Enhancing Long-Term Outcome in Child Behavior Disorders

描述(由申请人提供)：本申请扩展了一项急性治疗的结果研究(NIMH Grant#57727；“社区服务对行为问题的有效性”)，将基于社区(n=72)和基于临床(n=72)的幼儿(6-11岁)多模式治疗方案与对立违抗性障碍或品行障碍的诊断进行比较。正在通过最近的补充资料(MH 57727-02S1；6/1/00)将这两种特殊治疗与同一卫生系统(TAU；n=40)的常规治疗进行比较，并与由匹配的健康对照组成的第四个对照组(CONT；n=60；NINR Grant#07615；10/1/00)进行比较。在治疗前和治疗后，以及6个月、12个月和24个月的随访中进行结果评估。初步结果(事后)分析表明，更高的治疗完成率和从有利于社区(与临床)情况的ODD或CD中的一些不同的恢复率，以及在临床结果方面的许多总体改善，但很少有组内差异。此外，与TAU相比，专科治疗在这些措施上有几个改进。这项续签申请通过纳入一个新颖的长期评估和后续护理阶段来扩展这项工作，以满足这些目标：1)记录急性治疗的长期(36个月)随访效果，2)评估旨在通过促进现有成果的维持和防止其他不利的高风险结果来提高长期结果的强化治疗方案，以及3)检查多变量模型(个体、背景、治疗变量)，以预测这个大样本患者的长期结果，目前年龄为9-16岁。将考虑将特殊治疗病例随机分配到强化方案或常规后续护理条件下。所有四个样本都将参加36-MOS进行的评估。随访(强化前评估)，6个月后(强化治疗后；42个月)，然后在3个月(6个月[48个月]、1年[54个月]和2年后[66个月])。这一结果对行为问题的慢性护理模式的概念化和管理具有启示意义，并将提供第一次大规模评估对单纯性或CD儿童的强化治疗。

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.