Moderators and Mediators of Therapy for Conduct Disorder

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DESCRIPTION (provided by applicant): The overarching goal of this study is to improve the effectiveness of treatment of children referred for Conduct Disorder. The study focuses on understanding how treatment produces changes (mediators) and factors that contribute to outcome (moderators). The model underlying the study is that therapeutic change is influenced by characteristics that children, parents, and families "bring with" them to treatment, by characteristics that emerge during the treatment process (e.g., alliance, adherence), and by the intervention and associated features (e.g., therapist behavior, characteristics). The proposed study focuses on the first two components and will: 1) identify child, parent, and family factors that contribute to therapeutic change and 2) test key processes during the course of treatment that explain therapeutic change. Children (N=200, ages 6-12, including European and African American families) referred to outpatient treatment and who meet diagnostic criteria for Conduct Disorder will participate. All children and parents will receive problem-solving skills training and parent management training as a combined treatment. The central predictions are that: 1) responsiveness to treatment will be influenced by child dysfunction and impairment, parent dysfunction and stress, and adverse family relations in the home and by initial parent expectancies about treatment processes and outcome, and 2) therapeutic change will be mediated by a positive parent-therapist relationship, few perceived parent barriers to treatment during treatment, and parent and child adherence and compliance with treatment. The study will also permit evaluation of the predictions across the two ethnicities. Apart from improving the effectiveness of treatment for Conduct Disorder, the study is intended to advance a heuristic model for child therapy research more generally. The model conceptualizes antecedents, emerging processes, and interventions as sources of influence on outcome. Also, the design of the study permits evaluation of processes and causal models to help explain the processes of change.