Category: Child / Adolescent - Externalizing
Disruptive behavior problems are the most commonly diagnosed psychiatric disorders in public mental health care systems. Fortunately, there are promising treatment methods that emphasize a focus on specific targets in treatment and therapeutic practices. That said, in public mental health settings, comorbidity rates are high and treatment often focuses on a wide variety of problem areas. It is unclear whether and to what extent treatment effectiveness varies by patterns in treatment targeting. The primary aim of this study was to examine whether monthly patterns of targeting on four different DSM-related categories affects concurrent monthly progress on disruptive behavior problems.
Clinical data from the first six months of treatment was collected from 613 youth receiving intensive in-home services via Hawai‘i’s Child and Adolescent Mental Health Division (CAMHD) from 2006 to 2012. This primarily multiethnic (66.7%) sample was mostly male (74.1%) with an average age of 14.1 years (SD = 2.8). Therapist-identified treatment targets and progress ratings were collected using the Monthly Treatment and Progress Summary. Therapists selected targets addressed during each month of treatment, and reported progress on each target relative to the youth’s pre-treatment baseline (on a 0 to 6 scale). Youth in the sample had at least one of three possible disruptive behavior treatment targets (anger, aggression, oppositional/non-compliant behavior) endorsed at least twice in the first six months of treatment. Nineteen treatment targets were reliably coded to one of four diagnostic categories (disruptive behavior, depressed mood, anxiety, ADHD; k = 0.67 - 0.90).
Multilevel modeling techniques indicated that each additional disruptive behavior target endorsed in a month lowered disruptive behavior progress (p < 0.001), suggesting a sort of limited improvement when multiple disruptive behavior symptoms are addressed. On the other hand, and contrary to expectations, higher rates of depressed mood treatment targeting in a given month predicted higher progress ratings on these same disruptive behaviors (p < 0.01). Targets related to anxiety disorders and ADHD did not predict disruptive behavior progress ratings.
Findings suggest youth with decreased disruptive behavior targeting and increased depressed mood targeting in treatment saw more progress during that treatment month on disruptive behaviors. Given the correlational nature of these counter-intuitive findings, there are a number of explanations worth further examination, including whether therapists target more disruptive behavior targets in more difficult treatment months while targeting more depressed mood targets in months in which disruptive behavior is less severe. Further possibilities and implications for effective treatment practices in community mental health will be explored and discussed.