Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes - 23/09/17
, Donald Nathanson, LCSW a, Seth R. Axelrod, PhD b, Caitlin Merrill, BA c, Amy Walker, PhD d, Meredith Grossman, PhD e, James Rebeta, PhD f, Lawrence Scahill, MSN, PhD g, Joan Kaufman, PhD h, Barbara Flye, PhD a, Elizabeth Mauer, MS f, John Walkup, MD aAbstract |
Objective |
Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD.
Method |
Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants’ satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression–Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression–Severity scale.
Results |
Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C.
Conclusion |
DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C.
Clinical trial registration information—Adapting DBT for Children With DMDD: Pilot RCT; clinicaltrials.gov/; NCT01862549.
Le texte complet de cet article est disponible en PDF.Key words : dialectical behavior therapy, preadolescent children, disruptive mood dysregulation disorder, emotion dysregulation, randomized clinical trial
Plan
| Clinical guidance is available at the end of this article. |
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| This article was reviewed under and accepted by Ad Hoc Editor Argyris Stringaris, MD, PhD, MRCPsych. |
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| Grant support: K99/R00 MH087627 NIMH (PI - F. Perepletchikova); UL1 RR000457 NCATS (partial support for F. Perepletchikova); UL1-TR000457-06 NCATS (partial support for E. Mauer). |
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| Ms. Mauer served as the statistical expert for this research. |
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| Disclosure: Drs. Perepletchikova and Axelrod have served as trainers for Linehan’s DBT treatment dissemination company and have a contract with Guilford Press to convert the DBT-C treatment manual into a book. Dr. Scahill has served as a consultant to Neuren, Bracket, Roche, Shire, Supernus, and the Tourette Association of America. He has been a speaker for the Tourette Syndrome–Centers for Disease Control and Prevention outreach educational programs. He has received royalties from Oxford and Guilford. Dr. Walkup has received past research support from the National Institute of Mental Health for federally funded studies including free drug and placebo from Pfizer in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly and Co. in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette Association of America and The Hartwell Foundation. He has served as an unpaid advisor to the Anxiety Disorders Association of America and the Trichotillomania Learning Center. He has received honoraria and travel expenses for speaking engagements and meetings sponsored by the Tourette Association of America. He has received royalties from Guilford Press and Oxford University Press for multi-author books published about Tourette syndrome and from Wolters Kluwer for CME activity on childhood anxiety. He has served as a paid speaker for the Tourette Syndrome - Center for Disease Control and Prevention outreach educational programs, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. Drs. Walker, Grossman, Rebeta, Kaufman, Flye, Mr. Nathanson, Ms. Merrill, and Ms. Mauer report no biomedical financial interests or potential conflicts of interest. |
Vol 56 - N° 10
P. 832-840 - octobre 2017 Retour au numéro
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