title: Cognitive-behavioral therapy for externalizing disorders: A meta-analysis of treatment effectiveness.
abstract: Externalizing disorders are the most common and persistent forms of maladjustment in childhood. The aim of this study was to conduct a meta-analysis evaluating the effectiveness of Cognitive Behavioral Therapy (CBT) to reduce externalizing symptoms in two disorders: Attention Deficit Hyperactivity Disorder (ADHD) and Oppositive Defiant Disorder (ODD). The efficacy of CBT to improve social competence and positive parenting and reduce internalizing behaviors, parent stress and maternal depression was also explored. The database PsycInfo, PsycARTICLES, Medline and PubMed were searched to identify relevant studies. Twenty-one trials met the inclusion criteria. Results showed that the biggest improvement, after CBT, was in ODD symptoms (-0.879) followed by parental stress (-0.607), externalizing symptoms (-0.52), parenting skills (-0.381), social competence (-0.390) and ADHD symptoms (-0.343). CBT was also associated with improved attention (-0.378), aggressive behaviors (-0.284), internalizing symptoms (-0.272) and maternal depressive symptoms (-0.231). Overall, CBT is an effective treatment option for externalizing disorders and is also associated with reduced parental distress and maternal depressive symptoms. Multimodal treatments targeting both children and caregivers' symptoms (e.g. maternal depressive symptoms) appear important to produce sustained and generalized benefits.
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy; Department of Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy. Electronic address: gemma.battagliese@uniroma1.it.
authors.forename: Gemma
authors.initials: G
authors.lastname: Battagliese
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Caccetta
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy.
authors.forename: Olga Ines
authors.initials: OI
authors.lastname: Luppino
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy; Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, D-79104, Freiburg, Germany.
authors.forename: Chiara
authors.initials: C
authors.lastname: Baglioni
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy; Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cardi
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Mancini
authors.affiliation: Scuola di Psicoterapia Cognitiva S.r.l., Viale Castro Pretorio 116, 00185, Roma, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Buonanno
mesh_terms: D000293:Adolescent; D000328:Adult; D000374:Aggression / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000523:psychology / Q000628:therapy*; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000523:psychology / Q000628:therapy*; D017028:Caregivers; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004505:Education, Nonprofessional; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016487:Parenting; D010290:Parents; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
keywords: ADHD; Cognitive behavioral treatment; Externalizing disorders; ODD; Parenting strategies