Family-based treatments for disruptive behavior problems in children and adolescents: An updated review of rigorous studies (2014-April 2020)

Abstract

Disruptive behavior problems in youth are common and costly, lead to adverse outcomes, and are often left untreated. This article builds on previous work by providing an updated evaluation of family-based treatments based on results from randomized controlled trials (RCTs) for three populations: (1) children with disruptive behavior, (2) adolescents with disruptive behavior, and (3) adolescents with juvenile justice involvement. Using a comprehensive process, 28 new reports on 27 RCTs were identified for the 2014-April 2020 period, which when combined with the prior evidence base of all rigorous RCTs, resulted in 3 well-established, 11 probably efficacious, and 7 possibly efficacious family-based treatment categories. Many of the RCTs lent further support to existing treatment categories, more countries were represented, and several RCTs incorporated technology. Notable issues that remain include a limited number of family-based treatments for adolescents and for youth with juvenile justice involvement, as well as methodological concerns.

Keywords: delinquency; disruptive behavior; evidence-based practice; family therapy; parenting.

Figure 1. PRISMA Flow Diagram of Search and Selection Process for Stage 1: Empirical Literature Since Prior Reviews [2014-April 2020]

Note. RCT = randomized controlled trial. ^aBasic inclusion criteria are as follows: (1) focus on youth aged 3–19; (2) focus on disruptive behavior as a primary problem; and (3) evaluation of a psychosocial treatment that could be delivered in a community-based setting. Treatments requiring a (1) school-wide or classroom-based intervention, (2) facility outside the youth’s typical community (e.g., inpatient facility, wilderness camp), or (3) system-wide change in the way an existing facility operates (e.g., program requiring the entire JJ system to change operations) were excluded. ^bRegarding methods criteria, studies had to (1) involve an RCT design; (2) have treatments with manuals or a logical equivalent; (3) be conducted with a population treated for specified problems, for whom inclusion criteria were clearly delineated in a reliable, valid manner; (4) use reliable and valid outcome assessment measures gauging disruptive behavior problems; and (5) use appropriate data analyses and a sample size sufficient to detect expected effects (generally accepted as at least one condition with at least 20 cases and intent-to-treat research methods).