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Published on: February 11, 2017
Psychosocial treatment efficacy for disruptive behavior problems in very young children: a meta-analytic examination
Jonathan S Comer1, Candice Chow, Priscilla T Chan
1Early Childhood Interventions Program, Dept. of Psychology, Boston University, Boston, MA, USA. jcomer@bu.edu
Insights
Psychosocial treatments are highly effective for early disruptive behavior problems in children, showing significant improvements. These findings emphasize the need to increase access to these evidence-based interventions for young children.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Science
- Clinical Psychology
Background:
- Concerns exist regarding increased off-label prescribing and decreased psychotherapy for early disruptive behaviors.
- Meta-analysis offers a quantitative synthesis to clarify best practices and guide clinical decisions.
Purpose of the Study:
- To empirically evaluate the overall effect of psychosocial treatments on early disruptive behavior problems.
- To identify potential moderators of treatment response in young children.
Main Methods:
- Random-effects meta-analytic procedures were used.
- Thirty-six controlled trials involving 3,042 children (mean age 4.7 years, 72% male) were analyzed.
Main Results:
- Psychosocial treatments showed a large, sustained effect (Hedges' g = 0.82) on disruptive behaviors.
- Behavioral treatments yielded the largest effects (Hedges' g = 0.88), particularly for externalizing and oppositionality problems.
- Effects were strongest when compared against treatment as usual (Hedges' g = 1.17).
Conclusions:
- Psychosocial treatments are robustly supported as first-line interventions for early disruptive behavior problems.
- There is an urgent need to improve dissemination and remove barriers to accessing supported psychosocial care.
- Findings highlight the importance of evidence-based psychosocial interventions amidst concerning service use trends.
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.
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