Psychological interventions for delusions may be enhanced by targeting their presumed causal factors. An emotion-oriented variant of cognitive behavioral therapy for delusions (CBTd-E), designed to target affect regulation and maladaptive schemata, was evaluated for its effect on delusions. A single-blind, multicenter, randomized, waitlist-controlled trial was conducted in three German outpatient clinics. Ninety-four patients with psychotic disorders and persistent delusions were randomized to 25 individual sessions of CBTd-E over 6 months (n = 47) or waitlist (n = 47). CBTd-E included two modules designed to improve affect regulation and maladaptive schemata. Assessments were performed at baseline (T1), three months (T2), and six months (T3). Regression-based analysis of covariance at T3 in the intent-to-treat sample indicated no significant benefit for the CBT-E group in the primary outcome (Psychotic Symptom Rating Scale delusions subscale, d = -0.45 [CI: 0.36; -1.26]). Regarding secondary outcomes, a significant effect favoring CBTd-E was observed in general psychopathology (d = -0.56), but no effects on positive and negative symptoms, depression, general and social functioning, or antipsychotic dosage. Regarding the proposed target mechanisms, we found improved cognitive reappraisal (d = 0.59), worrying (d = -0.52), quality of sleep (d = -0.49), and self-esteem (d = 0.36). Despite its effect on the suggested target mechanisms, affect regulation and maladaptive schemata, and on general psychopathology, this emotion-focused variant of CBT did not show an effect on delusions. A possible avenue to achieve stronger effects on delusions is to personalize the modularized interventions. Trial registration: Clinicaltrials.gov Identifier: NCT02787135

Abstract Background This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD. Methods Participants were children (6;0–11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat. Results Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI [− 0.14, 0.13]; p = 0.95; d = –0.01, 95% CI [− 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = − 0.07, 95% CI [− 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms ( d = 0.29, 95% CI [0.00, 0.59], p = 0.05), and non-responders a large decrease ( d = − 1.00, 95% CI [− 1.27, − 0.73], p < 0.001). Conclusions TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH. Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details ; registered on December 18th 2015.

Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions. Participants were children (3–6 years) with either ADHD or oppositional defiant disorder (ODD) plus substantial ADHD symptoms. Study Step 1 (three months) comprised a randomised, waitlist-controlled trial on the efficacy of parent-directed telephone-assisted self-help (TASH). Based on the response to TASH, in Step 2 (six months), participants either received TASH booster sessions (full responders) or participated in another randomized controlled trial (partial/non-responders) comparing parent management and preschool teacher training (PMPTT) with treatment as usual (TAU). The primary outcome was change in blinded-clinician-rated ADHD and ODD symptoms. The primary analyses were by intention-to-treat. 189 children (79.9

BACKGROUND:The aim of this study was to develop and psychometrically evaluate a parent-rated parenting assessment scale including positive and negative dimensions of parenting. Factorial validity, reliability, measurement invariance, latent mean differences and construct validity of the Assessment Scale of Positive and Negative Parenting Behavior (FPNE) were tested in a pooled sample of five studies of 1,879 school-aged children (6.00 to 12.11 years). METHODS:Exploratory factor analysis (EFA) was performed on a first randomized split-half sample, and confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were conducted in the second half of the sample. Measurement invariance tests were conducted to assess factor structure equivalence across gender and age. RESULTS:The EFA results supported a two-factor structure and the CFA results revealed a model with two correlated factors (Positive Parenting, Negative Parenting), which included 23 items and showed acceptable model fit and good psychometric properties. ESEM did not yield a model with significantly better model fit. Internal consistencies were acceptable. Adequate concurrent validity was demonstrated by low to moderate correlations between the FPNE and similar constructs. The factor structure was invariant (configural, metric, scalar) across different age groups and gender. Tests of latent mean differences revealed that older children scored significantly higher on negative parenting than younger children, while boys showed lower levels of positive parenting and higher levels of negative parenting compared to girls. All effect sizes were small. CONCLUSIONS:The results suggest that the FPNE is a reliable and valid instrument for the assessment of parenting.

