Parent Training and Emotion Coaching for Children with Limited Prosocial Emotions

针对亲社会情绪有限的儿童的家长培训和情绪辅导

• 批准号: 8637606
• 负责人: LYNN Fainsilber KATZ
• 金额: $ 18.44万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8637606
• 关键词: 7 year old; Acting Out; Address; Adolescence; Adult; Affective; Aftercare; Age; Antisocial Personality Disorder; Awareness; Behavior; Behavioral; Child; Childhood; Clinic; Clinical; Clinical Trials; Communication; Community Mental Health Centers; Conduct Disorder; DSM-IV; Data; Development; Diagnosis; Early Intervention; Educational process of instructing; Effectiveness; Emotional; Emotions; Empathy; Family; Goals; Guilt; Individual; Interpersonal Relations; Intervention; Learning; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Mothers; Occupational; Oppositional Defiant Disorder; Outcome; Outcome Study; Parenting behavior; Parents; Participant; Pilot Projects; Population; Public Health; Randomized; Research; Research Proposals; Risk; Role; Sampling; Statistical Models; Substance Use Disorder; Testing; Theft; Time; Training; Training Programs; Youth; anti social; base; boys; callous unemotional trait; conduct problem; cost; design; early childhood; early onset; economic cost; effective therapy; evidence base; fighting; follow-up; high risk sexual behavior; improved; mortality; non-compliance; programs; response; satisfaction; skills; social; trend

Children with oppositional defiant disorder (ODD) are at significantly increased risk for a host of negative outcomes in later childhood, adolescence, and adulthood. These outcomes can include delinquency, early and risky sexual behavior, poor academic and occupational adjustment, poor interpersonal relations, and increased risk for various mental disorders. Effective treatment for ODD has typically been based on a social learning-based ¿parent management training¿ (PMT) model. Despite strong evidence for PMT, it is not effective with all children, with up to one third failing to show reliable and sustained improvement. Having limited prosocial emotions (e.g., lack of guilt and empathy, callous use of others) appears to be one factor that mitigates the effects of traditional PMT. Children with ODD with limited prosocial emotions present with more severe conduct problems and have poorer behavioral outcomes. It is therefore important to develop empirically based methods to enhance the efficacy of ¿traditional¿ PMT for those children with ODD and limited prosocial emotions. Recent meta-analytic research indicates that one key component of successful family based intervention approaches involves teaching parents skills related to emotional communication. Given evidence that children with ODD with limited prosocial emotions have deficits in the awareness/recognition of emotion and in empathy, incorporating an emotion-focused intervention (which has not been a focus of PMT) into traditional PMT should enhance outcomes for these children. Consistent with the aims of the R34 mechanism, the primary goal of this application is to develop and test the feasibility of a brief emotion-coaching (EC) intervention in combination with an evidence-based PMT program, Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), for use with clinic-referred children with ODD who have limited prosocial emotions. The Specific Aims are to: 1) develop and refine an empirically based combined HNC-EC parenting intervention to reduce CP in children with ODD and limited prosocial emotions; and 2) assess the viability of a later clinical trial by a) pilot testing the newly developed HNC-EC intervention compared to HNC alone with mothers and their 3-7 year-old children who have been referred for treatment of significant levels of oppositional behavior (and who also have limited prosocial emotions) in a community mental health center setting, and b) establishing the treatment feasibility (family and therapist-level feasibility, treatment fidelity, participant satisfaction) and research feasibility of the HNC-EC intervention compared to HNC alone. While pilot studies should not be used to estimate effect sizes, (Kraemer et al., 2006; Sherrill et al., 2009), we will explore trends in the data to facilitate consideration of possible designs for later statistical modeling in a larger trial. Promising findings would form the basis of a research proposal for a randomized clinical outcome study comparing HNC alone and in combination with an EC intervention for children with ODD and limited prosocial emotions. Should this combined intervention (which is focused on improving outcomes in this hard-to-treat population) prove to be effective, it will be one of the first interventions targeting known developmental mechanisms related to limited prosocial emotions in children. Given the increased likelihood that children with an early onset of CP and limited prosocial emotions are at increased likelihood of multiple negative outcomes extending into adulthood, at extraordinary social and economic cost, improving response rates to PMT (which is a low-cost, low-restrictiveness intervention) will have substantial public health impact.

对立违抗性障碍（ODD）儿童在童年后期，青春期和成年期出现一系列负面结果的风险显著增加。这些后果可能包括青少年犯罪，早期和危险的性行为，不良的学术和职业适应，不良的人际关系，以及各种精神障碍的风险增加。ODD的有效治疗通常基于基于社会学习的父母管理培训（PMT）模型。尽管有强有力的证据证明PMT对所有儿童都有效，但它并不是对所有儿童都有效，多达三分之一的儿童未能表现出可靠和持续的改善。具有有限的亲社会情绪（例如，缺乏内疚感和同情心，无情地利用他人）似乎是减轻传统PMT影响的一个因素。亲社会情绪有限的ODD儿童表现出更严重的行为问题，行为结果更差。因此，重要的是要发展经验为基础的方法，以提高疗效的传统的PMT为那些孩子与ODD和亲社会情绪有限。最近的元分析研究表明，成功的家庭干预方法的一个关键组成部分是教会父母与情感沟通有关的技能。有证据表明，亲社会情绪有限的ODD儿童在情绪的意识/识别和同理心方面存在缺陷，将以情绪为中心的干预（这不是PMT的重点）纳入传统PMT应该会提高这些儿童的结果。 与R34机制的目标一致，本申请的主要目标是开发和测试简短的情绪辅导（EC）干预与循证PMT计划相结合的可行性，帮助不顺从的孩子（HNC; Forehand & McMahon，1981; McMahon & Forehand，2003），用于临床转诊的亲社会情绪有限的ODD儿童。具体目标是：1）开发和完善基于经验的HNC-EC组合育儿干预，以减少ODD和亲社会情绪有限的儿童的CP;以及2）通过a）与单独的HNC相比，对新开发的HNC-EC干预进行试点测试，（并且也具有有限的亲社会情绪），以及B）建立与单独的HNC相比，HNC-EC干预的治疗可行性（家庭和治疗师水平的可行性、治疗保真度、参与者满意度）和研究可行性。虽然试点研究不应用于估计效应大小，（Kraemer等人，2006; Sherrill等人，2009），我们将探索数据的趋势，以便于考虑在更大的试验中进行后期统计建模的可能设计。有希望的发现将形成一个随机临床结果研究的研究建议的基础上，比较HNC单独和与EC干预相结合的儿童与ODD和有限的亲社会情绪。如果这种综合干预（重点是改善这一难以治疗人群的结果）被证明是有效的，它将成为针对与儿童有限亲社会情绪相关的已知发展机制的首批干预措施之一。由于CP早期发作和亲社会情绪有限的儿童更有可能出现多种负面结果，并延长到成年，因此社会和经济成本非常高，提高PMT（这是一种低成本，低限制性干预措施）的响应率将产生重大的公共卫生影响。