Evidence Base Update of Psychosocial Treatments for Adolescents with Disruptive Behavior

ABSTRACT

Objective

This article expands the review of psychosocial treatments for adolescents with disruptive behavior (DB), published previously by this journal. That earlier review focused on DB treatment studies published 1966–2014; the current paper updates the evidence base by incorporating DB treatment studies published 2014–2021.

Method

A literature search and screening process identified 63 new studies for inclusion in this updated review. The 63 new studies were combined with 86 studies from the prior review and evaluated using Journal of Clinical Child and Adolescent Psychology level of support criteria, which classify studies as well established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy based on the evidence.

Results

In total, 3 well-established, 7 probably efficacious, and 10 possibly efficacious treatments for adolescents with DB were identified. Further, 52 treatments were classified as experimental and 22 treatments were determined to have questionable efficacy.

Conclusions

There continues to be a large body of literature building the evidence base for treatments of adolescent DB. With a few exceptions, treatments falling into the top three evidence levels utilized more than one theoretical approach, enhancing each treatment’s ability to target DB from multiple angles. Key advances include broad representation of various demographic groups, countries of origin, treatment settings, and provider types in this body of research. Despite these advances, more research is needed to address key gaps in the field, including the need for more studies on treatments tailored to adolescents with DB who are not yet involved with the juvenile justice system.

This article updates the evidence base on psychosocial treatments for adolescents with disruptive behavior (DB) since completion of an earlier review for this journal by McCart and Sheidow (2016). DB during adolescence represents a serious public health problem, and the identification of effective treatments for DB remains a top priority (Steiner et al., 2017; Weisz et al., 2019). As defined here, DB includes various behaviors (e.g., physical aggression, truancy, stealing, vandalism, defiance toward authority figures) subsumed within the diagnostic categories of oppositional defiant disorder and conduct disorder, as specified in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; American Psychiatric Association, 2013). At the more severe end of the spectrum, these behaviors can trigger involvement with juvenile justice (JJ) authorities, and JJ-involved youth tend to be a DB subpopulation with more entrenched clinical problems relative to disruptive youth without JJ involvement. When left untreated, DB can lead to multiple negative long-term outcomes, including low educational attainment (Cleary & Nixon, 2012), substance abuse (Bevilacqua et al., 2018), physical health problems (Pang et al., 2010; von Stumm et al., 2011), relationship problems (Gornik et al., 2022), financial difficulties (Colman et al., 2009), motor vehicle accidents (Wickens et al., 2015, 2019), and premature death (Border et al., 2018; Maughan et al., 2014). Fortunately, the latest research offers evidence of effective treatments that can hinder this negative cascade.

In the earlier review, McCart and Sheidow (2016) summarized treatment studies for adolescent DB published over a 48-year period (i.e., 1966–2014). This article now updates the evidence by reviewing studies of DB treatments published between 2014 and 2021. As before, this review specifies the population for which a given treatment has evidence; these populations include JJ-involved youth, youth with DB who are not JJ involved, and youth whose behavior is limited to school or classroom disruption. By doing so, this paper aims to ensure that readers understand the limits of the research for a treatment (i.e., ensure that misunderstandings of the research findings are not generalized in a manner that leads to “off-label” use of the treatment for a notably different population). This differentiation is important so that less intensive treatments that have only been shown to work on less severe behaviors do not get directed to severe cases such as JJ-involved youth (unless the empirical literature supports this) and, likewise, that the most intensive treatments developed specifically for severe DB are not consuming unnecessary resources by being used for low severity behaviors.

Summary of Previous Review

The prior review by McCart and Sheidow (2016) summarized findings from 86 empirical papers covering 50 unique DB treatment protocols. Treatments were classified according to criteria specified by the Journal of Clinical Child and Adolescent Psychology (Southam-Gerow & Prinstein, 2014; see Table 1). For JJ-involved youth, two treatments (Multisystemic Therapy and Treatment Foster Care Oregon) were identified as well-established, three treatments (Equipping Youth to Help One Another, Solution-Focused Group Program, and Functional Family Therapy) were probably efficacious, and one treatment (Cognitive Mediation) was possibly efficacious. For youth with DB who are not JJ-involved, one treatment (Multisystemic Therapy) was probably efficacious and four treatments (Familias Unidas, NonViolent Resistance, Rational-Emotive Behavior Therapy, and Support to Reunite, Involve, and Value Each Other) were possibly efficacious. Several treatments were experimental and required more research to determine efficacy, and a number of treatments were of questionable efficacy. Notably, the most rigorous studies were of treatments based in behavioral, cognitive-behavioral, and/or family systems theories. Further, the treatments with the most extensive empirical support (i.e., Multisystemic Therapy and Treatment Foster Care Oregon) were multi-approach in nature, drawing tools and techniques from all of the behavioral, cognitive-behavioral, and family systems orientations. The success of such approaches aligns with evidence supporting the multidetermined conceptualization of DB in youth (Liberman, 2008; Loeber et al., 2009). Indeed, Multisystemic Therapy (MST) and Treatment Foster Care Oregon (TFCO) both aim to reduce adolescent DB by targeting risk factors at the levels of the individual (e.g., cognitive- and emotion-regulation deficits), family (e.g., maladaptive parenting), peer (e.g., delinquent and/or substance using friends), and school (e.g., low academic achievement). Further, mediation studies indicate that MST and TFCO achieve their treatments effects, at least in part, by eliciting change in one or more of those risk domains (e.g., Eddy & Chamberlain, 2000; Huey et al., 2000; Van Ryzin & Leve, 2012).

Table 1. Journal of Clinical Child and Adolescent Psychology evidence base update evaluation criteria.

Methods criteria
M.1	Group design: Study involved a randomized controlled design
M.2	Independent variable defined: Treatment manuals or logical equivalent were used for the treatment; assurance of treatment fidelity
M.3	Population clarified: Conducted with a population, treated for specified problems, for whom inclusion criteria have been clearly delineated
M.4	Outcomes assessed: Reliable and valid outcome assessment measures gauging the problems targeted (at a minimum) were used
M.5	Analysis adequacy: Appropriate data analyses were used, and sample size was sufficient to detect expected effects
Level 1: Well-Established Treatments
Evidence criteria
1.1	Efficacy demonstrated for the treatment by showing the treatment to be:
	1.1.a	Statistically significantly superior to pill or psychological placebo or to another active treatment
	OR
	1.1.b	Equivalent (or not significantly different) to an already well-established treatment in experiments
	AND
	1.1.c	In at least two (2) independent research settings and by two (2) independent investigatory teams demonstrating efficacy
AND
1.2	All five (5) of the Methods criteria
Level 2: Probably Efficacious Treatments
Evidence criteria
2.1	There must be at least two (2) good experiments showing the treatment is superior (statistically significantly so) to a waitlist or no-treatment control group
OR
2.2	One (1) or more good experiments meeting the Well-Established Treatment level except for criterion 1.1c (i.e., Level 2 treatments will not involve independent investigatory teams)
AND
2.3	All five (5) of the Methods criteria
Level 3: Possibly Efficacious Treatments
Evidence criteria
3.1	At least one (1) good randomized controlled trial showing the treatment to be superior to a waitlist or no treatment control group
AND
3.2	All five (5) of the Methods criteria
OR
3.3	Two (2) or more clinical studies showing the treatment to be efficacious, with two (2) or more meeting the last four (4) Methods criteria, but none being randomized controlled trials
Level 4: Experimental Treatments
Evidence criteria
4.1	Not yet tested in a randomized controlled trial
OR
4.2	Tested in one (1) or more clinical studies but not sufficient to meet Level 3.3 criteria
Level 5: Treatments of Questionable Efficacy
Evidence criterion
5.1	Tested in good group-design experiments and found to be inferior to another treatment, waitlist, or no-treatment control group; i.e., only evidence available from experimental studies suggests the treatment produces no beneficial effect

Note: Adapted from Silverman and Hinshaw (2008) and Division 12 Task Force on Psychological Interventions’ reports (Chambless et al., 1996, 1998), from Chambless and Hollon (1998), and from Chambless and Ollendick (2001).

Current Review

In recent years, treatment studies for adolescent DB have increased substantially and include worldwide contexts. Thus, the current review builds upon the prior paper by McCart and Sheidow (2016) by (a) reviewing treatment studies for adolescent DB published since 2014 and (b) updating research support designations for the full range of treatment approaches based on the Southam-Gerow and Prinstein (2014) criteria. Further, this review provides recommendations for practice and future research based on the new evidence.

Method

A two-stage process was used to identify and code relevant articles, and to integrate newly identified studies with the prior evidence base on psychosocial treatments for DB in adolescents (McCart & Sheidow, 2016). Methods for the present review were structured such that the search criteria and processes were consistent with the prior review.

Stage I: Empirical Literature Since Prior Review

Record Identification

Specific terms were searched in PsycINFO and PubMed: disruptive behavior, aggression, behavior problems, conduct disorder, oppositional defiant disorder, child behavior disorders, offending, or delinquency, each cross-referenced with therapy, treatment, or intervention. Searches were limited to peer-reviewed, English-language articles published from January 2014 to December 2021 and focused on youth. Duplicates were removed, for a total 14,790 unique records (see Figure 1).

