SCCAP/APA Convention/2017/Advancements in Research and Practice with Childhood Externalizing Problems

Advancements in Research and Practice with Childhood Externalizing Problems

Session Chair: Deborah J. Jones, PhD, University of North Carolina at Chapel Hill

Eight-million (16%) U.S. children have a Disruptive Behavior Disorder (DBD), including Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD), which co-occur with Attention- Deficit/Hyperactivity Disorder (ADHD). The standard of care for DBDs, Behavioral Parent Training (BPT; also referred to as Parent Management Training), has a rich history and robust evidence base; however, not all families engage in and/or benefit from treatment. Given the ten-fold increase in healthcare, education, and criminal justice costs incurred by individuals, families and society for un/inadequately treated DBDs, innovations in assessment and treatment remain a clinical and public health imperative. Accordingly, this symposium aims to provide an integrated overview of state-of-thefield research on assessment and treatment with the most vulnerable children and families, including low income families, who are more likely to have a child with a DBD, those exposed to high levels of neighborhood disadvantage, and the subset of youth with callous unemotional (CU) traits who may be less responsive to BPT. In terms of assessment, Dr. Luke Hyde will present findings from his group's research on the Michigan Twin Neurogenetic Study (MTwiNS), which aims to advance genetically informed neural approaches to understanding the development of antisocial behavior. Moving onto treatment, Dr. Deborah Jones will present research that aims to optimize engagement of the most vulnerable families in the treatment of early-onset DBDs and, in turn, the opportunity for children and families to benefit. Finally, Dr. Sarah Haas will present research blending both assessment and treatment with a focus on the subset of children with DBDs characterized by higher levels of CU traits and how treatment may need to be adapted for more optimal treatment outcomes. Building upon the progress of this collective work, future research directions, as well as implications for clinical practice, will be discussed.

Genetically Informed Neural Approaches to Understanding the Development of Antisocial Behavior

Presenter: Luke Hyde, PhD, University of Michigan, Ann Arbor

Co-Authors: Arianna M. Gard, MS, University of Michigan, Ann Arbor; Laura Murray, MS, University of Michigan, Ann Arbor; Rachel Roberts, BS, University of Michigan, Ann Arbor; Rebecca Waller, PhD, University of Michigan, Ann Arbor; S. Alexandra Burt, PhD, Michigan State University

Recent reviews indicate that antisocial behavior (AB) emerges from dysfunction across multiple affective and cognitive control neural regions during tasks that tap inhibitory control, reward, and socioemotional processing (e.g., Hyde, et al., 2013). Emerging research further suggests that these same neural regions are affected by living in disadvantage (e.g., low SES, dangerous neighborhoods), a well-documented predictor of AB. However, the origin of these associations remain unclear, as links among disadvantage, AB, and neural function may reflect environmental processes (i.e., disadvantage alters the brain and behavior) or heritable processes (i.e., gene environment correlation explains the effects of disadvantage on brain and behavior). Genetically informed studies are thus needed to disentangle heritable versus environmental effects. I will present data from the Michigan Twin Neurogenetic Study (MTwiNS), a project in the broader Michigan State University Twin Registry (MSUTR), in which we are examining neural function in youth (age 9-15) exposed to normative or high levels of neighborhood disadvantage (N = 100 twin pairs). Data includes neural reactivity during fMRI as elicited by 3 distinct tasks tapping: socioemotional processing (emotional faces), reward processing (a modified monetary incentive delay task), and inhibitory control (Go/No-Go). Data collection and analyses are underway and will be complete by summer. I will present analyses linking neural reactivity in regions of interest during each task to self-, parent-, and clinician-rated AB. We will also examine the extent to which living in disadvantage predicts these differences in neural functioning and the extent to which monozygotic and dizygotic twins are similar (or diverge) in their neural reactivity to these tasks (i.e., the heritability of the task-related neural reactivity). Preliminary results on this cohort (N=22) indicate robust effects of neighborhood disadvantage on amygdala reactivity in response to emotional faces, ventral striatum reactivity to reward, and middle frontal gyrus reactivity during errors of commission.

Notes from session

coming soon!

Engagement of Low-Income Families in Treatment for Early Onset DBDS: The Role of Technology

Presenter: Deborah J. Jones, PhD, University of North Carolina at Chapel Hill
Co-Authors: Rex Forehand, PhD, University of Vermont; Olga Khavjou, PhD, Research Triangle International, Raleigh, NC; Margaret Anton, MA, University of North Carolina at Chapel Hill

Background: Low income families are more likely to have a child with an early onset (3 to 8 years old) disruptive behavior disorder (DBD), yet less likely to engage in state of the field treatment, Behavioral Parent training (BPT; see Jones et al., 2013 for a review). Innovative strategies to help low income families more effectively engage in and complete treatment in the context of higher levels of family stress associated with economic hardship are, in turn, critical to better meeting the needs of underserved families (see Jones, 2014 for a review).

