Review: Evidence-Based Psychosocial Treatments for Childhood Irritability and Aggressive Behavior

Objective Irritability and aggression are among the most common reasons that children are referred to outpatient mental health services and represent symptoms of several child psychiatric disorders. Over the past forty years, several types of psychosocial interventions have been developed to treat these problems. This review examines well-established interventions for childhood irritability and aggression as well as newer interventions with a growing evidence base. Method This is a narrative review of evidence-based psychosocial treatments for childhood irritability and maladaptive aggression aimed at highlighting the key principles, techniques, and assessment tools as relevant to clinical practice. Results Parent management training (PMT) and cognitive-behavioral therapy (CBT) both have extensive evidence bases and are recognized as efficacious interventions for childhood aggression and disruptive behavior. There is also accumulating evidence that these modalities as well as dialectical behavior therapy (DBT) can be helpful for irritability in context of severe mood dysregulation and disruptive mood dysregulation disorder. Technology-based and telehealth interventions for childhood aggression and irritability show promising results and potential to improve access to services. Lastly, measurement based care, while still a developing area in child mental health, may provide a promising addition to enhancing the efficacy and precision of psychosocial treatments of childhood aggression and irritability. Conclusion Parent- and child-focused psychosocial interventions such as PMT, CBT and their combination, can be helpful for the reduction of irritability and aggression. Well-powered randomized controlled trials with outcome measures that reflect current conceptualization of maladaptive aggression and irritability are needed to extend this evidence-base to older adolescents and to examine the role of co-occurring psychopathology in treatment response.