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资助#57727;“社区服务对行为问题的有效性”），该研究比较了诊断为对立违抗性障碍或行为障碍的幼儿（6-11岁）基于社区（n = 72）和基于临床（n=72）的多模式治疗方案。 通过最近的补充（MH 57727- 02 S1; 6/1/00），将这两种专科治疗与同一卫生系统（TAU; n=40）中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比较组（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个月随访时进行结局评估。 初步结果（前后）分析表明，治疗完成率较高，从ODD或CD恢复的一些差异率有利于社区（与诊所）状况，以及许多总体改善，但临床结局的组间差异很少。 此外，专科治疗在这些指标上与TAU相比也有一些改进。 此更新应用程序通过纳入新的长期评估和后续护理阶段来扩展这项工作，以实现以下目标：（1）记录长期（36个月）急性治疗的随访效果，2）评价加强治疗方案，该方案旨在通过促进维持现有成果和预防其他不良、高风险结局来增强长期结局，以及3）检查多变量模型（个体、背景、治疗变量）以预测现在年龄为9-16岁的该大患者样本的长期结果。 专科治疗病例将被考虑随机分配至加强方案或常规随访护理条件。 所有4份样本将参加在36个月时进行的评估。随访（加强前评估），6个月后（加强治疗后; 42个月），然后在三次随访时（六个月[48个月]，1-年[54-月]，两年后（66个月）。 结果承担的概念化和管理的行为问题的慢性护理模式的影响，并将提供第一个大规模的评估助推器治疗ODD或CD儿童。

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.