Patterns Of Disruptive Behavior Research Articles

Technology-Assisted Parenting Intervention Plus Therapist Coaching: A Pilot Randomized Trial in a Community Practice Setting

ABSTRACT Disruptive behaviors are the most common clinical presentation in children and adolescents, particularly among disadvantaged youth referred to community mental health clinics (CMHCs). When left unaddressed, disruptive behaviors can increase the risk of adverse mental health outcomes. While parenting interventions are known to be efficacious and efficient treatment approaches, there are many barriers to involvement in such programs, particularly for disadvantaged populations. This pilot randomized controlled trial evaluated a technology-assisted parenting intervention (Parenting Wisely, PW) with therapist coaching compared to treatment as usual (TAU) at a CMHC. Participants included 53 caregiver-adolescent dyads and 13 clinicians recruited from a CMHC. Dyads randomized to PW + therapist coaching received a multi-component intervention that utilized a technology-assisted parenting program alongside therapist coaching sessions. Feasibility/acceptability assessments were conducted and preliminary findings on parenting outcomes and adolescent behavior outcomes were collected at 3- and 6-months post-baseline. Qualitative and quantitative results supported the feasibility and acceptability of the parenting PW + therapist coaching intervention as evidenced by caregiver engagement, therapist adherence, lack of treatment withdrawals, and satisfaction ratings. Exploratory analyses did not show differences between treatment conditions for parenting and adolescent behavioral outcomes. PW + therapist coaching may be better suited for early adolescents, who are at a critical period when disruptive behavior patterns are not yet ingrained, and parents have more authority and opportunity to address family interactions. Next steps for further evaluation include testing the effectiveness, predictors, moderators, and mechanisms of treatment outcomes of PW + therapist coaching as an adjunct to usual care.

Early risk factors associated with preschool developmental patterns of single and co-occurrent disruptive behaviors in a population sample.

The present study investigated prenatal and early postnatal risk factors associated with developmental patterns of disruptive behaviors (DBs; e.g., hyperactivity-impulsivity, noncompliance, physical aggression) from ages 1.5 to 5 years in a population birth cohort (N = 2,057; 50.7% boys). Six high-trajectory classes obtained by latent growth modeling were used as longitudinal indicators of single-DB and co-occurrent DBs. Children following low or moderate trajectories for all DBs served as the reference class. Results showed low commonality of risk factors among single-DB trajectory classes, suggesting that "pure" forms of DBs have specific etiologies. In contrast, the trajectory classes with a high DB in common shared 20.0% to 46.7% of their risk factors. Overall, 40.0% of significant risk factors across trajectory classes were common to between two and four classes, whereas 60.0% of the significant risk factors were specific to one class or another. However, risk factors common among classes accounted for the greater part (63.2%) of the associations, especially in co-occurrent DBs trajectory classes. These risk factors included male sex, a higher number of siblings, maternal symptoms of depression and conduct problems, young motherhood, lack of positive parenting, family dysfunction, and lower socioeconomic status. Children thus develop early distinct patterns of DBs associated with both common and specific prenatal and early postnatal risk factors. Longitudinal assessments of early manifestations of DB, including a range of behaviors and a variety of potential risk factors to reflect the distinctiveness of children and their families, could help guide etiological research, tailor early interventions, and prevent a cascade of deleterious influences and outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Aggression and delinquent behavior in a large representative sample of high school students: Cannabis use and victimization as key discriminating factors

PurposeSince conduct problems (CP) vary distinctly across youths, better subtyping CP may be an important vehicle to study specific risk factors associated to differential patterns of CP. In a sample of 63,196 adolescents, we employed a two-step method to the identify such CP patterns and to help classify youths based on several sociodemographic and psychopathological risk factors associated with CP. MethodsK-means clustering methods were first used to reduce the heterogeneity of CP by analyzing patterns of aggressive (AGG) and rule-breaking (RB) behaviors. A multi-class Classification and Regression Tree approach was further employed to examine the hierarchical interactions between risk factors specific to the emergence of different CP patterns. ResultsResults revealed a three-cluster solution: (i) Low AGG-RB, (ii) High AGG and low RB, and (iii) High AGG-RB. The frequency of cannabis use, level of victimization and hyperactivity symptoms were the three factors best discriminating youths’ membership to distinct patterns of CP. The model displayed a moderate to strong discriminatory capacity. ConclusionAlthough this study provides evidence of key factors that may increase the risk of youths following specific patterns of disruptive behavior, additional research is necessary to clarify the etiology, longitudinal trajectories and outcomes related to these patterns.

The Relationship Between Divorce and Children with AD/HD of Different Subtypes and Comorbidity: Results from a Clinically Referred Sample

This study investigated the relationship between divorce and the symptom profile of children with attention deficit/hyperactivity disorder (AD/HD). The files of 1,201 children from a pediatric practice in Sydney, Australia were used in this study. Children were aged 6 to 18 years, and were diagnosed with either the inattentive or combined type of AD/HD. Results show that 213 children had parents who were divorced. Children with the combined type, and especially boys with comorbid conduct disorder/oppositional defiant disorder (CD/ODD) were more common in the divorced group, and children of the inattentive type with comorbid learning disabilities were overrepresented in nondivorced families. Results suggest that divorce is associated with disruptive behavior patterns in children with AD/HD. The importance of including marital status as an important correlate in AD/HD treatment outcomes is discussed.

Linking Informant Discrepancies to Observed Variations in Young Children’s Disruptive Behavior

Prior work has not tested the basic theoretical notion that informant discrepancies in reports of children's behavior exist, in part, because different informants observe children's behavior in different settings. We examined patterns of observed preschool disruptive behavior across varying social contexts in the laboratory and whether they related to parent-teacher rating discrepancies of disruptive behavior in a sample of 327 preschoolers. Observed disruptive behavior was assessed with a lab-based developmentally sensitive diagnostic observation paradigm that assesses disruptive behavior across three interactions with the child with parent and examiner. Latent class analysis identified four patterns of disruptive behavior: (a) low across parent and examiner contexts, (b) high with parent only, (c) high with examiner only, and (d) high with parent and examiner. Observed disruptive behavior specific to the parent and examiner contexts were uniquely related to parent-identified and teacher-identified disruptive behavior, respectively. Further, observed disruptive behavior across both parent and examiner contexts was associated with disruptive behavior as identified by both informants. Links between observed behavior and informant discrepancies were not explained by child impairment or observed problematic parenting. Findings provide the first laboratory-based support for the Attribution Bias Context Model (De Los Reyes and Kazdin Psychological Bulletin 131:483-509, 2005), which posits that informant discrepancies are indicative of cross-contextual variability in children's behavior and informants' perspectives on this behavior. These findings have important implications for clinical assessment, treatment outcomes, and developmental psychopathology research.

Editorial: Behaviorally oriented therapies, corrections, and public policy.

As we release another issue of the Behavior Analyst Today, the first author was struck by the brightness of the future of the field of behavior analysis. Advances in basic research appear to demonstrate that many of the higher processes of the brain are automatized, such as social interaction, evaluations, and judgments, as well as goal setting suggesting these processes can be studied purely behaviorally without reference to conscious, will or internal guidance (Bargh & Ferguson, 2000). This places behavioral research as central in the discussion of public policy in issues such as socialization and social judgments. Readers of this journal of course will not be surprised by this for we have presented data and theoretical work for years on the role of reinforced function in establishing social behavior (see Patterson, 2002; Snyder, Stoolmiller, Patterson, Schrepferman, Oeser, Johnson, & Soetaert, 2003). In addition, a recent review by Dunst (2003) of 29 studies of infants including 862 infants found that response-contingent learning opportunities, in which the behavior of the child is clearly related to the consequences, produced the greatest amount of social responding and greatly attenuated both negative affect and negative social responding. This offers behaviorists with a clear explanation of positive social development in children and a method to help parents avoid emotional disturbances. ********** In studies with delinquents, while the effect size overall was moderate (Effect size .40) the long-term appropriateness of behavioral treatments for juvenile offenders was found by Gottschalk, Davidson, Mayer, and Gensheimer (1987)(1) and for social learning programs a larger moderate effect size (.77) (Mayer, Gensheimer, Davidson & Gottschalk, 1986) was found. Behavioral programs are well established according to APA criteria and should serve as the cornerstone to correctional practices. Indeed, with the growth in the prison population, it is far past the time for prisons (2), half way houses and diversionary programs to incorporate a resident behavior analyst to ensure that behavioral treatments are readily available for offender remediation in an effort to reduce recidivism. In addition, in a recent meta-analysis, French and Gendreau (2006) found that behaviorally oriented programs have a large effect size when reducing prison misbehavior and this correlates with post release recidivism. A recent survey found that we asked about theoretical orientation 69% of correctional psychologists reported adhering to behavioral model (Boothby & Clements, 2000). Outside of the residential environment behavioral treatments have also been effective. Behavioral parent training has not only received empirical validation (see Chambless, Baker, Baucom, et al. 1998) but has received support as the treatment of choice for children with disruptive disorders (e.g., Brestan & Eyberg, 1998). Behavioral parent training has support for both immediate and long-term outcomes (Bank, Marlowe, Reid, Patterson, & Weinrott, 1991; Barkley, 1997; Gallagher, 2003; McMahon & Wells, 1998; Webster-Stratton, 1996; Webster-Stratton, Kolpacoff, & Hollingsworth, 1988; Webster Stratton, Hollinsworth, & Kolpacoff, 1989). Conservative estimates show between of 50-66% of children with disruptive behavior patterns function in the normal range at the termination of treatment consisting of training parents in use of operant procedures (Dishion & Patterson, 1992)3. For a particular form of behavioral parent training, parent-child interaction therapy current research suggest that it not only reduces behavioral problems but also improves emotional adjustment (see Gallagher, 2003 for review). Behavioral parent training based on social learning principles has recently moved into the foster care environment. Both specialized foster care (Chamberlain & Reid, 1991; Bryant & Snodgrass, 1992) and multidimensional treatment foster care (Chamberlain & Moore, 1998; Fischer, Ellis, & Chamberlain, 1999) represent two program models built on the parent-training model. …

