Psychosocial Treatment Efficacy for Disruptive Behavior Problems in Very Young Children: A Meta-Analytic Examination

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 52; no. 1; pp. 26 - 36
• Main Authors: Comer, Jonathan S., Ph.D, Chow, Candice, M.A, Chan, Priscilla T., M.A, Cooper-Vince, Christine, M.A, Wilson, Lianna A.S., M.A
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Elsevier Inc 01.01.2013; Elsevier; Elsevier BV
• Subjects: Adolescence; Age; Age Differences; aggression; Aggression - psychology; Attention Deficit and Disruptive Behavior Disorders - diagnosis; Attention Deficit and Disruptive Behavior Disorders - psychology; Attention Deficit and Disruptive Behavior Disorders - therapy; Behavior; Behavior Problems; Best Practices; Biological and medical sciences; Child; Child & adolescent psychiatry; Child clinical studies; Child Development Disorders, Pervasive - diagnosis; Child Development Disorders, Pervasive - psychology; Child Development Disorders, Pervasive - therapy; Child, Preschool; Children; Children & youth; Clinical trials; Decision making; Decision Support Techniques; Disruptive behaviour; Drug Therapy; early childhood; Effect Size; externalizing problems; Female; Gender Differences; Humans; Hyperactivity; impulsive behavior; Male; Medical sciences; Men; Meta Analysis; Miscellaneous; Modeling (Psychology); Off-Label Use; Outcomes of Treatment; parent training; Pediatrics; preschool; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychosocial factors; Psychosocial therapy; Psychotherapies. Psychological and clinical counseling; Psychotherapy; Psychotropic Drugs - therapeutic use; Quality of care; Randomized Controlled Trials as Topic; Resistance (Psychology); Reviews; Selection Criteria; Social behavior disorders; Systematic review; Treatments; Young Children; Young people; parent training; preschool; externalizing problems; early childhood; aggression; Human; Preschool age; Parent training; Aggression; Treatment efficiency; Disruptive behavior; Psychotherapy; Conduct disorder; Review; Metaanalysis; Treatment; Social behavior disorder; Child
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2012.10.001

Abstact Objective Service use trends showing increased off-label prescribing in very young children and reduced psychotherapy use raise concerns about quality of care for early disruptive behavior problems. Meta-analysis can empirically clarify best practices and guide clinical decision making by providing a quantitative synthesis of a body of literature, identifying the magnitude of overall effects across studies, and determining systematic factors associated with effect variations. Method We used random-effects meta-analytic procedures to empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems, as well as potential moderators of treatment response. Thirty-six controlled trials, evaluating 3,042 children, met selection criteria (mean sample age, 4.7 years; 72.0% male; 33.1% minority youth). Results Psychosocial treatments collectively demonstrated a large and sustained effect on early disruptive behavior problems (Hedges’ g = 0.82), with the largest effects associated with behavioral treatments (Hedges’ g = 0.88), samples with higher proportions of older and male youth, and comparisons against treatment as usual (Hedges’ g = 1.17). Across trials, effects were largest for general externalizing problems (Hedges’ g = 0.90) and problems of oppositionality and noncompliance (Hedges’ g = 0.76), and were weakest, relatively speaking, for problems of impulsivity and hyperactivity (Hedges’ g = 0.61). Conclusions In the absence of controlled trials evaluating psychotropic interventions, findings provide robust quantitative support that psychosocial treatments should constitute first-line treatment for early disruptive behavior problems. Against a backdrop of concerning trends in the availability and use of supported interventions, findings underscore the urgency of improving dissemination efforts for supported psychosocial treatment options, and removing systematic barriers to psychosocial care for affected youth.