Abstract Background This study evaluates the psychometric properties of the newly developed semi-structured interview, Interview Version of the Symptoms and Functioning Severity Scale (SFSS-I), which is designed to provide a dimensional assessment of internalizing and externalizing symptoms. Methods Multi-informant baseline data from the OPTIE study was used, involving 358 children and adolescents aged 6 to 17 years (M = 11.54, SD = 3.4, n = 140 [39.1%] were female). Participants were screened for internalizing and externalizing symptoms. For validity analyses, caregiver (Child Behavior Checklist), youth (Youth Self Report), and teacher ratings (Teacher Report Form) were used. We performed Receiver Operating Characteristic (ROC) analyses to evaluate the effectiveness of the SFSS-I subscales in distinguishing between children and adolescents diagnosed with internalizing and externalizing disorders, as determined by clinical judgement in routine care. Results Confirmatory factor analyses supported a correlated two-factor model for internalizing and externalizing symptoms. Acceptable to good internal consistencies (α = 0.76 to 0.89; ω = 0.76 to 0.90) and excellent interrater reliability on the scale level (ICC ≥ 0.91) was found. The ROC analyses showed an acceptable accuracy in identifying internalizing diagnoses (AUC = 0.76) and excellent accuracy for externalizing diagnoses (AUC = 0.84). Conclusion The SFSS-I demonstrates potential as a clinically-rated instrument for screening and routine outcome monitoring, offering utility in both clinical practice and research settings for the dimensional assessment of broad psychopathological dimensions. Trial registration German Clinical Trials Register (DRKS) DRKS00016737 ( https://www.drks.de/DRKS00016737 ). Registered 17 September, 2019.

Studies on the treatment of attention-deficit/hyperactivity disorder (ADHD) in adolescence indicate small to moderate treatment effects (e.g., of parent training). Self-help interventions might overcome structural and personal barriers to treatment utilization. The present proof-of-concept study examined the feasibility and effectiveness of a twelve-month, telephone-assisted self-help (TASH) intervention for caregivers of adolescents with ADHD. This intervention comprised 8 booklets on the management of ADHD-related problems and 14 telephone counseling sessions. Sixty-six caregivers participated in the study with a one-group pretest-posttest design (intention-to-treat sample). Of these, forty-three families completed the intervention in accordance with the study protocol (per-protocol sample). Compared to families with early discontinuation (n = 23, drop-out sample), adolescents in the per-protocol sample demonstrated a higher level of caregiver-rated emotional problems and a lower level of quality of life at pre-assessment. Caregivers in the per-protocol sample showed high adherence and reported high satisfaction with the intervention. Analyses of the per-protocol sample yielded significant, moderate to large pre-to-post improvements in caregiver-rated ADHD symptoms (primary outcome; d = 0.81, 95

OBJECTIVE:This study examined the quality of therapeutic alliance from different rater perspectives (child, parent, therapist) in cognitive behavioural therapy for children with oppositional defiant disorder (ODD) and conduct disorder (CD), and its association with symptom severity. Further, a panel model with an autoregressive cross-lagged panel design was used to explore whether therapist-rated and parent-rated therapeutic alliance influences change in symptom severity, or vice versa.METHODS:Sixty boys aged 6-12 years with a principal diagnosis of ODD/CD, and their parents, received individually delivered social competence training for childhood aggressive behaviour problems. Child, therapist, and parent ratings of therapeutic alliance and symptom severity were measured twice.RESULTS:Our results indicate good to very good therapeutic alliance that was relatively stable over time. The cross-sectional analyses of the alliance-symptom association revealed moderate correlations. However, effects of early alliance on later treatment outcome or of early symptom severity on later alliance were marginal. The only significant association was found between early parent-rated therapist-parent alliance and later parent-rated symptom severity.CONCLUSION:Our study shows a moderate correlation between simultaneously assessed therapeutic alliance and symptoms. The findings of the panel model indicate that an early good therapeutic alliance is a component of later therapeutic success (parent perspective).

For children with externalising disorders, parent training programmes with different theoretical foundations are available. Currently, there is little knowledge concerning which programme should be recommended to a family based on their individual needs (e.g., single parenthood). The personalised advantage index (PAI) indicates the predicted treatment advantage of one treatment over another. The aim of the present study was to examine the usefulness of this score in providing individualised treatment recommendations. The analysis considered 110 parents (per-protocol sample) of children (4-11 years) with attention-deficit/hyperactivity (ADHD) or oppositional defiant disorder (ODD), randomised to either a behavioural or a nondirective telephone-assisted self-help parent training. In multiple moderator analyses with four different regression algorithms (linear, ridge, k-nearest neighbors, and tree), the linear model was preferred for computing the PAI. For ODD, families randomised to their PAI-predicted optimal intervention showed a treatment advantage of d = 0.54, 95% CI [0.17, 0.97]; for ADHD, the advantage was negligible at d = 0.35, 95% CI [-0.01, 0.78]. For children with conduct problems, it may be helpful if the PAI includes the treatment moderators single parent status and ODD baseline symptoms when providing personalised treatment recommendations for the selection of behavioural versus nondirective parent training. TRIAL REGISTRATION: The study was registered prospectively with ClinicalTrials.gov (Identifier NCT01350986).

