TREATING OPPOSITIONAL DEFIANT BEHAVIOR

说明：拟议的研究探讨了 在初级保健儿科环境中进行的心理干预， 对立违抗性障碍（oppositional defiant disorder，ODD） 这种疾病：1） 在初级保健环境中的幼儿中发生率很高; 2） 有可能在初级保健环境中被识别; 3） 如果早期治疗，可能更有反应; 4）具有长期后果 对于许多儿童，如果不治疗;和5）在原发性 护理领域如果及早发现，使儿童能够避免后来专门 心理健康服务，如果问题变得更加根深蒂固或严重 科摩罗发展。 拟议的研究是一项随机对照试验 两种初级保健治疗模式对儿童年龄 4-6多年来，ODD 这两个模型包括一个高度结构化的 父母培训干预的记录有效性，涉及10 会议，手动驱动的治疗伴随着录像带。 的 干预将由1）儿科办公室护士，或 2)一位在初级保健机构工作的心理健康专家。 这些 将两种干预模式与常规护理对照组进行比较 在一年的时间里。 检查行为问题的变化， 由于治疗导致的诊断，评估将在 基线、治疗后和一年随访。 将有195个孩子 4-6岁的儿童通过儿科协会参加研究， 在芝加哥地区的做法，包括服务于芝加哥的内部实践 市 参与的儿童将超过第90百分位数， 儿童行为检查表（CBCL）的外化障碍子量表， 符合对立违抗性障碍的标准 的设计 研究将使我们能够检查：1）结构化干预， 幼儿ODD的治疗可以在初级保健中有效 儿科环境; 2）由经过培训的儿科护士对ODD进行干预， 有效的精神卫生专业工作人员提供的， 儿科环境; 3）有抵消效应和相关的成本节约 提供这些服务。

Description: The proposed study examines the effectiveness of a psychological intervention conducted in primary care pediatric settings for the treatment of oppositional defiant disorder (ODD). This disorder: 1) occurs at a high rate among young children in the primary care setting; 2) has the potential to be identified in the primary care environment; 3) is likely to be more responsive if treated early; 4) has long term consequences for many children if not treated; and 5) may be treatable in the primary care area if identified early, enabling the child to avoid later specialized mental health services if the problem becomes more entrenched or significant comorbidity develops. The proposed study is a randomized controlled trial of the effectiveness of two primary care treatment models for children ages 4-6 years with ODD. The two models include a highly structured parent-training intervention of documented effectiveness, involving a ten sessions, manual-driven treatment with accompanying videotapes. The intervention will be provided either by 1) pediatric office staff nurses, or 2) a mental health professional working in the primary care setting. These two models of intervention will be compared to a usual care control group over the course of one year. To examine changes in behavior problems and diagnoses resulting from treatment, assessments will be conducted at baseline, posttreatment, and one-year follow-up. There will be 195 children ages 4-6 years enrolled in the study through a consortium of pediatric practices in the Chicago area, including practices serving Chicago's inner city. The participating children will have exceeded the 90th percentile on the externalizing disorders subscale of the Child Behavior Checklist (CBCL), and met criteria for an oppositional defiant disorder. The design of the study will allow us to examine whether: 1) a structured intervention for the treatment of ODD in young children can be effective in the primary care pediatric setting; 2) intervention for ODD by a trained pediatric nurse is as effective as that provided by a mental health professional working in the pediatric setting; 3) there are offset effects and cost savings associated with the provision of these services.