Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder

Feasibility and Outcomes

Francheska Perepletchikova*, Donald Nathanson, Seth R. Axelrod, Caitlin Merrill, Amy Walker, Meredith Grossman, James Rebeta, Lawrence Scahill, Joan Kaufman, Barbara Flye, Elizabeth Mauer, John Walkup

*Corresponding author for this work

Research output: Contribution to journalArticle

10 Citations (Scopus)

Abstract

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; http://clinicaltrials.gov/; NCT01862549.

Original languageEnglish (US)
Pages (from-to)832-840
Number of pages9
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Volume56
Issue number10
DOIs
StatePublished - Oct 1 2017

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Behavior Therapy
Mood Disorders
Randomized Controlled Trials
Therapeutics
Irritable Mood
Feasibility Studies
Random Allocation
Psychiatry
Parents
Clinical Trials

Keywords

  • dialectical behavior therapy
  • disruptive mood dysregulation disorder
  • emotion dysregulation
  • preadolescent children
  • randomized clinical trial

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Perepletchikova, Francheska ; Nathanson, Donald ; Axelrod, Seth R. ; Merrill, Caitlin ; Walker, Amy ; Grossman, Meredith ; Rebeta, James ; Scahill, Lawrence ; Kaufman, Joan ; Flye, Barbara ; Mauer, Elizabeth ; Walkup, John. / Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder : Feasibility and Outcomes. In: Journal of the American Academy of Child and Adolescent Psychiatry. 2017 ; Vol. 56, No. 10. pp. 832-840.
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abstract = "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; http://clinicaltrials.gov/; NCT01862549.",
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Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder : Feasibility and Outcomes. / Perepletchikova, Francheska; Nathanson, Donald; Axelrod, Seth R.; Merrill, Caitlin; Walker, Amy; Grossman, Meredith; Rebeta, James; Scahill, Lawrence; Kaufman, Joan; Flye, Barbara; Mauer, Elizabeth; Walkup, John.

In: Journal of the American Academy of Child and Adolescent Psychiatry, Vol. 56, No. 10, 01.10.2017, p. 832-840.

Research output: Contribution to journalArticle

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T1 - Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder

T2 - Feasibility and Outcomes

AU - Perepletchikova, Francheska

AU - Nathanson, Donald

AU - Axelrod, Seth R.

AU - Merrill, Caitlin

AU - Walker, Amy

AU - Grossman, Meredith

AU - Rebeta, James

AU - Scahill, Lawrence

AU - Kaufman, Joan

AU - Flye, Barbara

AU - Mauer, Elizabeth

AU - Walkup, John

PY - 2017/10/1

Y1 - 2017/10/1

N2 - 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; http://clinicaltrials.gov/; NCT01862549.

AB - 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; http://clinicaltrials.gov/; NCT01862549.

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