Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up.
Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up.
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DOI：
10.1007/s10802-009-9303-7
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发表时间：
2009-07
影响因子：
3.6
通讯作者：
Hart J
中科院分区：
文献类型：
--
作者：
Kolko DJ;Dorn LD;Bukstein OG;Pardini D;Holden EA;Hart J
这项研究考察了144名6-11岁的临床转诊男孩和女孩的治疗结果，这些男孩和女孩被诊断为对抗性违抗障碍(ODD)或品行障碍(CD)，他们被随机分配到基于模块的治疗方案，该方案由社区(COMM)或诊所(Clinic)的研究临床医生应用。为了检验规范性比较，纳入了69名健康对照儿童的匹配样本。多名被调查者在六个评估时间点(3年随访前)完成诊断性访谈和自我报告，以评估儿童行为和情绪问题、精神变态特征、功能障碍、诊断状态和服务参与度的变化。使用HLM和Logistic回归模型，COMM和临床在所有结果上都显示出显著的和可比的改善。经过3年的随访，36%的COMM和47%的临床患者不再符合ODD或CD的标准，这两种情况下分别有48%和57%的儿童父母评定的外在行为问题水平在正常范围内。我们讨论了这些新发现的性质和意义，这些发现涉及行为障碍的治疗环境或治疗环境的作用和长期结果。
This study examines the treatment outcomes of 144, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders.