Abstract
This study examined the effects of comorbid ADHD symptoms, internalizing psychopathology, Callous–Unemotional (CU) Traits, and conduct problem severity on children’s response to an evidence-based psychosocial intervention. Clinic-referred children with DBD ages 8–12 years (N = 76) participated in a 15-week multi-component intervention. Parents provided weekly ratings of children’s oppositionality-defiance, peer problems, and impairment. Oppositionality-defiance, peer problems, and impairment decreased significantly over the course of the intervention; however, there was considerable variability in weekly ratings. Baseline ADHD symptoms, internalizing psychopathology, CU traits, and conduct problem severity were unrelated to rate of change across treatment. However, ADHD symptoms uniquely predicted more oppositionality-defiance, peer problems, and impairment averaged across the 15 weeks of treatment. Follow-up analyses suggested this was driven by hyperactivity-impulsivity rather than inattention. Children with DBD and comorbid symptoms appear to benefit from a multi-component intervention, but those with ADHD symptoms may require additional support to address social and behavioral challenges.
Similar content being viewed by others
Notes
Published test–retest reliability values were not available for the single item measuring behavioral impairment and it was not possible to calculate internal consistency reliability given that only a single item is being used. Therefore, it was not possible to calculate the RCI for behavioral impairment.
References
Greene RW et al (2002) Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. Am J Psychiatry 159:1214–1224
Eyberg SM, Nelson MM, Boggs SR (2008) Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. J Clin Child Adolesc Psychol 37:215–237
The Conduct Problems Prevention Research Group (2002) Using the fast track randomized prevention trial to test the early-starter model of the development of serious conduct problems. Dev Psychopathol 14:925–943
Webster-Stratton C, Hammond M (1997) Treating children with early-onset conduct problems: a comparison of child and parent training interventions. J Consult Clin Psychol 65:93–109
Bakker MJ, Greven CU, Buitelaar JK, Glennon JC (2017) Practitioner review: psychological treatments for children and adolescents with conduct disorder problems—a systematic review and meta-analysis. J Child Psychol Psychiatry 58:4–18
Masi G et al (2013) Response to treatments in youth with disruptive behavior disorders. Compr Psychiatry 54:1009–1015
Waschbusch DA et al (2004) Investigation of the heterogeneity of disruptive behaviour in elementary-age children. Can J Behav Sci 36:97–112
Andrade BF, Wade M (2016) Latent profiles of externalizing psychopathology and their relation to children’s aggression and social behavior. J Dev Behav Pediatr 37:442–450
Kazdin AE, Whitley MK (2006) Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. J Consult Clin Psychol 74:455–467
Beauchaine TP, Webster-Stratton C, Reid MJ (2005) Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. J Consult Clin Psychol 73:371–388
Ollendick TH, Jarrett MA, Grills-Taquechel AE, Hovey LD, Wolff JC (2008) Comorbidity as a predictor and moderator of treatment outcome in youth with anxiety, affective, attention deficit/hyperactivity disorder, and oppositional/conduct disorders. Clin Psychol Rev 28:1447–1471
Frick PJ, Ray JV, Thornton LC, Kahn RE (2014) Annual research review: a developmental psychopathology approach to understanding callous-unemotional traits in children and adolescents with serious conduct problems. J Child Psychol Psychiatry 55:532–548
Kutcher S et al (2004) International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBDs): clinical implications and treatment practice suggestions. Eur Neuropsychopharmacol 14:11–28
Kolko DJ, Pardini DA (2010) ODD dimensions, ADHD, and callous–unemotional traits as predictors of treatment response in children with disruptive behavior disorders. J Abnorm Psychol 119:713–725
Costin JAN, Chambers SM (2007) Parent management training as a treatment for children with oppositional defiant disorder referred to a mental health clinic. Clin Child Psychol Psychiatry 12:511–524
Hartman RR, Stage SA, Webster-Stratton C (2003) A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors. J Child Psychol Psychiatry 44:388–398
McInnes A, Humphries T, Hogg-Johnson S, Tannock R (2003) Listening comprehension and working memory are impaired in attention-deficit hyperactivity disorder irrespective of language impairment. J Abnorm Child Psychol 31:427–443
Kurtz BE, Borkowski JG (1987) Development of strategic skills in impulsive and reflective children: a longitudinal study of metacognition. J Exp Child Psychol 43:129–148
Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J child Psychol psychiatry 40:57–87
Drabick DAG, Ollendick TH, Bubier JL (2010) Co-occurrence of ODD and anxiety: shared risk processes and evidence for a dual-pathway model. Clin Psychol 17:307–318
Beauchaine TP, Gartner J, Hagen B (2000) Comorbid depression and heart rate variability as predictors of aggressive and hyperactive symptom responsiveness during inpatient treatment of conduct-disordered, ADHD boys. Aggress Behav 26:425–441
Chase RM, Eyberg SM (2008) Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms. J Anxiety Disord 22:273–282
Frick PJ, Ray JV, Thornton LC, Kahn RE (2013) Can callous-unemotional traits enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review. Psychol Bull 140:1–57
Hawes DJ, Price MJ, Dadds MR (2014) Callous-unemotional traits and the treatment of conduct problems in childhood and adolescence: a comprehensive review. Clin Child Fam Psychol Rev 17:248–267
Dadds MR, Cauchi AJ, Wimalaweera S, Hawes DJ, Brennan J (2012) Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood. Psychiatry Res 199:201–207
