The efficacy of psychosocial interventions in reducing disruptive behaviors among adolescence: The importance of family interventions

A study opens in new tab/window in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that, psychosocial interventions aimed at reducing adolescents’ disruptive behaviors associated with conduct disorder and oppositional defiant disorder were accepted and effective, at least in the short term. The study highlighted that interventions that included families had a greater benefit on adolescents’ disruptive behavior.

Disruptive behavior disorders (DBDs) represent a common motive for referral among youths, as they are associated with both psychological and social negative consequences in adolescence and adulthood. Therefore, a meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs was conducted. This study tried to go deeper, thereby further assessing if the interventions’ efficacy changed as a function of the intervention’s theoretical background (e.g, cognitive-behavioral, psychodynamic, etc.) as well as the overall format (e.g., individual interventions, groups interventions, family interventions, etc.).

Following standard practices for conducting meta-analyses [i.e., a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trial], 6,006 records published before April 2020 were screened. Ultimately, 17 RCTs involving 18 cohorts (16 publications) were included in the meta-analysis focusing on the level of adolescents’ externalizing symptoms at the end of the intervention and at follow-up to assess the interventions’ efficacy. Data were analyzed in aggregated form by calculating the standardized mean difference [SMD]. The interventions’ overall acceptability was also assessed through the odds ratio (OR) of drop-out rates, and the methodological quality of the studies was investigated through the Risk of Bias 2 tool.

Taken together, the included studies comprised a total of 1,954 adolescents with a mean age of 14.09 (SD = 1.33) years, of which 61% were male. The mean intervention duration was 12 weeks, with a mean follow-up of 8 (SD = 3.98) months. Concern over risk of bias emerged in 12 studies, with high concern in 6, thereby highlighting the need to improve the methodological standard of studies evaluating the considered interventions’ efficacy. In this regard, psychosocial interventions had a large effect size when assessed at the end of the intervention (SMD = 0.98, 95% CI = 0.55 to 1.38, k = 18) and, overall, were deemed acceptable (drop-out OR = 1.29, 95% CI = 0.62 to 2.70, k = 13). However, the beneficial effect of these interventions did not persist at follow-up (SMD = 0.36, 95% CI = 0.06 to 0.78, k = 10). Moreover, daily format was the most effective, while no difference as a function of intervention’s theoretical background emerged.

Overall, these results are relevant for several reasons. Specifically, the present study was the largest meta-analysis to date on psychosocial interventions for adolescents with DBDs, encompassing more than the n = 1,474 adolescents and n = 13 RCTs that the most recently meta-analysis published in 2017. Moreover, it was the first meta-analysis to specifically focus on adolescents with DBD. In this regard, results clearly showed that psychosocial interventions should be the first-line treatment for adolescents with a DBD. Furthermore, as the family intervention format showed the largest effect size, the present results suggest that psychosocial treatment for this population should focus explicitly on families. The general aim of family interventions is to decrease proximal risk factors while enhancing protective factors, in order to facilitate long-term behavioral change. As the findings highlighted the short-term effect of these interventions, it is paramount that future studies focus on strategies, particularly on family-focused interventions, to achieve their long-term efficacy.

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Notes for editors

The article is "Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence” Tommaso Boldrini, PhD, Viola Ghiandoni, MSc, Elisa Mancinelli, MSc, Silvia Salcuni, PhD, Marco Solmi, MD, PhD https://doi.org/10.1016/j.jaac.2022.05.002 opens in new tab/window. It currently appears on the JAACAP Articles In Press opens in new tab/window page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 62, issue 2 (February 2023), published by Elsevier opens in new tab/window.

Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at [email protected] opens in new tab/window or +1 202 587 9674. Journalists wishing to interview the authors may contact Tommaso Boldrini, PhD; e-mail: [email protected] opens in new tab/window

About JAACAP

Journal of the American Academy of Child and Adolescent Psychiatry opens in new tab/window (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

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