Classes of adolescents with disruptive behaviors in a general population sample

To study disruptive behaviors adequately, we need to distinguish between individuals with different types of problems that may have a different etiology. The availability of a taxonomic system that helps in identifying homogeneous groups of individuals, with similar patterns of disruptive behaviors, is crucial to achieve this goal. Therefore, we examine which classes of preadolescents with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) can be identified in the general population. Disruptive behaviors of 2,230 10-12 year olds from the Dutch general population were assessed with the Child Behavior Checklist and Youth Self-Report. Latent class analysis revealed three classes of preadolescents: the first characterized by high scores on ADHD, ODD, and CD items; a second by high probabilities of ADHD and ODD symptoms; a third with low scores on all items. Because classes of preadolescents with symptoms of only one type of disruptive behavior problems could not be identified, it can be questioned how useful separate diagnostic distinctions are in general population studies.

Predictors of hyperactive-impulsive-inattention and conduct problems: A comparative follow-back investigation

Disruptive behavior patterns are particularly challenging for parents, teachers, and peers as these behaviors often interfere with classroom instruction, frequently lead to academic underachievement, and are associated with social skills acquisition and performance deficits. Children who exhibit a combination of hyperactivity–impulsivity–inattention and conduct problems (HIA + CP) have been shown to be at greater risk for negative social, behavioral, and legal outcomes than children with HIA-only or CP-only behavior patterns. This investigation explored the degree to which academic, social, and behavioral characteristics in Grade 4 could differentiate sixth-grade students with HIA + CP (n = 61), HIA-only (n = 29), and CP-only (n = 14). Results showed that the HIA-only group had higher academic achievement in Grade 4 as measured by teacher judgments and standardized tests than the HIA + CP and CP-only groups. By Grade 6, the HIA-only and HIA + CP groups showed lower academic competence than the CP-only group suggesting that by sixth grade, children having HIA alone or in combination with conduct problems are at greater risk for academic failure. Additionally, HIA + CP and CP-only groups had poorer social skills than the HIA-only group. Consistent with past research, students in the three risk groups showed no difficulties in either academic or social self-concept. Early screening and identification methods using a multiple-gating model were recommended as a means of proactive approaches to intervention design and prevention. © 2005 Wiley Periodicals, Inc. Psychol Schs 42: 721–736, 2005.

Process, mechanism, and explanation related to externalizing behavior in developmental psychopathology.

Advances in conceptualization and statistical modeling, on the one hand, and enhanced appreciation of transactional pathways, gene-environment correlations and interactions, and moderator and mediator variables, on the other, have heightened awareness of the need to consider factors and processes that explain the development and maintenance of psychopathology. With a focus on attentional problems, impulsivity, and disruptive behavior patterns, I address the kinds of conceptual approaches most likely to lead to advances regarding explanatory models in the field. Findings from my own research program on processes and mechanisms reveal both promise and limitations. Progress will emanate from use of genetically informative designs, blends of variable and person-centered research, explicit testing of developmental processes, systematic approaches to moderation and mediation, exploitation of "natural experiments," and the conduct of prevention and intervention trials designed to accentuate explanation as well as outcome. In all, breakthroughs will occur only with advances in translational research-linking basic and applied science-and with the further development of transactional, systemic approaches to explanation.

Identifying patterns of disruptive behavior in long-term care residents.

