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Disruptive Behavior Treatment Progress as a Function of Youth Diagnosis

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Title: Disruptive Behavior Treatment Progress as a Function of Youth Diagnosis
Authors: Wilkie, Daniel
Keywords: Disruptive behavior
ADHD
depression
treatment response
psychopathology
Issue Date: Dec 2016
Publisher: [Honolulu] : [University of Hawaii at Manoa], [December 2016]
Abstract: Disruptive behavior problems, the most common reason youth are referred for public mental health treatment, develop along multiple causal pathways often reflected in patterns of psychiatric diagnoses. Disruptive behavior treatment and youth response to such treatment might vary as a function of etiology/diagnostic differences. I predicted that youth with attention- deficit/hyperactivity disorder would respond worse and youth with depressive mood disorders would respond better than youth without either disorder on therapist-reported disruptive behavior treatment targets.
Clinical data from youth (N = 613) that received intensive in-home (IIH) services from the State of Hawai‘i, Child and Adolescent Mental Health Division (CAMHD) with a diagnosis (primary or comorbid) of (a) attention-deficit/hyperactivity disorder (ADHD), combined or primarily hyperactive/impulsive subtypes, but no mood disorder (n = 193); (b) depressive mood disorder; but no ADHD (n = 164); or (c) disruptive behavior disorder, but without any ADHD or depressive mood diagnosis (n = 256), were compared on clinician reported therapeutic progress on disruptive behavior treatment targets. A three-level multilevel model approach (level-1: progress over time, level-2: client factors, and level-3: therapist factors) was utilized to examine rate of change and final progress rating after at most six months of treatment by diagnostic category. These analyses also examined and controlled for the effects of additional client, therapist, and treatment characteristics.
The relationship between diagnostic group and disruptive behavior problem (DBP) progress ratings was not significant. However, and contrary to predictions, youth in the ADHD group trended towards higher progress ratings and youth in the depressive mood group trended towards lower progress ratings (p < .08). These findings suggest that usual care might be more successful in disruptive behavior treatment for youth exhibiting more prototypical disruptive behavior problems (e.g., with ADHD). Potential but unexplored contributing factors might include an unstructured approach to treatment in usual care, the possible greater utilization of practices supported by the evidence base for both ADHD and DBD, and greater therapist proficiency with or focus on behavioral relative to cognitive interventions. There was a positive, significant relationship between DBP progress ratings and higher age, lower total CAFAS impairment ratings, fewer DBPs endorsed in a given month, absence of a substance use disorder, and treatment length of at least 180 days. Future research directions might investigate whether specific therapeutic practices or more structured treatment programs, such as Multisystemic Therapy, impact DBP treatment response differentially across diagnostic profiles or other indicators of developmental psychopathology.
Description: M.A. University of Hawaii at Manoa 2016.
Includes bibliographical references.
URI/DOI: http://hdl.handle.net/10125/51545
Appears in Collections:M.A. - Psychology


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