Assessment of improvement from milieu therapy of children and adolescents with disruptive behavior disorders

Purpose: Disruptive behavior disorders are one of the most common reasons for psychiatric referrals in children and adolescents. Disruptive behavior disorders in children and adolescents lead to serious impairments in familial, academic and social areas. When these disorders left untreated, the problems they cause continue to increase in adult life, causing criminal behavior and antisocial personality disorders. This situation brought about by destructive behavior disorders reveals the importance of effective treatment of these disorders. The purpose of this study is to examine the use of milieu therapy in children and adolescents who have been followed up with the diagnosis of destructive behavioral disorder in Dokuz Eylül University Child and Adolescent Mental Health and Disorders Department inpatient treatment unit. Material and Method: The sample group of the study consisted of children and adolescents who were followed up with the diagnosis of conduct disorder or oppositional defiant disorder according to DSM-IV or DMS-V in the inpatient treatment unit of the Department of Child and Adolescent Mental Health and Disorders at Dokuz Eylül University Hospital. The necessary data for the study were obtained by scanning the patients' files retrospectively. 78 cases were included in the study. The improvements of the patients from the service were evaluated with The Children's Global Assessment Scale (CGAS) and the HoNOSCA-TR Clinical Outcome Scales (Children and Adolescents). Findings: At the end of treatment, the average CGAS scale scores of the cases increased from 34.19 to 53.08, and the average HONOSCA-TR scale scores decreased from 30 to 19.94. The change in both scales was statistically significant (p <, 001). Improvement was significantly higher in cases 13 years of age and older than cases younger than 13 years of age (p =, 046). Improvement did not differ according to gender, ADHD comorbidity, and parental education level. Individual and familial risk scores did not significantly affect improvement. High HONOSCA-TR score at admission had a positive, moderate level, statistically significant correlation with the HONOSCA-TR change score (p <, 001), a positive, low level, and statistically significant correlation with the CGAS change score (p = , 031). The duration of hospitalization and CGAS change scores have a positive, moderate level, statistically significant correlation (p =, 002), and HONOSCA-TR change scores have a positive, low level, statistically significant correlation (p =, 015). Results: In our study, we found that children and adolescents who were hospitalized with a diagnosis of destructive behavior disorder benefited from milieu therapy. Although there are studies investigating the effects of milieu therapy on various psychiatric disorders in the literature, the number of studies investigating its effect on disruptive behavior disorders is quite limited. According to the results of our study, patients benefit from milieu therapy not only in terms of symptoms of destructive behavioral disorders, but also in many areas of functionality. These findings show that milieu therapy is an alternative to other treatment modalities in the treatment of disruptive behavioral disorders. In our study, it was found that improvement was not affected by the education level of the parents and by individual and family risks. This finding suggests that milieu therapy is applicable to a large patient population. Keywords: Disruptive behaviour, Conduct disorder, Oppositional defiant disorder, Milieu therapy, Inpatient unit