Figure 1. PRISMA flow diagram of record search and selection process for updated review of empirical literature since prior review.

To identify articles that might have been missed in the electronic searches, we also reviewed the table of contents for the following journals during the 2014–2021 time period: Behavior Modification, Behaviour Research and Therapy, Behavior Therapy, Journal of Abnormal Child Psychology, Development and Psychopathology, Journal of Applied Behavior Analysis, Journal of Child Psychology and Psychiatry, Journal of Clinical Child and Adolescent Psychology, Journal of Consulting and Clinical Psychology, Journal of the American Academy of Child and Adolescent Psychiatry, American Journal of Orthopsychiatry, and Journal of Family Psychology. This table of contents search identified 52 additional records.

Finally, we examined meta-analytic studies of DB interventions that had been identified in the electronic and table of content searches (n = 12).¹ The purpose of that review was to identify any records missed by our other search methods. This yielded an additional 3 records. Thus, in total, 14,850 records were identified in step one.

Record Screening

Trained assistants reviewed all abstracts to identify records meeting basic inclusion criteria. First, articles needed to focus on youth aged 12 to 19. If age extended above or below this range, the study was included if M_age = 12–19. Second, youth needed to have DB at baseline (e.g., diagnosis, clinical level scores, selection due to behaviors such as a JJ sample) and studies needed to target DB as a primary problem. Studies in which the behaviors were solely due to attention-deficit hyperactivity disorder, substance use, sexual offending, or autism or where these were the focus of treatment were excluded because separate and extensive bodies of literature focus on such treatments. Third, studies needed to evaluate psychosocial treatments with therapeutic intent that could be delivered in community-based settings. Treatments requiring a (1) school-wide or classroom-based intervention, (2) facility outside the youth’s typical community (e.g., inpatient facility, wilderness camp), or (3) system-wide change (e.g., requiring the entire JJ system to change operations) were excluded. However, stand-alone treatments studied within one of these milieus that could logically be delivered in a community setting (e.g., CBT delivered while youth were detained) were considered, as were programs that could feasibly be implemented in a community without requiring system-wide change (e.g., converting a subset to be specialized treatment foster care homes vs. requiring all foster homes to change practices). If there was insufficient information in an abstract, the full text was retrieved and reviewed to confirm criteria. Records meeting basic inclusion criteria (n = 63) were promoted to step three.

Record Coding

The 63 records were assigned to the first, second, and/or third authors of this review for coding. A coding plan ensured that each record was independently coded by any two of the three authors. Disagreements between pairs of authors were discussed, and consensus was reached in all cases.

First, coders determined if the study met the methods criteria for rigorous intervention trials (Southam-Gerow & Prinstein, 2014; see Table 1): (1) randomized controlled trial (RCT) design; (2) use of a treatment manual or logical equivalent (e.g., detailed treatment descriptions that could provide for replicability) and some assurance of treatment fidelity; (3) focus on a population for whom inclusion criteria were clearly delineated in a reliable, valid manner (e.g., diagnosis, clinical level scores, JJ sample); (4) reliance on reliable and valid outcome measures gauging disruptive behavior problems (e.g., clinical assessment, re-arrests); (5) use of appropriate data analytic methods and a sample size sufficient to detect expected effects (generally accepted as intent-to-treat research methods and at least one condition with at least 20 cases or via the authors’ own power analyses).

Second, coders extracted data regarding participant demographics, treatment name, treatment approach (coded as behavior therapy or parenting skills, cognitive-behavior therapy [CBT], family therapy, psychodynamic therapy, and/or other),² treatment format (family, family group, parent group, parent individual, youth group, and/or youth individual), sample type, country, therapist (e.g., student, Master’s-level), treatment setting (clinic, home, school), informant(s) for disruptive behavior measures (official records, parent, self, teacher), and assessment timepoints post-baseline. For each statistical test conducted with a DB outcome (e.g., analysis of change over time, test of a group difference at post-treatment), the treatment was evaluated as superior to, equivalent to, or inferior to the comparison condition. Consistent with the previous review, a study was considered supportive of the target treatment if the treatment was (a) superior to an active placebo or treatment, (b) superior to a waitlist or no-treatment comparison, or (c) equivalent to an already well-established treatment on at least 50% of the DB outcome measures.

Stage II: Integration of Stage I Results with the Prior Evidence Base

Level of Support Classifications

The 63 newly coded records were combined with the 86 records from the prior review. Classifications were then made following the Southam-Gerow and Prinstein (2014) instructions (see Table 1), based on all published studies supportive of the target treatment. Specifically, well-established (Level 1) treatments have at least 2 rigorous RCTs, conducted by at least 2 independent research teams, demonstrating the target treatment is either 1.1a) significantly superior to a placebo or another active treatment or 1.1b) equivalent to a well-established treatment. Probably efficacious (Level 2) treatments have 2.1) at least 2 rigorous RCTs showing the target treatment is significantly superior to a waitlist or no-treatment control group or 2.2) at least 1 rigorous RCT meeting 1.1a or 1.1b criteria. Possibly efficacious (Level 3) treatments have 3.1) at least 1 rigorous RCT with evidence of superior treatment effects compared with a waitlist or no treatment control group or 3.3) 2 or more non-randomized, but otherwise methodologically rigorous, studies showing the treatment to be efficacious. Experimental (Level 4) treatments have been supported in 1 or more non-randomized studies that are not sufficient to meet Level 3.3 criteria. Finally, treatments of questionable efficacy (Level 5) represent those for which all available evidence suggests they produce no beneficial effect.

Treatment Approach Groupings

Treatments are grouped based on approach. Some treatments are characterized by a single approach (e.g., CBT). Treatments incorporating multiple approaches are grouped with a label indicating each approach (e.g., Combined Behavior Therapy and Family Therapy). This grouping methodology was based on recommendations by Southam-Gerow and Prinstein (2014) to summarize and categorize the evidence according to the broad approaches used in the treatments versus simply listing named interventions.

Results

Stage I: Empirical Literature Since the Prior Review

The PRISMA Diagram (Figure 1) summarizes the identification and inclusion of studies. In the screening of abstracts, most failed to meet one or more of the basic inclusion criteria (see Method section) such as focusing on an excluded sample (e.g., autism) and/or not evaluating a psychosocial treatment. This was true for abstracts identified from databases, as well as those from table of content and meta-analysis searches. In the next step of screening the full text of papers for inclusion criteria, 524 were excluded (510 generated from the database search and 14 generated from the table of content and meta-analysis searches), resulting in 63 papers meeting full inclusion criteria.

Among the 63 included papers, 17 reported on 16 rigorous RCTs (i.e., 1 paper was a follow-up report). The prior review identified 36 papers reporting on 27 rigorous RCTs (i.e., 9 papers were follow-up reports). Table 2 lists the coded data extracted from all rigorous RCTs to date, with additions from the current review denoted with a superscript † symbol. In contrast to the last update in which the majority (70.4%) of rigorous RCTs focused on JJ-Involved samples, this update revealed a balance between RCTs focused on JJ-Involved samples (43.8%) and DB (Not JJ-Involved) samples (56.3%). Nearly half (43.8%) of the 16 newly identified RCTs were conducted by independent investigators, a steep increase in proportion since the last review in which 29.6% of 27 rigorous RCTs were conducted by investigators independent from the treatment developers. Further, of the 16 newly identified RCTs, the majority (75.0%) were conducted in countries outside the U.S. This compares to the prior review where only 33.3% of RCTs were conducted outside the U.S. Indeed, across all of the rigorous RCTs in Table 2, several non-U.S. countries are represented, including Canada, China, India, Israel, Ireland, Italy, The Netherlands, Norway, Singapore, South Korea, Sweden, and the United Kingdom. Finally, 8 of the 16 RCTs in this update found empirical support for the treatment under study.

Table 2. Rigorous studies comprising the evidence base for psychosocial treatments of disruptive behavior among adolescents (by treatment Approach^a).

