Ollendick Thomas H, Greene Ross W, Austin Kristin E, Fraire Maria G, Halldorsdottir Thorhildur, Allen Kristy Benoit, Jarrett Matthew A, Lewis Krystal M, Whitmore Smith Maria, Cunningham Natoshia R, Noguchi Ryoichi J P, Canavera Kristin, Wolff Jennifer C
a Department of Psychology , Virginia Tech.
b Department of Psychiatry , McLean Hospital/Harvard Medical School.
J Clin Child Adolesc Psychol. 2016 Sep-Oct;45(5):591-604. doi: 10.1080/15374416.2015.1004681. Epub 2015 Mar 9.
This study examined the efficacy of Collaborative & Proactive Solutions (CPS) in treating oppositional defiant disorder (ODD) in youth by comparing this novel treatment to Parent Management Training (PMT), a well-established treatment, and a waitlist control (WLC) group. One hundred thirty-four youth (ages 7-14, 61.9% male, 83.6% White) who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for ODD were randomized to CPS, PMT, or WLC groups. ODD was assessed with semistructured diagnostic interviews, clinical global severity and improvement ratings, and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Responder and remitter analyses were undertaken using intent-to-treat mixed-models analyses. Chronological age, gender, and socioeconomic status as well as the presence of comorbid attention deficit/hyperactivity and anxiety disorders were examined as predictors of treatment outcome. Both treatment conditions were superior to the WLC condition but did not differ from one another in either our responder or remitter analyses. Approximately 50% of youth in both active treatments were diagnosis free and were judged to be much or very much improved at posttreatment, compared to 0% in the waitlist condition. Younger age and presence of an anxiety disorder predicted better treatment outcomes for both PMT and CPS. Treatment gains were maintained at 6-month follow-up. CPS proved to be equivalent to PMT and can be considered an evidence-based, alternative treatment for youth with ODD and their families.
本研究通过将这种新型治疗方法与成熟的家长管理培训(PMT)以及等待名单对照组(WLC)进行比较,检验了协作与积极解决方案(CPS)治疗青少年对立违抗性障碍(ODD)的疗效。134名符合《精神疾病诊断与统计手册》(第4版)ODD标准的青少年(年龄7 - 14岁,61.9%为男性,83.6%为白人)被随机分为CPS组、PMT组或WLC组。通过半结构化诊断访谈、临床总体严重程度和改善评分以及家长报告测量来评估ODD。评估在治疗前、治疗后以及治疗后6个月完成。使用意向性治疗混合模型分析进行反应者和缓解者分析。将实际年龄、性别、社会经济地位以及是否存在共病注意力缺陷/多动障碍和焦虑症作为治疗结果的预测因素进行检验。两种治疗条件均优于WLC条件,但在我们的反应者或缓解者分析中彼此没有差异。与等待名单组0%的情况相比,两种积极治疗组中约50%的青少年在治疗后无诊断且被判定有很大或非常大的改善。年龄较小和存在焦虑症预测PMT和CPS的治疗效果更好。治疗效果在6个月随访时得以维持。CPS被证明与PMT等效,可被视为针对患有ODD的青少年及其家庭的一种循证替代治疗方法。