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Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data

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Abstract

Disruptive behavior disorders (DBDs) are common mental health problems among early childhood American youth that, if poorly managed, pose costly psychological and societal burdens. There is limited real world evidence on how parent management training (PMT) – the evidence-based treatment model of choice – implemented in common practice settings within the United States influences the behavioral progress of early childhood DBDs, and the risk factors associated with poor outcomes. This study used data from a measurement feedback system implemented within a U.S.-based private practice to study how behavioral outcomes change as a function of PMT treatment engagement and associated risk factors for 4–7 year-old children diagnosed with DBDs. Over 50% of patients reached optimal outcomes after 10 appointments. Attending 24–29 appointments provided maximum treatment effect – namely, 75% of patients reaching optimal outcomes by end of treatment. Outcomes attenuate after reaching the maximum effect. Patients also had higher odds of reaching optimal outcomes if they had consistent attendance throughout the treatment course. Notable risk factors associated with lower odds of reaching optimal outcomes included Medicaid insurance-type, greater clinical complexity, and having siblings concurrently in treatment. Increased implementation of systems that monitor and provide feedback on treatment outcomes in U.S.-based practice settings and similar investigations using its data can further enhance ‘real world’ management of early childhood DBDs among American youth.

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References

  • Abidin, R. R. (1995). Parenting stress Index Manual (3rd ed.). Psychological Assessment Resources.

  • Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4–18, YSR, and TRF profiles. Dept. of Psychiatry, University of Vermont.

  • Altmann, R. A., Reynolds, C. R., Kamphaus, R. W., & Vannest, K. (2019). BASC-3. In J. Kreutzer, J. DeLuca, & B. Caplan (Eds.), Encyclopedia of clinical neuropsychology. Springer International Publishing Springer.

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). American Psychiatric Association.

  • Austin, P. C., White, I. R., Lee, D. S., & van Buuren, S. (2021). Missing Data in Clinical Research: A tutorial on multiple imputation. Canadian Journal of Cardiology, 37(9), 1322–1331. https://doi.org/10.1016/j.cjca.2020.11.010.

    Article  PubMed  Google Scholar 

  • Becraft, J. L., Cataldo, M. F., Yu-Lefler, H. F., Schenk, Y. A., Edelstein, M. L., & Kurtz, P. F. (2023). Correspondence between data provided by parents and trained observers about challenging behavior. Behavior Analysis: Research and Practice, 23(4), 254–274. https://doi.org/10.1037/bar0000276.

    Article  Google Scholar 

  • Bickman, L. (2008). Why don’t we have effective Mental Health services? Administration and Policy. Mental Health and Mental Health Services Research, 35(6), 437–439. https://doi.org/10.1007/s10488-008-0192-9.

    Article  Google Scholar 

  • Bickman, L. (2012). Why can’t Mental Health services be more like Modern Baseball? Administration and Policy. Mental Health and Mental Health Services Research, 39(1–2), 1–2. https://doi.org/10.1007/s10488-012-0409-9.

    Article  Google Scholar 

  • Bornheimer, L. A., Acri, M. C., Gopalan, G., & McKay, M. M. (2018). Barriers to Service Utilization and Child Mental Health Treatment Attendance among Poverty-Affected Families. Psychiatric Services, 69(10), 1101–1104. https://doi.org/10.1176/appi.ps.201700317.

    Article  PubMed  Google Scholar 

  • Bremer, R. W., Scholle, S. H., Keyser, D., Houtsinger, J. V. K., & Pincus, H. A. (2008). Pay for performance in behavioral health. Psychiatric Services (Washington D C), 59(12), 1419–1429. https://doi.org/10.1176/ps.2008.59.12.1419.

    Article  PubMed  Google Scholar 

  • Bultas, M. W., McMillin, S. E., Broom, M. A., & Zand, D. H. (2017). Brief, Rapid Response, parenting interventions within primary care settings. The Journal of Behavioral Health Services & Research, 44(4), 695–699. https://doi.org/10.1007/s11414-015-9479-2.

    Article  Google Scholar 

  • Burlingame, G. M., Cox, J. C., Wells, M. G., Lambert, M. J., Latkowski, M., & Ferre, R. (2005). The Administration and Scoring Manual of the Youth Outcome Questionnaire. American Professional Credentialing Services.

  • Burt, S. A., Hyde, L. W., Frick, P. J., Jaffee, S. R., Shaw, D. S., & Tremblay, R. (2018). Commentary: Childhood conduct problems are a public health crisis and require resources: a commentary on Rivenbark et al () Journal of Child Psychology and Psychiatry, 59(6), 711–713. https://doi.org/10.1111/jcpp.12930.