Target Treatment [Treatment Format^b]	Study Authors^c	Sample Type^d [Country]	Demographic Characteristics^e,f	Therapists [Setting]	Treatment Conditions^g	Types of Disruptive Behavior Measures^h	Assessment Point(s) Post-Baseline (in Months)	Significant Differences Favoring Target Treatment^i	Supportive of Target Treatment
Animal Assisted Therapy
Teacher’s Pet (TP): Dogs and Kids Learning Together [Youth Group]	(Seivert et al., 2018)^†	JJ Youth in detention facilities [United States]	Age 13–18 yrs (M = 15.7) Male = 70% Ethnicity: 46% W, 44% AA, 4% H, 3% Mixed, 3% Other	Certified dog trainers [Detention facility]	Dog walking (n = 55) TP (n = 83)	S, T	2.5	0/2	Not Superior to Active Placebo/Treatment
Behavior Therapy or Parenting Skills
Family Check-Up (FCU) [Parent Individual]	(Ghaderi et al., 2018)^c†	Youth with disruptive behavior (rated by parents or teachers [Sweden]	Age 10–13 yrs (M = NR) Male = NR Ethnicity: NR	Profes- sional therapists [Clinic]	iComet (n = 109) FCU (n = 122)	P, S, T	2.5, 12, 24	4/16	Not Superior to Active Placebo/Treatment
Parenting Toolkit [Parent Self-Directed]	(Irvine et al., 2015)^†	Youth with behavior problems [United States]	Age 11–14 yrs (M = 13.1) Male = 53% Ethnicity: 40% AA, 29% C, 29% H, 1% Asian	Self-Directed [Computer]	Waitlist (n = 152) Parenting Toolkit (n = 155)	P	1	1/2	Superior to Waitlist/No Treatment
Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program (ATP)) [Family & Parent Groups]	(Irvine et al., 1999)	Youth with disruptive behavior referred by schools or community social workers [United States]	Age M = 12.2 Male = 61% Ethnicity: 88% C, 12% NR	Paraprofessional [Clinic]	Waitlist (n = 152) ATP (n = 151)	P	3, 6, 9, 15	2/5	Not Superior to Waitlist/No Treatment
Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program (ATP)) [Family & Parent Groups Only]	(Dishion & Andrews, 1995)	Youth with disruptive behavior [United States]	Age 10–14 yrs (M = 12.4) Male = 53% Ethnicity: 95% C, Remainder NR	Professional and parent co-leader [Setting NR]	Self-directed Parenting Bibliotherapy (n = 29) ATP-Parent Only (n = 26)	P, T	4, 16	1/4	Not Superior to Active Placebo/Treatment
Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program (ATP)) [Youth Group Only]	See Dishion & Andrews (1995) above	See above	See above	Therapists NR [Setting NR]	Self-directed Parenting Bibliotherapy (n = 29) ATP-Youth Only (n = 32)	P, T	4, 16	0/4	Not Superior to Active Placebo/Treatment
Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program (ATP)) [Family & Parent Groups + Youth Group]	See Dishion & Andrews (1995) above	See above	See above	Professional and parent co-leader + therapists [Setting NR]	Self-directed Parenting Bibliotherapy (n = 29) ATP-Parent and Youth (n = 31)	P, T	4, 16	0/4	Not Superior to Active Placebo/Treatment
Cognitive-Behavior Therapy (CBT)
Aggression Replacement Training + Positive Peer Culture (Equipping Youth to Help One Another (EQUIP)) [Youth Group]	(Leeman et al., 1993)	JJ Youth in correctional placement for nonviolent crime [United States]	Age 15–18 yrs (M = 16.0) Male = 100% Ethnicity: 67% C, 32% AA, 1% H	Paraprofessional (Facility staff) [Detention facility]	TAU juvenile justice facility (n = 37) EQUIP (n = 20)	R	6, 12	1/2	Superior to Active Placebo/Treatment
Cognitive Mediation [Youth Group]	(Guerra & Slaby, 1990)	JJ Youth incarcerated for violent crime [United States]	Age 15–18 yrs (M = 17.0) Male = 50% Ethnicity: Primarily AA & H	Students [Detention facility]	Attention control group (academic skills) (n = 40) No treatment (n = 40) Cognitive Mediation (n = 40)	R, T	4, 24	1/2	Superior to Active Placebo/Treatment
						R, T	4, 24	1/2	Superior to Waitlist/No Treatment
Engage in Education-London (EIE-L) [Family, Youth Group, & Youth Individual]	(Obsuth et al., 2017)^c†	Youth with disruptive behavior (rated by teachers) [United Kingdom]	Age 12–15 yrs (M = 14.0) Male = 71% Ethnicity: 25% British European, 5% Other European, 40% Black African, 13% Asian, 2% Latin American, 11% Mixed	Therapists NR [Home & School]	No treatment (n = 306) EIE-L (n = 300)	R, S, T	4	0/9	Not Superior to Waitlist/No Treatment
New Perspectives Aftercare Program (NPAP) [Youth Individual]	(James et al., 2016)^c†	JJ Youth releasing from detention at medium-high recidivism risk [The Netherlands]	Age 15–26 yrs (M = 19.54) Male = 97% Ethnicity: 16% Dutch, 35% non-Western Immigrant, 28% Caribbean, 21% Other	Youth care workers [Setting NR]	TAU (n = 61) NPAP (n = 66)	S	9	0/1	Not Superior to Active Placebo/Treatment
Preventing HIV/AIDS among Teens (PHAT Life) [Youth Group]	(Kendall et al., 2017)^†	JJ Youth with elevated aggression [United States]	Age 13–17 yrs (M = 15.8) Male = 65% Ethnicity: 90% AA, 10% H	Trained facilitators [Evening Reporting Centers]	Health promotion group (n = 43) PHAT Life (n = 28)	S	6, 12	2/3	Superior to Active Placebo/Treatment
SafERteens: Delivered by Therapists In Person [Youth Individual]	(Walton et al., 2010)	Youth in emergency room who screened positive for violence and alcohol use [United States]	Age 14–18 yrs (M = 16.8) Male = 44% Ethnicity: 39% C, 56% AA, 7% H	Professional social workers [Emergency Room]	No treatment (brochure) (n = 235) Therapist delivered SafERteens (n = 254)	S	3, 6	4/12	Not Superior to Waitlist/No Treatment
Same sample 1 yr post-treatment	(Cunningham et al., 2010)					S	12	2/3	Superior to Waitlist/No Treatment
SafERteens: Delivered by Computer [Youth Self-Directed]	See Walton et al. (2010) above	See above	See above	Youth Self-Directed [Computer in Emergency Room]	No treatment (brochure) (n = 235) Computer delivered SafERteens (n = 237)	S	3, 6	1/12	Not Superior to Waitlist/No Treatment
Same sample 1 yr post-treatment	See Cunningham et al. (2010) above					S	12	0/3	Not Superior to Waitlist/No Treatment
Social Cognitive Intervention [Youth Group]	(Singh, 2017)^†	Youth with elevated aggressive behavior [India]	Age 12–15 yrs (M = 13.4) Male = 56% Ethnicity: NR	Therapists NR [School]	Attention control group (n = 63) Social Cognitive Intervention (n = 63)	S	1.5	1/1	Superior to Active Placebo/Treatment
Solution-Focused Group Program [Youth Group]	(Shin, 2009)	JJ Youth on probation [South Korea]	Age M = 17.0 Male = NR Ethnicity: NR	Professional social workers [Setting NR]	Individual supportive sessions (n = 20) Solution-Focused Group Program (n = 20)	S	1.5	1/1	Superior to Active Placebo/Treatment
Think Cool Act Cool Emotion Regulation Training [Youth Individual]	(Te Brinke et al., 2021)^†	Youth with disruptive behavior (rated by teachers) [The Netherlands]	Age 12–15 yrs (M = NR) Male = 71% Ethnicity: 40% Dutch, 60% Non-Dutch	Professional psychologist and social workers [School]	No treatment (n = 51) Think Cool Act Cool (n = 57	P, S, T	4	0/3	Not Superior to Waitlist/No Treatment
Combined Behavior Therapy and Attachment-Based Approach
Connect [Family & Parent Groups]	(Barone et al., 2021)^†	Youth with disruptive behavior [Italy]	Age 12–18 yrs (M = 14.89) Male = 60% Ethnicity: 89% Italian	Certified program leaders [Clinic]	TAU (n = 50) Connect (n = 50)	P, S	3, 4	4/4	Superior to Active Placebo/Treatment
Combined Behavior Therapy and Cognitive-Behavior Therapy (CBT)
Rational-Emotive Behaviour Therapy (REBT) [Youth Group]	(Kumar, 2009)	Youth with conduct disorder [India]	Age 11–18 yrs (M = NR) Male = 50% Ethnicity: 100% Indian	Therapists NR [School]	No treatment (n = 100) REBT (n = 100)	S	3	1/1	Superior to Waitlist/No Treatment
Support to Reunite, Involve, and Value Each Other (STRIVE) [Family]	(Milburn et al., 2012)	Youth who had run away from home [United States]	Age 12–17 yrs (M = 14.8) Male = 34% Ethnicity: 11% C, 21% AA, 62% H	Therapists NR [Home]	Continued care from referral agency or referral to community program (n = 83)^j STRIVE (n = 68)	S	12	1/1	Superior to Waitlist/No Treatment
Combined Behavior Therapy and Family Therapy
Familias Unidas [Family Group & Family]	(Pantin et al., 2009)	Youth with disruptive behavior (rated by teachers, parents) [United States]	Age 8th grade (M = 13.8) Male = 64% Ethnicity: 100% H	Master’s and PhD Professionals [Setting NR]	Referrals to community programs (n = 104)^j Familias Unidas (n  = 109)	P	30	1/2	Superior to Waitlist/No Treatment
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
Functional Family Therapy (FFT) [Family]	(Alexander & Parsons, 1973)	JJ Youth arrested or detained for behavioral offense [United States]	Age 13–16 yrs (M = NR) Male = 44% Ethnicity: NR	Students [Clinic]	Client-centered family groups (n = 19) Psychodynamic family therapy (n  = 11) No treatment (n = 10) FFT (n = 46)	R	18	1/2	Superior to Active Placebo/Treatment
Functional Family Therapy (FFT) [Family]	(Sexton & Turner, 2010)	JJ Youth sentenced to probation [United States]	Age 13–17 yrs (Mdn = 15.0) Male = 79% Ethnicity: 78% C, 10% AA, 3% Nat A, 5% Asian	Professional therapists [Home]	TAU probation services (n = 331) FFT-high adherent therapists (n = 211)	R	12	1/1	Superior to Waitlist/No Treatment
Functional Family Therapy (FFT) [Family]	(Hartnett et al., 2016)^†	Youth with behavior problems [Ireland]	Age M = 14.0 Male = 60% Ethnicity: 100% Irish	Professional therapists [Home & Clinic]	Waitlist (n = 55) FFT (n = 42)	P, S	5	2/3	Superior to Waitlist/No Treatment
