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.
Given the enormous individual, familial, and societal costs associated with early disruptive behavior disorders, transformative efforts are needed to develop innovative options for overcoming traditional barriers to effective care and for broadening the availability of supported interventions. This paper presents the rationale and key considerations for a promising innovation in the treatment of early-onset disruptive behavior disorders—that is, the development of an Internet-based format for the delivery of Parent-Child Interaction Therapy (PCIT) directly to families in their own homes. Specifically, we consider traditional barriers to effective care, and discuss how technological innovations can overcome problems of treatment availability, accessibility, and acceptability. We then detail our current Internet-delivered PCIT treatment program (I-PCIT), which is currently being evaluated across multiple randomized clinical trials relative to waitlist comparison, and to traditional in-office PCIT. Embedded video clips of children treated with I-PCIT are used to illustrate novel aspects of the treatment.
Four-year olds participated in versions of adult bargaining games (the ultimatum and dictator games) that were designed to test for understanding of fairness, reciprocity, and altruism and were adapted to be appropriate for their age group. They were also given endowment and theory of mind tasks. The results showed that young children were similar to adults in their preferences for fairness although they tended to make more altruistic offers. They also demonstrated some ability to think strategically about offers as well as some understanding of the importance of reciprocity in bargaining. But their ability to perform a cost-benefit analysis was limited as was their ability to act contingently. A third of the sample showed an endowment effect but whether a child showed this effect did not influence performance in the games. Those who passed theory of mind tasks were more likely to retain their endowment than those who did not. The results are discussed in relation to previous work and support the thesis that individuals may have an early and possibly innate propensity for fairness and altruism.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.