Effect of Comorbid Psychopathology and Conduct Problem Severity on Response to a Multi-component Intervention for Childhood Disruptive Behavior


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.

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    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.


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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.

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Correspondence to Brendan F. Andrade.

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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

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  • Conduct disorders
  • Treatment
  • Internalizing disorders
  • ADHD