Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Procedure
2.3. Measures
2.4. Treatment
2.4.1. The TAU Condition
2.4.2. The GCBT Condition
2.4.3. Treatment Integrity
2.5. Statistical Analysis
3. Results
3.1. Demographic Data
3.2. Change in Parent- and Teacher-Rated Scores over Time
3.3. Change in Parent- and Teacher-Rated Scores between Time Points and Groups
3.3.1. The Effectiveness of GCBT
3.3.2. Maintenance of Effects during Follow-Up
3.3.3. Comparison of GCBT and the TAU Condition
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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GCBT Group | TAU + GCBT Group | |
---|---|---|
Gender | ||
Boys n (%) | 38 (73.1) | 32 (62.7) |
Girls n (%) | 14 (26.9) | 19 (37.3) |
Age in years, median (Q1–Q3) | 9.4 (8.5–10.9) | 10.0 (8.8–11.5) |
Multiple psychiatric comorbidity a n (%) | 35 (72.9) | 35 (76.1) |
ADHD a n (%) | 29 (60.4) | 26 (56.5) |
Depression or anxiety a n (%) | 18 (37.5) | 17 (37.0) |
Other disorders of psychological development ab n (%) | 12 (25.0) | 15 (32.6) |
Conduct disorder a n (%) | 12 (25.0) | 5 (10.9) |
Autism spectrum disorder a n (%) | 9 (18.8) | 7 (15.2) |
Specific developmental disorders ac n (%) | 9 (18.8) | 6 (13.0) |
Tic disorder a n (%) | 3 (6.3) | 5 (10.9) |
Mother’s education level d n (%) | ||
Low level | 12 (23.5) | 15 (31.3) |
Mid-level | 18 (35.3) | 25 (52.1) |
High level | 21 (41.2) | 8 (16.7) |
Family type a n (%) | ||
Nuclear family | 26 (54.2) | 22 (47.8) |
Single-parent family | 21 (43.8) | 20 (43.5) |
Adoption/foster care | 1 (2.1) | 4 (8.7) |
Medication change a n (%) | 14 (29.2) | 13 (28.3) |
Change in teachers e n (%) | 16 (31.4) | 21 (44.7) |
Child welfare notification/service a n (%) | 1 (2.1) | 5(10.9) |
CBCL-Int, M (SD) | 63.8 (9.8) | 63.7 (8.3) |
CBCL-Ext, M (SD) | 64.1 (8.3) | 63.9 (10.5) |
CBCL-Tot, M (SD) | 65.7 (7.2) | 65.7 (8.2) |
TRF-Int, M (SD) | 63.1 (9.5) | 63.4 (10.1) |
TRF-Ext, M (SD) | 63.8 (10.7) | 62.5 (9.9) |
TRF-Tot, M (SD) | 67.1 (9.5) | 66.1 (9.1) |
GCBT Group (n = 52) | TAU + GCBT Group (n = 51) | |||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
CBCL-Scores | TRF-Scores | CBCL-Scores | TRF-Scores | |||||||||||
T1 | T2 | T3 | T1 | T2 | T3 | T1 | T2 | T3 | T4 | T1 | T2 | T3 | T4 | |
Present | 51 | 41 | 32 | 43 | 36 | 28 | 47 | 41 | 37 | 35 | 33 | 37 | 27 | 20 |
Missing (%) | 1 (1.9) | 11 (21.2) | 20 (38.5) | 9 (17.3) | 16 (30.8) | 24 (46.2) | 4 (7.8) | 10 (19.6) | 14 (19.6) | 16 (31.4) | 18 (35.3) | 14 (27.5) | 24 (47.1) | 31 (60.8) |
CBCL Int | CBCL Ext | CBCL Tot | TRF Int | TRF Ext | TRF Tot | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Predictor | Estimates (95% CI) | p | Estimates (95% CI) | p | Estimates (95% CI) | p | Estimates (95% CI) | p | Estimates (95% CI) | p | Estimates (95% CI) | p |
Intercept (Baseline) | 63.71 (61.85–65.58) | <0.001 | 63.65 (61.71–65.58) | <0.001 | 65.56 (63.96–67.17) | <0.001 | 63.68 (61.64–65.73) | <0.001 | 63.16 (60.98–65.34) | <0.001 | 66.68 (64.79–68.57) | <0.001 |
Time 2 | −4.13 (−5.81–−2.46) | <0.001 | −2.74 (−4.18–−1.31) | <0.001 | −3.52 (−4.90–−2.15) | <0.001 | −0.97 (−3.05–1.12) | 0.365 | −1.04 (−2.91–0.83) | 0.277 | −1.64 (−3.40–0.12) | 0.068 |
Time 3 | −4.75 (−6.54–−2.96) | <0.001 | −4.88 (−6.42–−3.34) | <0.001 | −5.23 (−6.71–−3.76) | <0.001 | −1.02 (−3.30–1.25) | 0.378 | −0.68 (−2.72–1.35) | 0.512 | −1.06 (−2.98–0.86) | 0.281 |
Time 4 | −3.68 (−6.01–−1.36) | 0.002 | −6.54 (−8.54–−4.53) | <0.001 | −5.38 (−7.30–−3.47) | <0.001 | −0.66 (−4.07–2.76) | 0.706 | −2.70 (−5.77–0.37) | 0.085 | −2.48 (−5.37–0.41) | 0.092 |