Functional Family Therapy (FFT) [Family]	(Humayun et al., 2017)^c†	JJ Youth sentenced for offending or with recent police contact for antisocial behavior [United Kingdom]	Age 10–18 yrs (M = 15.0) Male = 70% Ethnicity: 90% White British, 10% non-White British	Master’s Professionals [Home]	TAU (n = 46) FFT (n = 65)	P, R, S	6, 18	0/10	Not Superior to Active Placebo/Treatment
Functional Family Therapy (FFT) [Family]	(Gan et al., 2021)^c†	JJ Youth on community supervision [Singapore]	Age 13–18 yrs (M = 16.2) Male = 89% Ethnicity: NR	Professional therapists [Home]	TAU (n = 57) FFT (n = 63)	R	20	1/1	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Henggeler et al., 1992)	JJ Youth at risk of placement for serious criminal activity [United States]	Age M = 15.2 Male = 77% Ethnicity: 42% C, 56% AA	Master’s Professionals [Home]	TAU probation services (n = 41) MST (n = 43)	P, R, S	3.25, 14.75	4/5	Superior to Waitlist/No Treatment
Same sample M = 2.4 yrs post-referral	(Henggeler et al., 1993)					R	28.8	1/1	Superior to Waitlist/No Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Borduin et al., 1995)	JJ Youth in court for serious and chronic offending [United States]	Age 12–17 yrs (M = 15.0) Male = 69% Ethnicity: 76% C, 22% AA, 1% H, 1% Asian	Students [Home]	Individual therapy (blend of psychodynamic, client-centered, and behavioral) (n = 84) MST (n = 92)	P, R, T	6	3/4	Superior to Active Placebo/Treatment
Same sample M = 13.7 yrs post-treatment	(Schaeffer & Borduin, 2005)					R	164.4	5/6	Superior to Active Placebo/Treatment
Same sample M = 21.9 yrs post-treatment	(Sawyer & Borduin, 2011)					R	262.8	9/16	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Henggeler et al., 1997)	JJ Youth at risk of placement for violent or chronic offenses [United States]	Age 10–17 yrs (M = 15.2) Male = 82% Ethnicity: 19% C, 81% AA	Master’s Professionals [Home]	Usual community services (n = 73) MST delivered with low adherence (n = 82)	P, R, S	4.1, 20.4	1/7	Not Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Henggeler et al., 1999)	JJ Youth on probation with disruptive behavior who had substance abuse disorders [United States]	Age 12–17 yrs (M = 15.7) Male = 79% Ethnicity: 47% C, 50% AA, 1% H, 1% Asian	Master’s Professionals [Home]	Usual community services (n = 59) MST delivered with low adherence (n = 59)	R, S	4.3, 10.3	0/2	Not Superior to Active Placebo/Treatment
Same sample 4 yrs post-treatment	(Henggeler et al., 2002)					R, S	52.3	2/4	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Ogden & Halliday-Boykins, 2004)^c	JJ Youth with serious disruptive behavior [Norway]	Age 12–17 yrs (M = 15.0) Male = 63% Ethnicity: 95% Norwegian background	Bachelor's and Master’s Professionals [Home]	Usual child welfare services (n = 38) MST (n = 62)	P, S, T	6	2/3	Superior to Active Placebo/Treatment
Same sample 2 yrs post-recruitment	(Ogden & Hagen, 2006)^c					P, S, T	24	3/8	Not Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Timmons-Mitchell et al., 2006)^c	JJ Youth at risk of placement for felony offenses [United States]	Age 12–17 yrs (M = 15.1) Male = 88% Ethnicity: 78% C, 16% AA, 4% H	Master’s Professionals [Home]	Usual community services (n = 45) MST (n = 48)	R	6, 12, 24	5/6	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Sundell et al., 2008)^c	Youth with conduct disorder, referred by child welfare system [Sweden]	Age 12–17 yrs (M = 15.0) Male = 61% Ethnicity: 53% Swedish, 16% European, 9% African, 19% Asian	Bachelor's and Master’s Professionals [Home]	TAU child welfare services in Sweden (n = 77) MST delivered with low adherence (n = 79)	P, R, S	7	0/7	Not Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Glisson et al., 2010)	JJ Youth offenders at risk of placement [United States]	Age 9–17 yrs (M = 14.9) Male = 69% Ethnicity: 91% C, 5% AA, 1% H, 1% Nat A	Master’s and other Professionals [Home]	TAU (n = 299) MST (n = 316)	P	6, 18	1/4	Not Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Butler et al., 2011)^c	JJ Youth offenders [United Kingdom]	Age 13–17 yrs (M = 15.0) Male = 82% Ethnicity: 38% White British/European; 33% Black African/Afro-Caribbean British; 5% Asian British	Master’s Professionals [Home]	Youth Offending Teams (n = 52) MST (n = 56)	P, R, S	6, 18	7/14	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Asscher et al., 2013)^c	JJ Youth with severe and violent disruptive behavior [The Netherlands]	Age 12–18 yrs (M = 16.0) Male = 73% Ethnicity: 55% Dutch; 15% Moroccan; 14% Surinamese	Therapist NR [Home]	TAU (n = 109) MST (n = 147)	P, S	6	5/6	Superior to Active Placebo/Treatment
Same sample 3 yrs post-baseline	(Asscher et al., 2014)^c					P, R, S	12, 24, 36	5/15	Not Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Weiss et al., 2013)^c	Youth in self-contained behavior intervention classrooms; Note that this diverges from other MST studies [United States]	Age 11–18 yrs (M = 14.6) Male = 83% Ethnicity: 40% C, 60% AA	Bachelor's and Master’s Professionals [Home & School]	Behaviorally focused classroom management plan (n = 80) MST + Behaviorally focused classroom management plan (n = 84)	P, S, T	18, 30	2/4	Superior to Active Placebo/Treatment
Multisystemic Therapy (MST) [Family, Parent Individual, Youth Individual]	(Fonagy et al., 2018)^c†	Youth with moderate to severe antisocial behavior [United Kingdom]	Age 11–17 yrs (M = 13) Male = 63% Ethnicity: 79% White British/European, 10% Black African/Afro-Caribbean, 2% Asian, 7% Mixed/Other	Therapist NR [Home]	TAU (n = 342) MST (n = 342)	P, R, S	6, 12, 18	1/17	Not Superior to Active Placebo/Treatment
Same sample 5 yrs post-baseline	(Fonagy et al., 2020)^c†					P, R, S	36, 48, 60	0/14	Not Superior to Active Placebo/Treatment
Non-Violent Resistance (NVR) [Family]	(Weinblatt & Omer, 2008)	Youth with disruptive behavior [Israel]	Age 4–17 yrs (M = 12.6) Male = 68% Ethnicity: NR	Professional therapists [Clinic & Phone]	Waitlist (n = 20) NVR (n  = 21)	P	1	2/2	Superior to Waitlist/No Treatment
Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care (MTFC)) [Family & Youth Individual]	(Chamberlain & Reid, 1998)	JJ Youth mandated to placement for serious delinquency [United States]	Age 12–17 yrs (M = 14.9) Male = 100% Ethnicity: 85% C, 6% AA, 6% H, 3% Nat A	Trained foster parents, case managers, and therapists [Home]	TAU juvenile justice group care (n = 42) TFCO (n = 37)	R, S	12	4/4	Superior to Active Placebo/Treatment
Same sample 2 yrs post-baseline	(Eddy et al., 2004)					R, S	24	4/4	Superior to Active Placebo/Treatment
Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care (MTFC)) [Family & Youth Individual]	(Leve et al., 2005)	JJ Youth mandated to placement for serious delinquency [United States]	Age 13–17 yrs (M = 15.3) Male = 0% Ethnicity: 74% C, 2% AA, 9% H, 1% Asian, 12% Nat A	Trained foster parents, case managers, and therapists [Home]	TAU juvenile justice group care (n = 44) TFCO (n = 37)	P, R, S	12	2/4	Superior to Active Placebo/Treatment
Same sample 2 yrs post-baseline	(Chamberlain et al., 2007)					R, S	24	2/2	Superior to Active Placebo/Treatment
Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care (MTFC)) [Family & Youth Individual]	(Westermark et al., 2011)^c	JJ Youth with conduct disorder and risk of placement [Sweden]	Age 12–18 yrs (M = 15.4) Male = 51% Ethnicity: 74% Swedish, 26% Immigrant	Trained foster parents, case managers, and therapists [Home]	TAU (n = 15) TFCO (n = 20)	P, S	24	3/4	Superior to Active Placebo/Treatment
Treatment Foster Care Oregon (TFCO; formerly Multidimensional Treatment Foster Care (MTFC)) [Family & Youth Individual]	(Hansson & Olsson, 2012)^c	JJ Youth with conduct disorder and risk of placement [Sweden]	Age 12–17 yrs (M = 15.0) Male = 61% Ethnicity: 65% Swedish, 35% Immigrant	Trained foster parents, case managers, and therapists [Home]	TAU (n = 27) TFCO (n = 19)	P, S	12, 24	2/6	Not Superior to Active Placebo/Treatment
Usual Care Family Therapy [Family & Parent Individual]	(Hogue et al., 2015)^†	Youth with oppositional defiant disorder or conduct disorder [United States]	Age 12–18 yrs (M = 15.3) Male = 50% Ethnicity: 64% H, 20% AA, 17% Mixed/Other	Profes- sional therapists [Clinic]	Usual Care Other (n = NR) Usual Care Family Therapy (n = NR) Total Study (n = 205)	P, S	12	1/3	Not Superior to Active Placebo/Treatment
Combined Cognitive-Behavior Therapy (CBT), African Culture Reflective Identity and Life Skill Development, Case Management, and Peer Mentoring
Redemption Reintegration Services (RRS) [Youth Group & Youth Individual]	(Beausoleil et al., 2017)^†	JJ Youth releasing from prison [Canada]	Age 16–24 yrs (Intervention M = 19.5; Control M = 18.8) Male = 89% Ethnicity: 100% African Canadian	Case worker, housing worker, job counselor, resource developer, and nurse practitioner [Setting NR]	Usual reintegration services (n = 115) RRS (n = 115)	S	9	4/4	Superior to Active Placebo/Treatment
Interpersonal Therapy
Group Interpersonal Therapy (G-IPT) [Youth Group]	(Li et al., 2019)^c†	Youth with elevated aggressive behavior [China]	Age 18–19 yrs (M = NR) Male = 53% Ethnicity: NR	Therapist NR [Setting NR]	No treatment (n = 30) G-IPT (n = 30)	S	8	1/1	Superior to Waitlist/No Treatment

