Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a Community Mental Health Setting

  • Daniel P. Wilkie
  • David C. Cicero
  • Charles W. Mueller
Original Article
  • 53 Downloads

Abstract

Monthly disruptive behavior treatment progress for 613 youth ages 7–18 receiving intensive in-home services was examined. Multilevel modeling indicated carrying a depressive mood diagnosis predicted less disruptive behavior progress compared to youth with only externalizing diagnoses. Paradoxically, more monthly focus on disruptive behavior treatment targets predicted lower concurrent progress ratings, while greater focus on depressive mood targets predicted greater disruptive behavior progress for youth with a depressive mood diagnosis. Findings held when other predictors of disruptive behavior progress were included as covariates, including episode length, youth age, and functional impairment. Treatment and research implications are discussed.

Keywords

Children’s mental health Disruptive behavior Depression Usual care Treatment targets 

Notes

Acknowledgements

This study was supported in part from a research and evaluation contract awarded to the third author by the State of Hawaii Department of Health, Child and Adolescent Mental Health Division.

References

  1. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th edn., text rev.). Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Washington, DC: Author.CrossRefGoogle Scholar
  3. Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87.CrossRefPubMedGoogle Scholar
  4. Baker-Ericzén, M. J., Hurlburt, M. S., Brookman-Frazee, L., Jenkins, M. M., & Hough, R. L. (2010). Comparing child, parent, and family characteristics in usual care and empirically supported treatment research samples for children with disruptive behavior disorders. Journal of Emotional and Behavioral Disorders, 18(2), 82–99.CrossRefGoogle Scholar
  5. Barlow, D. H., Farchione, T. J., Fairholme, C. P., Ellard, K. K., Boisseau, C. L., Allen, L. B., & Ehrenreich-May, J. T. (2011). Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press.Google Scholar
  6. Beauchaine, T. P., Hinshaw, S. P., & Pang, K. L. (2010). Comorbidity of attention-deficit/hyperactivity disorder and early-onset conduct disorder: biological, environmental, and developmental mechanisms. Clinical Psychology: Science and Practice, 17(4), 327–336.Google Scholar
  7. Beauchaine, T. P., Webster-Stratton, C., & Reid, M. J. (2005). Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis. Journal of Consulting and Clinical Psychology, 73(3), 371–388.CrossRefPubMedGoogle Scholar
  8. Bickman, L. (2000). The most dangerous and difficult question in mental health services research. Mental Health Services Research, 2(2), 71–72.CrossRefGoogle Scholar
  9. Borntrager, C. F., Chorpita, B. E., Higa-McMillan, C., & Weisz, J. R. (2009). Provider attitudes toward evidence-based practices: Are the concerns with the evidence or with the manuals. Psychiatric Service, 60, 677–681.CrossRefGoogle Scholar
  10. Boylan, K., Vaillancourt, T., & Szatmari, P. (2012). Linking oppositional behavior trajectories to the development of depressive symptoms in childhood. Child Psychiatry & Human Development, 43, 484–497.CrossRefGoogle Scholar
  11. Burke, J. D., Hipwell, A. E., & Loeber, R. (2010). Dimensions of oppositional defiant disorder as predictors of depression and conduct disorder in preadolescent girls. Journal of the American Academy of Child & Adolescent Psychiatry, 49(5), 484–492.Google Scholar
  12. Burke, J. D., Loeber, R., Lahey, B. B., & Rathouz, P. J. (2005). Developmental transitions among affective and behavioral disorders in adolescent boys. Journal of Child Psychology and Psychiatry, 46(11), 1200–1210.CrossRefPubMedGoogle Scholar
  13. Burke, J. D., Rowe, R., & Boylan, K. (2014). Functional outcomes of child and adolescent oppositional defiant disorder symptoms in young adult men. Journal of Child Psychology and Psychiatry, 55(3), 264–272.CrossRefPubMedGoogle Scholar
  14. Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2005). Service provider monthly treatment and progress summary. Honolulu, HI: Hawaii Department of Health, Child and Adolescent Mental Health Division.Google Scholar
