Mediators, Moderators and Treatment Outcomes with Oppositional Defiant Disorder

对立违抗障碍的调解者、调节者和治疗结果

• 批准号: 8063094
• 负责人: THOMAS H. OLLENDICK
• 金额: $ 29.7万
• 依托单位: VIRGINIA POLYTECHNIC INST AND ST UNIV
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-05-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8063094
• 关键词: 12 year old; Accounting; Address; Adult; Adverse effects; Aftercare; Algorithms; Attention deficit hyperactivity disorder; Behavior; Behavior Disorders; Characteristics; Child; Childhood; Clinical; Cognitive Therapy; Comorbidity; Competence; Conduct Disorder; Data; Development; Diagnosis; Disease; Effectiveness; Environment; Evaluation; Family; Family Characteristics; Future; General Hospitals; Intervention; Investigation; Lead; Long-Term Effects; Massachusetts; Mediating; Mediation; Mediator of activation protein; Minor; Modeling; Monitor; Nature; Oppositional Defiant Disorder; Outcome; Parenting behavior; Parents; Participant; Pattern; Physical aggression; Pilot Projects; Principal Investigator; Problem Solving; Psychopathology; Randomized; Recurrence; Research; Research Personnel; Resistance; Severities; Specific qualifier value; Students; Study Section; Symptoms; Testing; Training; Treatment Failure; Treatment outcome; Virginia; Waiting Lists; Work; Youth; adverse outcome; authority; child mental health service; childhood anxiety; design; emotion regulation; follow-up; interest; intervention effect; peer; programs; psychosocial; randomized trial; response; skills; social; success; theories; treatment adherence; treatment response

DESCRIPTION (provided by applicant): The primary aim of this second resubmission is to evaluate the efficacy of Parent Management Training (PMT) and a relatively new Cognitive Behavior Therapy, Collaborative Problem Solving (CPS), in the treatment of 150 children between 8 and 12 years of age who are diagnosed with Oppositional Defiant Disorder (ODD). Children and their parents will be randomly assigned to PMT, CPS, or wait list control conditions. The current proposal will evaluate these children prior to treatment, throughout treatment, immediately following treatment, and 1 year thereafter. The secondary aim is to examine the predictors of durable gains associated with treatment. Research suggests a matrix of predictor variables worthy of investigation including child sociodemographics, severity of the disorder, comorbidity with other disorders, parental psychopathology, and family functioning. These potential predictors of treatment outcome will be obtained before treatment begins to determine their utility in the prediction of treatment outcome. Identification of these predictors might constitute the first step in determining which children with which characteristics respond best to treatment and which ones do not. Some of these predictors might function as moderators of treatment outcomes whereas others might serve as "nonspecific" predictors of treatment outcome. It is possible that such findings might also lead to enhanced treatment outcomes by altering treatments to address certain characteristics associated with change. The tertiary aim is to investigate various treatment mechanisms (mediating variables) thought to be associated with treatment outcomes. The identification of such variables is necessary in order to understand how treatments such as PMT and CPS actually work. Specifically we hope to examine changes in parenting practices as a mediator of PMT and changes in parent-child problem solving as a mediator of CPS. ODD is a childhood disorder that is characterized by a recurrent pattern of developmentally inappropriate levels of negativistic, defiant, disobedient, and hostile behavior toward authority figures, and is estimated to occur in 2 to 16 percent of children. Behaviors associated with ODD include temper outbursts; persistent stubbornness; resistance to directions; unwillingness to compromise, give in, or negotiate with adults or peers; deliberate or persistent testing of limits; and verbal (and minor physical) aggression. Parents of children with ODD are more likely to utilize child mental health services than parents of children with other behavior disorders, presumably due to the deleterious effects of ODD-related behaviors on interactions between children and their adult caretakers. Studies have shown that ODD, independent of its association with attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD), is a highly comorbid disorder with adverse effects on children's social and family functioning and long-term outcomes. Given its adverse outcomes the pursuit of treatments that work, both in the short-term and the long-term, are desired.

描述(由申请人提供)：第二次重新提交的主要目的是评估家长管理培训(PMT)和一种相对较新的认知行为疗法--协作问题解决(CPS)--在治疗150名8至12岁被诊断为对立违抗障碍(ODD)的儿童中的效果。孩子和他们的父母将被随机分配到PMT、CPS或等待名单控制条件。目前的提案将在治疗前、治疗过程中、治疗后立即和治疗后一年对这些儿童进行评估。 第二个目标是检查与治疗相关的持久收益的预测因素。研究表明，有一系列值得研究的预测变量，包括儿童的社会人口学、疾病的严重程度、与其他疾病的共病、父母的精神病理学和家庭功能。这些潜在的治疗结果预测指标将在治疗开始确定它们在预测治疗结果中的有效性之前获得。确定这些预测因素可能是确定哪些特征的儿童对治疗反应最好，哪些儿童不反应的第一步。这些预测因子中的一些可能作为治疗结果的调节因子，而另一些则可能作为治疗结果的“非特异性”预测因子。这些发现可能还会通过改变治疗方法来解决与变化相关的某些特征，从而提高治疗结果。 第三个目标是调查被认为与治疗结果相关的各种治疗机制(中介变量)。为了了解PMT和CPS等治疗方法的实际效果，有必要确定这些变量。具体地说，我们希望考察父母教养方式的变化作为PMT的中介，以及亲子问题解决作为CPS的中介的变化。ODD是一种儿童障碍，其特征是对权威人物的消极、挑衅、不服从和敌对行为的发展水平不适当的反复出现的模式，据估计发生在2%到16%的儿童中。与古怪有关的行为包括：脾气暴发；顽固顽固；抗拒指示；不愿妥协、让步或与成年人或同龄人谈判；故意或持续地测试极限；以及言语(和轻微的身体)攻击。与其他行为障碍儿童的父母相比，患有ODD儿童的父母更有可能使用儿童心理健康服务，这可能是因为与ODD相关的行为对儿童与其成年照顾者之间的互动产生了有害影响。研究表明，与注意力缺陷/多动障碍(ADHD)和品行障碍(CD)无关的ODD是一种高度并存的障碍，对儿童的社会和家庭功能以及长期结果产生不利影响。 考虑到它的不利后果，追求在短期和长期都有效的治疗方法是可取的。