Notes: New papers added to this table since completion of the prior review by McCart and Sheidow (2016) are denoted by a superscript † symbol.

^aApproach refers to Animal Assisted Therapy; Behavior Therapy or Parenting Skills; Cognitive-Behavior Therapy (CBT); Combined Behavior Therapy and Attachment-Based; Combined Behavior Therapy and Cognitive-Behavior Therapy (CBT); Combined Behavior Therapy and Family Therapy; Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy; Combined Cognitive-Behavior Therapy (CBT), African Culture Reflective Identity and Life Skill Development, Case Management, and Peer Mentoring; and Interpersonal Therapy.

^bFormat refers to Family, Family Group, Parent Group, Parent Individual, Youth Group, and/or Youth Individual.

^cIndicates studies that are by investigators independent from the treatment developers.

^dSamples denoted as JJ contain primarily juvenile justice-involved participants.

^eNR = Not Reported.

^fPrimary ethnicities are reported. AA = African American; C = Caucasian; H = Hispanic; Nat A = Native American.

^gTAU = Treatment as Usual.

^hP = Parent- or caregiver-report; R = Official records; S = Self-report; T = Teacher-report.

ⁱThis 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 experimental treatment showed significantly better outcomes than the control condition on 2 of the measures.

^jAlthough referrals were made to community programs, no information was provided on participants’ actual receipt of services.

Within the 16 newly identified RCTs, there were 14 named treatments examined. Most of these included treatments provided by professional therapists (8), but trials also included services provided by paraprofessionals (5) or via computer (1). This is similar to the prior review except that three of the previously identified rigorous RCTs included treatments delivered by clinically trained students. Similar to the prior review, treatments utilizing Behavior Therapy and/or CBT approaches were most prevalent. Of the newly identified treatments, familiar categories included CBT on its own (5), Combined CBT, Behavior Therapy, and Family Therapy (3), and Behavior Therapy with parents or families on its own (2). New treatment approaches were Combined Behavior Therapy and Attachment-Based methods (1), Combined CBT, African Culture Reflective Identity and Life Skills Development, Case Management, and Peer Mentoring (1), Animal-Assisted Therapy (1), and Interpersonal Therapy (1). Also similar to the prior review, a range of delivery methods was tested during this update period: Family (1), Family and Parent Individual (1), Family, Parent Individual, and Youth Individual (1), Family, Youth Groups, and Youth Individual (1), Family and Parent Groups (1), Parent Individual (1), Parent Self-Directed (1), Youth Groups (4), Youth Individual (2), and Youth Groups and Youth Individual (1).

Stage II: Integration of Stage I Results with the Prior Evidence Base

Studies supportive of the target treatment in either the current review or McCart and Sheidow (2016) were used to determine the Level of support based on the Criteria for Classifying Evidence-Based Psychosocial Treatments specified by Southam-Gerow and Prinstein (2014). Table 2 summarizes all 53 publications of rigorous RCTs by treatment approach and describes the target populations. These 53 publications represent 43 rigorous RCTs that examined 27 different treatments (or versions of treatments). A Supplemental Table summarizes all other studies (i.e., non-rigorous RCTs, open trials) identified for coding in either the current review (n = 46 publications) or McCart and Sheidow (2016; n = 52 publications). The 98 publications in the Supplemental Table represent 94 studies that examined 77 different treatments (or versions of treatments). Table 3 lists the treatments falling into each Level of Support.

Table 3. Level of support designations for adolescent disruptive behavior treatments.^a