Method: Low income families (N = 22) of children with early onset DBDs were randomized to either a standard mastery-based or technology-enhanced BPT. Sessions were monitored for fidelity and competence to the treatment manual via video review of sessions and weekly therapist supervision. Assessments were conducted pre- and post-treatment and families were paid $50/assessment.

Results: Each therapists’ first family served as a practice case for training purposes and 4 families dropped-out of treatment (2 from each group), yielding N = 19 families for analyses (Jones et al., 2013). Effect size analyses revealed that relative to standard BPT families, those randomized to technology-enhanced BPT were more likely to attend their weekly clinic-based treatment session, practice the skills at home, and to be available for the regularly scheduled mid-week call to problem solve skill progress and use at home. Moreover, analyses of trends within families randomized to technology-enhanced BPT suggest provide greater confidence that technology use in particular is associated with boosted engagement and treatment outcome (i.e., families who used the technology more evidenced relatively higher levels of engagement and better outcomes).  Although sunk costs for the technology-enhanced group were more expensive than standard BPT due to start-up costs (e.g., technology development), findings suggest that the implementation costs were less expensive primarily due to families requiring fewer sessions to master all program skills and complete treatment.

Conclusions: The availability and accessibility of cell phone technology among the low income creates new opportunities for connection with and support from the therapist between weekly treatment sessions and, in turn, caregiver autonomy using new skills for managing child behavior beyond the clinic setting and in the context of daily life.

Notes from session

coming soon!

The Impact of Standard and Modified Behavioral Treatment on the Behaviors of Children With Conduct Problems

Presenter: Sarah M. Haas, PhD, SUNY Buffalo
Co-Authors: Daniel Wasbusch, PhD, Penn State Hershey Medical Center; Michael T. Willoughby, PhD, Frank Porter Graham, Chapel Hill, NC; Sarah Helseth, MA, Florida International University; Kathleen Crum, BA, Florida International University; Amy Altszuler, MA, Florida International University; J. Megan Ross, MA, Florida International University; William Pelham, PhD, Florida International University

Background: Callous-unemotional (CU) traits tend to be associated with fewer behavioral treatment gains (Wilkinson, Waller, & Viding, 2015), and this may be due to CU traits being associate with a unique learning style in response to reward and punishment (Miller et al., 2011). This study examined the impact of two behavioral treatment packages that altered the emphasis on rewards and punishments.
Method: Participants were 45 children ages 7.0 to 12.6 years (M = 9.3, SD = 1.4), who attended an intensive eight-week Summer Treatment Program (STP) for children with disruptive behavior disorders (Pelham, Greiner, & Gnagy, 1998). All participants met diagnostic criteria for ADHD and ODD and had a t-score of 65 or above on CU scale of the Antisocial Process Screening Device as rated by the parent or teacher. Each child completed two packages of BT: standard BT (SBT; 4 weeks) in which rewards and punishments were used in a balanced manner and modified BT (MBT; 4 weeks) in which rewards were emphasized and punishments de-emphasized, with treatment order randomized. Treatment response was evaluated using parents and counselor ratings of Serious Conduct Problems, Rule Following Problems, and Overall Adjustment Problems. After treatment, counselors sorted children into treatment response groups.
Results: There were no differences between SBT and MBT according to counselor weekly ratings, but parents rated children as significantly less antisocial in MBT than in SBT, with effect sizes ranging from small to medium. Counselor data showed that 34% of children showed an equally positive response to either SBT or MBT, 27% responded best to SBT, 23% responded best to MBT, and 16% did not respond to either treatment.
Conclusions: Although behavioral treatment was generally effective for the majority of children with CP-CU, emphasizing reward and de-emphasizing punishment did not improve treatment outcomes of children with CP-CU s.Future research focused on understanding the importance of the consistency or salience of the contingency-outcome associations may be useful in understanding the learning styles and ultimately improving treatment response of children with CP-CU.

Notes from session

coming soon!

Other 2017 Resources

• Advancements in Research and Practice with Childhood Externalizing Problems
• Children's Mental Health in the Aftermath of Disaster
• Novel Approaches to Improve the Identification and Treatment of Suicide Risk
• Beyond Empirically Supported Treatments-Advances in the Evidence-Based Practice of Psychology