Mediators, Moderators and Treatment Outcomes with Oppositional Defiant Disorder

描述（由申请人提供）：第二次重新提交的主要目的是评价父母管理培训（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性障碍（ODD）的儿童中的疗效。儿童和他们的父母将被随机分配到PMT，CPS或等待列表控制条件。目前的提案将在治疗前、整个治疗过程中、治疗后立即和治疗后1年对这些儿童进行评估。 第二个目的是检查与治疗相关的持久收益的预测因素。研究表明，一个矩阵的预测变量值得调查，包括儿童社会人口统计学，疾病的严重程度，与其他疾病的合并症，父母的精神病理学，和家庭功能。这些治疗结果的潜在预测因子将在治疗开始前获得，以确定其在预测治疗结果中的效用。识别这些预测因子可能是确定哪些儿童具有哪些特征对治疗反应最好，哪些儿童没有反应的第一步。这些预测因子中的一些可能作为治疗结果的调节因子，而另一些可能作为治疗结果的“非特异性”预测因子。这些发现也可能通过改变治疗方法来解决与变化相关的某些特征，从而提高治疗效果。 第三个目的是研究被认为与治疗结果相关的各种治疗机制（中介变量）。这些变量的识别是必要的，以了解如何治疗，如PMT和CPS的实际工作。具体来说，我们希望研究的变化，父母的做法作为一个调解员PMT和变化，亲子问题解决的调解员CPS。ODD是一种儿童期疾病，其特征是对权威人物的消极、违抗、不服从和敌对行为的发展不适当水平的复发模式，估计发生在2%至16%的儿童中。与ODD相关的行为包括脾气爆发;持续的固执;抗拒方向;不愿意妥协，屈服，或与成年人或同龄人谈判;故意或持续测试极限;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，ODD儿童的父母更有可能利用儿童心理健康服务，这可能是由于ODD相关行为对儿童与成人照顾者之间的互动产生有害影响。研究表明，ODD与注意力缺陷多动障碍（ADHD）和行为障碍（CD）无关，是一种高度共病的疾病，对儿童的社会和家庭功能以及长期结果有不良影响。 鉴于其不良后果，需要寻求短期和长期有效的治疗方法。

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.