Random Effects | ||||||||||||
σ2 | 30.41 | 22.13 | 20.49 | 37.56 | 29.32 | 26.35 | ||||||
τ00 | 60.42 id | 77.02 id | 47.18 id | 52.65 id | 77.39 id | 52.25 id | ||||||
ICC | 0.67 | 0.78 | 0.70 | 0.58 | 0.73 | 0.66 | ||||||
N | 103 id | 103 id | 103 id | 96 id | 96 id | 96 id | ||||||
Observations | 284 | 284 | 284 | 224 | 224 | 224 | ||||||
Marginal R2/Conditional R2 | 0.045/0.680 | 0.053/0.789 | 0.070/0.718 | 0.002/0.585 | 0.005/0.727 | 0.008/0.668 |
Group | Time Point | Measure Mean (SD) Median (IQR) | |||||
---|---|---|---|---|---|---|---|
CBCL-Int | CBCL-Ext | CBCL-Tot | TRF-Int | TRF-Ext | TRF-Tot | ||
GCBT | Pre-GCBT | 63.8 (9.8) 65.0 (58.0–71.0) | 64.1(8.3) 64.0 (60.0–70.0) | 65.7 (7.2) 66.0 (61.0–72.0) | 63.1 (9.5) 64.0 (57.0–69.0) | 63.8 (10.7) 66.0 (55.0–73.0) | 67.1 (9.5) 67.0 (60.0–75.0) |
Post-GCBT | 57.3 (10.3) 59.0 (51.0–65.0) | 61.1 (9.6) 61.0 (53.5–67.0) | 60.7 (8.6) 61.0 (53.0–65.5) | 61.5 (10.1) 61.5 (56.0–69.0) | 62.7 (12.0) 64.0 (54.3–71.0) | 64.6 (10.4) 66.0 (60.3–71.5) | |
Follow-up | 60.0 (9.9) 63.5 (52.5–67.8) | 60.7 (8.9) 62.0 (51.3–67.8) | 61.0 (8.6) 63.0 (54.5–67.5) | 63.4 (9.1) 64.5 (58.0–68.8) | 63.1 (12.3) 62 (53.5–74.5) | 66.5 (9.4) 64.0 (59.0–75.0) | |
TAU + GCBT | Pre-TAU | 63.7 (8.3) 64.0 (58.0–69.0) | 63.9 (10.5) 66.0 (54.0–72.0) | 65.7 (8.2) 68.0 (61.0–71.0) | 63.4 (10.1) 64.0 (57.5–70.0) | 62.5 (9.9) 63.0 (58.5–69.0) | 66.1 (9.1) 67.0 (58.5–73.0) |
Post-TAU/ Pre-GCBT | 60.1 (8.7) 61.0 (53.0–66.5) | 59.5 (10.4) 60.0 (50.5–68.5) | 61.7 (8.1) 63.0 (56.0–68.0) | 63.2 (8.4) 64.0 (58.0–68.0) | 61.5 (9.6) 63.0 (57.0–69.0) | 64.9 (7.5) 67.0 (58.5–70.0) | |
Post-GCBT | 57.4 (9.8) 58.0 (49.0–63.5) | 55.1 (12.3) 56.0 (44.0–63.5) | 58.1 (9.2) 58.0 (51.5–61.5) | 60.3 (9.0) 63.0 (56.0–67.0) | 60.7 (10.4) 61.0 (53.0–69.0) | 62.7 (8.7) 63.0 (54.0–70.0) | |
Follow-up | 59.2 (9.5) 59.0 (52.0–66.0) | 55.1 (10.4) 56.0 (48.0–62.0) | 59.1 (7.6) 60.0 (53.0–65.0) | 63.0 (10.6) 62.5 (59.0–72.5) | 56.8 (9.6) 57.0 (49.0–67.0) | 61.6 (8.6) 64.5 (57.0–67.0) | |
Combined | Pre-GCBT | 62.15 (9.5) 62.5 (54.0–69.8) | 62.0 (9.6) 63.5 (56.5–70.0) | 63.9 (7.8) 64.0 (58.3–71.0) | 63.2 (9.0) 64.0 (58.0–68.8) | 62.7 (10.2) 64.5 (57.0–71.0) | 66.1 (8.6) 67.0 (59.3–72.0) |
Post-GCBT | 57.3 (10.0) 58.5 (50.0–64.3) | 58.3 (11.3) 60.0 (51.0–65.0) | 59.4 (8.9) 59.0 (53.0–65.0) | 61.0 (9.6) 63.0 (56.0–68.0) | 61.8 (11.3) 63.0 (53.0–70.0) | 63.8 (9.7) 65.0 (57.0–70.0) | |
Follow-up | 59.6 (9.6) 61 (52.0–67.0) | 57.8 (10.0) 60.0 (51.0–65.0) | 60.0 (8.1) 61 (54.0–66.0) | 63.2 (9.6) 63.5 (58.3–69.8) | 60.5 (11.5) 59.5 (53.0–69.8) | 64.5 (9.3) 64.5 (59.0–70.8) |
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Barron-Linnankoski, S.; Raaska, H.; Bergman, P.; Närvänen, E.; Elovainio, M.; Laasonen, M. Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders. Children 2022, 9, 1602. https://doi.org/10.3390/children9111602
Barron-Linnankoski S, Raaska H, Bergman P, Närvänen E, Elovainio M, Laasonen M. Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders. Children. 2022; 9(11):1602. https://doi.org/10.3390/children9111602
Chicago/Turabian StyleBarron-Linnankoski, Sarianna, Hanna Raaska, Paula Bergman, Eija Närvänen, Marko Elovainio, and Marja Laasonen. 2022. "Effectiveness of Group CBT on Internalizing and Externalizing Symptoms in Children with Mixed Psychiatric Disorders" Children 9, no. 11: 1602. https://doi.org/10.3390/children9111602