New research
Examination of Disruptive Behavior Outcomes and Moderation in a Randomized Psychotherapy Trial for Mood Disorders

https://doi.org/10.1016/j.jaac.2013.04.014Get rights and content

Objective

Multifamily psychoeducational psychotherapy (MF-PEP) is an efficacious treatment for children with mood disorders. Given the comorbidity between disruptive behaviors and mood disorders, this study examined associations between disruptive behaviors and impairment, impact of MF-PEP on disruptive behaviors, and whether disruptive behaviors affected treatment response of mood symptoms.

Method

Secondary analyses examined a randomized controlled trial of MF-PEP versus waitlist control (N = 165 children 8–11 years old with mood disorders and their parents). Comorbid behavioral diagnoses occurred in 97% of children. All participants continued treatment as usual.

Results

Greater degree of disruptive behaviors was associated with worse mood symptoms and impairment. Between-group analyses examining outcome of disruptive behaviors were nonsignificant. Within-group analyses and between-group effect sizes suggested that MF-PEP was associated with decreases in attention-deficit/hyperactivity disorder (d = 0.39), oppositional defiant disorder (d = 0.30), and overall disruptive behavior symptoms (d = 0.30), but not conduct disorder symptoms. Baseline severity of disruptive behaviors did not affect treatment response of mood symptoms to MF-PEP.

Conclusions

MF-PEP is an effective intervention for children with mood disorders and provides some benefit for disruptive behaviors. Given that disruptive behavior severity does not affect children’s ability to experience improved mood symptoms, MF-PEP may be an important early intervention for children with comorbid mood and disruptive behavior disorders. Subsequent intervention targeting behavioral symptoms after improvement in mood may be beneficial. Studies examining treatment sequencing for children with comorbid mood and disruptive behavior disorders are needed. Clinical trial registration information—Family psychoeducation for children with mood disorders; http://clinicaltrials.gov; NCT00050557.

Section snippets

Sample

Secondary analyses examined the MF-PEP RCT (National Institute of Mental Health grant R01MH061512), which included 165 children with mood disorders and their families.29 Participants were recruited from Midwestern rural and urban settings through a referral network of mental health professionals, presentations to professional and community-based groups, and media feature stories about the study. Children had to be 8 to 11 years old and have a mood disorder and IQ higher than 70.

The sample size

Baseline Data

Study recruitment and assessments were conducted from 2001 through 2005. Figure 1 presents the participant flow. Analyses included all participants for whom 12-month follow-up data were available, except for Pearson correlations, which used the intent-to-treat cohort. By 12-month follow-up, 18 families had dropped out of the IMM + TAU group and 26 had dropped out of the WLC + TAU group. Families not completing treatment (n = 49 who did not complete ≥6 sessions) did not differ from completers on

Discussion

Children with mood disorders commonly present with comorbid DBDs. Little is known about the impact of psychosocial mood interventions on DBD symptoms and the impact of DBDs on mood symptom treatment response. This secondary analysis of MF-PEP, an efficacious psychoeducational treatment for children with mood disorders, showed that disruptive behaviors were associated with more severe mood symptoms and worse global functioning at baseline. Between-group analyses examining outcomes of disruptive

References (41)

  • F. Muratori et al.

    A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children

    J Am Acad Child Adolesc Psychiatry

    (2003)
  • D.J. Miklowitz et al.

    Family-focused treatment for adolescents with bipolar disorder

    J Affect Disord

    (2004)
  • M.N. Pavuluri et al.

    Child- and family-focused cognitive-behavioral therapy for pediatric bipolar disorder: development and preliminary results

    J Am Acad Child Adolesc Psychiatry

    (2004)
  • A.E. West et al.

    Maintenance model of integrated psychosocial treatment in pediatric bipolar disorder: a pilot feasibility study

    J Am Acad Child Adolesc Psychiatry

    (2007)
  • E.B. Weller et al.

    Children’s Interview for Psychiatric Syndromes (ChIPS)

    J Am Acad Child Adolesc Psychiatry

    (2000)
  • E.O. Poznanski et al.