To enhance the understanding of how symptoms of attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorders such as oppositional defiant disorder (ODD), conduct disorder (CD), including callous-unemotional (CU) traits, differentially relate to functional impairment (FI). Participants were 474 German school-age children (age: M = 8.90, SD = 1.49, 81% male) registered for participation in the ESCAschool trial (ESCAschool: Evidence-based, Stepped Care of ADHD in school-aged children ). Clinicians assessed the severity of individual symptoms and five FI domains specifically associated with ADHD symptoms or ODD/CD/CU symptoms using a semi-structured clinical interview. We conducted two multiple linear regression analyses, combined with relative importance analyses, to determine the impact of individual symptoms on global FI associated with ADHD and ODD/CD/CU symptoms. Next, we estimated two networks and identified the strongest associations of ADHD symptoms or ODD/CD/CU symptoms with the five FI domains. Symptoms varied substantially in their associations with global FI. The ADHD symptom Easily Distracted (15%) and ODD symptom Argues with Adults (10%) contributed most strongly to the total explained variance. FI related to academic performance, home life and family members, and psychological strain were most strongly associated with ADHD inattention symptoms, whereas FI related to relationships with adults and relationships with children and recreational activities were most strongly associated with hyperactivity-impulsivity symptoms. By comparison, the ODD/CD/CU symptoms most closely linked to FI domains originated from the ODD and CD dimensions. Our findings contribute to a growing body of literature on the importance of analyzing individual symptoms and highlight that symptom-based approaches can be clinically useful.

Background Based on the current state of research regarding the treatment in pediatric obsessive–compulsive disorder (OCD), cognitive behavioral therapy (CBT) (in severe cases with additional pharmacotherapy) is considered as the first-line treatment according to internationally recognized guidelines. Research is mostly based on randomized controlled trials (RCTs; efficacy research). Thus, examined treatment conditions, especially the treatment duration, and patients’ characteristics do not necessarily correspond to those found within routine care. Studies showed CBT packages as a whole to be efficacious, but less is known about the effects of individual CBT components. Furthermore, effects on comorbid symptoms or psychosocial impairment have been often neglected and different rater perspectives have been hardly considered in previous research. Methods This effectiveness study aimed to examine the effects of multimodal CBT in children, adolescents, and young adults (age 6–20 years) with OCD ( n = 38) within routine care. Effects on obsessive–compulsive and co-existing symptoms were evaluated in a within-subject design by comparing changes during the assessment phase with 12-week standard treatment and with individually tailored extended treatment. Additionally, within the standard treatment, non-exposure treatment was compared to exposure treatment. Multi-informant assessment was applied, and the analyses included multilevel modeling and t-tests for pre-post comparisons. Results During the standard treatment and extended treatment, obsessive–compulsive symptoms, strain, and functional impairment significantly decreased. Moreover, a significant reduction of overall comorbid symptoms emerged, particularly regarding internalizing symptoms, including anxiety and depression. Comparisons of treatment components indicated that adding exposure with response prevention (ERP) has an additional positive effect. Clinical improvement and remission rates increased considerably when more treatment sessions were provided. Conclusions These results suggest that improvement after an initial 12-week course of treatment may not allow for the prediction of non-responders/non-remitters and for the termination of treatment. Overall, the findings show that results from randomized controlled trials are transferrable to routine care. Trial registration number This study was registered retrospectively at the German Clinical Trials Register ( https://drks.de/search/de/trial/DRKS00030050 ).

