The Kidman Centre, University of Technology Sydney; Graduate School of Health, University of Technology Sydney.
The Kidman Centre, University of Technology Sydney.
Behav Ther. 2023 Mar;54(2):400-417. doi: 10.1016/j.beth.2022.10.005. Epub 2022 Nov 8.
The aim of this study was to examine the relative effectiveness of Collaborative and Proactive Solutions (CPS) and Parent Management Training (PMT) for youth with oppositional defiant disorder (ODD) in a community setting. Based on a semistructured diagnostic interview, 160 youth with ODD (ages 7-14; 72% male; ethnicity representative of the wider Australian population) were randomized to CPS (n = 81) or PMT (n = 79) for up to 16 weekly sessions. The primary hypothesis was that participants in the CPS group, treated in a community setting, would exhibit significant improvement in ODD, equivalent to that of an evidence-based treatment, PMT. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semistructured diagnostic interviews, parent ratings of ODD symptoms, and global ratings of severity and improvement. Analyses were conducted with hierarchical growth linear modeling, ANCOVA, and equivalence testing using an intent-to-treat sample. Both treatments demonstrated similar outcomes, with 45-50% of youth in the nonclinical range after treatment, and 67% considered much improved. No differences were found between groups, and group equivalency was shown on the independent clinician and parent-rated measures. Gains were maintained at the 6-month follow-up. In conclusion, CPS works as effectively as the well-established treatment, PMT, for youths with ODD, when implemented in a community-based setting. As such, CPS provides a viable choice for families who seek alternate treatments.
本研究旨在考察协同与主动解决模式（CPS）和父母管理训练（PMT）对社区环境中对立违抗性障碍（ODD）青少年的相对有效性。基于半结构化诊断访谈，160 名患有 ODD 的青少年（年龄 7-14 岁；72%为男性；种族与澳大利亚更广泛的人口代表性一致）被随机分配到 CPS（n=81）或 PMT（n=79）组，接受最多 16 周的每周治疗。主要假设是，在社区环境中接受治疗的 CPS 组参与者在 ODD 方面会表现出显著改善，与基于证据的治疗 PMT 相当。在基线、干预后和 6 个月随访时进行评估，使用独立评定的半结构化诊断访谈、父母对 ODD 症状的评定、以及严重程度和改善的总体评定。采用分层增长线性模型、ANCOVA 和意向治疗样本的等效性检验进行分析。两种治疗方法均显示出相似的结果，治疗后有 45-50%的青少年处于非临床范围，67%的青少年被认为有明显改善。组间无差异，独立临床医生和父母评定的测量结果显示组间等效。在 6 个月的随访中，获益得到维持。总之，当在基于社区的环境中实施时，CPS 与经过验证的治疗方法 PMT 一样有效，适用于患有 ODD 的青少年。因此，CPS 为寻求替代治疗的家庭提供了一种可行的选择。
