Abstract
This study examines the treatment outcomes of 139, 6–11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child’s behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders.
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Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychiatry.
Attkisson, C. C., & Greenfield, T. K. (1996). The Client Satisfaction Questionnaire (CSQ) Scales and the Service Satisfaction Scale-30 (SSS-30). In L. I. Sederer, & B. Dickery (Eds.), Outcomes Assessment in Clinical Practice (pp. 120–127). Baltimore: Williams & Wilkins.
August, G. J., Realmuto, G. M., Joyce, T., & Hektner, J. M. (1999). Persistence and desistance of oppositional defiant disorder in a community sample of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1262–1270. doi:10.1097/00004583-199910000-00015.
Bickman, L., & Mulvaney, S. (2005). Large-scale evaluations of children’s mental health services: The Ft. Bragg and Stark County studies. In R. G. Steele, & M. C. Roberts (Eds.), Handbook of mental health services for children, adolescents, and families (pp. 371–386). New York, NY: Kluwer Academic/Plenum Publishers.
Bird, H., Shaffer, D., Fisher, P., & Gould, M. S. (1993). The Columbia impairment scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167–176.
Birmaher, B., Bridge, J., Williamson, D., Brent, D., Dahl, R. E., Axelson, D., et al. (2004). Psychosocial functioning in youths at high risk to develop major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 839–846. doi:10.1097/01.chi.0000128787.88201.1b.
Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J., & Pickrel, S. G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at posttreatment and 6-month follow-up. Children’s Services (Mahwah, N.J.), 2, 81–93. doi:10.1207/s15326918cs0202_2.
Burns, B. J., Farmer, E. M. Z., Angold, A., Costello, E. J., & Behar, L. (1996). A randomized trial of case management for youths with serious emotional disturbance. Journal of Clinical Child Psychology, 25, 476–486. doi:10.1207/s15374424jccp2504_12.
Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 647–652. doi:10.1097/chi.0b013e318033ff71.
Cotter, R. B., Burke, J. D., Loeber, R., & Navratil, J. L. (2002). Innovative retention methods in longitudinal research: A case study of the developmental trends study. Journal of Child and Family Studies, 11, 485–498. doi:10.1023/A:1020939626243.
Efron, B. (1980). Biostatistics casebook. Stanford, Il.: Standford University Press.
Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 215–237. doi:10.1080/15374410701820117.
Feindler, E. L., Ecton, R. B., Kingsley, D., & Dubey, D. R. (1986). Group anger-control training for insitutuionalized psychiatric male adolescents. Behavior Therapy, 17, 109–123. doi:10.1016/S0005-7894(86)80079-X.
Fleischman, M. J., Horne, A. M., & Arthur, J. L. (1983). Troubled families: A treatment program. Champaign, IL: Research Press.
Fonagy, P., & Target, M. (1994). The efficacy of psychoanalysis for children with disruptive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 45–55. doi:10.1097/00004583-199401000-00007.
Frick, P. J. (1994). Family dysfunction and the disruptive behavior disorders: A review of recent empirical findings. Advances in Clinical Child Psychology, 16, 203–226.
Garland, A. F., Hawley, K. M., Brookman-Frazee, L., & Hurlburt, M. (2008). Identifying common elements of evidence-based psychosocial treatments for children’s disruptive behavior problems. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 505–514. doi:10.1097/CHI.0b013e31816765c2.
Greenhill, L. L., Abikoff, H. B., Arnold, L. E., & Cantwell, D. P. (1996). Medication treatment strategies in the MTA study: Relevance to clinicians and researchers. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1304–1313. doi:10.1097/00004583-199610000-00017.
Hawes, D. J., & Dadds, M. R. (2007). Stability and malleability of callous-unemotional traits during treatment for childhood conduct problems. Journal of Clinical Child and Adolescent Psychology, 36, 347–355.
Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford.
Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868–874. doi:10.1097/00004583-200207000-00021.
Hoagwood, K., Horwitz, S., Stiffman, A., Weisz, J. R., Bean, D., Rae, D., et al. (2000). Concordance between parent reports of children’s mental health services and records: The services assessment for children and adolescents (SACA). Journal of Child and Family Studies, 9, 315–331. doi:10.1023/A:1026492423273.
Hodges, K. (1996). Utilization of the child and Adolescent Functional Assessment Scale (CAFAS) for assessing program and clincical outcomes. Paper presented at the Annual System of Care Research Conference, Tampa, Fl.
Hollingshead, A., & Redlich, F. (1958). Social class and mental illness: A community study. New York, NY: Wiley.
