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A randomized controlled trial of a new intervention in early symptomatic syndromes eliciting neurodevelopmental
Mats Johnson1, Carina Gillberg2, Ingrid Vinsa2
1Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12A, 411 19, Gothenburg, Sweden. mats.johnson@gnc.gu.se.
Insights
Problem Resolution in ESSENCE (PR-ESSENCE) effectively improved behavior in youth with neurodevelopmental disorders. This program showed significant positive outcomes for children and adolescents, outperforming standard care.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Behavioral Therapy
Background:
- Youth with neurodevelopmental disorders (ESSENCE) often exhibit challenging behaviors, necessitating effective interventions.
- Existing programs like Parent Management Training and Collaborative Problem Solving have shown promise.
Purpose of the Study:
- To evaluate the efficacy of a novel intervention, Problem Resolution in ESSENCE (PR-ESSENCE), for children and adolescents with neurodevelopmental problems and challenging behaviors.
- To compare PR-ESSENCE to treatment as usual in a randomized controlled trial.
Main Methods:
- A 10-week randomized controlled trial involving 108 children and adolescents (aged 5-18) with ESSENCE.
- Participants were randomized 2:1 to either PR-ESSENCE or treatment as usual.
- Outcomes were assessed using blinded clinician ratings (CGI-I) and parent/child self-reports (SNAP-IV, ECBI, BYI).
Main Results:
- PR-ESSENCE demonstrated large treatment effects on the Clinical Global Impression-Improvement scale (Effect Size 1.48).
- Treatment responders were significantly higher in the PR-ESSENCE group (51.4%) compared to controls (5.6%).
- Medium to large effect sizes were observed for reductions in ADHD, ODD, and general behavior problems.
Conclusions:
- PR-ESSENCE is an effective intervention for improving global functioning, behavior problems, and disruptive behaviors in youth with ESSENCE.
- The treatment effects of PR-ESSENCE are comparable to established interventions, highlighting its potential as a valuable therapeutic option.
Abstract:
The need for effective intervention programs for youth with neurodevelopmental problems (ESSENCE) and challenging behaviour is great. This study examines Problem Resolution in ESSENCE (PR-ESSENCE), a newly developed model in which children and parents develop mutual problem resolution strategies. Ten-week randomized controlled trial of PR-ESSENCE for children and adolescents aged 5-18 years, compared to treatment as usual. Outcomes were assessed at baseline and randomized period endpoint. Primary outcome was the Clinical Global Impression-Improvement scale (CGI-I) rated by blinded assessors. Secondary outcomes were rated by parents-SNAP-IV, Eyberg Child Behavior Inventory (ECBI), Relationship Problems Questionnaire, Family Burden of Illness Module, and children-Beck Youth Inventories (BYI). ClinicalTrials.gov identifier: NCT03780413. The study enrolled 108 participants (active n = 72; controls n = 36, randomized 2:1), of whom 95 completed the randomized period. No clinically significant group differences were found in baseline characteristics. More than half had autism and 80% had ADD or ADHD. Large treatment effects were seen on CGI-I (ITT analysis, Effect Size 1.48). Treatment responders, much/very much improved on CGI-I, were 51.4% in active group and 5.6% of controls. Effect sizes were medium to large in parent ratings on SNAP-IV (ODD and ADHD symptoms), ECBI (behaviour problems), and in BYI child self-ratings of disruptive behaviour. PR-ESSENCE treatment improved global symptoms and functioning (CGI-I), behaviour problems, ADHD and ODD symptoms, and disruptive behaviour. Treatment effects were at least equivalent to those in previous studies of well-established Parent Management Training and Collaborative Problem Solving programs.
