Many children suffer from disruptive behaviour or anxiety disorders, but access to care for this group is notoriously poor because there are so many barriers to receiving help. Psychotherapy takes time and there remains a lack of funding and a dearth of trained professionals to deliver quality care. Added to this is the stigma experienced by the children and their families, which often makes it extremely difficult for appropriate treatment to be found.
A new piece of research conducted by a team from Nova Scotia in Canada highlights a promising approach for children who are diagnosed with oppositional-defiant disorders (ODD), attention deficit hyperactivity disorders (ADHD) or anxiety disorders (AD).
The researchers conducted 3 randomised controlled trials and published the results together. They included 243 children in the study (80 with ODD, 72 with ADHD and 91 with AD) and randomised them to receive one of the two treatments being investigated:
- Treatment as usual
- Strongest Families Intervention. The treatment consisted of evidence-based handbooks and videos promoting skill-focused learning, and weekly telephone coaching sessions with the parent and/or child delivered by trained non-professionals. The anxiety group received 11-weekly telephone sessions and the ODD and ADHD groups received 12-weekly sessions; all 3 groups had booster calls 2 and 4 months after treatment completion.
Allocation was concealed and the assessors were blinded to the treatments. 95.9% of patients completed follow up and an intention to treat analysis was conducted for everyone in the trial.
The main outcome was a change of mental health diagnosis and this was measured at 120, 240 and 365 days.
Here’s what they found:
- When compared with treatment as usual the Strongest Families intervention significantly increased the likelihood of treatment success in children with ODD:
- at 120 days (p=0.01)
- and 240 days (p=0.04)
- but not 365 days (p=0.12)
- The Strongest Families intervention significantly increased the likelihood of treatment success in children with anxiety disorders or ADHD:
- at 240 days (p≤0.03)
- and 365 days (p=0.04)
- but not at 120 days (p≥0.1)
- When all three trials in the different disorders were combined, the Strongest Families intervention significantly increased treatment success at 120 days, 240 days and 365 days compared with usual care (p<0.001), with the Strongest Families intervention giving an odds ratio for success of 2.58 to 3.44 compared with usual care
The authors concluded:
Compared with usual care, telephone-based treatments resulted in significant diagnosis decreases among children with disruptive behavior or anxiety. These interventions hold promise to increase access to mental health services.
McGrath PJ, Lingley-Pottie P, Thurston C et al. Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. J Am Acad Child Adolesc Psychiatry. 2011 Nov;50(11):1162-72. Epub 2011 Sep 3. [PubMed abstract]