Treatment Of Disruptive Behavior Research Articles

Facial Affect Sensitivity Training for Young Children with Emerging CU Traits: An Experimental Therapeutics Approach

ABSTRACT Objective This article delineates best practices in the application of the experimental therapeutics framework for evaluating interventions within the context of randomized controlled trials (RCTs), offering a methodological primer and guiding framework for this approach. We illustrate these practices using an ongoing clinical trial conducted within the framework of a National Institute of Mental Health exploratory phased-innovation award for the development of psychosocial therapeutic interventions for mental disorders (R61/R33), describing the implementation of a novel “Facial Affect Sensitivity Training” (FAST) intervention for children with callous-unemotional (CU) traits. CU traits (e.g., lack of guilt or remorse, low empathy, shallow affect) are an established risk factor for persistent and severe youth misconduct, which reflect impairment in identified neurocognitive mechanisms that interfere with child socialization, and predict poor treatment outcomes, even with well-established treatments for disruptive behavior. Method We outline the stages, goals, and best practices for an experimental therapeutics framework. In the FAST trial, we assert that impaired sensitivity for emotional distress cues (fear and/or sadness) is mechanistically linked to CU traits in children, and that by targeting sensitivity to facial affect directly via a computerized automated feedback and incentive system, we can exert downstream effects on CU traits. Results In the context of an open pilot trial, we found preliminary support for feasibility and mechanism engagement using FAST. Conclusions We summarize pilot study limitations and how they are being addressed in the R61/R33 RCTs, as well as challenges and future directions for psychosocial experimental therapeutics.

Barriers to Increasing Access to Brief Pediatric Mental Health Treatment From Primary Care

A quality improvement process targeted mental health care uptake and system capacity in an underserved region. The pediatric program created pathways for rapid referral from primary care and schools to four sessions of evidence-based treatments for disruptive behavior and depression with community clinicians. Of 250 referrals, 46 families enrolled in treatments for disruptive behavior and 21 for depression. Many families did not respond or required more intensive treatment. Acceptability of the program was high for participating families, referrers, and clinicians. Brief treatment met most participating families' needs. The process demonstrated barriers to mental health care access and delivery and the need for integrated and multitiered care delivery.

A randomized controlled trial comparing parent child interaction therapy - toddler, circle of security\u2013 parenting\u2122 and waitlist controls in the treatment of disruptive behaviors for children aged 14\u201324\u2009months: study protocol

BackgroundIt is common for toddlers to display disruptive behaviors (e.g., tantrums, aggression, irritability) but when these become severe and persistent they can be the start of a trajectory towards poor outcomes in childhood and adolescence. Parent Child Interaction Therapy - Toddler is an intervention model designed to meet the specific developmental needs of toddlers aged 12–24 months presenting with disruptive behaviors.MethodsThis study will use a randomized controlled design to evaluate the efficacy of the Parent Child Interaction Therapy - Toddler intervention for children aged 14–24 months with disruptive behaviors. Ninety toddlers with parent-reported disruptive behavior will be randomly allocated to either Parent Child Interaction Therapy - Toddler, Circle of Security– Parenting™ or a waitlist control group. Key parenting capacity outcome variables will include positive and negative parenting, parenting sensitivity, parental sense of competence in managing negative toddler emotions, parent sense of caregiving helplessness, parent mentalizing about the child, parent emotion regulation, child abuse potential and parental stress. Key outcome variables for children will include child social-emotional functioning (initiative, relationship functioning, self-regulation), child emotion regulation, child attachment security, and child behavior.DiscussionDelivered in the early intervention period of toddlerhood, Parent Child Interaction Therapy - Toddler has the potential to bring about significant and lasting changes for children presenting with early onset behavioral issues.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), 12618001554257. Registered 24 September 2018 – retrospectively registered.

Prevalence and factors associated with disruptive behavior among Iranian students during 2015: a cross-sectional study

