Adapting DBT for Children With DMDD: Pilot RCT

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.

Study Overview

• Status: Completed
• Conditions: Disruptive Mood Dysregulation Disorder
• Intervention / Treatment: Behavioral: Treatment as Usual; Behavioral: Dialectical Behavior Therapy for children

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 43
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • White Plains, New York, United States, 10605
      • Weill Cornell Medical College

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 7 years to 12 years (Child)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Ages 7 years 0 months to 12 years 11 months
2. Meet criteria for Disruptive Mood Dysregulation Disorder on DSM-IV
3. Stabilized on psychiatric medication (at least 6 weeks).
4. Able to be treated on the outpatient basis

Children with suicidal ideation, suicidal behavior and non-suicidal self-injury will be included (assessed using Columbia Suicide and Self-Injury Severity Rating Scale) unless other interventions are indicated (e.g., hospitalization, medication).

Exclusion Criteria:

1. Documented cognitive disability ( if records are not available will use < 85 IQ on Wechsler Intelligence Scale for Children-IV Information and Block Design subtests).
2. Current diagnosis of a psychotic disorder (on K-SADS-PL)
3. Pervasive Developmental Disorder (on K-SADS-PL)
4. Child in the English as Second Language program at school and/or caregivers have language difficulties as per self-report
5. Child is in state custody.
6. As consistent with DMDD diagnosis, child's co-morbid conditions better account for disruptive mood.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: DBT for children; Dialectical Behavior Therapy for children is a 32 session intervention (it consists of 2 pre-treatment sessions and 30 treatment sessions; treatment sessions are to be delivered in 32 weeks total) with once per week meetings, including 30 min. individual child therapy, 20 min. meeting with a caregiver and 40 min. of skills training with both.	Behavioral: Dialectical Behavior Therapy for children
Active Comparator: Treatment as Usual; Children in active comparison conditions will receive Treatment as Usual (TAU) that primarily consists of 32 weekly sessions of supportive individual psychotherapy and adjunctive family interventions. Individual therapy included cognitive behavioral skills training (e.g., psychoeducation, cognitive modifications, thought blocking) and non-directive supportive therapy. Family therapy includes parenting skills training (e.g., limit setting, reinforcement techniques), structuring household environment, and safety planning.	Behavioral: Treatment as Usual

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Attendance and drop-out rate measure	32 weeks
Therapy Satisfaction Questionnaire	32 weeks
Therapist Satisfaction Questionaire	32 weeks
Psychosocial Treatment Compliance Scale	32 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Clinical Global Impression Scale	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Mood Symptoms Questionnnaire	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Children Coping Strategies Checklist	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Emotion Regulation Checklist	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Child Behavior Checklist	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Social Skills Rating Scale	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Measure of Aggression, Violence and Rage in Children	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Affective Reactivity Index	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Columbia Suicide and Self-Injury Serevity Rating Scale	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Services Assessment Form	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Difficulties in Emotion Regulation Scale	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up
Parental Response to Children's Negative Emotions Scale	pre-treatment, 8, 16, 24, 32 weeks, 3-month follow-up

Collaborators and Investigators

• Sponsor: Weill Medical College of Cornell University
• Investigators: Principal Investigator: Francheska Perepletchikova, PhD, Weill Medical College of Cornell University

Publications and helpful links

General Publications

• Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, Rebeta J, Scahill L, Kaufman J, Flye B, Mauer E, Walkup J. Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. J Am Acad Child Adolesc Psychiatry. 2017 Oct;56(10):832-840. doi: 10.1016/j.jaac.2017.07.789. Epub 2017 Aug 10.

Helpful Links

• NCBI Link

Study record dates

Study Major Dates

• Study Start: May 1, 2013
• Primary Completion (Actual): December 1, 2015
• Study Completion (Actual): December 1, 2016

Study Registration Dates

• First Submitted: May 20, 2013
• First Submitted That Met QC Criteria: May 21, 2013
• First Posted (Estimate): May 24, 2013

Study Record Updates

• Last Update Posted (Actual): March 1, 2019
• Last Update Submitted That Met QC Criteria: February 27, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Other Study ID Numbers: 1205012350

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No