Approach	Treatment Name	Target Population
Level 1: Well-Established Treatments
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
	Functional Family Therapy^b	JJ-Involved
	Multisystemic Therapy^b	JJ-Involved
	Treatment Foster Care Oregon (formerly Multidimensional Treatment Foster Care)	JJ-Involved
Level 2: Probably Efficacious Treatments
Cognitive-Behavior Therapy (CBT)
	Aggression Replacement Training + Positive Peer Culture (Equipping Youth to Help One Another)^b	JJ-Involved
	Preventing HIV/AIDS Among Teens	JJ-Involved
	Social Cognitive Intervention	Disruptive Behavior (not JJ-Involved)
	Solution-Focused Group Program	JJ-Involved
Combined Behavior Therapy and Attachment-Based Approach
	Connect Program	Disruptive Behavior (not JJ-Involved)
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
	Multisystemic Therapy^b	Disruptive Behavior (not JJ-Involved)
Combined Cognitive-Behavior Therapy (CBT), African Culture Reflective Identity and Life Skill Development, Case Management, and Peer Mentoring
	Redemption Reintegration Services	JJ-Involved
Level 3: Possibly Efficacious Treatments
Behavior Therapy or Parenting Skills
	Parenting Toolkit	Disruptive Behavior (not JJ-Involved)
Cognitive-Behavior Therapy (CBT)
	Cognitive Behavior Therapy + Phone Coaching (RealVictory Program)	JJ-Involved
	Cognitive Mediation	JJ-Involved
Combined Behavior Therapy and Cognitive-Behavior Therapy (CBT)
	Rational-Emotive Behavior Therapy	Disruptive Behavior (not JJ-Involved)
	Support to Reunite, Involve, and Value Each Other	Disruptive Behavior (not JJ-Involved)
Combined Behavior Therapy and Family Therapy
	Familias Unidas	Disruptive Behavior (not JJ-Involved)
Combined Family Therapy and Emotionally Focused Approach
	Family Centered Treatment	JJ-Involved
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
	Functional Family Therapy	Disruptive Behavior (not JJ-Involved)
	Non-Violent Resistance	Disruptive Behavior (not JJ-Involved)
Interpersonal Therapy
	Group Interpersonal Therapy	Disruptive Behavior (not JJ-Involved)
Level 4: Experimental Treatments
Art Therapy
	Integrated Arts Therapy Program	JJ-Involved
Behavior Therapy or Parenting Skills
	Behavior Management Training + Problem-Solving Communication Training	Disruptive Behavior (not JJ-Involved)
	Parenting with Love and Limits	Disruptive Behavior (not JJ-Involved)
	Parenting Skills Group	School/Classroom Disruption
	Triple P Teen	Disruptive Behavior (not JJ-Involved)
	Triple P Teen: Self-Directed Enhanced with Phone Consultations	Disruptive Behavior (not JJ-Involved)
Bibliotherapy
	Bibliotherapy	School/Classroom Disruption
Cognitive-Behavior Therapy (CBT)
	Aggression Replacement Training (Learned Resourcefulness)	School/Classroom Disruption
	Anger Coping Program	School/Classroom Disruption
	Anger Management Education Program	Disruptive Behavior (not JJ-Involved)
	Anger Management + Think Good, Feel Good	School/Classroom Disruption
	Assertive Training	School/Classroom Disruption
	Brief Acceptance and Commitment Therapy	Disruptive Behavior (not JJ-Involved)
	Cognitive-Behavior Therapy	Disruptive Behavior (not JJ-Involved)
	Cognitive-Behavior Therapy	JJ-Involved
	Girls Only Active Learning	JJ-Involved
	Graduated Successful Community Opportunity Growth	JJ-Involved
	Hostile Attribution Bias Modification	School/Classroom Disruption
	Juvenile Cognitive Intervention	JJ-Involved
	Juvenile Probation Services Intervention	JJ-Involved
	Life Skills (Psychoeducation)	JJ-Involved
	Mindfields	JJ-Involved
	Multi-Family Group Counseling	School/Classroom Disruption
	Problem-Solving Intervention	School/Classroom Disruption
	Rational-Emotive and Cognitive Behavior Education	Disruptive Behavior (not JJ-Involved)
	Rational-Emotive Mental Health Program	Disruptive Behavior (not JJ-Involved)
	Responsive-Aggression Regulation Therapy	JJ-Involved
	SafERteens: Delivered by Therapists Remotely	Disruptive Behavior (not JJ-Involved)
	Violence Prevention Program	JJ-Involved
	Williams Lifeskills Training	JJ-Involved
Family Therapy
	Brief Strategic Family Therapy	Disruptive Behavior (not JJ-Involved)
Mentoring
	Monitored Youth Mentoring Program	School/Classroom Disruption
Mindfulness
	Mindfulness Training Program	School/Classroom Disruption
Combined Behavior Therapy and Attachment-Based Approach
	Multiple-Family Group Intervention	JJ-Involved
Combined Behavior Therapy and Cognitive-Behavior Therapy (CBT)
	Anger Control Training with Contingency Management	Disruptive Behavior (not JJ-Involved)
	Anger Management for Female Juvenile Offenders	JJ-Involved
	Dialectical Behavior Therapy	Disruptive Behavior (not JJ-Involved)
	Dialectical Behavior Therapy-Corrections Modified	JJ-Involved
	Dialectical Behavior Therapy-Skills Training Only	Disruptive Behavior (not JJ-Involved)
	Juvenile Justice Anger Management	JJ-Involved
	Motivational Interviewing + Solution-Focused Counseling + Behavior Shaping	Disruptive Behavior (not JJ-Involved)
	Multimodal Treatment Program	Disruptive Behavior (not JJ-Involved)
	Parent Management + Problem-Solving + Cognitive-Behavior Therapy	Disruptive Behavior (not JJ-Involved)
Combined Cognitive-Behavior Therapy (CBT) and Mindfulness
	Meditation on the Soles of the Feet	Disruptive Behavior (not JJ-Involved)
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
	Family-Centered, Feedback-Informed Treatment Program	Disruptive Behavior (not JJ-Involved)
	Family TIES	JJ-Involved
	Functional Family Therapy + Intensive Supervision, Psychiatric Support, and Family Mentoring	JJ-Involved
	Integrated Families and Systems Treatment	Disruptive Behavior (not JJ-Involved)
	Multidimensional Family Therapy-Outpatient	Disruptive Behavior (not JJ-Involved)
	Multisystemic Therapy-Emerging Adults	JJ-Involved
	Treatment Foster Care Oregon (formerly Multidimensional Treatment Foster Care) + Trauma-Focused CBT	JJ-Involved
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Wraparound
	Parenting with Love and Limits-Re-Entry	JJ-Involved
Level 5: Treatments of Questionable Efficacy
Animal Assisted Therapy
	Teacher’s Pet: Dogs and Kids Learning Together	JJ-Involved
Behavior Therapy or Parenting Skills
	Contingency Management	Disruptive Behavior (not JJ-Involved)
	Family Check-Up	Disruptive Behavior (not JJ-Involved)
	Parenting with Love and Limits	JJ-Involved
	Positive Family Support-Family Check-Up (formerly Adolescent Transitions Program)	Disruptive Behavior (not JJ-Involved)
	Relaxation Breathing Exercise	JJ-Involved
Cognitive-Behavior Therapy (CBT)
	Aggression Replacement Training	JJ-Involved
	Changing Lives Program	School/Classroom Disruption
	Engage in Education-London	School/Classroom Disruption
	Motivational Interviewing (Personal Aspiration and Concerns)	JJ-Involved
	New Perspectives Aftercare Program	JJ-Involved
	New Perspectives Aftercare Program	Disruptive Behavior (not JJ-Involved)
	Positive Life Changes	Disruptive Behavior (not JJ-Involved)
	SafERteens: Delivered by Therapists In Person	Disruptive Behavior (not JJ-Involved)
	SafERteens: Delivered by Computer	Disruptive Behavior (not JJ-Involved)
	Think Cool Act Cool Emotion Regulation Training	Disruptive Behavior (not JJ-Involved)
Psychodynamic
	Human Relations Training	Disruptive Behavior (not JJ-Involved)
Combined Behavior Therapy and Cognitive-Behavior Therapy (CBT)
	Aggression Replacement Training + Token Economy	JJ-Involved
	Anger Control Training with Behavior Management	Disruptive Behavior (not JJ-Involved)
Combined Behavior Therapy, Cognitive-Behavior Therapy (CBT), and Family Therapy
	Functional Family Therapy-Gang	JJ-Involved
	Usual Care Family Therapy	Disruptive Behavior (not JJ-Involved)
Combined Humanistic, Bibliotherapy, Psychodynamic, and Cognitive-Behavior Therapy (CBT)
	Counseling Intervention	School/Classroom Disruption

^aCumulative support from studies included in Brestan and Eyberg (1998), Eyberg et al. (2008), McCart and Sheidow (2016), and the current review.

^bFor this particular treatment, one or more studies directly evaluated model adherence, and low adherence was shown to impact treatment effectiveness.

JJ = Juvenile justice.

Well-Established (Level 1)

There are three well-established treatments, all using the same approach and all three for Adolescents with JJ-Involvement. This is an increase of one.

Adolescents with DB (Not JJ-Involved)

Currently, there are no well-established treatments.

Adolescents with JJ-Involvement

Incorporating Behavior Therapy, CBT, and Family Therapy is well-established. Treatments using this approach are Functional Family Therapy (FFT), Multisystemic Therapy (MST), and Treatment Foster Care Oregon (TFCO). MST and TFCO were previously well-established. Both offer 24/7 support to families through a treatment team. They also both include individual and skill-building sessions with the youth and parents using CBT tenets by teaching different ways to change thinking patterns and improving problem-solving and coping skills. Often, while in treatment, multiple stakeholders in the child’s environment are engaged (e.g., teachers, probation officers). They target DB, in part, by using behavior modification principles, where desired behaviors are reinforced and undesired behaviors are ignored or given negative consequences (e.g., privilege loss). Behavior Therapy with parents and families teaches parents effective child behavior management skills and how to improve the parent-child relationship through such practices as providing specific praise, creating house rules, and using charts and other incentive systems. FFT is elevated since the prior review from probably efficacious for this population due to having an independent rigorous RCT demonstrating positive DB outcomes. FFT uses similar methods of targeting DB but is delivered via family sessions. This is conducted in-home by trained and certified therapists assessing and intervening in youths’ risks and protective factors across their environments through five major components: engagement, motivation, relational assessment, behavior change, and generalization.

Probably Efficacious (Level 2)

There are seven probably efficacious treatments. There are now three for Adolescents with DB (Not JJ-Involved)–an increase of two – and four for Adolescents with JJ-Involvement – with two being newly added treatments.

Adolescents with DB (Not JJ-Involved)

CBT as a treatment approach is newly added for this population; specifically, Social Cognitive Intervention is a group-based intervention that demonstrated reduced aggression post-treatment. The other new treatment approach added for this population is a Combined Behavior Therapy and Attachment-Based approach delivered in a mix of family sessions and parent groups (i.e., Connect Program) and is an elevation from experimental since the prior review due to having a rigorous RCT comparing Connect to an active placebo and multiple supportive clinical studies. In addition, treatment incorporating Behavior Therapy, CBT, and Family Therapy delivered via a combination of family, parent, and child sessions (i.e., MST; further described above) remains probably efficacious for this population.

Adolescents with JJ-Involvement

CBT as a treatment approach continues to be probably efficacious for this population, although an additional treatment is added for a total of three treatments. Equipping Youth to Help One Another (EQUIP) had been identified in the prior review and includes aggression replacement training with a positive peer culture approach. A Solution-Focused Group Program also had been identified in the prior review and is a group-based intervention that demonstrated improvements at post-treatment. Newly added is Preventing HIV/AIDS Among Teens (PHAT Life), a group-based intervention that demonstrated reduced detentions (self-reported) at 12-month follow-up. Finally, a new approach is added for treatment incorporating CBT, African Culture Reflective Identity and Life Skill Development, Case Management, and Peer Mentoring; Redemption Reintegration Services (RRS) is a treatment delivered via group and individual sessions to youth releasing from detention, and it demonstrated positive outcomes across a variety of self-reported 9-month outcomes.

Possibly Efficacious (Level 3)

There are ten possibly efficacious treatments. There are now seven for Adolescents with DB (Not JJ-Involved)–an increase of three – and three for Adolescents with JJ-Involvement – an increase of one.

Adolescents with DB (Not JJ-Involved)

Two new treatment categories added for this population are interventions that did not combine approaches: Behavior Therapy via a parent self-directed approach (i.e., Parenting Toolkit) and Interpersonal Therapy via youth groups (i.e., Group Interpersonal Therapy [G-IPT]). An existing treatment approach for this population, Combined Behavior Therapy, CBT, and Family Therapy, added one treatment to the existing treatment (i.e., Non-Violent Resistance was existing, FFT is added). Finally, there were two existing approaches that remained unchanged as being possibly efficacious for youth who have DB without JJ involvement. Combined Behavior Therapy and Family Therapy remains possibly efficacious, with Familias Unidas delivered via parent groups and family sessions. Behavior Therapy combined with CBT remains possibly efficacious and includes two treatments: Rational-Emotive Behavior Therapy (REBT) delivered via groups in school and Support to Reunite, Involve, and Value Each Other (STRIVE) delivered via family sessions for youth who have a history of running away from home.