Frick PJ, Cornell AH, Barry CT, Bodin SD, Dane HE (2003) Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. J Abnorm Child Psychol 31:457–470
Andrade BF, Sorge GB, Na JJ, Wharton-Shukster E (2014) Clinical profiles of children with disruptive behaviors based on the severity of their conduct problems, callous-unemotional traits and emotional difficulties. Child Psychiatry Hum Dev 46:567–576
Fleischman MJ (1981) A replication of Patterson’s intervention for boys with conduct problems. J Consult Clin Psychol 49:342–351
Waschbusch DA (2002) A meta-analytic examination of comorbid hyperactive-impulsive-attention problems and conduct problems. Psychol Bull 128:118–150
National Collaborating Centre for Mental Health. Antisocial behaviour and conduct disorders in children and young people. (2013). http://www.nice.org.uk/guidance/cg158/chapter/2-research-recommendations#parent-training-programmes-for-children-aged-12-years-and-over-with-a-conduct-disorder
Wells KC, Lochman JE, Lenhart LA (2008) Coping Power Parent Group Program. Oxford University Press, Oxford
Lochman JE, Wells KC, Lenhart LA (2008) Coping Power Child Group Program. Oxford University Press, Oxford
Muratori P et al (2017) Evaluation of improvement in externalizing behaviors and callous-unemotional traits in children with disruptive behavior disorder: a 1-year follow up clinic-based study. Adm Policy Ment Heal Ment Heal Serv Res 44:452–462
Lochman JE, Wells KC, Qu L, Chen L (2013) Three year follow-up of coping power intervention effects: evidence of neighborhood moderation? Prev Sci 14:364–376
Lochman JE, Wells KC (2002) The Coping Power Program at the middle school transition: universal and indicated prevention effects. Psychol Addict Behav 16:S40–S54
Lochman JE, Wells KC (2004) The Coping Power Program for preadolescent aggressive boys and their parents: outcome effects at the 1-Year follow-up. J Consult Clin Psychol 72:571–578
Powell N, Lochman JE, Boxmeyer CL, Barry TD, Pardini DA (2017) The Coping Power program for aggressive behavior in children. In: Weisz JR, Kazdin AE (eds) Evidence-based psychotherapies for children and adolescents. Guilford, New York, pp 159–176
NIMH-DISC Editorial Board (2000) The National Institute of Mental Health Diagnostic Interview Schedule for Children (Version 14)
Reynolds CR, Kamphaus RW (2004) Behavior Assessment System for Children (BASC-2). Pearson, London
Fabiano GA et al (2006) A practical measure of impairment: Psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. J Clin Child Adolesc Psychol 35:369–385
Kaufman AS, Kaufman NL (2004) Kaufman brief intelligence test. Pearson, London
Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol psychiatry 38:581–586
Stone LL, Otten R, Engels RC, Vermulst A, Janssens JM (2010) Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4- to 12-Year-olds: a review. Clin Child Fam Psychol Rev 13:254–274
Aitken M, Martinussen R, Wolfe RG, Tannock R (2015) Factor structure of the strengths and difficulties Questionnaire in a Canadian elementary school sample. Assess Eff Interv 40:155–165
Achenbach TM, Rescorla LA (2001) Manual for the ASEBA school-age forms and profiles. University of Vermont, Research Center for Children, Youth, & Families, Burlington
Stein S, Watson T, Wickstrom K (2007) Behavior assessment system for children, 2nd edn. In: Geisinger KF, Spies RF, Carlson JF, Plake BS (eds) The seventeenth mental measurements yearbook. Buros Centre for Testing, Lincoln
Reynolds CR, Kamphaus RW, Vannest KJ (2011) Encyclopedia of clinical neuropsychology. Springer, New York, pp 366–371. https://doi.org/10.1007/978-0-387-79948-3_1524
Waschbusch DA, Graziano PA, Willoughby MT, Pelham WE (2015) Classroom rule violations in elementary school students with callous-unemotional traits. J Emot Behav Disord 23:180–192
Frick PJ, Hare RD (2001) Antisocial processes screening device. Multi-Health Systems, North Tonawanda
Hawes SW et al (2014) Refining the parent-reported Inventory of Callous-Unemotional Traits in boys with conduct problems. Psychol Assess 26:256–266
Frick PJ (2004) Inventory of Callous-Unemotional Traits. University of New Orleans, New Orleans
Atkins MS, Pelham WE, Licht MH (1988) The development and validation of objective classroom measures of conduct and attention deficit disorders. In: Prinz RJ (ed) Advances in behavioral assessment of children and families. JAI Press, Greenwich, pp 3–31
Jacobson NS, Truax P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 59:12–19
Barkley R (1997) Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull 121:65–94
Bjørnebekk G, Kjøbli J (2017) Observed callousness as a predictor of treatment outcomes in parent management training. Clin Child Psychol Psychiatry 22:59–73
Stadler C et al (2008) Heart rate and treatment effect in children with disruptive behavior disorders. Child Psychiatry Hum Dev 39:299–309
Muthén BO, Muthén LK (2000) Integrating person-centered and variable-centered analyses: growth mixture modeling with latent trajectory classes. Alcohol Clin Exp Res 24:882–891
Acknowledgements
Dr. Andrade’s research has been funded by the Ontario Mental Health Foundation, the Canadian Child Health Clinician-Scientist Program, and Canadian Institutes of Health Research. Dr. Aitken’s research is supported by the CAMH Foundation. We thank Marcos Sanches for his guidance regarding the analyses.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Rights and permissions
About this article
Cite this article
Aitken, M., Waxman, J.A., MacDonald, K. et al. Effect of Comorbid Psychopathology and Conduct Problem Severity on Response to a Multi-component Intervention for Childhood Disruptive Behavior. Child Psychiatry Hum Dev 49, 853–864 (2018). https://doi.org/10.1007/s10578-018-0800-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10578-018-0800-1