  • Bybee, T. S., Lambert, M. J., & Eggett, D. (2007). Curves of expected recovery and their predictive validity for identifying treatment failure. Dutch Journal of Psychotherapy, 33, 419–434.

    Google Scholar 

  • Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., Lee, D., & Pulgarin, B. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child and Family Psychology Review, 19(3), 204–215. https://doi.org/10.1007/s10567-016-0205-2.

    Article  PubMed  Google Scholar 

  • Charles, J. M., Bywater, T., & Edwards, R. T. (2011). Parenting interventions: A systematic review of the economic evidence. Child: Care Health and Development, 37(4), 462–474. https://doi.org/10.1111/j.1365-2214.2011.01217.x.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20. https://doi.org/10.1007/s11020-005-1962-6.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., Phillips, L., Ward, A., Lynch, R., Trent, L., Smith, R. L., Okamura, K., & Starace, N. (2011). Evidence-based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness: Evidence-based treatments for children and adolescents. Clinical Psychology: Science and Practice, 18(2), 154–172. https://doi.org/10.1111/j.1468-2850.2011.01247.x.

    Article  Google Scholar 

  • Crockett, J. L., Yu-Lefler, H. F., Shumate, E. D., Benson, J. L., Karray, N., Perkins-Parks, S., & Riley, A. W. (2020). Retention in Outpatient Child Behavioral Health Services among Military and civilian families. The Journal of Behavioral Health Services & Research, 47(1), 126–138. https://doi.org/10.1007/s11414-019-09663-7.

    Article  Google Scholar 

  • de Jong, K. (2016). Challenges in the implementation of Measurement Feedback systems. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 467–470. https://doi.org/10.1007/s10488-015-0697-y.

    Article  PubMed  Google Scholar 

  • Dishion, T. J., Stormshak, E. A., & Kavanagh, K. (2011). Everyday parenting: A professional’s guide to building family management skills (1st ed.). Research.

  • Drugli, M. B., Fossum, S., Larsson, B., & Morch, W. T. (2010a). Characteristics of young children with persistent conduct problems 1 year after treatment with the incredible years program. European Child & Adolescent Psychiatry, 19(7), 559–565. https://doi.org/10.1007/s00787-009-0083-y.

    Article  Google Scholar 

  • Drugli, M. B., Larsson, B., Fossum, S., & Mørch, W. T. (2010b). Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training: Long-term outcome after parent training. Journal of Child Psychology and Psychiatry, 51(5), 559–566. https://doi.org/10.1111/j.1469-7610.2009.02178.x.

    Article  PubMed  Google Scholar 

  • Esri Incorporated (2019). ArcGIS Pro (2.4.2) [Computer software]. Esri Inc. https://www.esri.com/en-us/arcgis/products/arcgis-pro/.

  • Eyberg, S. M. (2013). Treating the Behaviorally Disordered Child. In G. P. Koocher, J. C. Norcross, & B. Greene (Eds.), Psychologists’ desk reference (Third edition, pp. 411–414). Oxford University Press.

  • Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology: The Official Journal for the Society of Clinical Child and Adolescent Psychology American Psychological Association Division, 53(1), 215–237. https://doi.org/10.1080/15374410701820117. 37.

    Article  Google Scholar 

  • Fleming, G. E., Kimonis, E. R., Datyner, A., & Comer, J. S. (2017). Adapting internet-delivered parent-child Interaction Therapy to treat Co-occurring disruptive behavior and callous-unemotional traits: A Case Study. Clinical Case Studies, 16(5), 370–387. https://doi.org/10.1177/1534650117699471.

    Article  Google Scholar 

  • Forehand, R., Lafko, N., Parent, J., & Burt, K. B. (2014). Is parenting the mediator of change in behavioral parent training for externalizing problems of youth? Clinical Psychology Review, 34(8), 608–619. https://doi.org/10.1016/j.cpr.2014.10.001.

    Article  PubMed  PubMed Central  Google Scholar 

  • Forehand, Jones, D. J., & Parent, J. (2013). Behavioral parenting interventions for child disruptive behaviors and anxiety: What’s different and what’s the same. Clinical Psychology Review, 33(1), 133–145. https://doi.org/10.1016/j.cpr.2012.10.010.

