Introduction prevention and intervention with aggressive and disruptive children: Next steps in behavioral intervention research

doi:10.1016/S0005-7894(03)80027-8

Behavior Therapy

Volume 34, Issue 4, Autumn 2003, Pages 413-419

https://doi.org/10.1016/S0005-7894(03)80027-8 Get rights and content

The current paper introduces the special section on intervention for children and adolescents with aggressive and disruptive behavior disorders. A great deal of knowledge has been accumulated regarding the treatment of aggressive and disruptive behavior disorders over the last several decades (Kazdin, 2000), and much of this research indicates that we are making remarkable progress. Specifically, treatment programs continue to be refined and outcome studies continue to show significant treatment effects. The current special section adds to this literature base by providing data regarding the efficacy of multimodal interventions, the importance of teacher and parent training, and the importance of providing encouragement to parents to keep them highly engaged in the treatment process. Moreover, the studies covered in this special section span a developmental range from early childhood to adolescence and, importantly, provide both proximal and distal outcome data. One paper in this special section examines the cost-effectiveness of implementing a multimodal treatment program for aggressive children. The papers presented in this special section suggest that early intervention is important, effective, and, in the long run, cost-efficient.

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Cited by (16)

“I'm not here to push you:” raising adolescents' treatment engagement via autonomy support
2023, Behaviour Research and Therapy
More than 45% of adolescents with aggressive behavior problems drop out of treatment prematurely. Building on insights from self-determination theory, we examined in three studies whether clinicians can raise adolescents' treatment engagement by supporting their autonomy. In an interview study (Study 1), clinicians (N = 16; 43.8% female; ages 30–57) spontaneously described 12 times more autonomy-supportive than controlling strategies to engage adolescents. In a preregistered experiment (Study 2), clinicians (N = 68; 88.2% female; ages 23–65) were confronted with videos of adolescents displaying resistance. We manipulated the DSM diagnosis of adolescents to indicate either aggressive behavior problems or other problems. We found that, regardless of diagnosis, clinicians used both autonomy-supportive strategies (57.7% of responses) and controlling strategies (39.3%), suggesting that applying autonomy support can be challenging with any adolescent displaying resistance. In an experimental study (Study 3), adolescents (N = 252; 50.0% female; ages 12–17) reported higher therapeutic alliance (d = 0.95, 95% CI [0.80, 1.10]) and treatment engagement (d = 0.77, 95% CI [0.63, 0.91]) after listening to audio-recorded autonomy-supportive versus controlling responses from clinicians, regardless of whether these adolescents had aggressive behavior problems. Overall, this research suggests that clinicians can raise adolescents’ treatment engagement through autonomy support.
A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care
2013, Clinical Psychology Review
Citation Excerpt :
For instance, children with untreated disorders are likely to grow up as adults who rely on mental health services, which has negative consequences for themselves, their surroundings and society (Dulmus & Wodarski, 1996; Kazdin, Mazurick, & Siegel, 1994; Kazdin & Wassell, 1998; Reis & Brown, 1999). Compared to children who do receive treatment, children with untreated behavioral problems (premature terminators or those who do not receive treatment at all) are more likely to leave school without a qualification, engage in delinquent activities, abuse drugs and alcohol and become unemployed (Lochman & Salekin, 2003; Moffitt, Caspi, Harrington, & Milne, 2002). In addition, untreated, early-onset anxiety disorders often continue into adulthood (Dadds et al., 1999) and academic underachievement and substance dependence are likely to follow (Woodward & Fergusson, 2001).
A large proportion (28% up to 75%) of the treatments in youth mental health care results in premature termination (dropout). It is important to gain knowledge of the determinants of dropout because it can have very severe consequences. The aim of our meta-analytic review was to provide an overview of findings from empirical studies on this subject. We structured the often contradicting results from two perspectives. First, we compared studies with efficacy and effectiveness designs. Second, we compared studies which used a dropout definition based on the opinion of therapists, with those that took the number of predetermined completed sessions as a criterion. Third, we studied three groups of predictors, i.e., pre-treatment child variables, pre-treatment family or parent variables, and treatment and therapist variables or treatment participation barriers.
The meta-analytic review showed that dropout percentages were strongly influenced by study design: Percentages were lower in efficacy than in effectiveness studies. Within effectiveness studies, the dropout percentages were lower when the therapist's opinion was used rather than when the number of sessions was used as a criterion. In efficacy studies on the contrary, the dropout percentages were similar for studies using the first or the second criterion. With respect to dropout predictors, results were less clear. Some of the dropout predictors were influenced by study design or dropout definition, but for most predictors this influence could not be analyzed because they were not studied in all groups of studies or because the effect sizes were small or non-significant. Treatment and therapist variables or experienced treatment participation barriers were overall stronger dropout predictors than the pre-treatment child variables and pre-treatment family or parent variables, although some strong predictive pre-treatment variables emerged as well.
