Moderators of Psychosocial Intervention Response for Children and Adolescents with Conduct Problems

ABSTRACT

Objective: The purpose of this Brief Report is to synthesize the current evidence base examining moderators of psychosocial intervention response for children and adolescents with conduct problems (CP). We also provide directions for future research.

Method: We focused on four categories of psychosocial interventions for the prevention and/or treatment of CP: (1) parent management training (PMT) for children, (2) other family-based interventions for adolescents, (3) youth skills training, and (4) multicomponent interventions (i.e., family-based intervention plus skills training). Emphasis is placed on findings from meta-analyses.

Results: Moderation analyses have occurred more frequently for PMT than for other types of interventions. Variables for which there was consistent evidence for positive moderation included higher initial severity of CP, father engagement, higher maternal depressive symptoms, individual administration (vs. group), and treatment/targeted prevention approaches (vs. universal prevention). Variables where there was evidence for no moderation (demonstrating generalizability) included child diagnostic status and family risk in PMT, and diagnostic status and intervention setting for skills training. However, for some variables, evidence of moderation was dependent on intervention type.

Conclusions: Future research should examine multiple moderators in combination; incorporate innovative techniques such as integrative data analyses, individual participant data, and class-based modeling, which may identify moderator effects that are undetected by more traditional variable-oriented moderation analyses; and conduct moderated mediation models for informing developmental theory on the interplay of risk and protective factors.

Disclosure Statement

No potential conflict of interest was reported by the authors.

Notes

¹ Because conventions for defining race, ethnicity (as well as “cultural diversity” and “minority status”) have evolved over the period in which the studies included in the meta-analyses were conducted, there is likely variability in how these terms were defined, not only across individual studies but in the meta-analyses as well. Further complicating the issue is that many of the meta-analyses were conducted with European samples, which included both European White/Caucasian groups and ethnic groups from other parts of the world that are regarded as ethnic minorities in those particular European countries. We have elected to employ the terminology used by the study authors to describe their samples, recognizing that this may not accurately capture this aspect of sample composition using current conceptualizations of these constructs. We have adopted a similar approach to the use of “sex” and “gender.”

² Conversely, some meta-analytic findings suggest that larger effects for MST have been obtained for European American youth (in the U.S.) and U.S. samples (compared to non-U.S. samples) (van der Stouwe et al., 2014). Rather than reflecting moderator effects related to race/ethnicity, these latter findings may be linked to challenges in implementing MST in countries outside of the U.S. (e.g., poor treatment adherence), as well as to lower base rates and severity of offending behavior and to higher quality of usual care services (the typical control treatment to MST) in other countries (McMahon & Frick, 2019). Similarly, a recent meta-analysis suggests that EQUIP’s effects on recidivism were positive only in studies conducted in the U.S., which seemed to be due to low implementation fidelity in European studies, and for Caucasian participants regardless of nationality (van Stam et al., 2014).

³ Intervention integrity is another potential moderator of outcome for CP. A meta-analytic review by Goense et al. (2016) found that intervention integrity moderated the effects of evidence-based (mostly multicomponent) interventions for youth antisocial behavior. However, because nearly half (42.9%) of the effect sizes were based on substance abuse, it is not possible to draw any conclusions specific to CP.

⁴ A recent meta-analytic review found clear evidence of genetic differential susceptibility in intervention studies focused on externalizing behaviors (van IJzendoorn & Bakermans-Kranenburg, 2015). However, because ADHD and substance use disorders were included in their definition of “externalizing,” it is not possible to draw any conclusions specific to CP.

⁵ We acknowledge that the narrative nature of our review may temper the representativeness of our findings and conclusions.

Additional information

Funding

Partial support for this article was provided by a B.C. Children’s Hospital Research Institute Investigator Grant Award and a Canada Foundation for Innovation Award to Robert J. McMahon. Dr. McMahon receives royalties from Guilford Press.