Enhancing Long-Term Outcome in Child Behavior Disorders

描述（由申请人提供）：本申请扩展了急性治疗的结果研究（NIMH赠款#57727；“行为问题社区服务的有效性”），比较了针对诊断为对立违抗性障碍或行为障碍的6-11岁幼儿（n=72）的社区（n=72）和临床（n=72）多模式治疗方案。通过最近的补充（MH 57727-02S1; 6/1/00），将这两种特殊治疗方法与同一卫生系统中的常规治疗（TAU; n=40）以及由匹配健康对照组成的第四组（CONT; n=60; NINR Grant #07615; 10/1/00）进行比较。在治疗前和治疗后以及6、12和24个月的随访中进行结果评估。初步结果（前后）分析表明，更高的治疗完成率和一些不同的ODD或CD恢复率有利于社区（与诊所）条件，并且在临床结果上有许多总体改善，但几乎没有组间差异。此外，与TAU相比，特殊治疗在这些措施上有一些改进。这项更新申请通过纳入新的长期评估和后续护理阶段来扩展这项工作，以实现这些目标：1)记录急性治疗的长期（36个月）随访效果；2)评估旨在通过促进维持现有收益和预防其他不良、高风险结局来提高长期结果的强化治疗方案；3)检查多变量模型（个体、环境、治疗变量）以预测该大患者样本的长期结果，目前年龄为9-16岁。特殊治疗病例将考虑随机分配到加强方案或常规随访护理条件。所有四个样本都将参加36岁时进行的评估。随访（加强前评估），6个月后（加强后治疗，42个月），然后进行3次随访（6个月[48个月]）。， 1年[54-mos]。]， 2年后[66个月])。该结果对行为问题的慢性护理模式的概念化和管理具有重要意义，并将为ODD或CD儿童的强化治疗提供首次大规模评估。

DESCRIPTION (provided by applicant): This application extends an outcome study of acute treatment (NIMH Grant #57727; "Effectiveness of Community Services for Conduct Problems") that compares Community-based (n=72) and Clinical-based (n=72) multimodal treatment protocols for young children (ages 6-11) with a diagnosis of Oppositional Defiant Disorder or Conduct Disorder. The two specialty treatments are being compared to treatment-as-usual in the same health system (TAU; n=40) through a recent supplement (MH 57727-02S1; 6/1/00) and to a fourth comparison group composed of matched healthy controls (CONT; n=60; NINR Grant #07615; 10/1/00). Outcome assessments were conducted at pre- and post-treatment, and at 6-, 12- and 24-month follow-ups. Preliminary outcome (pre-post) analyses indicate higher rates of treatment completion and some differential rates of recovery from ODD or CD favoring the Community (vs. Clinic) condition, and many overall improvements, but few group differences, on clinical outcomes. In addition, specialty treatment shows several improvements on these measures, relative to TAU. This renewal application extends this work by incorporating a novel, long-term assessment and follow-up care phase to address these aims: 1) document the long-term (36-month) follow-up effects of acute treatment, 2) evaluate a booster treatment protocol that is designed to enhance long-term outcome by promoting the maintenance of existing gains and preventing other adverse, high-risk outcomes, and 3) examine multivariate models (individual, contextual, treatment variables) to predict long-term outcomes in this large patient sample, now aged 9-16 years. The specialty treatment cases will be considered for randomization to the booster protocol or routine follow-up care conditions. All four samples will participate in assessments conducted at 36-mos. follow-up (pre-booster assessment), six months later (post-booster treatment; at 42-mos.), and then at three follow-ups (six-months [48-mos.], 1-year [54-mos.], and 2-years later [66-mos.]). The results bear implications for the conceptualization and administration of a chronic care model of behavior problems and will provide the first large-scale evaluation of booster treatment in ODD or CD children.