Adolescents with JJ-Involvement

A new approach for this population is added: Combined Family Therapy and Emotionally-Focused (i.e., Family Centered Treatment). This is an elevation since the prior review from experimental for this population due to having multiple supportive clinical studies. CBT was an existing approach and includes Cognitive Mediation as a group-based treatment. In addition, this approach now contains the RealVictory Program (includes CBT delivered to youth individually and in groups, plus phone coaching); this treatment is elevated since the prior review from experimental for this population due to having multiple supportive clinical studies.

Experimental (Level 4)

There are fifty-two experimental treatments, spread across twelve approaches. There are twenty-six newly added treatments and two newly added approaches.

Adolescents with DB (Not JJ-Involved)

There are now thirty-two experimental treatments across nine approaches for Adolescents with DB or School/Classroom Disruption (Not JJ-Involved). Fifteen of these experimental treatments are new. New approaches include: Bibliotherapy (1 treatment) and Mindfulness (1 treatment). Existing approaches include: Behavior Therapy or Parenting Skills (5 treatments, 2 of which are new); CBT (13 treatments, 8 of which are new); Family Therapy (1 treatment); Mentoring (1 treatment); Combined Behavior Therapy and CBT (6 treatments, 1 of which is new); Combined CBT and Mindfulness (1 treatment); Combined Behavior Therapy, CBT, and Family Therapy (3 treatments, 2 of which are new).

Adolescents with JJ-Involvement

There are now twenty experimental treatments across six approaches for Adolescents with JJ-Involvement. Eleven of these experimental treatments are new. New approaches include: Art Therapy (1 treatment) and Combined Behavior Therapy and Attachment-Based Approach (1 treatment). Existing approaches include: CBT (10 treatments, 5 of which are new); Combined Behavior Therapy and CBT (3 treatments, 1 of which is new); Combined Behavior Therapy, CBT, and Family Therapy (4 treatments, 3 of which are new); Combined Behavior Therapy, CBT, and Wraparound (1 treatment).

Questionable Efficacy (Level 5)

There are twenty-two treatments of questionable efficacy, spread across seven approaches. There are twelve newly added treatments and two newly added approaches.

Adolescents with DB (Not JJ-Involved)

There are now fourteen treatments of questionable efficacy across six approaches for Adolescents with DB or School/Classroom Disruption (Not JJ-Involved). Seven of these treatments are new. There is one new approach: Combined Behavior Therapy, CBT, and Family Therapy (i.e., Usual Care Family Therapy). There are five existing approaches, some of which have added treatments. Behavior Therapy for Adolescents with DB now includes Family Check-Up, but also retains Contingency Management, Positive Family Support-Family Check-Up. CBT retains Positive Life Changes and SafERteens: Delivered by Therapists In Person, but newly added treatments are Changing Lives Program, Engage in Education-London, New Perspectives Aftercare Program, SafERteens: Delivered by Computer, and Think Cool Act Cool Emotion Regulation Training. Remaining approaches that were existing in the prior update were Psychodynamic (i.e., Human Relations Training), Combined Behavior Therapy and CBT (i.e., Anger Control Training with Behavior Management), and Combined Humanistic, Bibliotherapy, Psychodynamic, and CBT (i.e., Counseling Intervention).

Adolescents with JJ-Involvement

There are now eight treatments of questionable efficacy across five approaches for Adolescents with JJ-Involvement. Five of these treatments are new. There were two new approaches: Animal Assisted Therapy (i.e., Teacher’s Pet: Dogs and Kids Learning Together) and Combined Behavior Therapy, CBT, and Family Therapy (i.e., Functional Family Therapy-Gang). There were three existing approaches, some of which have added treatments. Behavior Therapy now includes Parenting with Love and Limits and retains Relaxation Breathing Exercise. CBT now includes Aggression Replacement Training and retains Motivational Interviewing (Personal Aspiration and Concerns). Finally, Combined Behavior Therapy and CBT retains Aggression Replacement Training + Token Economy.

Discussion

This article updates a prior review of psychosocial treatments for adolescents with DB completed by McCart and Sheidow (2016). Treatments were evaluated according to JCCAP evaluation criteria, which use existing evidence to designate a treatment’s level of empirical support (Southam-Gerow & Prinstein, 2014; see Table 1). The evaluation criteria were applied to all DB treatment studies published between 1966 and 2021. Thus, support designations are based on cumulative evidence from research published over a 55-year period. A central aim of these JCCAP updates is to provide user-friendly summaries of treatments for common presenting problems. Such lists guide the selection of appropriate treatments by practitioners, funders, and consumers, and also shed light on areas of need in future research. The final list of evidence-based treatments for adolescents with DB is presented in Table 3. In accordance with JCCAP guidelines, treatments are organized by approach. Consistent with the prior review, each treatment’s target population is also specified.

In total, this update identified 3 well-established (Level 1), 7 probably efficacious (Level 2), and 10 possibly efficacious (Level 3) treatments for adolescents with DB. Further, this review classified 52 treatments as experimental (Level 4) and 22 treatments as having questionable efficacy (Level 5). With only a few exceptions, treatments falling into one of the top three evidence levels utilized more than one approach, enhancing the treatment’s ability to target DB from multiple angles. Indeed, treatments meeting the “gold-standard” designation of well-established – FFT, MST, and TFCO – leverage behavioral, cognitive-behavioral, and family systems orientations to target multiple risk factors for DB across youths’ individual and environmental contexts. MST and TFCO met the well-established designation in the prior review, and FFT is now elevated to that category. Another notable multi-approach treatment added to Level 2 (probably efficacious) for this update is RRS. This innovative intervention leverages multiple approaches to target risk and protective factors for DB in an African culture reflective framework. As highlighted by McCart and Sheidow (2016), the success of treatments utilizing multiple approaches to target domains of risk is not surprising in light of evidence showing that DB in youth is multidetermined (Liberman, 2008; Loeber et al., 2009). If multiple risk domains give rise to DB, it stands to reason that multi-approach interventions will achieve the greatest success in reducing DB and sustaining those reductions long-term. Consistent with that view, evidence supports the durability of treatment effects for as long as 2 years for TFCO (Chamberlain et al., 2007) and a remarkable 21.9 years for MST (Sawyer & Borduin, 2011). Of note, however, the majority of interventions’ evidence for durability was limited by short follow-up windows.

Table 3 also includes some probably efficacious and possibly efficacious treatments that target risk factors in only one domain. For example, CBT-only protocols intervene primarily on the individual domain, with strategies geared toward remediating youths’ cognitive and emotion regulation deficits. CBT has not amassed as much empirical support as the multi-approach interventions represented in Level 1. However, this might be an artifact of more studies having been conducted on FFT, MST, and TFCO relative to CBT-only treatments. Thus, it remains to be seen, pending further research, if any of the CBT-only treatments for DB will eventually achieve a well-established designation. However, as noted by McCart and Sheidow (2016), the role of contextual factors in maintaining cognitive deficits suggests that our strongest DB treatments, and especially those with long-lived outcomes, might need to go beyond basic CBT. Specifically, maladaptive parenting practices are linked with hostile attribution biases in youth (Nelson & Coyne, 2009). Rejection from prosocial peers (Lansford et al., 2010) and affiliation with deviant peers (Werner & Hill, 2010) contribute to and are exacerbated by cognitive deficits. Broader contextual factors, such as low school monitoring (Farrell et al., 2010) and community violence (McMahon et al., 2009) also make cognitive deficits and DB more likely. In light of this research, CBT programs that focus primarily on youths’ cognitive deficits might be insufficient to ameliorate serious DB among adolescents for long windows of time. Without changing the contextual factors that instill and reinforce maladaptive social decision-making, as well as factors that provide opportunities for continued behavior problems (e.g., time with delinquent peers, school expulsion), DB is more likely to persist. Following this notion, many of the treatments in Table 3 that use CBT combine it with other approaches.

Research Advances

This update reveals exciting advances with regard to treatments for adolescents with DB. It is noteworthy that we were able to identify such a large number of rigorous RCTs (n = 43; see Table 2) targeting a single category of presenting problems in youth. In addition, the RCTs in Table 2 have considerable range in terms of sample demographics (e.g., biological sex, ethnicity) and country of origin. Further, a broad array of treatment settings (e.g., home, school, detention center) and provider types (e.g., paraprofessionals, Master’s level therapists, caseworkers) are represented. A common misconception in the behavioral health treatment field is that most RCTs take place in tightly-controlled university clinics with advanced therapists and predominantly Caucasian samples. However, the treatment literature on adolescents with DB clearly supports the opposite. Indeed, many of the studies included in this review were conducted in community settings utilizing real-world providers and involving youth of considerable ethnic and socioeconomic diversity. Finally, while many of the U.S.-based RCTs were likely costly and dependent upon large federal grants, that money is well spent considering the aforementioned negative long-term outcomes associated with DB in youth. Further, and as described next, many of the RCTs in Table 2 took place outside the U.S., emphasizing that methodologically rigorous treatment research can feasibly be completed in settings around the globe and without the financial backing of a well-resourced U.S. federal funding agency.