Kaufman, A. S., & Kaufman, N. L. (1990). Kaufman Brief Intelligence Test. Circle Pines, MN: American Guidance Service, Inc.
Kaufman, J., Birmaher, B., Brent, D. A., Rao, U., & Ryan, N. D. (1996). KIDDIE-SADS-present and lifetime version (K-SADS-PL). Instrument developed at Western Psychiatric Institute and Clinic, Pittsburgh, PA.
Kazdin, A. (1996). Combined and multimodal treatments in child and adolescent psychotherapy: Issues, challenges, and research directions. Clinical Psychology: Science and Practice, 3, 69–100.
Kazdin, A. (2005). Child, parent, and family-based treatment of aggressive and antisocial child behavior. In E. D. Hibbs, & P. S. Jensen (Eds.), Psychosocial treatments for child and adolscent disorders: Empirically based strategies for clincial practice (pp. 445–476, 2nd ed.). Washington, DC: American Psychological Association.
Kazdin, A., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28, 160–172. doi:10.1207/s15374424jccp2802_4.
Kazdin, A., & Whitley, M. K. (2006). Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. Journal of Consulting and Clinical Psychology, 74, 455–467. doi:10.1037/0022-006X.74.3.455.
Kazdin, A., Esveldt-Dawson, K., French, N. H., & Unis, A. S. (1987). Problem-solving skills training and relationship therapy in the treatment of antisocial child behavior. Journal of Consulting and Clinical Psychology, 55, 76–85. doi:10.1037/0022-006X.55.1.76.
Kazdin, A., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60, 733–747. doi:10.1037/0022-006X.60.5.733.
Kolko, D. J. (1995). Multimodal partial/day treatment of child antisocial behavior: Service description and multilevel program evaluation. Continuum, 2, 3–24.
Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322–342. doi:10.1177/1077559596001004004.
Kolko, D. J. (2001). Efficacy of cognitive-behavioral treatment and fire safety education for firesetting children: Initial and follow-up outcomes. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 359–369. doi:10.1111/1469-7610.00729.
Kolko, D. J., & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage.
Kolko, D. J., Loar, L. L., & Sturnick, D. (1990). Inpatient social-cognitive skills training groups with conduct disordered and attention deficit disordered children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 31, 737–748. doi:10.1111/j.1469-7610.1990.tb00814.x.
Kolko, D. J., Bukstein, O. G., & Barron, J. (1999). Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: Main and incremental effects across settings. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 578–586. doi:10.1097/00004583-199905000-00020.
Kolko, D. J., Dorn, L. D., Bukstein, O. G., & Burke, J. D. (2008). Clinically referred ODD children with or without CD and healthy controls: Comparisons across contextual domains. Journal of Child and Family Studies, 17, 714–734.
Kovacs, M. (1985). The children’s depressive inventory (CDI). Psychopharmacology Bulletin, 21, 995–998.
Lahey, B. B., Loeber, R., Burke, J. D., Rathouz, P. J., & McBurnett, K. (2002). Waxing and waning in concert: Dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 17 years among clinic-referred boys. Journal of Abnormal Psychology, 111, 556–567. doi:10.1037/0021-843X.111.4.556.
Lavori, P. W. (1992). Clinical trails in psychiatry. Should protocol deviation censor patient data. Neuropsychopharmacology, 6, 39–48.
Lochman, J. E., & Wells, K. C. (2003). Effectiveness of the Coping Power Program and of classroom intervention with aggressive children: Outcomes at a 1-year follow-up. Behavior Therapy, 34, 493–515. doi:10.1016/S0005-7894(03)80032-1.
Lochman, J. E., Lampron, L. B., Gemmer, T. C., & Harris, S. R. (1987). Anger-coping interventions for aggressive children: Guide to implementation in school settings. In P. A. Keller, & S. Heyman (Eds.), Innovations in Clinical Practice: A Source Book (vol. Vol. 6, (pp. 339–356)). Sarasota, FL: Professional Resource Exchange.
Lochman, J. E., Coie, J. D., Underwood, M., & Terry, R. (1993). Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children. Journal of Consulting and Clinical Psychology, 61, 1053–1058. doi:10.1037/0022-006X.61.6.1053.
Loeber, R., Farrington, D. P., Stouthamer-Loeber, M., & Van Kammen, W. B. (1998). Antisocial behavior and mental health problems: Explanatory factors in childhood and adolescence (First volume of the Pittsburgh Youth Study). Mahwah, NJ: Lawrence Erlbaum.
Luborsky, L., McLellan, A. T., Woody, G. E., O’Brien, C. P., & Auerbach, A. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602–611.
Martinez, C. R. J., & Forgatch, M. S. (2001). Preventing problems with boys’ noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69, 416–428. doi:10.1037/0022-006X.69.3.416.
McCart, M. R., Priester, P. E., Davies, W. H., & Azen, R. (2006). Differential effectiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: A meta-analysis. Journal of Abnormal Child Psychology, 34, 527–543. doi:10.1007/s10802-006-9031-1.
McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory. Research and Practice, 20, 368–375.
McKay, M. M., Hibbert, R., Hoagwood, K., Rodriguez, J., Murray, L., Legerski, J., et al. (2004). Integrating evidence-based engagement interventions into “real world” child mental health settings. Brief Treatment and Crisis Intervention, 4, 177–186. doi:10.1093/brief-treatment/mhh014.
Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 20. doi:10.1037/1082-989X.7.1.105.
Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., et al. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44, 1811–1820. doi:10.1016/j.brat.2006.01.004.
Nixon, R. D. V., Sweeny, L., Erickson, D. B., & Touyz, S. W. (2003). Parent–child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251–260. doi:10.1037/0022-006X.71.2.251.
Osgood, D. W., & Smith, G. L. (1995). Applying hierarchical linear modeling to extended longitudinal evaluations. Evaluation Review, 19, 3–38. doi:10.1177/0193841X9501900101.
Pardini, D. A., & Loeber, R. (2007). Interpersonal and affective features of psychopathy in children and adolescents: Advancing a development perspective: Introduction to the special section. Journal of Clinical Child and Adolescent Psychology, 36, 269–275.
Patterson, G. R., Reid, J. B., & Dishion, T. (1992). Antisocial boys, vol. 4. Eugene, OR: Castalia.
Pelham, W. E., Milich, R., Murphy, D. A., & Murphy, H. A. (1989). Normative data on the IOWA Conners Teacher Rating Scale. Journal of Clinical Child Psychology, 18, 259–262. doi:10.1207/s15374424jccp1803_9.
Raudenbush, S., Bryk, A., Cheong, Y. F., & Congdon, R. (2004). HLM 6: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International.
Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-up of children who received the Incredible Years Intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34, 471–491. doi:10.1016/S0005-7894(03)80031-X.
Robin, A. L., & Foster, S. L. (1989). Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach. New York, NY: Guilford.
Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68, 624–640. doi:10.1037/0022-006X.68.4.624.
Shaw, D. S., Dishion, T., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a family-centered approach to the prevention of early conduct problems: 2 year effects of the family check-up in early childhood. Journal of Consulting and Clinical Psychology, 74, 1–9. doi:10.1037/0022-006X.74.1.1.
Sheldrick, R. C., Kendall, P. C., & Heimberg, R. G. (2001). The clinical significance of treatments: A comparison of three treatments for conduct disordered children. Clinical Psychology: Science and Practice, 8, 418–430. doi:10.1093/clipsy/8.4.418.
Stambaugh, L. F., Mustillo, S. A., Burns, B. J., Stephens, R. L., Baxter, B., Edwards, D., et al. (2007). Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15, 143. doi:10.1177/10634266070150030201.
Walker, H. M., Horner, R. H., Sugai, G., Bullis, M., Sprague, J. R., Bricker, D., et al. (1996). Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. Journal of Emotional and Behavioral Disorders, 4, 194–209.
Webster-Stratton, C., Reid, J. B., & Hammond, M. (2001a). Preventing child conduct problems, promoting social competence: A parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology, 30, 283–302. doi:10.1207/S15374424JCCP3003_2.
Webster-Stratton, C., Reid, J. B., & Hammond, M. (2001b). Social skills and problem-solving training for children with early-onset conduct problems: Who benefits? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 943–952. doi:10.1111/1469-7610.00790.
Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: Intervention outcomes for parent, child, and teacher training. Journal of Clinical Child and Adolescent Psychology, 33, 105–124. doi:10.1207/S15374424JCCP3301_11.
Weissberg, R. P., Gesten, E. L., Caplan, M., & Jackson, A. S. (1990). Social problem-solving training for fourth graders: An abridged revision of the Rochester social problem-solving program. New Haven, CT: Yale University.
Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. The American Psychologist, 47, 1578–1585. doi:10.1037/0003-066X.47.12.1578.
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This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.
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Kolko, D.J., Dorn, L.D., Bukstein, O.G. et al. Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up. J Abnorm Child Psychol 37, 591–609 (2009). https://doi.org/10.1007/s10802-009-9303-7
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DOI: https://doi.org/10.1007/s10802-009-9303-7