Predicting Psychotherapy Benefit: A Probabilistic and Individualized Approach
2012, Behavior Therapy
Citation Excerpt :
We suggest that the lack of consensus on definitions for terms such as “response” and “outcome” has contributed to confusing and contradictory reports. This is especially true of the literature on moderators and predictors of treatment effects, which has been observed to yield mixed and even contradictory conclusions (Lochman & Salekin, 2003). We argue that terms such as “response” and “outcome” should be defined precisely and used consistently across studies, and that both are important to evaluate and predict the outcomes of a given treatment.
We describe the development of the probability of treatment benefit (PTB) chart that incorporates, integrates, and extends more recent approaches to describing treatment effects, such as the Reliable Change Index (Jacobson & Truax, 1991) and normative comparisons (Kendall, Marrs-Garcia, Nath, & Sheldrick, 1999), by including parameters that are simultaneously probabilistic and individualized. To illustrate the PTB chart, data are taken from an effectiveness trial (N = 139) of a modular treatment for disruptive behavior disorders. The results highlight both individual variability and the probabilistic nature of psychotherapy benefit. Finally, we discuss the utility of the PTB chart in terms of research, policy, and practice implications. Probability tables, such as the PTB chart, have the potential to be used as simple clinical tools to supplement traditional effect sizes and help patients make truly informed decisions about treatment participation.
Use of a parent management training intervention with urban foster parents: A pilot study
2011, Children and Youth Services Review
Citation Excerpt :
Furthermore, mental health services for foster children are characterized by administrative barriers (Raghavan, Inkelas, Franke, & Halfon, 2007), low caregiver involvement (Orme & Buehler, 2001; Zima et al., 2000), and reliance on individual child treatment based on attachment theory with no empirical support (Barth et al., 2005). In many service systems, foster parents rarely participate in services, despite foster children's high prevalence of disruptive behavior problems, which require caregiver involvement for effective treatment (Landsverk, Burns, Stambaugh, & Reutz, 2009; Lochman, Salekin, & Haaga, 2003; McNeil, Capage, Bahl, & Blanc, 1999). Despite these challenges, child welfare systems also present unique opportunities for the development and support of effective mental health services.
The development of effective interventions for foster children with behavior problems is essential given the consequences of behavior problems for children's placement stability and permanency outcomes. This article presents findings from a pilot study of an intervention providing parent management training (PMT) and support to foster parents in groups and home visits. The intervention was an adaptation of the KEEP (Keeping Foster Parents Trained and Supported) group intervention, provided in a large urban child welfare agency serving predominantly African American foster parents. The study used an intent-to-treat design, with 25 foster parents of 31 children (ages 4–12) in specialized foster care assigned to either an intervention or treatment as usual control group. Longitudinal outcomes were analyzed using random effect regression models. Over time, children's behavior problems were significantly lower in the intervention group relative to the control group, and the effect of the intervention was partially mediated by parents' understanding of how to appropriately use the intervention parenting skills. These results provide support for the effectiveness of KEEP with urban foster children with significant behavior problems.
Evaluation of two interventions to reduce aggressive and antisocial behavior in first and second graders in a resource-poor setting
2009, International Journal of Educational Research
We conducted a three-arm cluster randomized controlled trial (n = 2491) to evaluate a teacher delivered intervention to reduce aggressive and antisocial behavior and increase prosocial behavior in the classroom. A second aim of this trial was to establish whether combining this intervention with an intervention for parents was better than the teacher-only intervention. This evaluation was conducted in a resource-poor setting (Pereira, Colombia). The findings show that both interventions prevented increases in aggressive and antisocial behavior. However, the teacher-only intervention also had a positive impact on increasing prosocial behavior.
Externalizing conditions
2008, Developmental-Behavioral Pediatrics: Evidence and Practice

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^*: The completion of this article has been supported by grants to the first author from the National Institute for Drug Abuse (DA 08453; DA 16135), the Center for Substance Abuse Prevention (UR6 5907956; KD1 SP08633), the Centers for Disease Control and Prevention (R49/CCR 418569), and the U.S. Department of Justice (2000CKWX0091).

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Special Series: Behaviorally Oriented Interventions For Children With Aggressive Behavior And/Or Conduct ProblemsIntroduction prevention and intervention with aggressive and disruptive children: Next steps in behavioral intervention research*

Behavior Therapy

Behavior Therapy

Behavior Therapy

Behavior Therapy

Behavior Therapy

Behavior Therapy

Behavior Therapy

Effective psychosocial treatment of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids

Journal of Clinical Child Psychology

Special issue: Prevention and intervention science: Contributions to developmental theory

Development and Psychopathology

Predictor variables associated with positive Fast Track outcomes at the end of third grade

Journal of Abnormal Child Psychology

Special Series: Behaviorally Oriented Interventions For Children With Aggressive Behavior And/Or Conduct Problems
Introduction prevention and intervention with aggressive and disruptive children: Next steps in behavioral intervention research*