OBJECTIVE: Service use trends showing increased off-label prescribing in very young children and reduced psychotherapy use raise concerns about quality of care for early disruptive behavior problems. Meta-analysis can empirically clarify best practices and guide clinical decision making by providing a quantitative synthesis of a body of literature, identifying the magnitude of overall effects across studies, and determining systematic factors associated with effect variations. METHOD: We used random-effects meta-analytic procedures to empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems, as well as potential moderators of treatment response. Thirty-six controlled trials, evaluating 3,042 children, met selection criteria (mean sample age, 4.7 years; 72.0% male; 33.1% minority youth). RESULTS: Psychosocial treatments collectively demonstrated a large and sustained effect on early disruptive behavior problems (Hedges' g = 0.82), with the largest effects associated with behavioral treatments (Hedges' g = 0.88), samples with higher proportions of older and male youth, and comparisons against treatment as usual (Hedges' g = 1.17). Across trials, effects were largest for general externalizing problems (Hedges' g = 0.90) and problems of oppositionality and noncompliance (Hedges' g = 0.76), and were weakest, relatively speaking, for problems of impulsivity and hyperactivity (Hedges' g = 0.61). CONCLUSIONS: In the absence of controlled trials evaluating psychotropic interventions, findings provide robust quantitative support that psychosocial treatments should constitute first-line treatment for early disruptive behavior problems. Against a backdrop of concerning trends in the availability and use of supported interventions, findings underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.
OBJECTIVE: Service use trends showing increased off-label prescribing in very young children and reduced psychotherapy use raise concerns about quality of care for early disruptive behavior problems. Meta-analysis can empirically clarify best practices and guide clinical decision making by providing a quantitative synthesis of a body of literature, identifying the magnitude of overall effects across studies, and determining systematic factors associated with effect variations. METHOD: We used random-effects meta-analytic procedures to empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems, as well as potential moderators of treatment response. Thirty-six controlled trials, evaluating 3,042 children, met selection criteria (mean sample age, 4.7 years; 72.0% male; 33.1% minority youth). RESULTS:Psychosocial treatments collectively demonstrated a large and sustained effect on early disruptive behavior problems (Hedges' g = 0.82), with the largest effects associated with behavioral treatments (Hedges' g = 0.88), samples with higher proportions of older and male youth, and comparisons against treatment as usual (Hedges' g = 1.17). Across trials, effects were largest for general externalizing problems (Hedges' g = 0.90) and problems of oppositionality and noncompliance (Hedges' g = 0.76), and were weakest, relatively speaking, for problems of impulsivity and hyperactivity (Hedges' g = 0.61). CONCLUSIONS: In the absence of controlled trials evaluating psychotropic interventions, findings provide robust quantitative support that psychosocial treatments should constitute first-line treatment for early disruptive behavior problems. Against a backdrop of concerning trends in the availability and use of supported interventions, findings underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.
Authors: Margaret J Briggs-Gowan; Alice S Carter; Joan Bosson-Heenan; Amanda E Guyer; Sarah M Horwitz Journal: J Am Acad Child Adolesc Psychiatry Date: 2006-07 Impact factor: 8.829
Authors: Laurence Greenhill; Scott Kollins; Howard Abikoff; James McCracken; Mark Riddle; James Swanson; James McGough; Sharon Wigal; Tim Wigal; Benedetto Vitiello; Anne Skrobala; Kelly Posner; Jaswinder Ghuman; Charles Cunningham; Mark Davies; Shirley Chuang; Tom Cooper Journal: J Am Acad Child Adolesc Psychiatry Date: 2006-11 Impact factor: 8.829
Authors: Helen Link Egger; Alaattin Erkanli; Gordon Keeler; Edward Potts; Barbara Keith Walter; Adrian Angold Journal: J Am Acad Child Adolesc Psychiatry Date: 2006-05 Impact factor: 8.829
Authors: Jantien Van Zeijl; Judi Mesman; Marinus H Van IJzendoorn; Marian J Bakermans-Kranenburg; Femmie Juffer; Mirjam N Stolk; Hans M Koot; Lenneke R A Alink Journal: J Consult Clin Psychol Date: 2006-12
Authors: Christine E Cooper-Vince; Mariah DeSerisy; Danielle Cornacchio; Amanda Sanchez; Katie A McLaughlin; Jonathan S Comer Journal: Dev Psychobiol Date: 2017-03-06 Impact factor: 3.038
Authors: Ernest N Jouriles; David Rosenfield; Renee McDonald; Nicole L Vu; Caitlin Rancher; Victoria Mueller Journal: J Clin Child Adolesc Psychol Date: 2016-06-30
Authors: Edward G Feil; Jason W Small; John R Seeley; Hill M Walker; Annemieke Golly; Andy Frey; Steven R Forness Journal: Behav Disord Date: 2016-02-01
Authors: Justin D Smith; Lauren Wakschlag; Sheila Krogh-Jespersen; John T Walkup; Melvin N Wilson; Thomas J Dishion; Daniel S Shaw Journal: Dev Psychopathol Date: 2019-12