus high in teacher emotional support. However, by spring, disruptive behavior was higher in classes with low teacher emotional support compared to classes high in teacher emotional support. Social network analyses, conducted with stochastic actor-based models, indicated that students were more likely to become similar to their friends in regards to disruptive behavior in classes low in teacher emotional support compared to classes high in teacher emotional support. Thus, the level of disruptive behavior and students' susceptibility to friend influence on disruptive behavior depend on the nature of the classroom context. This study contributes to a growing body of research showing that teachers play an important role in shaping the nature of peer relationships in the classroom. (PsycINFO Database Record