Tantrum Tool: Development and Open Pilot Study of Online Parent Training for Irritability and Disruptive Behavior

Abstract

Objectives: Parent management training is an effective treatment for disruptive behavior disorders but it is often underutilized in clinical settings. Access to care is limited due to logistical barriers as well as limited service availability. This study examines in an open trial the acceptability, feasibility, and clinical effects of a digital parent management training intervention that includes videoconference coaching, called ''Tantrum Tool.'' Methods: Fifteen children, ages 3-9 years, participated in an open trial of an 8-week intervention. The primary symptom measure was the Disruptive Behavior Rating Scale (DBRS), and the secondary outcome measure was the Affective Reactivity Index (ARI) completed by the primary caregiver before and after treatment. Results: Treatment retention was high (80%), and parents reported a high level of satisfaction with the program. There was a significant reduction in the mean DBRS score from 13.5 -5.5 at baseline to 7.3 -3.4 at endpoint, p < 0.001. There was also a significant reduction in the mean ARI irritability score from 7.2 -2.6 at baseline to 3.75 -2.1 at endpoint, p < 0.01.Conclusions: This open pilot study supports the feasibility and acceptability of a digital parent training program for young children with disruptive behavior. Findings provide preliminary support for a clinically meaningful reduction of both disruptive behavior and irritability. Using the Tantrum Tool to deliver online treatment for children could increase access to first-line treatments for disruptive behavior and irritability in young children. ClinicalTrials.gov: NCT03697837.

Pediatric behavioral telehealth in the age of COVID-19: Brief evidence review and practice considerations

“…Lastly, some parenting programs combine videoconfering with asynchronous approaches. For instance, the Tantrum Tool, 44 designed for children between 3 and 9 years old with ODD, combines 8 asynchrnonous online modules containing didactic information on behavior management with 3 teleconferencing sessions. Similarly, Project PEAK (Promoting Engagement for ADHD in Pre-Kindergartners), designed for children 5–11 at risk for ADHD, included one in-person session with self-paced subsequent sessions.…”

Characterizing the Neural Correlates of Response Inhibition and Error Processing in Children With Symptoms of Irritability and/or Attention-Deficit/Hyperactivity Disorder in the ABCD Study®

“…Given that co-occurring irritability in ADHD increases risks for later anxiety and depression (8,104), treatments that target irritability symptoms may help improve the long-term outcomes of ADHD. Moreover, given that irritability symptoms may exacerbate caregiver stress and mental health risks such as parental depression, adjunct caregiver interventions improving parenting skills and stress management can be especially beneficial (7,75). Differential group differences in the neural coactivation networks provided a more nuanced understanding that the neural mechanisms vary subtly between ADHD, irritability, and their co-occurring conditions, and are more associated with response inhibition than error processing at the systems neuroscience level.…”

“…Indeed, it is estimated that up to 35%+ of youths in the community samples, and up to 70%+ in the clinical samples, have both severe chronic irritability/DMDD and ADHD (4,41). Compared to youth with one condition alone, co-occurring ADHD and irritability are associated with greater symptom severity (9,74), cause greater impairment, and exacerbate caregiver stress and mental health risks (5,7,9,75,76). Comorbidities may be particularly detrimental to young school-age children (e.g., the 9-10-year-olds in this sample), as interacting and forming relationships with peers and those outside the home environment are an important developmental task in this developmental stage.…”

COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions

“…Finally, early results suggest iPCIT is associated with comparable treatment acceptability and satisfaction relative to in-clinic/person BPT (e.g., Comer et al, 2017 ), and it may even yield improved treatment engagement among traditionally underserved populations ( Sanchez et al, 2021 ). In addition to iPCIT, synchronous group-based parent programs such as Triple P ( Reese et al, 2012 , Reese et al, 2015 ), Defiant Child ( Xie et al, 2013 ), and Bootcamp for ADHD ( Fogler et al, 2020 ), as well as asynchronous models (e.g., Tantrum Tool; Diaz-Stransky et al, 2020 ), are accumulating evidence favoring their effectiveness in reducing child behavior challenges (for a review of existing telehealth behavioral interventions, see Monzon et al, 2021 , Ros-DeMarize et al, 2021 ). Accordingly, iPCIT and other virtual iterations are the linchpins in many pandemic-era child mental health practitioners’ array of evidence-based treatments, and we hope remote tele-BPT will remain a central offering going forward.…”