To determine the frequency, timing, and pattern of 45 operationalized disruptive behaviors (DB) in older people in long-term care units. Nursing staff collected prospective descriptive data over 21 consecutive shifts for each patient to document prevalence, frequency, and co-occurrences of DBs. All of the eight long-term care units and one acute/admission unit of a large Veterans Administration Medical Center (VAMC). Each 40-bed unit had patients with varying levels of cognitive impairment and skilled nursing needs. The sample consisted of 240 hospitalized VA patients with a mean age of 72.8 (SD = 8.6) years and mean length of stay of 4.02 (SD = 8.6) years. Residents had dementia, a psychiatric diagnosis, or mixed dementia and psychiatric diagnoses. The Disruptive Behavior Scale (DBS), an instrument designed for collecting patient-level data on 45 separate DBs. In a 24-hour period, the average frequency was 3.6 DBs per subject. We found that 41.2% of DB occurred during the day shift, 39.2% during the evening shift, and 19.6% during the night shift. In 32% of observed occurrences, only one DB occurred within the hour. In the remaining 68% of observations, two or more DBs occurred within the same hour. We found two behaviors, Does Not Follow Directions and Excessive Motor Activity, to occur with multiple behaviors in multiple categories. Several characteristic patterns were noted; e.g., physically aggressive behaviors rarely co-occurred with verbal DBs. Physically nonaggressive behaviors seemed to occur most frequently with other physically nonaggressive behaviors and, to a lesser extent, with verbal DBs. These findings lend support to the existence of patterns of DBs in long-term care patients, a useful step toward targeting interventions early in the behavioral sequence.

Assessing cardiovascular status in the older adult with cognitive impairments.

When caring for older adults with cognitive impairments, nurses may find that their usual approaches to cardiovascular assessment are not effective. This article summarizes the geropsychiatric nursing literature about interventions that assist people with chronic cognitive impairments to maintain functional skills and decrease disruptive behavior patterns. A case study illustrates application of theory from behavioral gerontology and research from studies of persons with dementia to develop an approach to cardiovascular assessment that can assist clinicians in obtaining accurate data about cardiovascular status.

Factors associated with continuity and changes in disruptive behavior patterns between childhood and adolescence.

The relationships between disruptive behaviors in middle childhood (7 to 9 years) and conduct disorder in adolescence (14 to 16 years) were studied in a birth cohort of New Zealand children. Latent class analysis suggested strong behavioral continuity, with children showing early disruptive behaviors having odds of adolescent conduct disorder that were over 16 times higher than children who did not display early disruptive behavior. Nonetheless, in the region of 12% of children showed a discontinuous history, with 5% of children showing an early onset of conduct problems and later remission while 7% showed later onset conduct problems. Children showing discontinuous histories of behavior problems came from backgrounds in which levels of risk were intermediate between those of children who showed a persistent pattern of conduct problems and those who were consistently nonproblem children. Peer factors played an influential role in behavioral change in adolescence, with individuals showing late onset of conduct problems having high rates of affiliation with delinquent peers but those showing remission of problem behaviors in adolescence having relatively low rates of such affiliations.

Structure of DSM-III-R Criteria for Disruptive Childhood Behaviors: Confirmatory Factor Models

The aims of this analysis were to examine the extent to which DSM-III-R criteria for disruptive behavior patterns were consistent with the system of diagnoses proposed. Particular attention was paid to (1) whether oppositional defiant disorder is factorially distinct from conduct disorder (CD) and (2) the extent to which CD can be further classified into overt and covert CD behaviors. Data were gathered on DSM-III-R criteria for disruptive behavior patterns for a sample of 739 New Zealand 15-year-olds using data provided by parental and self-report. These data were supplemented by officially recorded police contact data. Application of methods of confirmatory factor analysis suggested that the diagnostic criteria in DSM-III-R reflected a constellation of distinct but highly correlated behavioral domains, with these domains corresponding to oppositional defiant disorder, overt CD (aggression, violence), covert CD (theft, dishonesty), and attention-deficit hyperactivity disorder behavior. Results of second-order factor analysis methods suggested that these dimensions reflected two general higher-order factors, with the first factor reflecting the extent to which the individual displayed behavioral symptoms of oppositional defiant disorder and attention-deficit hyperactivity disorder and the second reflecting the extent to which the individual expressed antisocial, conduct-disordered behaviors. The results of confirmatory factor analysis generally support and validate the diagnostic classifications proposed in DSM-III-R but suggest possible refinements that draw distinctions between overt and covert expressions of CD.

Sundowning and Rate of Decline in Mental Function in Alzheimer's Disease

Nocturnal exacerbation of disruptive behaviors has long been recognized as a common occurrence in Alzheimer's disease (AD), however the basis for such sleep disruption is poorly understood. In this study, caregivers of 60 patients with probable/possible AD were asked to indicate the typical temporal pattern of occurrence of any of seven disruptive behaviors over the 24-hour day. Patterns of disruptive behavior were defined as sundowning (afternoon, evening, or nocturnal exacerbation), morning exacerbation, and as a nontemporally specific pattern of behavioral disruption. About 28 % of the patients were reported to sundown whereas 20% showed a pattern of morning exacerbation. Sundowning was unrelated to total score on the Mini-Mental State Exam (MMSE), however, sundowning was related to a faster rate of decline over time in selected mental functions on the MMSE. Specifically, declines in ideo-kinetic praxis abilities were related to sundowning.