A Randomized Clinical Trial of an Integrative Group Therapy for Children With Severe Mood Dysregulation
Open accessAbstract
Objective Nonepisodic irritability is a common and impairing problem, leading to the development of the diagnoses severe mood dysregulation (SMD) and disruptive mood dysregulation disorder (DMDD). No psychosocial therapies have been formally evaluated for either, with medication being the most common treatment. This study examined the feasibility and efficacy of a joint parent-child intervention for SMD.Method A total of 68 participants aged 7 to 12 years with attention-deficit/hyperactivity disorder (ADHD) and SMD were randomly assigned to the 11-week therapy or community-based psychosocial treatment. All participants were first stabilized on psychostimulant medication by study physicians. Of the participants, 56 still manifested impairing SMD symptoms and entered the therapy phase. Masked evaluators assessed participants at baseline, midpoint, and endpoint, with therapy participants reassessed 6 weeks later.Results All but 2 therapy participants attended the majority of sessions (n = 29), with families reporting high levels of satisfaction. The primary outcome of change in mood symptoms using the Mood Severity Index (MSI) did not reach significance except in the subset attending the majority of sessions (effect size = 0.53). Therapy was associated with significantly greater improvement in parent-rated irritability (effect size = 0.63). Treatment effects for irritability but not MSI diminished after therapy stopped. Little impact on ADHD symptoms was seen. Results may not be generalizable to youth with SMD and comorbidities different from those seen in this sample of children with ADHD, and are limited by the lack of a gold standard for measuring change in SMD symptoms.Conclusion While failing to significantly improve mood symptoms versus community treatment, the integrative therapy was found to be a feasible and efficacious treatment for irritability in participants with SMD and ADHD.Clinical trial registration information Group-Based Behavioral Therapy Combined With Stimulant Medication for Treating Children With Attention Deficit Hyperactivity Disorder and Impaired Mood; http://clinicaltrials.gov/; NCT00632619.
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Evidence indicates significant gains in functional outcomes, self-efficacy, and daily structure when ADHD coaching is integrated into comprehensive treatment plans.
“Evidence indicates significant gains in functional outcomes, self-efficacy, and daily structure when coaching is integrated into comprehensive treatment plans.”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [165]
The Results (Other Parent Ratings of Behavior; page unavailable) say improvements in social skills and problem behaviors were not statistically significant, contrary to the claimed significant functional gains. The paper evaluates group therapy for children with ADHD and severe mood dysregulation, not ADHD coaching, and reports no gains in self-efficacy or daily structure. (LLM, conf=0.84)
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References 70 · Cited by 87
Research works printed but not linked: 5
- [33]Lochman JE Wells KC Lenhart LA Coping Power: Child group facilitator’s guide New York Oxford University Press 2008
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- Authors
- Waxmonsky, J. G., Waschbusch, D. A., Belin, P., Li, T., Babocsai, L., Humphery, H., Pariseau, M. E., Babinski, D. E., Hoffman, M. T., Haak, J. L., Mazzant, J. R., Fabiano, G. A., Pettit, J. W., Fallahazad, N., & Pelham, W. E.
- Affiliations
- Pennsylvania State University (US)
- Florida International University (US)
- University at Buffalo, State University of New York (US)
- Corresponding author
- Waxmonsky, James G.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-03
- Volume
- 55
- Issue
- 3
- Pages
- 196-207
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC4764804
- OpenAlex
- W2221413780
- Cited by
- 87
- References
- 70
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 9 · 2020: 6 · 2019: 12 · 2018: 11 · 2017: 8 · 2016: 6 · 2013: 1
- FWCI
- 10.35
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R34MH080791, MH080791)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD055882)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- severe mood dysregulation, disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, integrative therapy, psychosocial interventions, irritability, treatment feasibility, stimulant medication, children
- MeSH terms
- Behavior Therapy, Child, Female, Humans, Male, Parent-Child Relations, Psychotherapy, Group, Treatment Outcome, Mood Disorders
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