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Published on: June 12, 2020
A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation
James G Waxmonsky1, Daniel A Waschbusch2, Peter Belin3
1Penn State College of Medicine, Hershey, PA; Herbert Wertheim College of Medicine and the Center for Children and Families, Florida International University, Miami.
Insights
This study found a joint parent-child therapy was feasible and effective for irritability in children with severe mood dysregulation (SMD) and ADHD, though it did not significantly improve overall mood symptoms compared to community treatment.
Area of Science:
- Child and Adolescent Psychiatry
- Behavioral Therapy
- Mood Disorders
Background:
- Nonepisodic irritability is a common problem leading to diagnoses of severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD).
- Psychosocial therapies for SMD/DMDD have not been formally evaluated; medication is the primary treatment.
- This study investigated a joint parent-child intervention for SMD in children with ADHD.
Purpose of the Study:
- To examine the feasibility and efficacy of a joint parent-child intervention for severe mood dysregulation (SMD).
- To assess the impact of the intervention on mood symptoms and irritability in children with ADHD and SMD.
Main Methods:
- 68 children (7-12 years) with ADHD and SMD were randomized to 11-week therapy or community treatment after medication stabilization.
- 56 participants with persistent SMD symptoms entered the therapy phase.
- Masked evaluators assessed outcomes at baseline, midpoint, endpoint, and 6-week follow-up.
Main Results:
- High attendance (n=29) and satisfaction were reported for the therapy group.
- The therapy did not significantly improve overall mood symptoms (MSI), but significantly improved parent-rated irritability (effect size = 0.63).
- Improvements in irritability were not sustained post-therapy; ADHD symptoms were unaffected.
Conclusions:
- The integrative, joint parent-child therapy demonstrated feasibility and efficacy for irritability in children with SMD and ADHD.
- While not superior to community treatment for overall mood, the therapy showed promise for managing irritability symptoms.
Objective:
Nonepisodic irritability is a common and impairing problem, leading to the development of the diagnoses severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD). No psychosocial therapies have been formally evaluated for either, with medication being the most common treatment. This study examined the feasibility and efficacy of a joint parent-child intervention for SMD.
Method:
A total of 68 participants aged 7 to 12 years with attention-deficit/hyperactivity disorder (ADHD) and SMD were randomly assigned to the 11-week therapy or community-based psychosocial treatment. All participants were first stabilized on psychostimulant medication by study physicians. Of the participants, 56 still manifested impairing SMD symptoms and entered the therapy phase. Masked evaluators assessed participants at baseline, midpoint, and endpoint, with therapy participants reassessed 6 weeks later.
Results:
All but 2 therapy participants attended the majority of sessions (n = 29), with families reporting high levels of satisfaction. The primary outcome of change in mood symptoms using the Mood Severity Index (MSI) did not reach significance except in the subset attending the majority of sessions (effect size = 0.53). Therapy was associated with significantly greater improvement in parent-rated irritability (effect size = 0.63). Treatment effects for irritability but not MSI diminished after therapy stopped. Little impact on ADHD symptoms was seen. Results may not be generalizable to youth with SMD and comorbidities different from those seen in this sample of children with ADHD, and are limited by the lack of a gold standard for measuring change in SMD symptoms.
Conclusion:
While failing to significantly improve mood symptoms versus community treatment, the integrative therapy was found to be a feasible and efficacious treatment for irritability in participants with SMD and ADHD.
Clinical Trial Registration Information:
Group-Based Behavioral Therapy Combined With Stimulant Medication for Treating Children With Attention Deficit Hyperactivity Disorder and Impaired Mood; http://clinicaltrials.gov/; NCT00632619.
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