A Review of Common Elements of Effective Interventions for Reducing Disruptive Behavior and Traumatic Stress Among Adolescent Girls

Background and Purpose: Girls constitute a growing proportion of adolescents in the juvenile justice system, and research documents upward trends in certain disruptive behaviors among female adolescents. The vast majority of girls displaying disruptive behaviors report a history of trauma, with as many as 93% of girls in the juvenile justice system having experienced physical or sexual abuse (Smith, Leve, & Chamberlain, 2006). The adolescent mental health literature includes several studies of interventions to reduce adolescent disruptive behavior and traumatic stress symptoms, several of which specify effects for girls. This study aims to synthesize the evidence on effective interventions with girls who demonstrate disruptive behavior and are coping with trauma-related symptoms by reporting those interventions with the best support as well as common practice elements across effective interventions.

Methods: This study involved searching a database of 430 random clinical trials of mental health interventions for youth. Only studies meeting the American Psychological Association's criteria for “Best Support” were included in the study. For inclusion, intervention studies must have: aimed to reduce disruptive behaviors and reduce traumamatic stress; targeted adolescents ages 12-18; and include subgroup analysis of female participants. An innovative database system, PracticeWise Evidence-Based Services Database (http://www.practicewise.com), was used to identify studies, to identify effective interventions across studies, and to identify the most commonly occurring practice elements across effective interventions. Common practice elements are coded in the database by a team of experts who review the manualized protocols of effective interventions, identifying the specific practice strategies used in each.

Results: This systematic review identified 14 randomized clinical trials of six different effective interventions: Multisystemic Therapy, Cognitive Behavioral Therapy, Cognitive Behavior Therapy with Parents, Parent Management Training, Assertiveness Training, and Social Skills Training. Across these six intervention types, 8 common practice elements were used at varying degrees of frequency. Common practice elements and the percentage of interventions that included each element included: goal setting (73%), monitoring (67%), communication skills (60%), praise (60%), problem solving (60%), psycho-education with parents (60%), social skills training (60%), and tangible rewards (60%).

Conclusions and Implications: Our synthesis suggests the existence of a number of interventions to effectively reduce girls' disruptive behaviors and traumatic stress symptoms. Several practice elements or strategies are common across these effective interventions. Deconstructing complex and expensive intervention protocols into practice elements may be a cost-efficient method for training practitioners to use evidence-based practices in treating adolescents, and it may guide practitioners who wish to provide gender-specific treatment supported by research evidence. Previous research finds mental health practitioners prefer learning and using common elements as they provide flexibility and adaptation to their clients' specific needs (Chorpita, Daleiden, Weisz, 2005). These common practice elements, implemented independently and in bundles, need to be tested to determine if they have similar effects on disruptive behavior and traumatic stress as manualized interventions.