Study Finds Exposure to Interpersonal Violence May Affect Treatments for Behavior Disorders

Disruptive behavior disorders (DBD) are some of the most prevalent psychiatric conditions among children and adolescents. Examples of DBDs are conduct disorder, attention deficit disorder, and oppositional defiant disorder. There are a number of established interventions for children with DBD and their families. However, despite positive short-term outcomes, scientists are uncertain about the long-term benefits of interventions.  

According to previous research, approximately half of children with DBD continued to have or regained symptoms three to five years after they received treatment. Chad Shenk, Assistant Professor of Human Development and Family Studies, wanted to learn more about the factors that accounted for variations in a child’s response to treatment. Why did some children display less problematic behaviors, while others continued to act out? 

Children with DBD often have a history involving one or more interpersonal violence (IPV) experiences. IPV includes exposures to sexual and physical assault, domestic violence, and violence outside of the home. Researchers know that IPV increases the risk for DBD symptoms, neuroendocrine disruption, and callous-unemotional (CU) traits, which include severe emotional conditions like an extreme lack of empathy or an indifference to rules or laws. Children with CU traits typically have the most severe conduct problems. Dr. Shenk was curious if these IPV experiences were affecting treatment results.

“For decades researchers have studied the effectiveness of behavioral interventions and clinical trials that treat DBD,” Dr. Shenk said. “We wanted to see if the differences in outcomes depended on whether the child had been exposed to IPV or not.”

Dr. Shenk and his colleagues recruited 66 boys between the ages of 6 and 11, all of whom had received treatment for DBD symptoms. Using a 15-item questionnaire, the research team identified which of the participants had a history of IPV. Fifty-four percent of the participating boys had at least one IPV experience.

The research team conducted six treatment evaluations over a three-year period to examine the long-term effects of the treatment.  In the evaluations, CU traits, DBD symptoms, and cortisol levels were monitored. Individuals who are exposed to a traumatic event typically have high levels of cortisol, measured using saliva samples. The team predicted that for those boys with an IPV history, treatment would not be as successful over the long term.

“We found that the boys who had experienced at least one incident of IPV did far worse in their response to initial treatment,” Dr. Shenk said. “For boys who were not exposed to IPV, treatment successfully reduced symptoms to a significantly greater magnitude when compared to those boys with an IPV history.”

The research found that in addition to a lack of emotional symptoms from boys with IPV histories, interventions had little effect on cortisol trajectories for these boys as well, indicating no change in stress levels. These results provide a basis to screen for IPV before conducting interventions for DBDs. There are many evidence-based interventions that treat DBD. These programs aim to reduce emotional and behavioral problems among children by incorporating trauma-informed treatment components into DBD interventions

“Once clinicians find out that a child has an IPV history, it’s pretty clear—based on this research—that you need to do something more than the traditional treatment for DBD,” Dr. Shenk said.

Future steps include adding these trauma-focused components to interventions that treat DBD. The team will work on implementing the IPV screen into diagnostic practice and monitor its success in improving established interventions.