University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany.
University of Cologne, Germany, and the School for Child and Adolescent Cognitive Behavior Therapy (AKiP), University Hospital Cologne, Germany.
J Am Acad Child Adolesc Psychiatry. 2022 Nov;61(11):1329-1340. doi: 10.1016/j.jaac.2022.03.027. Epub 2022 Apr 6.
Computer-assisted child-focused interventions are expected to improve efficiency and personalization of therapist-led treatments for children and adolescents. However, therapist-led, outpatient interventions using computer assistance are lacking for children with oppositional defiant disorder (ODD) or conduct disorder (CD). The present randomized controlled trial examined the efficacy of individualized computer-assisted social skills training for children with aggressive behavior compared to a resource activation intervention.
A total of 100 children aged 6-12 years with a diagnosis of ODD/CD and peer-related aggression were randomly (1:1) assigned to either individually delivered computer-assisted social skills training (ScouT) or an individually delivered supportive resource activation treatment (STARK). The primary outcome was parent-rated peer-related aggression, assessed with the respective scale of the Questionnaire for Aggressive Behavior of Children (FAVK) and measured at pre-assessment and after the 16-week intervention (post-assessment). Further parent-, self-, teacher- and/or clinician-rated outcomes included ODD and CD symptoms, a wide range of behavioral and emotional symptoms, callous-unemotional traits, functional impairment, and quality of life.
After correcting for multiple testing, analyses of covariance comparing the efficacy of ScouT to the efficacy of STARK yielded small to moderate treatment effects in favor of the ScouT condition regarding parent-rated peer-related aggression (primary outcome; d = -0.64, 95% CI = -1.05, -0.24), parent-rated callous and uncaring traits, and parent-rated quality of life. However, the analyses did not reveal any significant effects for self- or teacher-rated peer-related aggression assessed with the respective scale of the FAVK (self-report: d = -0.21, 95% CI = -0.69, 0.29; teacher rating: d = -0.17, 95% CI = -0.56, 0.22). Moreover, after controlling for multiple comparisons, no significant effects emerged for the following: parent-, self-, and teacher-rated adult-related aggression; parent-, self-, teacher-, and clinician-rated ODD and CD symptoms; parent-, self-, and teacher-rated emotional and behavioral symptoms; and parent-rated functional impairment.
According to parent ratings, school-age children with disruptive behavior disorders and peer-related aggression seem to benefit more from individualized, computer-assisted social skills training than from resource activation treatment. However, this conclusion is limited by the missing effects on the clinician-, self-, and teacher-rated measures.
Treatment of Children With Peer Related Aggressive Behavior (ScouT); https://clinicaltrials.gov/; NCT02143427.
计算机辅助的以儿童为中心的干预措施有望提高治疗师主导的儿童和青少年治疗的效率和个性化程度。然而，对于患有对立违抗性障碍（ODD）或品行障碍（CD）的儿童，缺乏使用计算机辅助的治疗师主导的门诊干预措施。本随机对照试验研究了个体化计算机辅助社交技能训练对具有攻击性行为的儿童的疗效，与资源激活干预进行了比较。
共纳入 100 名年龄在 6-12 岁之间、具有 ODD/CD 诊断和同伴相关攻击性的儿童，按 1:1 随机分配至个体化计算机辅助社交技能训练（ScouT）或个体化支持资源激活治疗（STARK）组。主要结局是父母评定的同伴相关攻击性，使用攻击性儿童问卷（FAVK）的相应量表评估，在预评估和 16 周干预后（后评估）进行测量。进一步的父母、自我、教师和/或临床医生评定的结局包括 ODD 和 CD 症状、广泛的行为和情绪症状、无情特质、功能障碍和生活质量。
在进行多次检验校正后，比较 ScouT 与 STARK 的疗效的协方差分析显示，在父母评定的同伴相关攻击性（主要结局；d=-0.64，95%CI=-1.05，-0.24）、父母评定的无情特质和父母评定的生活质量方面，ScouT 组的治疗效果优于 STARK 组。然而，分析并未显示自我或教师评定的使用 FAVK 的相应量表评估的同伴相关攻击性有任何显著影响（自我报告：d=-0.21，95%CI=-0.69，0.29；教师评定：d=-0.17，95%CI=-0.56，0.22）。此外，在进行多次比较校正后，以下结果均无显著影响：父母、自我和教师评定的成人相关攻击性；父母、自我、教师和临床医生评定的 ODD 和 CD 症状；父母、自我和教师评定的情绪和行为症状；以及父母评定的功能障碍。
根据父母的评估，患有破坏性行为障碍和同伴相关攻击性的学龄儿童似乎从个体化、计算机辅助的社交技能训练中获益更多，而不是从资源激活治疗中获益。然而，这一结论受到临床医生、自我和教师评定措施缺失效果的限制。
治疗具有同伴相关攻击性的儿童（ScouT）；https://clinicaltrials.gov/；NCT02143427。