    Article  PubMed  Google Scholar 

  • Forehand, Parent, J., Linnea, K., Merchant, M. J., Long, N., & Jones, D. J. (2011). Why do parents seek help when their children’s behavior is within normative levels? Journal of Psychopathology and Behavioral Assessment, 33(4), 438–445. https://doi.org/10.1007/s10862-011-9254-5.

    Article  Google Scholar 

  • Garland, A. F., Haine-Schlagel, R., Brookman-Frazee, L., Baker-Ericzen, M., Trask, E., & Fawley-King, K. (2013). Improving community-based Mental Health Care for children: Translating knowledge into action. Administration and Policy in Mental Health and Mental Health Services Research, 40(1), 6–22. https://doi.org/10.1007/s10488-012-0450-8.

    Article  PubMed  Google Scholar 

  • Gatti, U., Grattagliano, I., & Rocca, G. (2019). Evidence-based psychosocial treatments of conduct problems in children and adolescents: An overview. Psychiatry Psychology and Law, 26(2), 171–193. https://doi.org/10.1080/13218719.2018.1485523.

    Article  Google Scholar 

  • Gopalan, G., Goldstein, L., Klingenstein, K., Sicher, C., Blake, C., & McKay, M. M. (2010). Engaging families into child mental health treatment: Updates and special considerations. Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal De l’Academie Canadienne De Psychiatrie De L’enfant Et De L’adolescent, 19(3), 182–196.

    PubMed  Google Scholar 

  • Green, A. L., Lambert, M. C., & Hurley, K. D. (2019). Measuring activation in parents of youth with emotional and behavioral disorders. The Journal of Behavioral Health Services & Research, 46(2), 306–318. https://doi.org/10.1007/s11414-018-9627-6.

    Article  Google Scholar 

  • Harpaz-Rotem, I., Leslie, D., & Rosenheck, R. A. (2004). Treatment retention among children entering a new episode of mental health care. Psychiatric Services (Washington D C), 55(9), 1022–1028. https://doi.org/10.1176/appi.ps.55.9.1022.

    Article  PubMed  Google Scholar 

  • Helander, M., Asperholm, M., Wetterborg, D., Öst, L. G., Hellner, C., Herlitz, A., & Enebrink, P. (2022). The efficacy of parent management training with or without involving the child in the treatment among children with clinical levels of disruptive behavior: A Meta-analysis. Child Psychiatry & Human Development. https://doi.org/10.1007/s10578-022-01367-y.

    Article  Google Scholar 

  • Herschell, A. D., McNeil, C. B., & McNeil, D. W. (2006). Clinical child psychology’s progress in disseminating empirically supported treatments. Clinical Psychology: Science and Practice, 11(3), 267–288. https://doi.org/10.1093/clipsy.bph082.

    Article  Google Scholar 

  • Johnson, C. A., & Katz, R. C. (1973). Using parents as Change agents for their children: A review. Journal of Child Psychology and Psychiatry, 14(3), 181–200. https://doi.org/10.1111/j.1469-7610.1973.tb01186.x.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E. (1995). Child, parent, and family dysfunction as predictors of outcome in cognitive behavioral treatment of antisocial children. Behavior Research and Therapy, 33, 271–281.

    Article  Google Scholar 

  • Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: Clinical results and practice suggestions. Journal of Clinical Psychology, 61(2), 165–174. https://doi.org/10.1002/jclp.20113.

    Article  PubMed  Google Scholar 

  • Larsson, B., Fossum, S., Clifford, G., Drugli, M. B., Handegård, B. H., & Mørch, W. T. (2009). Treatment of oppositional defiant and conduct problems in young Norwegian children: Results of a randomized controlled trial. European Child & Adolescent Psychiatry, 18(1), 42–52. https://doi.org/10.1007/s00787-008-0702-z.

    Article  Google Scholar 

  • Lindhiem, O., & Kolko, D. J. (2010). Trajectories of Symptom Reduction and Engagement during treatment for Childhood Behavior disorders: Differences across settings. Journal of Abnormal Child Psychology, 38(7), 995–1005. https://doi.org/10.1007/s10802-010-9416-z.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lindhiem, O., & Kolko, D. J. (2011). Trajectories of Symptom Reduction during treatment for behavior problems in Pediatric Primary-Care settings. Administration and Policy in Mental Health and Mental Health Services Research, 38(6), 486–494. https://doi.org/10.1007/s10488-011-0335-2.