  15. Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2008). Instructions and codebook for provider monthly treatment and progress summary. Honolulu, HI: Hawai’i Department of Health Child and Adolescent Mental Health Division.Google Scholar
  16. Child and Adolescent Mental Health Division, Hawai’i Department of Health Child and Adolescent Mental Health Division. (2012). Child and adolescent mental health performance standards. Retrieved from http://health.hawaii.gov/camhd.
  17. Copeland, W. E., Shanahan, L., Costello, E. J., & Angold, A. (2009). Childhood and adolescent psychiatric disorders as predictors of young adult disorders. Archives of General Psychiatry, 66(7), 764–772.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Daleiden, E., Lee, J., & Tolman, R. (2004). Annual evaluation report: Fiscal year 2004. Honolulu, HI: Hawaii Department of Health.Google Scholar
  19. Foster, E. M., & Jones, D. E. & The Conduct Problems Prevention Research Group. (2005). The high costs of aggression: Public expenditures resulting from conduct disorder. American Journal of Public Health, 95(10), 1767–1772.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Garland, A. F., Bickman, L., & Chorpita, B. F. (2010a). Change what? Identifying quality improvement targets by investigating usual mental health care. Administration and Policy in Mental Health and Mental Health Services Research, 37(1–2), 15–26.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Garland, A. F., Brookman-Frazee, L., Hurlburt, M. S., Accurso, E. C., Zoffness, R. J., Haine-Schlagel, R., et al. (2010b). Mental health care for children with disruptive behavior problems: A view inside therapists’ offices. Psychiatric Services, 61(8), 788–795.CrossRefPubMedPubMedCentralGoogle Scholar
  22. Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youths across five sectors of care. Journal of the American Academy of Child & Adolescent Psychiatry, 40(4), 409–418.CrossRefGoogle Scholar
  23. Heck, R. H., Thomas, S. L., & Tabata, L. N. (2013). Multilevel and longitudinal modeling with IBM SPSS: Quantitative methodology series (2nd edn.). New York: Routledge.Google Scholar
  24. Hinshaw, S. P., & Lee, S. S. (2003). Conduct and oppositional defiant disorders. In E. J. Mash & R. A. Barkley (Eds.), Child Psychopathology (pp. 144–198). New York: The Guilford Press.Google Scholar
  25. Hodges, K. (2000). Child and Adolescent Functional Assessment Scale. Ypsilanti, MI: Eastern Michigan University.Google Scholar
  26. Hodges, K., & Gust, J. (1995). Measures of impairment for children and adolescents. The Journal of Behavioral Health Services and Research, 22(4), 403–413.Google Scholar
  27. Hodges, K., & Wong, M. M. (1996). Psychometric characteristics of a multidimensional measure to assess impairment: The Child and Adolescent Functional Assessment Scale. Journal of child and Family Studies, 5(4), 445–467.CrossRefGoogle Scholar
  28. Jackson, D. S., Keir, S. S., Sender, M., & Mueller, C. W. (2017). Reliable change and outcome trajectories across levels of care in a mental health system for youth. Administration and Policy in Mental Health and Mental Health Services Research, 44(1), 141–154.CrossRefPubMedGoogle Scholar
  29. Jarrett, M., Siddiqui, S., Lochman, J., & Qu, L. (2014). Internalizing problems as a predictor of change in externalizing problems in at-risk youth. Journal of Clinical Child & Adolescent Psychology, 43(1), 27–35.CrossRefGoogle Scholar
  30. Kazdin, A. E. (1997). Conduct disorder across the life-span. In S. S. Luthar, J. A. Burack, D. Cicchetti & J. R. Weisz (Eds.), Developmental psychopathology: Perspectives on adjustment, risk, and disorder (pp. 248–272). Cambridge: Cambridge University Press.Google Scholar
  31. Kazdin, A. E. (2015). Treatment as usual and routine care in research and clinical practice. Clinical Psychology Review, 42, 168–178.CrossRefPubMedGoogle Scholar
  32. Loeber, R., Burke, J. D., & Pardini, D. A. (2009). Development and etiology of disruptive and delinquent behavior. Annual Review of Clinical Psychology, 5, 291–310.CrossRefPubMedGoogle Scholar