Background:Children experiencing unfavorable family circumstances have an increased risk of developing externalizing symptoms. The present study examines the direct, indirect and total effects of family adversity, parental psychopathology, and positive and negative parenting practices on symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children with ADHD.Methods:Data from 555 children (M = 8.9 years old, 80.5% boys) who participated in a multicenter study on the treatment of ADHD (ESCAschool) were analyzed using structural equation modeling (SEM).Results:The SEM analyses revealed that (a) family adversity and parental psychopathology are associated with both child ADHD and ODD symptoms while negative parenting practices are only related to child ODD symptoms; (b) family adversity is only indirectly associated with child ADHD and ODD symptoms, via parental psychopathology and negative parenting practices; (c) the detrimental effect of negative parenting practices on child ADHD and ODD symptoms is stronger in girls than in boys (multi-sample SEM); (d) there are no significant associations between positive parenting practices and child ADHD or ODD symptoms.Conclusions:Family adversity, parental psychopathology, and negative parenting practices should be routinely assessed by clinicians and considered in treatment planning.Trial registration (18th December 2015): German Clinical Trials Register (DRKS) DRKS00008973.

The stability and effectiveness of the Treatment Program for Children with Aggressive Behavior (THAV) in terms of reducing behavioral problems in children with oppositional defiant disorder (ODD) and conduct disorder (CD) were examined at a 10-month follow-up (FU). A total of 76 families and their children (boys aged 6–12 years), who previously participated in a randomized controlled trial comparing THAV with an active control group, took part in the 10-month FU assessment. Outcome measures were rated by parents and included the evaluation of child aggressive behavior, prosocial behavior, problem-maintaining and problem-moderating factors, and comorbid symptoms. Linear mixed models for repeated measures (MMRM) were conducted. The results revealed that THAV effects remained stable (problem-maintaining and problem-moderating factors; comorbid symptoms) and even partially improved (aggressive behavior; ADHD symptoms) over the FU period. Additionally, the differences between the THAV intervention group and the control group, which were apparent at the end of the treatment (post), mainly also remained at the FU assessment. It can be concluded that THAV is an effective and stable intervention for boys aged 6–12 years with ODD/CD.

This study analyzes whether the association between parental internalizing symptoms (depression, anxiety, stress) and child symptoms of attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD) is mediated by positive and negative parenting behaviors. Cross-sectional data of 420 parents of children (age 6–12 years) with elevated levels of externalizing symptoms were collected in a randomized controlled trial. Measures included parent ratings of their internalizing symptoms and parenting behaviors and of their child’s externalizing symptoms. Two mediation models were examined, one including ADHD symptoms and one including ODD symptoms as the dependent variable. Parental internalizing symptoms were modeled as the independent variable and positive and negative parenting behaviors were modeled as parallel mediators. Regression analyses support negative parenting behavior as a mediator of the association between parental internalizing symptoms and child ODD symptoms. For the ADHD model, no significant mediator could be found. Future studies should use prospective designs and consider reciprocal associations.

BackgroundCognitive Behavior Therapy for psychosis (CBTp) effectively reduces positive symptoms, but the effects for delusions are small. Using approaches that focus on improving putative causal factors of delusions (emotion regulation [ER] and negative self-schemata) may be a way to improve CBTp for delusions.ObjectivesTo pilot an emotion-focused CBTp intervention comprised of cognitive-behavioral and third-wave interventions targeting ER and negative self-schemata (CBT-E) to investigate its feasibility and its potential efficacy.MethodsA single-blind 2-centered randomized wait-list controlled trial was performed. Patients with delusions in the context of a psychotic disorder (n = 64) were randomized to CBT-E (treatment group [TG]: n = 35) or wait list (WL: n = 29). TG received individual CBT-E in weekly sessions over 6 months, WL received CBT-E after a 6-month waiting time. Assessments were performed at baseline, after 6 months, and after 12 months.ResultsRates of patients who consented and retained in CBT-E suggest acceptable feasibility and high acceptance of CBT-E. Multiple regression analysis in the intent-to-treat sample revealed no significant advantage in favor of the TG in the primary outcome delusions (PSYRATS delusions, PDI), no effect on the mediators (ER, negative self-schemata) and a significant advantage in only one of the 8 secondary outcome variables, namely general psychopathology.DiscussionAlthough the intervention was feasible and acceptable, its effects on delusions did not hold up with the effects found for "targeted" approaches in previous research and it needs to be improved to produce a stronger effect on the targets ER and self-schemata before proceeding to a large-scale randomized-controlled trial. Clinicaltrials.gov-Identifier: NCT02787122.