Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up.
This study examines the treatment outcomes of 139, 6-11 year-old, clinically referred boys and girls diagnosed with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) who were randomly assigned to a modular-based treatment protocol that was applied by research study clinicians either in the community (COMM) or a clinic office (CLINIC). To examine normative comparisons, a matched sample of 69 healthy control children was included. Multiple informants completed diagnostic interviews and self-reports at six assessment timepoints (pretreatment to 3-year follow-up) to evaluate changes in the child's behavioral and emotional problems, psychopathic features, functional impairment, diagnostic status, and service involvement. Using HLM and logistic regression models, COMM and CLINIC showed significant and comparable improvements on all outcomes. By 3-year follow-up, 36% of COMM and 47% of CLINIC patients no longer met criteria for either ODD or CD, and 48% and 57% of the children in these two respective conditions had levels of parent-rated externalizing behavior problems in the normal range. We discuss the nature and implications of these novel findings regarding the role of treatment context or setting for the treatment and long-term outcome of behavior disorders.
Kolko
David J
DJ
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. kolkodj@upmc.edu
Dorn
Lorah D
LD
Bukstein
Oscar G
OG
Pardini
Dustin
D
Holden
Elizabeth A
EA
Hart
Jonathan
J
D017668:Age of Onset; D000554:Ambulatory Care Facilities; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000628:therapy*; D019090:Case Management; D002648:Child; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D019955:Conduct Disorder / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010379:Peer Group; D011998:Recreation; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome