Conduct Disorders in Adolescence, Oppositional Defiant Disorder
Conditions
Keywords
Adolescence, MBT, Conduct Disorder, Externalizing behaviour disorders, Treatment-as-usual
Brief summary
The goal of this clinical trial is to investigate if Mentalization-based therapy (MBT) is superior to enhanced usual care (treatment-as-usual-plus (TAU-plus)) for adolescents with disruptive behavior or dissocial disorders. MBT is an intervention that aims to improve mentalizing. Mentalizing is the ability to reflect on mental states in oneself and others that motivate behavior. TAU-plus consists of psychiatric care for the adolescent, along with additional emotion-focused skills training for the parents. Participants will be randomized in one of two groups using one study center.
Detailed description
The study includes adolescents between the ages 12 to 19 of any gender who have been diagnosed with Oppositional defiant or Conduct-dissocial disorder (serious problems with following rules or criminal behavior). The diagnosis is the primary outcome, which is assessed based on a diagnostic interview. Secondary outcomes include antisocial behavior, quality of life, symptom burden, and personality functioning (measured through self-report questionnaires), as well as aggressive behavior (measured through interview). During the study, there will be monthly process assessments. In these assessments, participants will be asked questions about mentalizing, emotion regulation, therapy experience, antisocial behavior, and how much they trust others. These variables are considered mediators of changes in outcome. Participants will also be interviewed regarding personality functioning to investigate whether dissocial disorders are related to personality disorders.
Interventions
BEHAVIORALMentalization-Based Therapy (MBT)
MBT is a manualized psychodynamic therapy based on attachment theory, designed to restore adolescents' mentalizing in general and in emotionally stressful situations and relationships. It targets to rebuilt epistemic trust, to successfully mentalize oneself and others.
BEHAVIORALTreatment-as-usual-plus (TAU-plus)
The adolescents receive supportive child psychiatric consultations. For the parents the EFST sessions combine mindfulness, theoretical input, and experiential practice. Parents learn and apply four core skills: validation, repair, motivation, and setting boundaries.
Sponsors
Vereinigung für analytische und tiefenpsychologisch fundierte Kinder- & Jugendlichen- Psychotherapie
University Hospital Heidelberg
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
12 Years to 19 Years
Healthy volunteers
No
Inclusion criteria
* Primary diagnosis of Oppositional defiant disorder (ODD) / Conduct-dissocial disorder (CDD) (ICD-11: 6C90-6C91; ICD-10: F91.0-F91.9; DSM-5: 312.81, 313.81) * Aged 12 to 19 years * Living with their parents * Provide written informed consent (plus parental consent for minors) * At least one parent provides written informed consent and agrees to active participation in treatment and study, including randomization
Exclusion criteria
* Severe acute substance dependence requiring inpatient detoxification * Acute psychotic symptoms or early-onset schizophrenia * Neurological impairments or intellectual disability (IQ \< 80) * Insufficient proficiency in German * Other clinical contraindications for outpatient psychotherapy (e.g., acute suicidality)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Remission rate based on diagnostic criteria for Disruptive behavior or Dissocial disorders | Day 0, Month 14 | Remission is defined as the proportion of participants no longer meeting full diagnostic criteria for Conduct-dissocial disorder (CDD) or Oppositional defiant disorder (ODD). CDD is assessed with the Diagnostisches Interview bei psychischen Störungen - Version für Jugendlichen (J-DIPS) and ODD with the Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (K-DIPS). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Social aggression assessed with the subscale from Subtypes of Antisocial Behavior Questionnaire (STAB) | day 0 month 11 and month 14 | Score range 11 - 55, with higher score representing higher value of Social aggression |
| Quality of life assessed with the Kidscreen 10 Index | day 0, month 11, month 14 | Score range: 10-50, with higher scores representing better quality of life |
| Symptom burden assessed with the Strengths and Difficulties Questionnaire (SDQ) | day 0, month 11, month 14 | Score range: 0 - 40, with higher score representing higher value of difficulties or strengths respectively |
| Aggressive behavior assessed with the german Modified Overt Aggression Scale (MOAS-D) | day 0, month 11 month 14 | Score range: 0 - 300, with higher score representing higher value of aggressive behavior |
| Gender typicality assessed with the Instrument zur Erfassung des Geschlechtsrollen-Selbstkonzepts im Jugendalter (GRI-JUG) | day 0, month 14 | There are four subscales - femenine positive and negative and Masculine positive and negative. Score range for each subscale: 1-5, with high scores indicate a high expression of the respective facet of the gender role self-concept. |
| Personality functioning assessed with the Level of Personality Functioning Brief Form (LPFS-BF) | day 0, month 11, month 14 | Score range: 12-48, with higher score representing higher value of personality pathology |
| Participation assessed with the mini self-rating for psychological activities and participation (Mini-ICF-APP) | day 0, month 14 | Score range: 0 - 7, with higher score represeting higher value of overall capacity level |
Countries
Germany
Contacts
Primary ContactMeike M. Hurrle, Dipl.-Psych.
Outcome results
None listed