Scahill Lawrence, Sukhodolsky Denis G, Bearss Karen, Findley Diane, Hamrin Vanya, Carroll Deirdre H, Rains Adrienne L
Yale Child Study Center, New Haven, CT 06520-7900, USA.
J Child Neurol. 2006 Aug;21(8):650-6. doi: 10.1177/08830738060210080201.
Oppositional, defiant, and disruptive behaviors are common in clinical samples of children with tic disorders. In this study, we sought to evaluate the short-term efficacy of a structured parent training program in children with tic disorders accompanied by disruptive behavior. Children with tic disorders and at least a moderate level of disruptive behavior were randomly assigned to a 10-session structured parent management training program or to continue treatment as usual. Twenty-four children (18 boys and 6 girls) between the ages of 6 and 12 years (mean 8.9 +/- 2.0 years) were enrolled; 23 subjects completed the study. At baseline, subjects showed moderate to severe levels of oppositional and defiant behavior. Twenty subjects (83%) were on stable medication. The parent-rated Disruptive Behavior Rating Scale score decreased by 51% in the parent management training group compared with a decrease of 19% in the treatment as usual group (P < .05). On the Improvement scale of the Clinical Global Impression, a rater masked to treatment assignment classified 7 of 11 subjects who completed parent management training as much improved or very much improved compared with 2 of 12 subjects in the treatment as usual group (Fisher exact test, P < .05). These results suggest that parent management training is helpful for short-term improvement in disruptive behavior problems in children with tic disorders. Larger randomized clinical trials are needed.
对立、违抗和破坏性行为在抽动障碍儿童的临床样本中很常见。在本研究中，我们试图评估一项结构化家长培训计划对伴有破坏性行为的抽动障碍儿童的短期疗效。患有抽动障碍且至少有中度破坏性行为水平的儿童被随机分配到一个为期10节的结构化家长管理培训计划中，或继续按常规治疗。招募了24名年龄在6至12岁之间（平均8.9 +/- 2.0岁）的儿童（18名男孩和6名女孩）；23名受试者完成了研究。在基线时，受试者表现出中度至重度的对立和违抗行为。20名受试者（83%）正在接受稳定的药物治疗。家长管理培训组中家长评定的破坏性行为评定量表得分下降了51%，而常规治疗组下降了19%（P <.05）。在临床总体印象改善量表上，一名对治疗分配不知情的评定者将完成家长管理培训的11名受试者中的7名评定为明显改善或非常明显改善，而常规治疗组的12名受试者中有2名被如此评定（Fisher精确检验，P <.05）。这些结果表明，家长管理培训有助于短期改善抽动障碍儿童的破坏性行为问题。需要进行更大规模的随机临床试验。