Rigorous RCTs were conducted with families in a range of countries, often by investigators independent of the treatment developers. Many of those RCTs were supportive, suggesting replicability and cross-cultural generalizability of treatments for adolescent DB. This is not surprising given evidence that the key risk factors for DB in youth (and therefore the primary treatment targets) demonstrate remarkable cross-cultural consistency (McCart et al., 2014). At the same time, while FFT and MST have amassed considerable empirical support in the U.S. and various international settings, those two well-established treatments did not outperform treatment as usual control conditions in large, rigorous RCTs conducted in the United Kingdom (Fonagy et al., 2018; Humayun et al., 2017). One hypothesis is that usual care in the United Kingdom might involve more substantial and higher-quality services relative to usual care in the U.S. and other countries that have tested those treatment models. Further, while international representation expanded considerably in the current update, most (albeit not all) of the countries represented have a history of conducting DB research. Future work should continue to test treatments for adolescent DB in the larger international field.

Finally, in comparison to the prior review, technology-facilitated interventions are somewhat more prevalent. Examples from this update include the Parenting Toolkit, SafERteens, and RealVictory programs. Interventions like these that incorporate technology (e.g., virtual sessions, self-directed computer-based instruction, phone coaching) might be less burdensome and more accessible (Bishop et al., 2006), especially for families in rural or other low-resourced communities. Research with parents also has reported increased interest in web-based alternatives to more traditional in-person services (Metzler et al., 2012). Nevertheless, the abovementioned technology-based programs are all in the early stages of evaluation, emphasizing the need for continued research on these novel approaches to treatment delivery.

Research Gaps

This update also highlights unfortunately persistent research gaps. It is clear from Table 3 that DB treatments for adolescents without JJ-involvement continue to lag behind treatments for JJ-involved youth. There currently is not a single well-established treatment for adolescent populations with DB who have not come into contact with the JJ system. On one hand, focusing on treatments for JJ-involved adolescents is warranted given their more severe behaviors compared to non-JJ-involved adolescents with DB. On the other hand, intervention with less severe behaviors could prevent JJ-involvement and improve the life trajectory of youth with DB (Bevilacqua et al., 2018; Frick, 2016). Once involved with JJ, it can be difficult to prevent further entrenchment. Adolescents with DB usually come into contact with service providers of some sort before they become involved with JJ, and this provides a critical window of opportunity. Indeed, DB is a common reason for receipt of mental health services in the U.S. (Ghandour et al., 2019), and practitioners are in dire need for effective interventions. In that context, it seems critical to more rigorously study the 2 probably efficacious treatments and the 8 possibly efficacious treatments in Table 3 that target adolescents with DB and no JJ involvement. One example is the Connect Program, a manualized group-based intervention for caregivers of adolescents with serious DB, which has generated empirical support in one rigorous RCT (Barone et al., 2021) and two non-randomized clinical studies (Moretti & Obsuth, 2009; Moretti et al., 2015). This combined behavior therapy and attachment-based approach promotes parenting skills and parent-child cooperation via experiential and emotion-focused role-plays and reflection activities. Notably, Connect is available in five languages and via virtual program delivery (e.g., see www.connectattachmentprograms.org). That said, Connect and similar programs for non-JJ involved adolescents with DB are still in the early stages of examination, so testing of both replicability and durability of outcomes is needed.

Future treatment studies also should place greater emphasis on longer-term follow-up assessments to measure maintenance of treatment gains. It is encouraging that of the 43 rigorous RCTs in Table 2, 16 (37%) included outcome measurements at 2 or more years post-baseline. However, a bulk of the studies were limited to post-treatment measurements or short-term follow-up only. As noted in McCart and Sheidow (2016), maintaining treatment gains should be a critical consideration in determining the preference for a treatment, but this update indicates that long-term follow-up evaluations continue to be relatively rare.

One final observation is that while great progress has been made in the field of treatments for adolescents with DB, even greater strides would be achievable with attention to stronger research methods. Specifically, for several of the rigorous RCTs in Table 2, reliance on waitlist or no-treatment control conditions (versus psychological placebo or another active treatment) was a limiting factor for considering the well-established and probably efficacious levels. Further, the Supplemental Table includes 98 studies lacking rigorous methods, such as reliance on non-randomized designs, inadequate attention to treatment fidelity, and/or absence of an intent-to-treat analytic approach (i.e., analyzing treatment completers only). Beyond those issues, studies often measured key outcomes only via parent- and/or self-report, which could introduce bias when the parent or adolescent are the direct recipients of the intervention. Finally, there is continued need to identify the mechanisms of action for effective DB treatments, which could be accomplished in the context of rigorous RCTs and/or via advanced experimental methods such as manipulation-of-mediator designs (e.g., Pirlott & MacKinnon, 2016).

Limitations

Treatments are categorized by theoretical approach, consistent with guidelines provided by Southam-Gerow and Prinstein (2014). This strategy is beneficial for identifying approaches that seem consistently superior. However, interventions with the same approach can vary widely in terms of delivery method and techniques. Similarly, the outcomes for such treatments can vary. Therefore, when aiming to select a particular treatment, practitioners and consumers are advised to carefully consider multiple aspects of the treatment versus relying solely on its listed approach. Second, to be included in this review, youth needed to have DB at baseline (e.g., diagnosis, clinical level scores). Thus, studies designed to prevent DB were excluded. However, comprehensive reviews of prevention programs can be found in Daly et al. (2018) and Farrington et al. (2017). Finally, some studies might have been missed by this review; however, attempts were made to capture all relevant articles via extensive and varied literature search methods.

Conclusions

There has continued to be a large body of empirical literature building the evidence base for treatments of adolescent DB, particularly for adolescents with JJ system involvement. Notably, there were new treatments added to each level of evidence in this updated review, as well as new categories for treatment approaches. There was a modest increase in the number of treatments at Levels 1, 2, and 3. The number of treatments added to Level 4 (experimental), was quite large (26), showing that there was a lot of testing for new treatments since the last review. One caveat is that the number of treatments with questionable efficacy increased by 12, for a total of 22. Thus, caution should be taken when selecting treatments for adolescent DB. This is especially true for adolescents not involved in the justice system, as there are so few options at the upper levels of evidence.

Aside from the menu of well-established and probably efficacious treatments provided by this update, there are a number of additional points that can guide clinicians, funders, and policy-makers when selecting treatments. Treatment fidelity is a critical consideration for achieving desired outcomes (see McCart & Sheidow, 2016), and there is little evidence of maintaining fidelity in the absence of a strong ongoing quality assurance system (e.g., Smith-Boydston et al., 2014). So, consideration of implementation factors and providing adequate resources when selecting a treatment is critical. As described in McCart and Sheidow (2016), clinicians and organizations that do not have the resources to implement the well-established and probably efficacious treatments could seek out the published descriptions and manuals that are available for public consumption. However, while clinicians are free to borrow from these and to adopt the strategies viewed as useful, clinicians cannot conclude that they are implementing the identified treatments without validation of such. In addition, those interventions designated as well-established or probably efficacious may have been tested for particular types of samples (e.g., JJ-involved), locations (e.g., in-home), or providers (e.g., therapists), but may not work or be applicable for other samples, locations, or providers. This may be critical for someone selecting a treatment to consider.

In conclusion, there remain areas for growth to fill the gaps in this literature, but the field continues to produce rigorous research targeting reductions in DB among adolescents. The expansion at all levels of evidence is encouraging; it is also fitting given the need for treatments for this population (Steiner et al., 2017; Weisz et al., 2019). Further, while there remain subpopulations where gaps remain, the growth in DB treatment research conducted in diverse locations and populations is inspiring. From the research dating back to 1966 to the most recent trials in 2021, the work in this area has continued to expand and build a large and diverse evidence base.

Acknowledgments

The authors would like to thank Colleen Walsh, Jenene Peterson, and Jessica Hughitt for assisting with the literature review.

Disclosure statement

Michael R. McCart and Ashli J. Sheidow are co-owners of Science to Practice Group, LLC, which provides the training and quality assurance for an adaptation of Multisystemic Therapy for emerging adults (MST-EA). There is a management plan in place to ensure this conflict does not jeopardize the objectivity of their research.

Supplementary Material

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2022.2145566.

Additional information

Funding

The authors’ effort in the preparation of this publication was supported by grants from the National Institutes of Health under award numbers R01DA043578 (Michael R. McCart), R01DA041434 (Ashli J. Sheidow), and R01DA050669-02S1 (Jamie Jaramillo). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Notes

¹ A list of the twelve meta-analytic studies is available from the authors upon request.

² Treatment approach was determined based on the approach used to elicit behavior change. For example, behavior therapy or parenting skill protocols elicited change via behavior modification. Cognitive-behavior therapy relied on cognitive strategies to elicit behavior change. Family therapy elicited change by targeting the family system. Psychodynamic therapy elicited change via enhanced awareness of unconscious drives and conflicts. Some treatments used multiple approaches and are labeled as multicomponent, with the specific treatment approaches identified.