Disruptive behavior treatment progress as a function of disruptive behavior and depressed mood practices derived from the evidence base

Wilkie, Daniel
Mueller, Charles W.
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Disruptive behavior problems, the most common reason for referral to youth public mental health care, develop along multiple causal pathways and are associated with a wide variety of co-occurring problems, including irritability, emotional dysregulation, and mood disorders. Much of the evidence-based treatment literature for disruptive behavior problems tends to ignore these complexities, which cannot be easily ignored in actual practice. As such, effective treatment practices for youth disruptive behavior in usual care settings might differ from what the efficacy research suggests. I predicted that practices derived from the evidence base (PDEs) for mood problems and for both mood and disruptive behavior problems would predict disruptive behavior progress for both adolescent and preadolescent youth, while practices for disruptive behavior problems only would predict disruptive behavior progress for preadolescent but not adolescent youth. Clinical data from adolescent (ages 13-17; N = 1210) and preadolescent (ages 8-12; N = 626) youth samples that received intensive in-home (IIH) services from the State of Hawai‘i, Child and Adolescent Mental Health Division (CAMHD) and were treated for disruptive behavior problems were examined. Both youth samples were studied to determine the association between disruptive behavior problem (DBP) treatment progress and PDEs for (a) depressed mood problems only (PDEMOOD), (b) disruptive behavior problems only (PDEDBD.13+ for adolescent PDEs, PDEDBD.12- for preadolescent PDEs), and (c) practices that appear in both depressed mood and disruptive behavior problem evidence-based treatment (PDEBOTH). Using data from PracticeWise, LLC, PDEs in the study were defined as those that appear in at least 20% of active treatment arms in published evidence-based treatment studies that met criteria for Good Support or Better as of August 27, 2018. When entered simultaneously into a multilevel model for the adolescent sample, PDEMOOD¬ and PDEBOTH significantly predicted positive DBP progress, while PDEDBD.13+ did not. When entered simultaneously into a multilevel model for the preadolescent sample, PDEMOOD and PDEDBD.12- significantly predicted DBP progress, while PDEBOTH did not. When examined as individual predictors in their own growth models, all three PDE categories predicted DBP progress, and PDEMOOD had the largest associated positive effect size for DBP progress in both age groups. Further analyses suggest that practices focused on individual youth skills tended to be more associated with DBP progress than practices focused on caregivers, particularly for adolescent youth. These findings suggest that practices supported by the evidence base for depressed mood problems might be effective in the treatment of disruptive behavior problems in community mental health care, potentially by treating underlying irritability or emotional dysregulation and/or by focusing more on youth skills rather than caregiver skills. Potential but unexplored contributing factors might include increased difficulty in effectively implementing more complicated caregiver-focused practices to fidelity and the increased use of caregiver practices in months when disruptive behavior problems are at their worst. Across both samples, lower CAFAS scores and fewer DBP targets predicted higher DBP progress. For the adolescent sample, higher age predicted higher DBP progress, while for the preadolescent sample, lower age and treatment length of 6 months or less predicted higher DBP progress. Future research directions might investigate whether PDEs for depressed mood delivered to high fidelity in a structured treatment program might be effective in DBP treatment, particularly for youth with irritable mood or youth whose caregivers have multiple barriers to treatment.
Clinical psychology, community mental health, depression, disruptive behavior, psychopathology, treatment response
104 pages
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