BackgroundDisruptive behavior can have lifetime consequences for youth. Prevention, early identification and treatment of disruptive behavior can improve outcomes for these youth. The purpose of the present study was to assess the prevalence of disruptive behavior among a sample of Iranian youth, and the relationship of disruptive behavior to other psychological phenomena that may be targeted for prevention, early identification and treatment.MethodThe sample consisted of 600 high school students (300 boys and 300 girls; ages 15 to 18 years old) selected through multi-stage random sampling in Saveh city, of Iran, in 2015. Questionnaires assessed several phenomena including demographics, life satisfaction, social support, depression, stress, smoking and hopefulness. The Disruptive Behavior Scale was also utilized. Univariate analyses were followed by multiple logistic regressions to examine relations among disruptive behavior and other constructs.ResultsPrevalence of disruptive behavior was 7.5%, in boys and 3.1%, in girls. Mean scores were 22.97 ± 1.17 for boys and 19.15 ± 1.06 for girls, with a significant difference between them (P < 0.05). The results of regression revealed low life satisfaction (OR = 3.75; 95% CI: (2.37–5.91), social support (OR = 0.72; 95% CI: (0.56–0.82) and hopefulness (OR = 0.85; 95% CI: (0.62–0.92); and smoking (OR = 3.65; 95% CI: (2.19–6.06), being male (OR = 2.55; 95% CI: (1.54–4.22), and higher stress (OR = 1.92; 95% CI: (1.60–2.91) and depression (OR = 2.76; 95% CI: (1.82–4.88) were significant factors in predicting disruptive behavior.ConclusionDisruptive behavior was associted with life satisfaction, smoking, being a boy, social support, hopefulness, stress, and depression. Targeting constructs (e.g., support, stress) associated with disruptive behavior may assist in prevention, early identification and treatment of problem behavior. For example, health promotion programs to increase hopefulness, satisfaction and support, and reduce stress, depression and smoking might be of importance for prevention and treatment of disruptive behavior.

A Systematic Review and Evaluation of Clinical Practice Guidelines for Children and Youth with Disruptive Behavior: Rigor of Development and Recommendations for Use.

Clinical practice guidelines (CPG) provide a framework for evidence-based practice; however, few studies have assessed the methodological quality of CPGs relevant to child and youth mental health. This study was a systematic review of CPGs for the assessment, prevention and treatment of disruptive behavior, including attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), conduct disorder (CD) and aggression in children and youth. Systematic review identified 29 CPGs meeting inclusion criteria that were appraised using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) validated tool. Twenty-two guidelines addressed ADHD, 2 CD, 1 ODD, 2 for Behavior Disorders collectively and 2 for Aggression. Among the 29 guidelines, two that were developed for ADHD (NICE 2013a; Spanish Ministry of Health, 2010) and one practice guideline developed for CD (NICE 2013b) met high quality criteria; one guideline for behavior disorders (Gorman et al. 2015), two for ADHD (AAP 2011a, b; SIGN 2009a, b, c, d, e), and two for aggression (Knapp et al. 2012; Scotto Rosato et al. 2012a, b) met minimum quality criteria. Findings from this review provide important information for clinicians and organizations who want to utilize guidelines to implement best-practice clinical services for children and youth with disruptive behavior.

Meta-Analyses: Key Parenting Program Components for Disruptive Child Behavior

Parenting programs are the recommended strategy for the prevention and treatment of disruptive child behavior. Similar to most psychosocial interventions, it is unknown which components of parenting programs (ie, parenting techniques taught) actually contribute to program effects. Identifying what parents need to be taught to reduce disruptive child behavior can optimize intervention strategies, and refine theories on how parenting shapes disruptive child behavior. In two meta-analyses, we updated the evidence-base for effectiveness of parenting programs delivered at various levels of prevention and treatment of disruptive behavior. We searched six databases (eg, PsycINFO, MEDLINE) for randomized trials and coded the parenting techniques taught in each program. We identified the techniques associated with program effects in general, and for prevention versus treatment, and immediate versus longer-term effects, specifically. Parenting program effects on disruptive behavior gradually increased per level of prevention (universal d=-0.21, selective d=-0.27, indicated d=-0.55) and treatment (d=-0.69) (Meta-Analysis 1: 154 trials, 398 effect sizes). Three of 26 parenting techniques were associated with stronger program effects: positive reinforcement, praise in particular, and natural/logical consequences. Several additional techniques (eg, relationship building and parental self-management) were associated with stronger effects in treatment but weaker effects in prevention. No techniques were associated with stronger longer-term effects (Meta-Analysis 2: 42 trials, 157 effect sizes). Positive reinforcement and nonviolent discipline techniques (eg, applying natural/logical consequences) seem to be key parenting program techniques to reduce disruptive child behavior. Additional techniques (eg, parental self-management skills) might improve program effects in treatment, but not in prevention.

6.1 Primary Care Partnership From Afar: Bringing Evidence-Based Child Behavioral Treatments for Disruptive Behavior and Depression to Remote Communities

6.1 Primary Care Partnership From Afar: Bringing Evidence-Based Child Behavioral Treatments for Disruptive Behavior and Depression to Remote Communities

60.4 Impact of Child Maltreatment on Clinical Presentation and Treatment of Disruptive Behavior

The goals of this session are to examine the ways that maltreatment frames and feeds aggressive and disruptive conditions and to understand the implications for treatment.

Individualized Assessments in Treatment Research: An Examination of Parent-Nominated Target Problems in the Treatment of Disruptive Behaviors in Youth with Tourette Syndrome

Youth with Tourette syndrome (TS) often exhibit disruptive behaviors. Although improvement data on rating scales support the efficacy of structured psychotherapeutic interventions, there is growing interest in personalized outcome assessments. This report examined parent-nominated target problems (PTPs) as an individualized outcome measure in 48 youth with TS and disruptive behaviors, who participated in one of two randomized psychotherapy trials. At baseline, parents described two primary problems to an independent evaluator who generated a structured narrative for each problem. These narratives were reviewed and updated at endpoint. When rated by five treatment-blind judges, the PTP rating demonstrated excellent reliability and good convergent validity with the Disruptive Behavior Rating Scale (DBRS). The PTP rating exhibited comparable treatment effects to the DBRS, and accounted for additional variance in global treatment outcome. The PTP rating serves a reliable, valid, and sensitive personalized assessment in research trials that provides complementary information to standardized rating scales.

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).

A Methodology for Evaluating the Relationship Between Staff Attention and Disruptive Behavior Displayed by Nursing Home Residents with Dementia

We conducted descriptive analyses of disruptive behavior exhibited by four elderly adults residing in a nursing home. Reciprocal interactions between the nursing home staff and participants were examined using a recently refined methodology for evaluating descriptive data (Vollmer, Borrero, Wright, Van Camp, & Lalli, 2001) that builds upon previous work on descriptive analysis (e.g., Bakeman & Gottman, 1997). Data analysis revealed that the staff provided low levels of attention to the residents overall. Three participants' disruptive behavior neither increased nor decreased the amount of attention that they received from the staff. For the other participant, staff were somewhat more likely to remove their attention when the resident was engaged in disruptive behavior than when the resident was not disruptive. Results suggest that this methodology may be useful for investigating staff-resident interactions and for furthering our understanding about important relations between staff behavior and disruptive behavior. Implications of the findings for the treatment of disruptive behavior and directions for future research are discussed.

Classes of disruptive behaviour in a sample of young elementary school children.

The objectives were to (1) classify young children to groups differing in disruptive behaviour, (2) determine whether the patterns of disruptive behaviour in these groups are in accordance with the conceptualisation of disruptive disorders as described in DSM-IV, and (3) optimise the classification of children in groups. Disruptive behaviour of 636 seven-year-old elementary schoolchildren was assessed with the CBCL/4-18. Using CBCL items rated as very consistent with DSM-IV categories Conduct Disorder, Oppositional Defiant Disorder and Attention-Deficit/Hyperactivity Disorder, latent class analyses were applied to identify classes of children differing in patterns of disruptive behaviour. Three classes were identified: (1) high levels of oppositional defiant problems (ODD problems) and attention-deficit/hyperactivity problems (ADH problems) and intermediate levels of Conduct problems; (2) intermediate ODD problems and ADH problems and low levels of Conduct problems; (3) low levels on all disruptive behaviours. No classes were identified in which children had symptoms of only Conduct problems, only ODD problems or only ADH problems. Covariates (socio-economic status, gender, parenting stress) improved the classification of children. The findings are discussed in terms of implications for classification, identification of children at risk, prevention and treatment of disruptive behaviour in young children.

Self-modeling as an intervention to reduce disruptive classroom behavior

This study employed a multiple baseline design across individuals with a follow-up to examine self-modeling as a treatment for disruptive behavior in 4 school-aged males with social and emotional disorders. Self-modeling is defined as the positive change in behavior that results from viewing oneself on edited videotapes that depict only exemplary behavior. The students viewed two 5-minute edited videotapes of themselves behaving appropriately in the classroom on 6 occasions over a 2-week period. After viewing the intervention videotapes, all students evidenced a substantial reduction in disruptive behavior. To differing degrees, the students maintained their treatment gains at follow-up.

Antecedent exercise as a treatment for disruptive behavior: Testing hypothesized mechanisms of action

AbstractThis study evaluated the effects of antecedent physical exercise (AE) and a mastery task on behaviorally disturbed children's self‐concepts and rates of disruptive behaviors. In addition, we evaluated whether changes in self‐concept mediated any exercise induced changes in rates of disruptive behavior. Fifty‐eight children were randomly assigned to one of three conditions: (a) antecedent exercise (jog/walk), (b) “mastery” task (a successive improvement miniaturebasketball shooting task), and (c) no treatment control group. A week of baseline was followed by 4 weeks of treatment and, finally another week of return to baseline. Results indicated that: (a) AE produced significantly less disruptive behavior than no treatment, (b) the “Mastery” task did not produce significantly less disruptive behavior than no treatment, (c) neither treatment produced increases in self‐concept relative to no treatment, and (d) changes in self‐concept did not mediate AE induced reductions in disruptive behaviors.

