None listed
Conditions
Brief summary
Approximately 30% of patients referred to the outpatient Mental Health service at The Royal Children’s Hospital present with significant and impairing irritability, aggression and mood dysregulation. Irritability and mood dysregulation are defined as a proneness to anger that is out of proportion to the situation and which often leads to verbally or physically aggressive outbursts. Children who are highly irritable have been found to have poorer quality of life, daily functioning, and social functioning, and are at very high risk of developing multiple psychiatric disorders. Currently however, there are no evidence based treatments for irritability. As such this study aims to assess the feasibility and acceptability of a behavioural treatment program in children (aged 6-15 years) referred to the RCH outpatient mental health service with severe irritability, and to explore the impact on child and family outcomes. Participants will be randomised into usual care (n=15) or a 6 session intervention (n=15). The intervention consists of six hour-long weekly sessions. All participants will be assessed three months post-randomisation to assess preliminary outcomes.
Interventions
The intervention is a psychological therapy called Collaborative & Proactive Solutions. It will be delivered by trained child psychiatrists or psychologists within a Child & Adolescent Mental Health Service. The intervention comprises 6x1 hour sessions once a week for six weeks (total of 6 sessions). The intervention is administered face-to-face with the child and parent/s. Sessions can include time with the parent/s alone, with the child alone, and with both the child and parent/s present. The structure of the intervention is as follows: (a) Identification of lagging skills and unsolved problems that contribute to temper outbursts, and a discussion of how existing parental responses may be counterproductive; (b) Prioritization—helping parents prioritize which unsolved problems will be the focal point of initial problem-solving discussions; (c) Introduction of the Plans framework— helping parents understand the three potential responses to solving problems: Plan A (solving a problem unilaterally, through imposition of adult will and often accompanied by adult-imposed consequences), Plan B (solving a problem collaboratively and proactively), and Plan C (setting aside the problem for now); and (d) Implementing Plan B—helping parents and children become proficient in the use of Plan B and largely discontinuing the use of Plan A. Although the clinician actively guides the problem-solving process initially, the goal of treatment is to help the child and parents become increasingly independent in solving problems together.
Sponsors
Study design
Eligibility
Inclusion criteria
Children aged 6-15 years referred to a Child and Adolescent Mental Health Service with a score of 4 or higher on the parent rated Affective Reactivity Index.
Exclusion criteria
- Major illness or disability (e.g., intellectual disability) - Non-English speaking - Children with a psychotic disorder (e.g. schizophrenia or bipolar disorder), a depressive disorder or considered to be at risk of self-harm will be excluded from the study.