The feasibility of a randomised controlled trial of Dyadic Developmental Psychotherapy

BMC Psychiatry

Helen Minnis²  Kathleen A Boyd¹  Nicole RS Boyer¹  Nicholas Watson³  Fiona Turner-Halliday² 

[1] Institute of Health & Wellbeing, University of Glasgow, Health Economics and Health Technology Assessment, 1 Lilybank Gardens, Glasgow G12 8RZ, UK;Institute of Health & Wellbeing, University of Glasgow, Academic Unit of Mental Health & Wellbeing, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, UK;Institute of Health & Wellbeing, University of Glasgow, College of Medical, Veterinary and Life Sciences, 1 Lilybank Gardens,, Glasgow G12 8RZ, UK

关键词: Measurement;    Qualitative;    RCT;    Evidence;    Feasibility;    Dyadic Developmental Psychotherapy;   

Others  :  1090620
DOI  :  10.1186/s12888-014-0347-z

 received in 2013-04-09, accepted in 2014-11-20,  发布年份 2014

【 摘 要 】

Background

Maltreated children have significant and complex problems which clinicians find difficult to diagnose and treat. Previous US pilot work suggests that Dyadic Developmental Psychotherapy (DDP) may be effective; however, rigorous evidence from a randomised controlled trial (RCT) is lacking. The purpose of this study is to establish the feasibility of an RCT of DDP by exploring the ways that DDP is operating across different UK sites and the impacts of current practice on the potential set-up of an RCT.

Methods

Qualitative methods (interviews, focus groups and teleconferences) were used to explore trial feasibility with therapists and service managers from teams implementing both DDP and possible control interventions. Data were analysed thematically and related to various aspects of trial design.

Results

DDP was commonly regarded as having a particular congruence with the complexity of maltreatment-associated problems and a common operating model of DDP was evident across sites. A single control therapy was harder to establish, however, and it is likely to be a non-specific and context-dependent intervention/s offered within mainstream Child and Adolescent Mental Health Services (CAMHS). Because a ‘gold standard’ Treatment as Usual (TAU) does not currently exist, randomisation between DDP and TAU (CAMHS) therefore looks feasible and ethical.

The nature of family change during DDP was regarded as multi-faceted, non-linear and relationship-based. Assessment tools need to be carefully considered in terms of their ability to capture change that covers both individual child and family-based functioning.

Conclusions

An RCT of DDP is feasible and timely. This study has demonstrated widespread interest, support and engagement regarding an RCT and permissions have been gained from sites that have shown readiness to participate. As maltreated children are among the most vulnerable in society, and as there are currently no treatments with RCT evidence, such a trial would be a major advance in the field.

