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家长管理培训 (PMT) 和相对较新的认知行为疗法、协作问题解决 (CPS) 在治疗 150 名 8 岁到 10 岁之间的儿童时的效果。 12 岁以下被诊断患有对立违抗障碍 (ODD) 的人。儿童及其父母将被随机分配到 PMT、CPS 或候补名单控制条件。目前的提案将在治疗前、治疗过程中、治疗后立即以及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，值得研究的预测变量矩阵包括儿童社会人口统计学、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。这些治疗结果的潜在预测因子将在治疗开始之前获得，以确定它们在预测治疗结果中的效用。识别这些预测因素可能是确定哪些具有哪些特征的儿童对治疗反应最好、哪些则不然的第一步。其中一些预测因子可能充当治疗结果的调节因子，而另一些则可能充当治疗结果的“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，从而改善治疗结果。 第三个目标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 等治疗方法的实际效果，有必要识别这些变量。具体来说，我们希望研究作为 PMT 中介因素的养育方式的变化以及作为 CPS 中介因素的亲子问题解决的变化。 ODD 是一种儿童期障碍，其特征是反复出现对权威人物的消极、挑衅、不服从和敌对行为，这些行为与发育不相适应，估计有 2% 至 16% 的儿童会出现这种情况。与 ODD 相关的行为包括脾气暴躁；持续的固执；对指示的抵抗力；不愿意与成年人或同龄人妥协、让步或谈判；故意或持续测试极限；以及言语（和轻微的身体）攻击。患有 ODD 的儿童的父母比患有其他行为障碍的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 相关行为对儿童与其成年照顾者之间的互动产生有害影响。研究表明，与注意力缺陷/多动障碍 (ADHD) 和品行障碍 (CD) 相关的 ODD 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产生不利影响。 鉴于其不良后果，人们希望寻求短期和长期有效的治疗方法。