More Research Needed on Family-Based Treatments for Disruptive Behavior

Ashli Sheidow, PhD

A plethora of new study parameters have emerged in recent years for evidence-based treatments for disruptive behavior.

A team, led by Ashli J. Sheidow, PhD, Oregon Social Learning Center, evaluated family-based treatments based on the results of published studies on children with disruptive behavior, adolescents with disruptive behavior, and adolescents with juvenile justice involvement.

“Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated,” the authors wrote.

The Review

The investigators identified 27 randomized controlled trials between 2014 and April 2020 and combined them with prior evidence. The team also expanded significantly on prior reviews by including the entirety of previous rigorous evidence for both childhood and adolescence and included all treatments with at least 1 rigorous randomized controlled trial.

The result was 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories.

The focus was on serious disruptive behavior, including aggression, rule-breaking, property destruction, and stealing, which can often result in a diagnosis of oppositional defiant disorder (ODD) or conduct disorder (CD).

Numerous identified trials supported the existing treatment categories, with more countries represented. There were also several randomized controlled trials that incorporated technology.

Concerns

However, some issues still persist, including a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodical concerns.

Some of the updates found in the study in recent years included a notable expansion in the different methods of treatment settings, including home-based, providers such as caseworkers, countries, such as China and Portugal, and delivery via the internet.

“Indeed, many of the studies were conducted in community-based settings utilizing real-world providers and involving youth of considerable diversity in terms of biological sex, race, and ethnicity,” the authors wrote. “Finally, while many of the larger U.S.-based RCTs were likely costly and dependent upon large federal grants, that money appears well spent considering the focus on promoting individual and family health.”

The Future

The study could result in a better implementation of evidence-based treatments for disruptive behavior, giving clinicians and patients the best information on the efficacy of the treatment options available to them.

Along with efficacy, a number of treatments were proven to be cost effective, giving decision-makers more information on choosing the best option.

The investigators also suggest future research should focus on family-based therapies, treatment durability, and length of treatment.

According to data from the National Survey of Children’s Health, 7.4% of individuals between 3-17 years had a current behavioral or conduct problem, 47% of which did not receive treatment.

This can lead to a number of long-term adverse outcomes, including school dropouts, comprised mental health in depression, anxiety, substance use and suicidal behaviors, family and relationship problems, and economic issues that can persist for up to 40 years.

The study, “Family- based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies,” was published online in the Journal of Marital and Family Therapy.