Adapting psychosocial treatment to target parenting stress and parent–child relationships associated with transdiagnostic emotional and behavioural dysregulation in a culturally diverse population

ABSTRACT

Objective: Child and family-focused cognitive-behavioural therapy (CFF-CBT/RAINBOW) is a psychosocial treatment model developed for Paediatric Bipolar Disorder (PBD). In this study, we describe its adaptation to a population of culturally and linguistically diverse youth with transdiagnostic emotional and behavioural dysregulation (EBD), with a particular focus on changes to parent and family interventions.

Method: Adaptations were recorded for this culturally and linguistically diverse sample of youth with EBD. In addition, 14 families were enrolled in a pilot data collection; measures of parenting stress, parent–child interactions, and mood symptoms were collected pre-post treatment in a subsample of six families.

Results: Results suggest that CFF-CBT/RAINBOW is feasible to deliver to youth with transdiagnostic EBD. Adaptations were required with regard to the conceptualization of EBD versus a mood disorder, affect regulation and behaviour management strategies to address comorbid symptoms, and family problem-solving strategies given the broader range of symptoms, impairments, and psychosocial contexts in this unique population. Quantitative data were not conclusive due to the small sample size.

Conclusions: It is important to consider the need to make appropriate adaptations to evidenced-based practices when serving novel, transdiagnostic, culturally- and linguistically- diverse populations of youth.

KEY POINTS

(1) An intervention originally designed for youth with pediatric bipolar disorder (Child and Family-Focused Cognitive-Behavioral Therapy/CFF-CBT/RAINBOW) was adapted for delivery to families of children with transdiagnostic emotional and behavioral dysregulation (EBD). Preliminary study findings demonstrate that CFF-CBT/RAINBOW is feasible to adapt to a population of youth with transdiagnostic EBD; however, adaptations to parent and family interventions may be required to meet the needs of this unique population.

(2) While most of the interventions in CFF-CBT/RAINBOW were relevant and effective for this unique transdiagnostic EBD population, key adaptations were made to (1) content/language/conceptual understanding of transdiagnostic EBD vs a mood disorder diagnosis; (2) affect regulation and behavioral management strategies to address issues of comorbidity and transdiagnostic symptoms; and (3) family-problem solving techniques in the context of broad range of symptoms and impairments.

(3) The adaptation of evidence-based interventions to novel, culturally- and linguistically- diverse populations should be done carefully and with regard to potential conflicts between intervention methods and cultural norms or practices.

KEYWORDS:

• Children
• mental health
• evidence-based intervention
• adaptation
• culture

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by grants UL1TR001855 and UL1TR000130 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.