Examination of Disruptive Behavior Outcomes and Moderation in a Randomized Psychotherapy Trial for Mood Disorders

Abstract

Objective Multi-family psychoeducational psychotherapy (MF-PEP) is an efficacious treatment for children with mood disorders. Given comorbidity between disruptive behaviors and mood disorders, this study examined associations among disruptive behaviors and impairment, impact of MF-PEP on disruptive behaviors, and whether disruptive behaviors affected treatment response of mood symptoms. Method Secondary analyses examined the randomized controlled trial of MF-PEP versus waitlist control (N = 165 children ages 8–11 with mood disorders and their parents). Comorbid behavioral diagnoses occurred in 97% of children. All participants continued treatment as usual. Results Greater degree of disruptive behaviors was associated with worse mood symptoms and impairment. Between-group analyses examining outcome of disruptive behaviors were non-significant. Within-group analyses and between-group effect sizes suggest MF-PEP was associated with reductions in attention-deficit/hyperactivity disorder (d = 0.39), oppositional defiant disorder (d = 0.30), and overall disruptive behavior symptoms (d = 0.30), but not conduct disorder symptoms. Baseline severity of disruptive behaviors did not impact treatment response of mood symptoms to MF-PEP. Conclusions MF-PEP is an effective intervention for children with mood disorders and provides some benefit for disruptive behaviors. Given that disruptive behavior severity does not impact children’s ability to experience improved mood symptoms, MF-PEP may be an important early intervention for children with comorbid mood and disruptive behavior disorders. Subsequent intervention targeting behavioral symptoms after improvement in mood may be beneficial. Studies examining treatment sequencing for children with comorbid mood and disruptive behavior disorders are needed. Clinical trial registration information—Family psychoeducation for children with mood disorders; http://www.clinicaltrials.gov; NCT00050557.

Treatment Moderators of Child- and Family-Focused Cognitive-Behavioral Therapy for Pediatric Bipolar Disorder

“…15, 16, 45 However, our younger sample may allow for intervention at an earlier point in the continuum of suicidality severity, thus resulting in more favorable treatment outcomes. Findings for comorbid anxiety, as well as the inability to examine moderation of comorbid DBD due to limited variability, parallel recent PBD research 46, 47 . The lack of effects for age and sex are consistent with past treatment studies with children, 8, 18 suggesting that age and sex within younger populations do not affect treatment outcomes, although limited variability in age range may influence findings.…”

Family-Based Interventions for Childhood Mood Disorders

“…41 In a pilot RCT, MF-PEP demonstrated greater improvements in family interactions and knowledge of mood disorders compared with WLC. [41][42][43] In addition, comorbid behavior and anxiety disorders did not impede improvement in mood, 44,45 and behavioral symptoms improved with treatment. 44 These findings suggests that MF-PEP is efficacious in treating mood disorders and improving service engagement.…”

“…[41][42][43] In addition, comorbid behavior and anxiety disorders did not impede improvement in mood, 44,45 and behavioral symptoms improved with treatment. 44 These findings suggests that MF-PEP is efficacious in treating mood disorders and improving service engagement. An individual-family version of MF-PEP, called Individual-Family Psychoeducational Psychotherapy (IF-PEP), 38 has demonstrated a medium effect size in ameliorating mood symptom severity for children with BPSD.…”

Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months

“…Camp NERF program (Enhanced Care, Standard Care, or Active Control) will occur 2 days per week for approximately 4 hours each day. This is expected to equate to 64 h of direct exposure per child, a sufficient dose for eliciting behavior change in the targeted outcomes [33–42]. Table 1 provides an overview of a sample day at an Enhance Care site.…”