    Article  PubMed  Google Scholar 

  • Lindhiem, O., Higa, J., Trentacosta, C. J., Herschell, A. D., & Kolko, D. J. (2014). Skill Acquisition and utilization during evidence-based psychosocial treatments for Childhood disruptive behavior problems: A review and Meta-analysis. Clinical Child and Family Psychology Review, 17(1), 41–66. https://doi.org/10.1007/s10567-013-0136-0.

    Article  PubMed  PubMed Central  Google Scholar 

  • Liu, F. F., Cruz, R. A., Rockhill, C. M., & Lyon, A. R. (2019). Mind the gap: Considering disparities in implementing measurement-based care. Journal of the American Academy of Child & Adolescent Psychiatry, 58(4), 459–461. https://doi.org/10.1016/j.jaac.2018.11.015.

    Article  Google Scholar 

  • Lochman, J. E., Boxmeyer, C., Powell, N., Dillon, C., Powe, C., & Kassing, F. (2017). Disruptive Behavior disorders. In C. A. Flessner, & J. C. Piacentini (Eds.), Clinical handbook of psychological disorders in children and adolescents: A step-by-step treatment manual (1st ed., pp. 299–328). The Guilford.

  • Malone, N. C., Williams, M. M., Fawzi, S., Bennet, M. C., Hill, J., Katz, C., J. N., & Oriol, N. E. (2020). Mobile health clinics in the United States. International Journal for Equity in Health, 19(1), 40. https://doi.org/10.1186/s12939-020-1135-7.

    Article  PubMed  PubMed Central  Google Scholar 

  • Michelson, D., Davenport, C., Dretzke, J., Barlow, J., & Day, C. (2013). Do evidence-based interventions work when tested in the real world? A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clinical Child and Family Psychology Review, 16(1), 18–34. https://doi.org/10.1007/s10567-013-0128-0.

    Article  PubMed  Google Scholar 

  • Mueller, C. W., Tolman, R., Higa-McMillan, C. K., & Daleiden, E. L. (2010). Longitudinal predictors of Youth Functional Improvement in a public Mental Health System. The Journal of Behavioral Health Services & Research, 37(3), 350–362. https://doi.org/10.1007/s11414-009-9172-4.

    Article  Google Scholar 

  • Muratori, P., Milone, A., Manfredi, A., Polidori, L., Ruglioni, L., Lambruschi, F., Masi, G., & Lochman, J. E. (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. Administration and Policy in Mental Health and Mental Health Services Research, 44(4), 452–462. https://doi.org/10.1007/s10488-015-0660-y.

    Article  PubMed  Google Scholar 

  • Nelson, P. L., Warren, J. S., Gleave, R. L., & Burlingame, G. M. (2013). Youth Psychotherapy Change trajectories and early warning system accuracy in a Managed Care setting: Youth outcomes and warning system accuracy. Journal of Clinical Psychology, 69(9), 880–895. https://doi.org/10.1002/jclp.21963.

    Article  PubMed  Google Scholar 

  • Parks, A. L., & O’Malley, P. G. (2016). From choosing wisely to practicing Value—more to the story. JAMA Internal Medicine, 176(10), 1571. https://doi.org/10.1001/jamainternmed.2016.5034.

    Article  PubMed  Google Scholar 

  • Reid, Rabideau, B., & Sood, N. (2016). Low-Value Health Care Services in a commercially insured Population. JAMA Internal Medicine, 176(10), 1567. https://doi.org/10.1001/jamainternmed.2016.5031.

    Article  PubMed  Google Scholar 

  • Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent training efficacy for child externalizing behavior problems—A meta-analytic review. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47(1), 99–111. https://doi.org/10.1111/j.1469-7610.2005.01544.x.

    Article  PubMed  Google Scholar 

  • Reynolds, C. R., & Kamphaus, R. W. (2004). The behavior assessment system for children (2nd ed.). Pearson.

  • Rivenbark, J. G., Odgers, C. L., Caspi, A., Harrington, H., Hogan, S., Houts, R. M., Poulton, R., & Moffitt, T. E. (2018). The high societal costs of childhood conduct problems: Evidence from administrative records up to age 38 in a longitudinal birth cohort. Journal of Child Psychology and Psychiatry, 59(6), 703–710. https://doi.org/10.1111/jcpp.12850.

    Article  PubMed  Google Scholar 

  • Stewart, R. E., Lareef, I., Hadley, T. R., & Mandell, D. S. (2017). Can we pay for performance in behavioral Health Care? Psychiatric Services (Washington D C), 68(2), 109–111. https://doi.org/10.1176/appi.ps.201600475.

