Understanding the Families' Needs: Interventions for Family Members of Adolescents with Disruptive Behavior Disorders

Purpose: Adolescents with Disruptive Behavior Disorders (DBD) including Oppositional Defiant Disorder and Conduct Disorder present unique challenges to their families. DBD are prevalent and serious mental disorders first diagnosed in childhood. DBD are characterized by hostile, aggressive, defiant, and antisocial behaviors. These adolescents are at risk to drop out of school, abuse drugs, or be arrested. Therefore, family members of adolescents with DBD experience overwhelming and unrelenting stress related to the difficult challenges of managing the adolescents' behavior problems and interacting-often on a daily basis-with the mental health, schools, child welfare, and juvenile systems. While most emperically-supported treatments for DBD are family-based, the emphasis is typically on the behavior of the child rather than on the life challenges and the resultant distress experienced by the family members. To develop interventions to address the needs of family members, a better understanding of what mental health services they desire is needed. The purpose of this study is describe what multiple family members including those rarely considered (i.e., fathers, siblings, and other adult family members) need for support from mental health professionals.

Methods: The Double ABCX Model of Family Stress and Adaptation by McCubbin and Patterson (1983) was used to guide the study. The model proposes that families experience life events or stressors such as the serious illness of a family member. The stressor may overwhelm available family resources and lead to hardships that affect all family members.  Based on this model, we anticipated that  caring for an adolescent with DBD is a demand that will likely exceed the family's capacity to meet the demand and therefore could result in altered family functioning, emotional stress, and the need for outside support. Fifteen families of adolescents (13 - 18 years old) with DBD were recruited from a large publicly funded community mental health center in Midwestern United States. Data were gathered from participants (parents or primary caregivers, adolescents with DBD, siblings, and other adult family memebrs) using in-depth individual interviews and  a focus group interview (three parents or primary caregivers). Interviews were analysed by standard content analytic procedures.

Results: The sample included 15 parents (14 females and one male, average age 45 years), 10 other adult family members (four females and eight males, average age 37 years), 15 adolescents with DBD (five females and 10 males, average age 15 years), and 12 siblings (four females and eight males, average age 14 years). The racial breakdown of the 52 participants was 61% African American, 16% Caucasian, and 23% biracial (mostly African American/Caucasian). The average annual household income for the families was less than $30,000. Most of the data was provided by parents and other adult family members but a few of the adolescents with DBD and their siblings also gave their opinion about mental health interventions. Families said that they would prefer multi family groups that included both psychoeducational sessions led by professionals and the time to network with other families that share their challenges, and offered in their own neigborhoods. Families described a number of issues or topics they would like professionals to address, including managing the adolescents' disruptive behaviors, family communication and conflict resolution, education about the disorders, strategies to manage the adolescents' care and service use, the personal issues and feelings of family members, and positive outcomes experienced by families.

Conclusion: Findings provide the foundational data to begin the development of an emperically supported intervention for family members of adolescents with DBD. The findings also suggest that psychiatric nurses and other clinicians can clearly address some of the needs expressed by the family members in the context of everyday clinical practice.