【 授权许可】

   
2015 Turner-Halliday et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Meltzer H, Gatward R, Corbin T, Goodman R, Ford T: The Mental Health of Young People Looked after by Local Authorities in England. The Stationery Office, London; 2003.
• [2]Rutter M, Beckett C, Castle J, Colvert E, Kreppner J, Mehta M, Stevens S, Sonuga-Barne E: Effects of profound early institutional deprivation: an overview of findings from a UK longitudinal study of Romanian adoptees. Eur J Dev Psychol 2007, 4(3):332-350.
• [3]Rutter M, Colvert E, Kreppner J, Beckett C, Castle J, Groothues C, Hawkins A, O’Connor TG, Stevens SE, Sonuga-Barke EJ: Early adolescent outcomes for institutionally-deprived and non-deprived adoptees. I: disinhibited attachment. J Child Psychol Psychiatry 2007, 48(1):17-30.
• [4]Minnis H, Green J, O’Connor T, Liew A, Glaser D, Taylor E, Follan M, Young D, Barnes J, Gillberg C, Pelosi A, Arthur J, Burston A, Connolly B, Sadig FA: An exploratory study of the association between reactive attachment disorder and attachment narratives in early school-age children. J Child Psychol Psychiatry 2009, 50(8):931-942.
• [5]Smyke AT, Zeanah CH, Gleason MM, Drury SS, Fox NA, Nelson CA, Guthrie D: A randomized controlled trial comparing foster care and institutional care for children with signs of reactive attachment disorder. Am J Psychiatr 2012, 169(5):508-514.
• [6]Stevens SE, Sonuga-Barke EJ, Kreppner JM, Beckett C, Castle J, Colvert E, Groothues C, Hawkins A, Rutter M: Inattention/overactivity following early severe institutional deprivation: presentation and associations in early adolescence. J Abnormal Child Psychol 2008, 36(3):385-398.
• [7]Kocsovska E, Puckering C, Follan M, Smillie M, Gorski C, Barnes J, Wilson P, Young D, Lidstone E, Pritchett R, Hockaday H, Minnis H: Neurodevelopmental problems in maltreated children referred with indiscriminate friendliness. Res Dev Disabil 2012, 33(5):1560-1565.
• [8]Minnis H, Everett K, Pelosi A, Dunn J, Knapp M: Children in foster care: Mental health, service use and costs. Eur Child Adolesc Psychiatry 2006, 15:63-70.
• [9]Byrne JG: Referral biases and diagnostic dilemmas. Attach Human Dev 2003, 5:249-252.
• [10]Minnis H: Maltreatment- associated psychiatric problems (MAPP) – an example of environmentally-triggered ESSENCE? Scie World J – Special Issue – ‘Early Symptomatic Syndromes Eliciting Neurodevelopmental Clin Examination’ 2013, 11:1-5.
• [11]Boyer N, Boyd KA, Turner-Halliday F, Watson N, Minnis H: Examining the feasibility of an economic analysis of dyadic developmental psychotherapy for children with maltreatment associated psychiatric problems in the United Kingdom. BMC Psychiatry 2014, 14:346. BioMed Central Full Text
• [12]Dyadic Developmental Psychotherapy Institute [http://www.dyadicdevelopmentalpsychotherapy.org/]
• [13]Scott S, Knapp M, Henderson J, Maughan B: Financial cost of social exclusion: follow up study of antisocial children into adulthood. Br Med J 2001, 323:1-5.
• [14]Becker-Weidman A: Treatment for children with trauma-attachment disorders: Dyadic Developmental Psychotherapy. Child Adolesc Social Work 2006, 23(2):147-171.
• [15]Becker-Weidman A: Dyadic Developmental Psychotherapy: A multi-year follow-up. In New Developments in Child Abuse Research. Edited by Sturt SM. Nova Science Publishers Inc, New York; 2006:43-60.
• [16]Cochrane Consumer Network [http://consumers.cochrane.org/levels-evidence]
• [17]Craig P, Dieppe P, MacIntyre S, Michie S, Nazareth I, Petticrew M: Developing and evaluating complex interventions: the new Medical Research Council guidance. Br Med J 2008, 337:a1655.
• [18]Rushton A, Monck E, Leese M, McCrone P, Sharac J: Enhancing adoptive parenting: a randomized controlled trial. Clin Child Psychol Psychiatry 2010, 15(4):529-542.
• [19]Rushton A, Monck E: A “real-world” evaluation of an adoptive parenting programme: Reflections after a randomized controlled trial. Clin Child Psychol Psychiatry 2010, 15(4):543-554.
• [20]Goodyer IM, Dubicka B, Wilkinson P, Kelvin R, Roberts C, Byford S, Breen S, Ford C, Barrett B, Leech A, Rothwell J, White L, Harrington R: Selective serotonin reuptake inhibitors (SSRIs) and routine specialist care with and without cognitive behaviour therapy in adolescents with major depression: randomised controlled trial. Br Med J 2007, 335:142.
• [21]Clark J: How to peer review a qualitative manuscript. In Peer Review in Health Sciences. 2nd edition. Edited by Godlee F, Jefferson T. BMJ Books, London; 2003:219-235.
• [22]Giddens A: Social Theory and Modern Sociology 1987. Polity Press, Cambridge; 1987.