    Article  PubMed  Google Scholar 

  • van Aar, J., Leijten, P., Orobio de Castro, B., & Overbeek, G. (2017). Sustained, fade-out or sleeper effects? A systematic review and meta-analysis of parenting interventions for disruptive child behavior. Clinical Psychology Review, 51, 153–163. https://doi.org/10.1016/j.cpr.2016.11.006.

    Article  PubMed  Google Scholar 

  • Weisz, J. R., & Gray, J. S. (2008). Evidence-based psychotherapy for children and adolescents: Data from the Present and a model for the future. Child and Adolescent Mental Health, 13(2), 54–65. https://doi.org/10.1111/j.1475-3588.2007.00475.x.

    Article  PubMed  Google Scholar 

  • Wertz, J., Agnew-Blais, J., Caspi, A., Danese, A., Fisher, H. L., Goldman-Mellor, S., Moffitt, T. E., & Arseneault, L. (2018). From Childhood Conduct problems to poor functioning at Age 18 years: Examining explanations in a Longitudinal Cohort Study. Journal of the American Academy of Child & Adolescent Psychiatry, 57(1), 54–60e4. https://doi.org/10.1016/j.jaac.2017.09.437.

    Article  Google Scholar 

  • Whipple, J. L., & Lambert, M. J. (2011). Outcome measures for practice. Annual Review of Clinical Psychology, 7(1), 87–111. https://doi.org/10.1146/annurev-clinpsy-040510-143938.

    Article  PubMed  Google Scholar 

  • Wilkie, D. P., Cicero, D. C., & Mueller, C. W. (2018). Disruptive Behavior Treatment Progress as a Function of Therapy Focus and Youth Diagnosis in a community Mental Health setting. Administration and Policy in Mental Health and Mental Health Services Research, 45(3), 484–494. https://doi.org/10.1007/s10488-017-0840-z.

    Article  PubMed  Google Scholar 

  • Yu-Lefler, H. F., Marsteller, J., & Riley, A. W. (2022). Outcomes accountability systems for early childhood disruptive behaviors: A scoping review of availability. Administration and Policy in Mental Health and Mental Health Services Research, 49(5), 735–756. https://doi.org/10.1007/s10488-022-01196-0.

    Article  PubMed  Google Scholar 

  • Yu-Lefler, H. F., Hsu, Y. J., Sen, A., & Marsteller, J. (2023). Service utilization for parent management of early childhood behavior problems in a private outpatient behavioral clinic: The impact of out-of-Pocket cost, Travel Distance, and initial treatment progress. Administration and Policy in Mental Health and Mental Health Services Research, 50(5), 834–847. https://doi.org/10.1007/s10488-023-01282-x.

    Article  PubMed  Google Scholar 

  • Yu-Lefler, Lindauer, S., & Riley, A. W. (2021). Clinician-identified factors in success of parent-Directed behavioral therapy for children’s tantrums. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-021-01155-1.

    Article  PubMed  Google Scholar 

  • Yu-Lefler, Riley, A. W., Wakeman, J., Rolinec, C., Clark, K. C., Crockett, J. C., Perkins-Parks, S., Richman, G., Lynne, S., Majszak, H., & Cataldo, M. F. (2019). A Clinical Outcomes System to Track Treatment Progress and Promote Care Accountability in Outpatient Pediatric Behavioral Healthcare. Poster of the 2019 annual meeting of the American Public Health Association (APHA), Philadelphia, PA.

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Acknowledgements

We thank the clinicians and clinical leadership at two outpatient behavioral therapy clinics at the Kennedy Krieger Institute for their commitment to treatment quality and participating as key informants in this study. We acknowledge the foundational efforts of the Director of the Department of Behavioral Psychology, Dr. Michael Cataldo, PhD., who supported and initially guided the investments to create the outcomes monitoring and feedback infrastructure within the outpatient behavioral psychology clinics. We also thank faculty from the Bloomberg School of Public Health who provided guidance in the development of this study.

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  1. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

    Helen Yu-Lefler, Jill Marsteller, Yea-Jen Hsu & Anne W. Riley

  2. Kennedy Krieger Institute, Baltimore, Maryland, USA

    Helen Yu-Lefler & Steven Lindauer

  3. Johns Hopkins School of Medicine, Baltimore, Maryland, USA

    Jill Marsteller, Steven Lindauer & Anne W. Riley

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Correspondence to Helen Yu-Lefler.

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Yu-Lefler, H., Marsteller, J., Hsu, YJ. et al. Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data. Res Child Adolesc Psychopathol (2024). https://doi.org/10.1007/s10802-024-01192-y

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