Evidence-Based Psychosocial Treatments for Children and Adolescents With Disruptive Behavior

Abstract

This article reviews the literature from 1996 to 2007 to update the 1998 Brestan and Eyberg report on evidence-based psychosocial treatments (EBTs) for child and adolescent disruptive behavior, including oppositional defiant disorder and conduct disorder. Studies were evaluated using criteria for EBTs developed by the task force on promotion and dissemination of psychological procedures (Chambless et al., 1998; Chambless et al., 1996). Sixteen EBTs were identified in this review, up from 12 in the earlier report, and 9 “possibly efficacious” treatments (Chambless & Hollon, 1998) were identified as well. This article describes the EBTs and their evidence base and covers research on moderators and mediators of treatment outcome, as well as the clinical representativeness and generalizability of the studies. Best practice recommendations from the current evidence base also are offered, as well as calls for future research that increases understanding of the moderators and mechanisms of change for children and adolescents with disruptive behavior disorders.

Melanie McDiarmid Nelson is now at the University of Oklahoma Health Sciences Center, Department of Pediatrics, Section on Developmental and Behavioral Pediatrics. We are grateful to the reviewers of this manuscript during the editorial process for their very detailed and extensive review and suggestions.

Notes

Note: Treatment studies that included comparisons of one treatment to a component of itself were not included in this table. AA = African American; C = Caucasian; H = Hispanic; Nat A = Native American; O = Direct observation; P = Parent or caregiver report; PE = Peer report; R = Official records; S = Self report; T = Teacher report.

^a This column indicates the number of disruptive behavior measures in the study that showed a statistically significant (p < .05) between-group difference favoring the target treatment. For example, an entry of 2/3 would indicate that the study included 3 measures of disruptive behavior and that the EBT showed significantly better outcomes on 2 of these measures than the control condition.

^b This column refers to the effect sizes of between-group differences favoring the EBT obtained on the measures of disruptive behavior examined in the study. Effect sizes were those reported by the investigator in the published study or were calculated from data presented in the study by subtracting the post-treatment mean of the EBT condition from the post-treatment mean of the control/comparison condition and dividing that number by the pooled standard deviation of the post-treatment scores; an entry of 3/4 in this column would indicate that there were 4 measures of disruptive behavior in the study and that the effect sizes for differences was 0.20 or greater in favor of the EBT on 3 of the measures.

Note: WE=well-established treatment; PE=probably efficacious treatment.

¹Because of an error in recording the direction of group differences for the Spaccarelli, Cotler, and Penman (1992) study, IY Parent Training was incorrectly classified as a supporting study by an independent investigatory team.

²Treatments meeting criteria for probably efficacious treatments in the first but not second review were Group Anger Control Training (Feindler, Marriott, & Iwata, 1984), Delinquency Prevention Program (Vitaro & Tremblay, 1994), and Self-Administered Treatment Plus Signal Seat (Hamilton & MacQuiddy, 1984). One study of Group Anger Control Training (Schlichter & Horan, 1981) showed statistically significant group differences on only 2 of 5 measures of disruptive behavior. The Delinquency Prevention Program studies did not select participants for clinically significant problem behaviors before study inclusion. Self-Administered Treatment Plus Signal Seat was compared only to waitlist control and an earlier version of itself.

³A revision of the Forehand and McMahon (1981) treatment manual for HNC was published by McMahon and Forehand in 2003.

Note: IY = Incredible Years.