Disruptive Mood Dysregulation Disorder Clinical Trial
Official title:
Adapting Dialectical Behavior Therapy for Children With Disruptive Mood Dysregulation Disorder: Pilot Randomized Clinical Trial
This study examines feasibility and preliminary efficacy of Dialectical Behavior Therapy adapted to children (DBT-C). DBT-C as compared to treatment-as-usual (TAU) is hypothesized to have lower drop-out rate, and higher treatment attendance and satisfaction. Further, DBT-C as compared to TAU will have significantly greater reduction in symptoms of Disruptive Mood Dysregulation disorder, including verbal and behavioral outbursts and angry/irritable mood.
Specific Aims:
I: Conduct Pilot Randomized Clinical Trial to evaluate feasibility and efficacy of DBT for
children with Disruptive Mood Dysregulation Disorder (DMDD) as compared with
Treatment-As-Usual (TAU) (up to 30 children and caregivers in DBT-C and up to 30 children and
caregivers in the treatment as usual comparison condition).
Specific Aim 1: Examine feasibility of DBT-C by evaluating the drop-out rates, number of
session attended, and treatment satisfaction and any differences in these rates by groups, as
well as therapist treatment adherence and competence.
Hypothesis 1: Attendance rate in DBT-C, as compared to TAU, will be at least 10% higher and
drop-out rate will be at least 10% lower (primary feasibility endpoint). Further, DBT-C, as
compared with TAU will have significantly higher treatment satisfaction rating by subjects
(on the child and caregiver Therapy Satisfaction Questionnaires), and by therapists (on
Therapist Satisfaction Scale), and higher patient compliance (on Psychosocial Treatment
Compliance Scale). Therapist treatment adherence and competence as measured by DBT-C
Treatment Integrity Scale, will not fall below 80%.
Specific Aim 2: Examine preliminary efficacy of DBT-C in reducing symptoms of Disruptive Mood
Dysregulation Disorder.
Hypothesis 2: Children in DBT-C condition as compared to TAU will have significantly greater
reduction in irritability, anger, aggression, temper outbursts, and mood instability (on
Clinical Global Impression - Improvement scale [primary categorical outcome] Exploratory Aim
3: Examine efficacy of DBT-C in improving adaptive coping skills, emotional and behavioral
regulation, social skills, and reducing aggressive behaviors, affective reactivity,
non-suicidal self-harm behaviors, suicidal ideations, suicidal attempts, and non-suicidal
self-harm urges.
Hypothesis 3: Children in DBT-C condition as compared to TAU will have significantly greater
improvement in adaptive coping skills (on the Children's Coping Strategies Checklist),
emotional and behavioral regulation (on the Emotion Regulation Checklist and Child Behavior
Checklist - Dysregulation Syndrome) and social skills (on the Social Skills Rating Scale),
and significantly greater reduction in aggressive behaviors (Measure of Aggression, Violence
and Rage in Children), affective reactivity (on the Affective Reactivity Index and Mood
Symptoms Questionnaire). ), and greater reduction in non-suicidal self-harm behaviors (in
Columbia Suicide and Self-Injury Severity Rating Scale [C-SSIS] self-injurious behaviors),
suicidal ideations (in the C-SSRS suicidal ideation classification category), suicidal
attempts (in C-SSIS suicide attempts category), and non-suicidal self-harm urges (in C-SSIS
self-injurious urges, no suicidal intent category).
Exploratory Aim 4: Examine efficacy of DBT-C in reducing the need for higher level services.
Hypothesis 4: Children in DBT-C condition as compared to TAU will have significantly fewer
psychiatric hospitalization, emergency room visits, total number of days inpatient, and
residential care placements (on the Services Assessment Form).
Exploratory Aim 5: Examine whether parent emotion regulation moderate the relationship
between intervention and outcomes, while parent ability to effectively cope with children's
negative emotions and children's coping skills and emotion regulation mediate outcomes.
Hypothesis 5: Parents' own emotion regulation (on the Difficulties in Emotion Regulation
Scale) will moderate outcomes and parents' ability to effectively cope with children's
negative emotions (on the Parental Response to Children's Negative Emotions), children coping
skills (on the Children's Coping Strategies Checklist) and emotion regulation (on Emotion
Regulation Checklist) will mediate outcomes.
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