    Preliminary studies of the reliability and validity of the children’s depression rating scale

    J Am Acad Child Psychiatry

    (1984)
  • E.J. Costello et al.

    Prevalence and development of psychiatric disorders in childhood and adolescence

    Arch Gen Psychiatry

    (2003)
  • A.R. Van Meter et al.

    Meta-analysis of epidemiologic studies of pediatric bipolar disorder

    J Clin Psychiatry

    (2011)
  • P. Vostanis et al.

    Treatment for children and adolescents with depression: lessons from a controlled trial

    Clin Child Psychol Psychiatry

    (1996)
  • J.R. Weisz et al.

    Cognitive-behavioral therapy versus usual clinical care for youth depression: an initial test of transportability to community clinics and clinicians

    J Consult Clin Psychol

    (2009)

    • Cited by (24)

    • Outcome Findings and Issues in Psychotherapy With Children and Adolescents: Internalizing Disorders

      2022, Comprehensive Clinical Psychology, Second Edition

    • Psychoeducational and Skill-building Interventions for Emotion Dysregulation

      2021, Child and Adolescent Psychiatric Clinics of North America
      Citation Excerpt :

      PEP is an example of the class of well-established interventions, family psychoeducation plus skill building for youth with mood disorders who experience considerable emotion dysregulation. The novel findings presented in this article support the efficacy of MF-PEP for reducing irritability and aggressive/disruptive behavior, whereas the summarized prior findings show benefits of MF-PEP for overall mood symptom severity18 and disruptive behavior.17 IF-PEP, especially when combined with omega-3 supplementation, also has been shown to reduce mood symptoms,23 disruptive behavior,24 and executive functioning deficits.25

    • How can adolescent aggression be reduced? A multi-level meta-analysis

      2020, Clinical Psychology Review

    • Comorbid disorders as moderators of response to family interventions among adolescents with bipolar disorder

      2019, Journal of Affective Disorders
      Citation Excerpt :

      DBDs (ODD and CD) were examined as one group due to the small sample of participants with CD (see Table 1). However, based on research indicating differential effects of multifamily psychoeducational psychotherapy (MF-PEP) on ODD and CD symptoms in youth with mood disorders (Boylan et al., 2013), we conducted secondary analyses examining ODD only. Analyses of variance (ANOVA) were used to examine differences across comorbidity groups (anxiety, ADHD, DBDs) and treatment groups (FFT versus EC) in the percentage of time with and without depressive or (hypo)manic symptoms over the 2-year study.

    • The role of family interventions in bipolar disorder: A systematic review

      2016, Clinical Psychology Review
      Citation Excerpt :

      In adolescents with BD and comorbid substance used disorder, preliminary findings of a pilot single-arm open treatment study on family focused treatment (Goldstein et al., 2014) indicated that the intervention might be effective in treating mood symptoms but the reduction in substance use was modest. Positive findings have been obtained with multifamily psychoeducation for youth with comorbid mood and disruptive behavior disorders (Boylan et al., 2013). Nevertheless, despite the differences between studies, the findings of this review support the benefits of adjunctive family intervention in BD.

    • Family-Based Interventions for Childhood Mood Disorders

      2015, Child and Adolescent Psychiatric Clinics of North America
      Citation Excerpt :

      In a pilot RCT, MF-PEP demonstrated greater improvements in family interactions and knowledge of mood disorders compared with WLC.41–43 In addition, comorbid behavior and anxiety disorders did not impede improvement in mood,44,45 and behavioral symptoms improved with treatment.44 These findings suggests that MF-PEP is efficacious in treating mood disorders and improving service engagement.

    View all citing articles on Scopus

    Dr. Boylan served as the statistical expert for this research.

    Disclosure: Dr. Fristad has received royalties for a treatment manual published by Guilford Press and multifamily psychoeducational psychotherapy (MF-PEP) workbooks (http://www.moodychildtherapy.com). She has also received funding from the National Institute of Mental Health. Dr. Boylan and Ms. MacPherson report no biomedical financial interests or potential conflicts of interest.

    View full text
    Copyright © 2013 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.