TOPLINE:

In preschool and school-aged children with disruptive behavior disorders, programs involving parents — either alone or with the child and a caregiver or teacher — were associated with reductions in behavior scores right after treatment. Findings in adolescents were mixed.

METHODOLOGY:

• Researchers conducted a systematic review and meta-analysis to identify which psychosocial interventions were associated with reduced disruptive behaviors in children and teens.
• They searched four databases ranging from 2014 to 2024. The included trials enrolled children and teens younger than 18 years with a diagnosis of a disruptive behavior or clinical range behavior scores; about one third of participants were girls.
• For the final analysis, researchers pooled 64 randomized controlled trials of preschool (< 5 years) or school-aged (5-12 years) children; they included but did not pool 20 trials of adolescents (13-17 years).
• Programs were grouped into those that only coached parents, multicomponent programs (for parents or teachers and the child together), or child-only programs. These were compared with usual care or a waitlist.
• Researchers assessed disruptive behavior scores as reported by parents immediately after treatment, and in the short term (≤ 24 weeks), intermediate term (25-47 weeks), and long term (≥ 48 weeks).

TAKEAWAY:

• Preschoolers in parent-only programs had reduced disruptive behavior scores immediately after treatment (13 studies; standardized mean difference [SMD], -0.61; I² = 79%).
• School-aged children in parent-only programs had reduced disruptive behavior scores immediately after treatment (11 studies; SMD, -0.39; I² = 53%) and at short-term follow-up (five studies; SMD, -0.60; I² = 85%). Small reductions favoring parent-only programs also appeared at intermediate (six studies; SMD, -0.25; I² = 0%) and long-term (three studies; SMD, -0.21; I² = 36%) follow-ups.
• Preschoolers in multicomponent programs had reduced scores immediately after treatment (10 studies; SMD, -0.96; I² = 81%). In school-aged children, these programs showed modest improvements immediately after treatment and at all follow-ups, with I² ranging from 17% to 75%.
• Child-only programs in school-aged children showed uncertain results from three studies and nonsignificant estimates. Adolescent trials had mixed results, with family therapy more often favorable than usual care.

IN PRACTICE:

“When a behavioral health specialist is not readily available, primary care clinicians must rely on external referral sources, including online or internet-assisted psychosocial interventions or school-based psychosocial interventions. Once resources and/or referrals are provided, it is important to have systems to ensure that care proceeded as planned and that there was clinical improvement,” experts wrote in a commentary accompanying the article.

SOURCE:

The study was led by Shelley Selph, MD, MPH, Oregon Health & Science University, Portland, Oregon. It was published online on January 13, 2026, in Pediatrics.

LIMITATIONS:

Studies varied widely by age, programs, and outcomes; thus, conclusions were hard to draw. Researchers excluded trials in children with less severe disruptive behaviors.

DISCLOSURES:

The study received funding from the Agency for Healthcare Research and Quality and the US Department of Health and Human Services in partnership with the Patient-Centered Outcomes Research Institute. The authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.