A systematic review and meta-analysis found that psychosocial interventions involving families were the most effective intervention in the short term for adolescents with disruptive behavior disorders (DBDs). These findings were published in the Journal of the American Academy of Child & Adolescent Psychiatry.
Investigators at the University of Padua and University of Perugia in Italy searched publication databases through April 2020 for studies of psychosocial interventions for adolescents with DBDs. A total of 17 randomized controlled trials published between 1996 and 2017 were included.
The study population (N=1954) was 61% boys or men aged mean 14.09 (standard deviation [SD], 1.33) years. In total, 1016 participants received an intervention of psychotherapy (n=642), training (n=208), counselling (n=60), or combined interventions (n=106). The interventions were delivered in a group setting in 11 studies, a family setting in 3 studies, individually in 1 study, and a combination of delivery settings in 1 study. The control conditions were no treatment or waitlist (n=513) or an active nonpsychosocial intervention such as tutoring (n=503).
The psychosocial interventions were found to improve externalizing symptoms short term (standardized mean difference [SMD], -0.968; 95% CI, -0.55 to -1.385; P <.001; I2, 94.161%) without significant dropout, indicating acceptability (SMD, 1.265; 95% CI, 0.620-2.705; P =.491; I2, 23.741%). At follow-up there was little evidence of long term efficacy (SMD, -0.358; 95% CI, 0.063 to -0.779; P =.096; I2, 92.97%).
In a sensitivity analysis the interventions were effective in the short term when stratifying DBDs by structured criteria (SMD, -0.803; 95% CI, -1.107 to -0.5; P <.001; I2, 80.411%) and in studies without high risk for bias (SMD, -0.831; 95% CI, -0.447 to -1.216; P <.001; I2, 89.047%).
Short term efficacy was observed for psychotherapy (SMD, -1; P =.003), training (SMD, -0.881; P =.001), counseling (SMD, -0.726; P <.001), and mixed (SMD, -0.412; P =.004) interventions. For delivery methods, family (SMD, -1.464; P <.001), group (SMD, -0.991; P <.001), and mixed (SMD, -0.398; P =.012) interventions were effective at improving externalizing symptoms but an individual delivery was not effective (SMD, -0.012; 95% CI, -0.186 to 0.161; P =.89).
The duration of the intervention was found to be a significant moderator (P =.043). Age (P =.716) and gender (P =.412) were not moderators.
This analysis was limited by the significant study heterogeneity in the primary analysis.
“In conclusion, psychosocial interventions involving the family of adolescents with symptoms of or a full-blown DBD are effective and acceptable in the short term, but not at follow-up. Future studies should focus on strategies to maintain the efficacy of psychosocial interventions for DBDs over the long term, and real-world data on large collaborative cohorts of DBD adolescents treated with psychotherapy and other interventions are also needed,” stated the study authors.
Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Boldrini T, Ghiandoni V, Mancinelli E, Salcuni S, Solmi M. Systematic review and meta-analysis: Psychosocial treatments for disruptive behavior symptoms and disorders in adolescence. J Am Acad Child Adolesc Psychiatry. Published online May 9, 2022. doi:10.1016/j.jaac.2022.05.002