Moderators and Mediators of Therapy for Conduct Disorder

描述(由申请人提供)：这项研究的首要目标是改善行为障碍转介儿童的治疗效果。这项研究的重点是了解治疗如何产生变化(调节因素)和影响结果的因素(调节因素)。这项研究的基础模型是，治疗的变化受到儿童、父母和家庭“带来”他们接受治疗的特征、治疗过程中出现的特征(例如，联盟、坚持)以及干预和相关特征(例如，治疗师行为、特征)的影响。这项拟议的研究侧重于前两个组成部分，将：1)确定促成治疗变化的儿童、父母和家庭因素；2)测试治疗过程中解释治疗变化的关键过程。转诊到门诊治疗的儿童(N=200，6-12岁，包括欧洲和非洲裔美国家庭)，符合品行障碍诊断标准的儿童将参与其中。所有儿童和家长将接受问题解决技能培训和家长管理培训，作为综合治疗。中心预测是：1)治疗的反应性将受到儿童功能障碍和损害、父母功能障碍和压力、家庭中的不利家庭关系以及父母对治疗过程和结果的初始期望的影响，以及2)治疗变化将受到积极的父母与治疗师的关系、在治疗过程中很少感觉到父母对治疗的障碍以及父母和孩子对治疗的依从性和顺应性的影响。这项研究还将评估这两个种族的预测。除了提高品行障碍治疗的有效性外，这项研究还旨在为更广泛的儿童治疗研究提供一个启发式模型。该模型将前置因素、新出现的过程和干预措施概念化，作为影响结果的来源。此外，研究的设计允许评估过程和因果模型，以帮助解释变化的过程。

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.