Therapy that involves a child's parents in the treatment of disruptive behavior disorders (DBDs) appears to be the best, most effective approach, new research shows.
Results of a comprehensive review of 64 studies that included 26 treatment types revealed only two methods – group therapy focused on parental behavior, and individual parent behavior therapy with child participation – were "well-established" for evidence-based success.
"Parents seeking help for their children with disruptive behavior problems can play an active role in their child's treatment," lead investigator Jennifer Kaminski, PhD, Centers for Disease Control and Prevention, Atlanta, Georgia, said in a statement.
"These therapies can provide parents the tools to serve as their child's best advocate and guide their child's behavior during their everyday interactions. Given the range of therapies in practice, this update provides information about the most effective approaches to ensure families are receiving evidence-based care," she added.
The findings were published online May 1 in the Journal of Clinical Child and Adolescent Psychology.
Poor Adult Outcomes
DBDs have a range of symptoms that put individuals at odds with peers, family members, and authority figures and can lead to serious negative outcomes in later life, including comorbid mental disorders, incarceration, or even premature death, the investigators note.
For instance, they point out that that among those diagnosed with conduct disorder, 40% have antisocial personality disorders as adults.
In the United States, statistics for the period 2007-2008 indicate that of children aged 3 to 17 years, 4.6%, or approximately 2.8 million, had a parent who reported that their child had a history of a behavioral or conduct problem, such as oppositional defiant disorder or conduct disorder. An estimated 3.5%, or approximately 2.2 million children, were reported to be currently having a behavioral or conduct problem.
In addition, the authors note that these data do not include children with high levels of disruptive behaviors but who have not received a DBD diagnosis.
The investigators point out that children do best with early intervention and that it is important to choose treatments with a strong evidence base to ensure the best possible outcome.
The researchers set out to review the state of the science on psychosocial treatments for disruptive behaviors in children up to age 12 and to update previous reviews on the subject that were published in 1998 and 2008.
The investigators conducted a literature search of peer-reviewed journals from 2007 to 2016 for all relevant studies on treatments for DBDs along with the studies in the previous two reviews.
The researchers applied criteria from the Journal of Clinical Child and Adolescent Psychology to grade the level of evidence to support each treatment, using a four-level scale.
Well-established treatments were superior to placebo or other treatments or were found to be equivalent to an already well-established treatment in at least two independent settings by two independent teams.
Treatments were rated "probably efficacious" when they were shown to be more effective than no treatment in at least two studies or when they were shown to be better than another treatment or equivalent to a well-established treatment in one study or in multiple studies by nonindependent teams of researchers.
The other levels, including possibly efficacious, experimental, or unclassifiable treatments, had mixed or varying degrees of scientific support.
From the pool of 64 eligible studies, the researchers found only two treatments – group parent behavior and individual parent behavior with child participation – for which there was scientifically supported evidence of efficacy based on multiple published randomized trials by independent research teams.
"The results of this review add even more support behind the notion that parental involvement in treating disruptive behavioral issues in children is very important.
"Parents should consider these two therapies when looking for the right treatment for their child. With the help of trained professionals, they can be an active participant in their child's treatment," said Dr Kaminski.
The authors have disclosed no relevant financial relationships.
J Clin Child Adolesc Psychol. Published online May 1, 2018. Full text
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Cite this: Parent-Based Therapy Tops All Others for Disruptive Behavior - Medscape - May 04, 2017.
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