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: 7414573
• 负责人: THOMAS H. OLLENDICK
• 金额: $ 30.29万
• 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 2012-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7414573
• 关键词: Accounting; Address; Adherence; Adult; Adverse effects; Age-Years; Algorithms; Attention deficit hyperactivity disorder; Behavior; Behavior Disorders; Characteristics; Child; Childhood; Clinical; Cognitive Therapy; Comorbidity; Competence; Condition; Conduct Disorder; Daily; Data; Development; Diagnosis; Disease; Disease regression; Effectiveness; Effectiveness of Interventions; Environment; Evaluation; Family; Family Characteristics; Follow-Up Studies; Future; General Hospitals; Intervention; Investigation; Lead; Lifestyle-related condition; 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; Randomized Controlled Clinical Trials; Rate; Recurrence; Research; Research Personnel; Resistance; Severities; Specific qualifier value; Students; Study Section; Symptoms; Testing; Thinking; Training; Treatment Failure; Treatment outcome; Virginia; Waiting Lists; Week; Work; Youth; authority; child mental health service; childhood anxiety; design; desire; emotion regulation; follow-up; interest; peer; programs; psychosocial; response; size; skills; social; success; theories

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父母管理培训（PMT）和相对较新的认知行为疗法，协作解决问题（CPS）的疗效，以治疗150名被诊断出患有相对反抗障碍的8至12岁之间的儿童。儿童及其父母将被随机分配给PMT，CPS或等待列表控制条件。当前的提案将在治疗，整个治疗，治疗后以及此后1年的治疗前评估这些儿童。 次要目的是检查与治疗相关的持久收益的预测因素。研究表明，值得调查的预测变量矩阵，包括儿童社交人口统计学，疾病的严重程度，与其他疾病的合并症，父母的心理病理学和家庭功能。这些潜在的治疗结果预测指标将在治疗开始确定治疗结果预测的效用之前获得。这些预测因素的识别可能构成确定哪些儿童对哪些特征对治疗的反应最佳的第一步，哪些特征对治疗的反应最佳。这些预测因素中的一些可能是治疗结果的主持人，而其他预测因素可能是治疗结果的“非特异性”预测指标。这种发现可能还可能通过改变治疗方法来解决与变化相关的某些特征，从而导致增强的治疗结果。 三级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）。为了了解PMT和CPS等治疗方法的实际工作，需要识别此类变量。具体来说，我们希望将育儿实践的变化作为PMT的调解人，以及作为CPS调解人的父子问题解决方案的变化。奇怪的是一种儿童疾病，其特征是反复发育不当程度的消极主义，反抗，不听话和对权威人物的敌对行为，估计在2％至16％的儿童中发生。与奇数相关的行为包括脾气暴躁；持续的固执；对方向的抵抗；不愿意妥协，屈服或与成年人或同伴进行谈判；故意或持续测试极限；和口头（和次要的身体）侵略。与患有其他行为障碍的儿童的父母相比，患有奇怪儿童的父母更有可能利用儿童心理健康服务，这大概是由于奇怪的行为对儿童及其成人看护人之间互动的有害影响。研究表明，与注意力缺陷/多动症（ADHD）和行为障碍（CD）无关的奇数是一种高度合并症，对儿童的社会和家庭功能和长期结局有不利影响。 鉴于其不利的结果，需要在短期和长期的工作中追求工作的治疗方法。