Brown School, International Center for Child Health and Development, Washington University in St. Louis, St. Louis, MO, USA.
Brown School, Washington University in St. Louis, St. Louis, MO, USA.
J Child Psychol Psychiatry. 2022 Nov;63(11):1252-1260. doi: 10.1111/jcpp.13566. Epub 2022 Jan 6.
Oppositional Defiant Disorders (ODDs) and other Disruptive Behavior Disorders (DBDs) are common among children and adolescents in poverty-impacted communities in sub-Saharan Africa. Without early intervention, its progression into adulthood can result in dire consequences. We examined the impact of a manualized family strengthening intervention called Amaka Amasanyufu designed to reduce ODDs and other DBDs among school-going children residing in low-resource communities in Uganda.
We used longitudinal data from the SMART Africa-Uganda study (2016-2022). Public primary schools were randomized to: (1) Control condition (receiving usual care comprising generalized psychosocial functioning literature), 10 schools; (2) intervention delivered via parent peers (Amaka-parents), 8 schools or; (3) intervention delivered via community healthcare workers (Amaka-community), 8 schools. All the participants were blinded. At baseline, 8- and 16-weeks postintervention initiation, caregivers completed the Iowa Conners Scale, which measured Oppositional Defiant Disorder (ODD) and Impairment Rating Scale to evaluate children's overall impairment and impaired functioning with peers, siblings, and parents; impaired academic progress, self-esteem, and family functioning. Three-level linear mixed-effects models were fitted to each outcome. Pairwise comparisons of postbaseline group means within each time point were performed using Sidak's adjustment for multiple comparisons. Only children positive for ODD and other DBDs were analyzed.
Six hundred and thirty-six children screened positive for ODDs and other DBDs (Controls: n = 243; Amaka-parents: n = 194; Amaka-community: n = 199). At 8 weeks, Amaka-parents' children had significantly lower mean scores for overall impairment compared to controls, (mean difference: -0.71, p = .001), while Amaka-community children performed better on ODD (mean difference: -0.84, p = .016). At 16 weeks, children in both groups were performing better on ODD and IRS than controls, and there were no significant differences between the two intervention groups.
The Amaka Amasanyufu intervention was efficacious in reducing ODD and impaired functioning relative to usual care. Hence, the Amaka Amasanyufu intervention delivered either by Amaka-community or Amaka-parents has the potential to reduce negative behavioral health outcomes among young people in resource-limited settings and improve family functioning.
ClinicalTrials.gov, ID: NCT03081195. Registered on 16 March 2017.
对立违抗性障碍（ODD）和其他破坏性行为障碍（DBD）在撒哈拉以南非洲受贫困影响社区的儿童和青少年中很常见。如果不进行早期干预，其发展为成年期可能会导致严重后果。我们研究了一种名为 Amaka Amasanyufu 的规范化家庭强化干预措施对乌干达资源匮乏社区上学儿童 ODD 和其他 DBD 的影响。
我们使用了来自 SMART 非洲-乌干达研究（2016-2022 年）的纵向数据。公立小学被随机分配到：（1）对照组（接受包括一般心理社会功能文献在内的常规护理），10 所学校；（2）通过家长同伴进行干预（Amaka-parents），8 所学校；（3）通过社区卫生工作者进行干预（Amaka-community），8 所学校。所有参与者均被蒙蔽。在基线时，在干预启动后 8 周和 16 周时，照顾者完成了爱荷华 Conners 量表，该量表测量了对立违抗性障碍（ODD）和损伤评定量表，以评估儿童的整体损伤和与同伴、兄弟姐妹和父母的受损功能；受损的学业进展、自尊和家庭功能。对每个结果都进行了三级线性混合效应模型拟合。在每个时间点，使用 Sidak 调整进行了事后组均值的两两比较。仅对 ODD 和其他 DBD 阳性的儿童进行了分析。
636 名儿童被筛查出 ODDs 和其他 DBDs（对照组：n=243；Amaka-parents：n=194；Amaka-community：n=199）。在 8 周时，与对照组相比，Amaka-parents 的孩子在总体损伤方面的平均得分明显较低（平均差异：-0.71，p=0.001），而 Amaka-community 的孩子在 ODD 方面表现更好（平均差异：-0.84，p=0.016）。在 16 周时，两组儿童在 ODD 和 IRS 方面的表现均优于对照组，两组之间没有显著差异。
与常规护理相比，Amaka Amasanyufu 干预在减少 ODD 和受损功能方面是有效的。因此，由 Amaka-community 或 Amaka-parents 提供的 Amaka Amasanyufu 干预有可能减少资源有限环境中年轻人的负面行为健康结果，并改善家庭功能。
ClinicalTrials.gov，ID：NCT03081195。于 2017 年 3 月 16 日注册。