  33. Loeber, R., & Hay, D. (1997). Key issues in the development of aggression and violence from childhood to early adulthood. Annual Review of Psychology, 48, 371–410.CrossRefPubMedGoogle Scholar
  34. Love, A. R., Mueller, C. W., Tolman, R. T., & Powell, A. K. (2014). Frequency, level, and rate of improvement for treatment targets in a children’s mental health community-based intensive in-home therapeutic setting. Administration and Policy in Mental Health and Mental Health Services Research, 41(4), 421–433.CrossRefPubMedGoogle Scholar
  35. Love, A. R., Okado, I., Orimoto, T. E., & Mueller, C. W. (2016). Factor analysis of therapist-identified treatment targets in community-based children’s mental health. Administration and Policy in Mental Health and Mental Health Services Research.  https://doi.org/10.1007/s10488-016-0770-1 Google Scholar
  36. Matro, A. T., Milette-Winfree, M., Wilkie, D. P., Jackson, D., Maesaka, T., & Mueller, C. W. (2017, November). Limited early progress predicts unsuccessful treatment discharge in public mental health services for youth. Poster to be presented at the 51st Annual Convention of the Association for Behavioral and Cognitive Therapies. San Diego, CAGoogle Scholar
  37. Milette-Winfree, M., & Mueller, C. (2017). Treatment-as-usual therapy targets for comorbid youth disproportionately focus on externalizing problems. Psychological Services.  https://doi.org/10.1037/ser0000162 PubMedGoogle Scholar
  38. Moffitt, T. E., Caspi, A., Harrington, H., & Milne, B. J. (2002). Males on the life-course-persistent and adolescent-limited antisocial pathways: Follow-up at age 26 years. Development and Psychopathology, 14, 179–207.CrossRefPubMedGoogle Scholar
  39. Mueller, C., Tolman, R., Higa-McMillan, C. K., & Daleiden, E. (2010). Longitudinal predictors of youth functional improvement in a public mental health system. Journal of Behavioral Health Services and Research, 37, 350–362.CrossRefPubMedGoogle Scholar
  40. Nakamura, B. J., Daleiden, E. L., & Mueller, C. W. (2007). Validity of treatment target progress ratings as indicators of youth improvement. Journal of Child and Family Studies, 16(5), 729–741.CrossRefGoogle Scholar
  41. Newcorn, J. H., & Halperin, J. M. (2000). Attention-deficit disorders with oppositionality and aggression. In. In T. E. Brown (Ed.), Attention-deficit disorders and comorbidities in children, adolescents, and adults (pp. 171–207). Washington, DC: American Psychiatric Press, Inc.Google Scholar
  42. Nezu, A. M., & Nezu, C. M. (1993). Identifying and selecting target problems for clinical interventions: A problem-solving model. Psychological Assessment, 5(3), 254–263.  https://doi.org/10.1037/1040-3590.5.3.254.CrossRefGoogle Scholar
  43. Scott, S., Knapp, M., Henderson, J., & Maughan, B. (2001). Financial cost of social exclusion: Follow up study of antisocial children into adulthood. British Medical Journal, 323, 191–194.CrossRefPubMedPubMedCentralGoogle Scholar
  44. Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.CrossRefGoogle Scholar
  45. Stalk, H., Love, A., & Mueller, C. (2015). Age of conduct disorder onset and comorbid anxiety and depression. Journal of Forensic Psychiatry and Psychology, 26, 337–350.CrossRefGoogle Scholar
  46. Stringaris, A. (2011). Irritability in children and adolescents: A challenge for DSM-5. European Child & Adolescent Psychiatry, 20, 61–66.CrossRefGoogle Scholar
  47. Weisz, J. R., Donenberg, G. R., Han, S. S., & Kauneckis, D. (1995). Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity? Journal of Abnormal Child Psychology, 23(1), 83–106.CrossRefPubMedGoogle Scholar
  48. Wilkie, D. P., Orimoto, T. E., Miyamoto, K. D., Stalk, H. L., & Mueller, C. W. (2016). Comorbidity of psychiatric disorders. In R. Levesque (Ed.), Encyclopedia of adolescence (2nd ed.). New York: Springer.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Daniel P. Wilkie
    • 1
  • David C. Cicero
    • 1
  • Charles W. Mueller
    • 1
  1. 1.Department of PsychologyUniversity of Hawai‛i at MānoaHonoluluUSA

Personalised recommendations