Antecedent exercise in the treatment of disruptive behavior: A meta-analytic review.

A review and meta-analysis of 42 group and single-case studies evaluating antecedent exercise (AE) as a means of reducing disruptive behaviors was conducted. Of 16 group studies, 12 produced positive results and 4 produced negative results. The weighted mean effect size, expressed as Cohen's d, was .33 with a standard error of .08. Moderator analysis indicated that studies using direct behavioral observation, hyperactive subjects, or nonaerobic exercise obtained greater effects, and that studies of higher quality obtained weaker effects. Of 26 single-case studies, 22 produced positive results, 1 produced no effect, and 3 produced negative results. The weighted mean effect size, expressed as d, was 1.99 with a standard error of .411. Among the single-subject studies, moderator analyses were unable to detect statistically significant moderators of effect size. Information was reviewed suggesting that AE is socially acceptable, can be implemented with treatment integrity, and has a benign side effect profile. The extent to which AE is functionally based remains open to question due to a lack of understanding regarding mechanism of action. Ten hypothesized mechanisms of action are briefly discussed.

Factors Influencing Nurses' Acceptability of Treatments for Problem Behaviors of Nursing Home Residents

The effect of treatment options, side effect profile, and time to implement treatment on ratings of the acceptability of treatments was evaluated Differential reinforcement (DRO) received the highest acceptability rating for treatment of aggressive behavior. Time-out and medication were equally acceptable as treatments for disruptive behavior. Side effect profile decreased ratings of all treatments except DRO. Time involvement and side effect profile resulted in equivalent ratings for disruptive behavior. The use of the least restrictive intervention for disruptive behavior may be especially difficult due to the low ratings of DRO. These results suggest that the time required to use applied behavior analysis interventions in nursing homes is not an impediment to use of such procedures.

Resident Behavior and Staff Distress in the Nursing Home

Newly enacted Federal regulations have focused increasing attention on the use of psychoactive drugs and on the treatment of disruptive behavior in the nursing home. To study the interaction between resident behavior and staff distress in nursing homes, we measured the frequency of seven types of behavior problems among 346 residents of intermediate care facilities who were receiving some form of psychoactive medication. Nurses were interviewed on two shifts to determine their perception of the frequency and severity of each behavior in each patient as well as the level of distress it caused among caregivers. The most common behavior problems noted were agitation (42%), withdrawal (33%), and noisiness (27%). Only half of the reported instances of behavior disorders were considered distressful by nursing home staff. While physical abuse caused distress 92% of the time and verbal abuse 90% of the time, wandering was seen as distressful to staff only 50% of the time. Nearly a third of "wandering" patients were restrained; they produced less distress than non-restrained wanderers. There was substantial disagreement, ranging from 6% to 22% for individual residents, over the presence of distress-causing behavior, although day and evening nursing shifts rated the frequencies of behavior and the degrees of distress equally on average. Residents with higher cognitive function were less likely to cause distress for all behaviors, except for verbal abuse where the reverse was true. Age and dependency in activities of daily living were not associated with problematic behavior or staff distress. These findings indicate that the existence of "problematic" behaviors in a given resident is often perceived differently by different staff, and its impact on staff also differs widely.

Assessment of disruptive behavior associated with dementia: the Disruptive Behavior Rating Scales.

Disruptive behavior associated with dementia is a major clinical problem, but there has been limited methodology for assessing it. This study describes the development of a set of rating scales used to measure four dimensions of disruptive behavior that present frequent problems in patients with dementia: physical aggression, verbal aggression, agitation, and wandering. In addition, a total disruptive behavior scale is derived by averaging scores from these four scales. A sample of 16 patients in a skilled nursing facility was used to test interrater reliability and validity of this instrument. Interrater reliability was quite favorable for all scales. There was clear evidence for convergent validity of all scales except the verbal aggression scale, where a substantial correlation was found with one relevant external measure but not the other. There was also favorable evidence of discriminant validity for all scales except the verbal aggression scale. Psychometric properties of this instrument appear to be promising and indicate that it has potential utility for further research on causes and treatments for disruptive behavior in demented patients.

Use of contingent-interrupted music in the treatment of disruptive behavior while riding a bus.

Control of disruptive crying and head-banging by a severely retarded child during a bus ride was obtained in 28 days using contingent-interrupted music.