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A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation - 22/02/16

Doi : 10.1016/j.jaac.2015.12.011 
James G. Waxmonsky, MD a, , Daniel A. Waschbusch, PhD b, Peter Belin, MD c, Tan Li, PhD d, Lysett Babocsai, PhD c, Hugh Humphery, MD c, Meaghan E. Pariseau, PhD e, Dara E. Babinski, PhD f, Martin T. Hoffman, MD g, Jenifer L. Haak, MD g, Jessica R. Mazzant, PhD h, Gregory A. Fabiano, PhD e, Jeremy W. Pettit, PhD h, Negar Fallahazad, BS d, William E. Pelham, PhD h
a Penn State College of Medicine, Hershey, PA; Herbert Wertheim College of Medicine and the Center for Children and Families, Florida International University, Miami 
b Penn State College of Medicine 
c Herbert Wertheim College of Medicine and the Center for Children and Families, Florida International University 
d Robert Stempel College of Public Health and Social Work, Florida International University 
e Counseling, School and Educational Psychology, SUNY Buffalo, Buffalo, NY 
f Penn State College of Medicine 
g SUNY Buffalo School of Medicine 
h Center for Children and Families, Florida International University 

Correspondence to James G. Waxmonsky, MD, Associate Professor of Psychiatry, Pennsylvania State University, Psychiatry, 500 University Drive, Dept of Psychiatry H073, Hershey Medical Center, Hershey, PA 17033Associate Professor of PsychiatryPennsylvania State UniversityPsychiatry500 University Drive, Dept of Psychiatry H073, Hershey Medical CenterHersheyPA 17033



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.


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.


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.


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; clinicaltrials.gov/; NCT00632619.

Le texte complet de cet article est disponible en PDF.

Key words : severe mood dysregulation, disruptive mood dysregulation disorder, ADHD, psychosocial treatment, group therapy


 Clinical guidance is available at the end of this article.
 After study completion, Drs. Waxmonsky, Waschbusch, and Babinski moved to Penn State.
 This study was fully funded by a grant from the National Institute of Mental Health (MH080791; Principal Investigator: Waxmonsky).
 Drs. Li and Waschbusch served as the statistical experts for this research.
 The authors thank Mary Fristad, PhD, of Ohio State University, and Charles Cunningham, PhD, of McMaster University, for consulting on this project and allowing use of their programs as guides for the development of the program, as well as John Lochman, PhD, of the University of Alabama, for allowing the authors to use his program as a guide for the development of AIM.
 Disclosure: Dr. Waxmonsky has received research funding from the National Institutes of Health (NIH), Noven Pharmaceuticals, and Shire Inc., served on the advisory board for Noven and Iron Shore, and provided CME talks funded by Quintiles Inc., in the past 3 years. Dr. Waschbusch has received funding from NIH. Dr. Fabiano has received funding from the Institute of Education Sciences (IES), the Administration for Children and Families (ACF), and NIH, and royalties from Guilford Press. Dr. Pettit has received research funding from the American Psychological Foundation and NIH, and book royalties from the American Psychological Association and New Harbinger Publications. Dr. Pelham has received funding from NIH, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, IES, and the Society of Clinical Child and Adolescent Psychology. Drs. Belin, Li, Babocsai, Humphrey, Pariseau, Babinski, Hoffman, Haak, Mazzant, and Ms. Fallahazad report no biomedical financial interests or potential conflicts of interest.

© 2016  American Academy of Child and Adolescent Psychiatry. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 55 - N° 3

P. 196-207 - mars 2016 Retour au numéro
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