ORIGINAL ARTICLE Community-Based Treatment for Youth with Co- and Multimorbid Disruptive Behavior Disorders Trina E. Orimoto • Charles W. Mueller • Kentaro Hayashi • Brad J. Nakamura Ó Springer Science+Business Media New York 2013 Abstract Little is known about the types of psychothera- peutic practices delivered to youth with comorbid and mul- timorbid diagnoses in community settings. The present study, based on therapists’ self-reported practices with 569 youth diagnosed with a disruptive behavior disorder (ODD or CD), examined whether specific therapeutic practice applications varied as a function of the number and type of comorbid disorders. While type of comorbid disorder (AD/HD or internalizing) did not predict therapists’ practices, youth with more than two diagnoses (multimorbid) received treatment characterized by a more diverse set and a higher dosage of practices. Keywords Disruptive behavior disorders Á Comorbidity Á Treatment as usual Á Usual care Á Treatment practices Á Youth Á Multimorbidity Introduction Disruptive behavior disorders (DBD), specifically opposi- tional defiant disorder (ODD) and conduct disorder (CD) are among the most prevalent childhood disorders served in mental health clinics (Frick 1998; Kazdin 1995). Youth with DBD are of great concern, as they account for approximately 30 % of the youth client population, often show high levels of impairment (Lahey et al. 1999), and incur sizeable societal costs (e.g., harm to others, incarceration, mental health services; Scott et al. 2001). Fortunately, various treatment methods have been shown to lessen symptoms and improve longer-term outcomes (e.g., Becker et al. 2011; Weisz et al. 2006). A recent analysis of 175 randomized-controlled trials for DBD interventions found ‘‘best support’’ for certain treatment types or categories, primarily characterized by parent management training and youth skill building (Becker et al. 2011; Webster-Stratton and Hammond 1997). These programs were comprised of com- mon therapeutic practices (or practice elements; PE), for example, praise, time out, tangible rewards, problem solving, cognitive skill development, and social skill training tech- niques (Chorpita and Daleiden 2009). As one might logically expect, there was significant overlap between the evidence- based practice profiles for DBDs and other externalizing disorders such as Attention-Deficit Hyperactivity Disorder (ADHD; e.g., praise, problem solving, and psychoeducation for the parent), but considerable divergence between the profiles for DBDs and internalizing disorders (e.g., anxiety and depression; Chorpita and Daleiden 2009; Evidence Based Services Committee 2009). The fact that the common element content of evidence- based treatment manuals differs across disorders brings into question how these approaches should be implemented in community settings, particularly for youth with comor- bid problems. There is considerable research indicating that youth with DBDs often meet criteria for one or more additional disorders (over 80 %; Greene et al. 2002) and the rates of comorbidity for youth referred to community services are quite high (approximately 70 %; e.g., Mueller et al. 2010). ‘‘Comorbidity’’ is the term that is most con- sistently used to describe this phenomenon, but ‘‘multi- morbidity,’’ the occurrence of more than two diagnoses, also occurs (Krueger and Bezdjian 2009). Given the long- T. E. Orimoto (&) Á C. W. Mueller Á K. Hayashi Á B. J. Nakamura Department of Psychology, University of Hawai’i at Ma ¯noa, 2530 Dole Street, Sakamaki C 400, Honolulu, HI 96822-2294, USA e-mail: trinao@hawaii.edu 123 Adm Policy Ment Health DOI 10.1007/s10488-012-0464-2