Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence

Tommaso Boldrini; Viola Ghiandoni; Elisa Mancinelli; Silvia Salcuni; Marco Solmi

doi:10.1016/j.jaac.2022.05.002

Systematic Review and Meta-analysis: Psychosocial Treatments for Disruptive Behavior Symptoms and Disorders in Adolescence

J Am Acad Child Adolesc Psychiatry. 2023 Feb;62(2):169-189. doi: 10.1016/j.jaac.2022.05.002. Epub 2022 May 9.

Authors

Tommaso Boldrini¹, Viola Ghiandoni², Elisa Mancinelli³, Silvia Salcuni³, Marco Solmi⁴

Affiliations

¹ University of Padua, Via Venezia, Italy. Electronic address: tommaso.boldrini@unipd.it.
² University of Perugia, Perugia, Italy.
³ University of Padua, Via Venezia, Italy.
⁴ University of Ottawa, Ontario, Canada; The Ottawa Hospital, Ontario, Canada; Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program. University of Ottawa, Ontario; and Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.

PMID: 35551985
DOI: 10.1016/j.jaac.2022.05.002

Abstract

Objective: Disruptive behavior disorders (DBDs) represent a common motive for referral among youths. This meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs.

Method: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trials was conducted. Eligible studies were randomized controlled trials (RCTs) administering psychosocial interventions to adolescents with DBD, published before April 5, 2020. From the initial set of 6,006 records, 17 RCTs involving 18 cohorts (16 publications) were subjected to a random-effect meta-analysis (involving sensitivity, subgroup, and meta-regression analyses). Primary and secondary outcomes were externalizing symptoms at RCT endpoint (ie, standardized mean difference [SMD]) and acceptability (drop-out odds ratio [OR]), respectively. Risk of bias was assessed using the Risk of Bias 2 tool.

Results: A total of 17 RCTs, involving 1,954 adolescents, were included. The mean age was 14.09 (SD 1.33) years; 61% were male. The mean RCT 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. Psychosocial interventions had a large effect size at RCT endpoint (SMD = 0.98, 95% CI = -0.55 to -1.38, k = 18) and were acceptable (drop-out OR = 1.29, 95% CI = 0.62-2.70, k = 13). However, this beneficial effect did not persist at follow-up (SMD = -0.36, 95% CI = 0.06 to -0.78, k = 10). Family format was the most effective variable. No other clinically significant moderator was found.

Conclusion: Psychosocial interventions involving the families of DBD adolescents are effective and acceptable in the short term. Future studies should focus on strategies to achieve their long-term efficacy.

Keywords: adolescents; disruptive behavior; meta-analysis; psychosocial treatment.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adolescent
Child Behavior Disorders* / therapy
Female
Humans
Male
Problem Behavior*
Psychosocial Intervention*
Randomized Controlled Trials as Topic
Treatment Outcome