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Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial

Published online by Cambridge University Press:  12 November 2013

S. Salzer ,
C. Cropp ,
U. Jaeger ,
O. Masuhr  and
A. Streeck-Fischer
S. Salzer*
Affiliation:
Clinic of Psychosomatic Medicine and Psychotherapy, University of Goettingen, Germany
C. Cropp
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
U. Jaeger
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
O. Masuhr
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
A. Streeck-Fischer
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany International Psychoanalytic University (IPU) Berlin, Germany
*
* Address for correspondence: S. Salzer, D.Sc., Clinic of Psychosomatic Medicine and Psychotherapy, Georg-August University of Goettingen, von-Siebold-Str. 5, 37075 Goettingen, Germany. (Email: ssalzer@gwdg.de)
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Abstract

Background

Co-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders.

Method

In a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up.

Results

The sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42–108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes.

Conclusion

PDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.

Keywords

Adolescentsconduct disorderin-patient treatmentpsychodynamic therapyrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 10 , July 2014 , pp. 2213 - 2222
Copyright
Copyright © Cambridge University Press 2013 

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References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Becker, A, Hagenberg, N, Roessner, V, Woerner, W, Rothenberger, A (2004). Evaluation of the self-reported SDQ in a clinical setting: do self-reports tell us more than ratings by adult informants? European Child and Adolescent Psychiatry 13 (Suppl. 2), II17–II24.CrossRefGoogle Scholar
Chanen, AM, Jovev, M, McCutcheon, LK, Jackson, HJ, McGorry, PD (2008). Borderline personality disorder in young people and the prospects for prevention and early intervention. Current Psychiatry Reviews 4, 48–57.CrossRefGoogle Scholar
Chanen, AM, McCutcheon, LM (2013). Prevention and early intervention for borderline personality disorder: current status and recent evidence. British Journal of Psychiatry 202, s24–s29.CrossRefGoogle Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Erlbaum Associates: Hillsdale, NJ.Google Scholar
Curtis, MN, Ronan, KR, Borduin, CM (2004). Multisystemic treatment: a meta-analysis of outcome studies. Journal of Family Psychology 18, 411–419.CrossRefGoogle ScholarPubMed
Derogatis, LR (1992). SCL-90-R, Administration, Scoring and Procedures – Manual-II for the R(evised) Version and Other Instruments of the Psychopathology Rating Scale Series. Clinical Psychometric Research: Townson, MD.Google Scholar
Dilling, H, Mombour, W, Schmidt, MH (eds) (1993). International Classification of Mental Disorders – ICD-10 German Version [in German]. Huber: Bern.Google Scholar
Doepfner, M, Lehmkuhl, G (2000). DISYPS-KJ. Diagnostic System of Mental Disorders in Childhood and Adolescence. Huber: Bern.Google Scholar
Essau, CA, Groen, G, Conradt, J, Turbanisch, U, Petermann, F (2001). Validity and reliability of the SCL-90-R: results from the Bremen Adolescent Study [in German]. Zeitschrift für Differentielle und Diagnostische Psychologie 22, 139–152.CrossRefGoogle Scholar
Eyberg, SM, Nelson, MN, Boggs, SR (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology 37, 215–237.Google Scholar
Ezpelata, L, Domènech, AA (2006). A comparison of pure and comorbid CD/ODD and depression. Journal of Child Psychology and Psychiatry 47, 704–712.Google Scholar
Farmer, EMZ, Compton, SN, Burns, BJ, Robertson, E (2002). Review of the evidence base for treatment of childhood psychopathology: externalizing disorders. Journal of Consulting and Clinical Psychology 70, 1267–1302.Google Scholar
Faul, F, Erdfelder, E, Lang, AG, Buchner, A (2007). G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods 39, 175–191.CrossRefGoogle ScholarPubMed
Fergusson, DM, Horwood, LJ, Ridder, EM (2007). Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug and Alcohol Dependence 88 (Suppl. 1), 14–26.Google Scholar
Franke, G (2002). SCL-90-R. Symptom-Checklist-90-R of L.R. Derogatis [in German]. Beltz Test: Göttingen.Google Scholar
Goodman, R (1997). The Strengths and Difficulties Questionnaire: a research note. Journal of Child Psychology and Psychiatry 38, 581–586.Google Scholar
Ingoldsby, EM, Kohl, GO, McMahon, RJ, Lengua, L (2006). Conduct problems, depressive symptomatology and their co-occurring presentation in childhood as predictors of adjustment in early adolescence. Journal of Abnormal Child Psychology 34, 603–621.Google Scholar
Jacobs, RH, Becker-Weidman, EG, Reinecke, MA, Jordan, N, Silva, SG, Rohde, P, March, JS (2010). Treating depression and oppositional behaviour in adolescents. Journal of Clinical Child and Adolescent Psychology 39, 559–567.Google Scholar
Kazdin, AE (2002). The state of child and adolescent psychotherapy research. Child and Adolescent Mental Health 7, 53–59.CrossRefGoogle ScholarPubMed
Leichsenring, F, Masuhr, O, Jaeger, U, Dally, A, Streeck, U (2010). The effectiveness of psychoanalytic-interactional therapy in borderline personality disorder. Bulletin of the Menninger Clinic 74, 206–218.Google Scholar
Leichsenring, F, Rabung, S (2006). Change norms: a complementary approach to the issue of control groups in psychotherapy outcome research. Psychotherapy Research 16, 594–605.Google Scholar
Littell, JH, Campbell, M, Green, S, Toews, B (2009 a). Multisystemic therapy for social, emotional, and behavioral problems in youth aged 10–17. Cochrane Database of Systematic Reviews. Issue 4, Art. No. CD004797.Google Scholar
Littell, JH, Winsvold, A, Bjorndal, A, Hammerstrom, KT (2009 b). Functional Family Therapy for families of youth (age 11–18) with behaviour problems. Cochrane Database of Systematic Reviews. Issue 2, Art. No. CD006561.Google Scholar
Loeber, R, Burke, JD, Pardini, DA (2009 a). Perspectives on oppositional defiant disorder, conduct disorder, and psychopathic features. Journal of Child Psychology and Psychiatry 50, 133–142.CrossRefGoogle ScholarPubMed
Loeber, R, Burke, JD, Pardini, DA (2009 b). Development and etiology of disruptive and delinquent behavior. Annual Review of Clinical Psychology 5, 291–310.Google Scholar
Loeber, R, Farrington, DP (2000). Young children who commit crime: epidemiology, developmental origins, risk factors, early interventions, and policy implications. Development and Psychopathology 12, 737–762.Google Scholar
Midgley, N, Kennedy, E (2011). Psychodynamic psychotherapy for children and adolescents: a critical review of the evidence base. Journal of Child Psychotherapy 37, 232–260.CrossRefGoogle Scholar
Miller, AL, Muehlenkamp, JJ, Jacobson, CM (2008). Fact or fiction: diagnosing borderline personality disorder in adolescents. Clinical Psychology Review 28, 969–981.Google Scholar
Mordre, M, Groholt, B, Kjelsberg, E, Sandstad, B, Myhre, AM (2011). The impact of ADHD and conduct disorder in childhood on adult delinquency: a 30 years follow-up study using official crime records. BMC Psychiatry 11, 1–10.Google Scholar
MTA Cooperative Group (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multimodal treatment study of children with ADHD. Archives of General Psychiatry 56, 1073–1086.Google Scholar
Odgers, CL, Caspi, A, Broadbent, JM, Dickson, N, Hancox, RJ, Harrington, H, Poulton, R, Sears, MR, Thomson, WM, Moffitt, TE (2007). Prediction of differential adult health burden by conduct problem subtypes in males. Archives of General Psychiatry 64, 476–484.Google Scholar
Odgers, CL, Moffitt, TE, Broadbent, JM, Dickson, N, Hancox, RJ, Harrington, H, Poulton, R, Sears, MR, Thomson, WM, Caspi, A (2008). Female and male antisocial trajectories: from childhood origins to adult outcomes. Development and Psychopathology 20, 673–716.Google Scholar
Pardini, D, White, HR, Stouthamer-Loeber, M (2007). Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood. Drug and Alcohol Dependence 88 (Suppl. 1), 38–49.Google Scholar
Raudenbush, SW, Bryk, AS (2002). Hierarchical Linear Models, 2nd edn. Sage: Newbury Park, CA.Google Scholar
Reef, J, Diamantopoulou, S, van Meurs, I, Verhulst, F, van der Ende, J (2009). Child to adult continuities of psychopathology: a 24-year follow-up. Acta Psychiatrica Scandinavica 120, 230–238.Google Scholar
Rey, JM, Morris-Yates, A, Singh, M, Andrews, F, Stewart, GW (1995). Continuities between psychiatric disorders in adolescents and personality disorders in young adults. American Journal of Psychiatry 152, 895–900.Google ScholarPubMed
Rohde, P, Clarke, GN, Mace, DE, Jorgensen, JS, Seeley, JR (2004). An efficacy/effectiveness study of cognitive-behavioral treatment for adolescents with comorbid major depression and conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry 43, 660–668.CrossRefGoogle ScholarPubMed
Sterne, JAC, White, IR, Carlin, JB, Spratt, M, Royston, P, Kenward, MG, Wood, AM, Carpenter, JR (2009). Multiple imputation for missing data in epidemiological and clinical research: potential and pitfalls. British Medical Journal 339, 157–160.Google Scholar
Streeck, U, Leichsenring, F (2009). Handbook of Psychoanalytic-Interactional Therapy. Treatment of Patients who Suffer from Structural Disorders and Severe Personality Disorders. Vandenhoeck & Ruprecht: Göttingen.Google Scholar
Streeck-Fischer, A (2002). In-patient psychotherapy with adolescents [in German]. Psychotherapie im Dialog 4, 353–361.Google Scholar
Streeck-Fischer, A (2008). The borderline personality (development) disorder during adolescence. psychological assessment, treatment prerequisites, framework design, treatment phases [in German]. Praxis der Kinderpsychologie und Kinderpsychiatrie 57, 693–717.Google Scholar
Streeck-Fischer, A (2013). Adolescence and borderline behavior – between personality development and personality disorder. Adolescent Psychiatry 3, 220–232.Google Scholar
Streeck-Fischer, A, Streeck, U (2010). Psychoanalytic-interactional psychotherapy of severely disturbed adolescents [in German]. Praxis der Kinderpsychologie und Kinderpsychiatrie 59, 435–452.Google Scholar
TADS Team (2003). Treatment for Adolescents with Depression Study (TADS): rationale, design, and methods. Journal of the American Academy of Child and Adolescent Psychiatry 42, 531–542.Google Scholar
Wechsler, D (1997). Wechsler Adult Intelligence Scale – Third Edition (WAIS-III) . Psychological Corporation: San Antonio, TX.Google Scholar
Wittchen, HU, Zaudig, M, Fydrich, T (1997). Structured Clinical Interview for DSM Disorders. German Version. Hogrefe: Göttingen.Google Scholar
Woerner, W, Becker, A, Friedrich, C, Klasen, H, Goodman, R, Rothenberger, A (2002). Normative data and evaluation of the German parent-rated Strengths and Difficulties Questionnaire (SDQ): results of a representative field study [in German]. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 30, 105–112.Google Scholar
Woolfenden, S, Williams, KJ, Peat, J (2009). Family and parenting interventions in children and adolescents with conduct disorder and delinquency aged 10–17. Cochrane Database of Systematic Reviews. Issue 2, Art. No. CD003015.Google Scholar