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CONTENTS SPECIAL SERIES: BEHAVIORALLY ORIENTED INTERVENTIONS FOR CHILDREN WITH AGGRESSIVE BEHAVIOR AND/OR CONDUCT PROBLEMS Guest Editors: John E. Lochman and Randall T. Salekin
ABSTRACTS
John E. Lochman, The University of Alabama, and Randall T. Salekin, The University of Alabama The current paper introduces the special section on intervention for children and adolescents with aggressive and disruptive behavior disorders. A great deal of knowledge has been accumulated regarding the treatment of aggressive and disruptive behavior disorders over the last several decades (Kazdin, 2000), and much of this research indicates that we are making remarkable progress. Specifically, treatment programs continue to be refined and outcome studies continue to show significant treatment effects. The current special section adds to this literature base by providing data regarding the efficacy of multimodal interventions, the importance of teacher and parent training, and the importance of providing encouragement to parents to keep them highly engaged in the treatment process. Moreover, the studies covered in this special section span a developmental range from early childhood to adolescence and, importantly, provide both proximal and distal outcome data. One paper in this special section examines the cost-effectiveness of implementing a multimodal treatment program for aggressive children. The papers presented in this special section suggest that early intervention is important, effective, and, in the long run, cost-efficient.
Nicolle M. H. van de Wiel and Walter Matthys, Department of Child and Adolescent Psychiatry and Rudolph Magnus Institute for Neurosciences, University Medical Center Utrecht, Peggy Cohen-Kettenis, University Amsterdam, and Herman van Engeland, Department of Child and Adolescent Psychiatry and Rudolph Magnus Institute for Neurosciences, University Medical Center Utrecht We conducted a study in which referred children with disruptive behavior disorders were randomly assigned either to a combination of parent management training and social problem-solving skills training—i.e., the Utrecht Coping Power Program (UCPP), given by clinically inexperienced, but specifically trained, therapists—or to care as usual (C), given by experienced clinicians. From pretreatment to 6-month follow-up, the costs per family were twice as high in the C-condition as in the UCPP-condition. From pretreatment to 6-month follow-up, the mean costs per mean standard deviation improvement were 42% lower in the UCPP-condition than in the C-condition. No influence of therapist experience on treatment effect was found. The number of switches in treatment method was lower in the UCPP-condition than in the C-condition. The number of treatments that ended without the mutual consent of therapist and family was lower in the UCPP-condition than in the C-condition. We conclude that for the treatment of children with disruptive behavior disorders in everyday clinical practice, manualized behavior therapy is preferable to care as usual.
The Metropolitan Area Child Study Research Group* and Deborah Gorman-Smith, University of Illinois at Chicago *The Metropolitan Area Child Study Research Group is a collaboration of (in alphabetical order) Leonard Eron, University of Michigan; Nancy Guerra, University of California, Riverside; David Henry, University of Illinois at Chicago; L. Rowell Huesmann, University of Michigan; Patrick Tolan, University of Illinois at Chicago; and Richard VanAcker, University of Illinois at Chicago. This investigation tested the effects of the Metropolitan Area Child Study (MACS) classroom enhancement intervention on teacher behavior. The teacher intervention consisted of teacher seminars and individual consultation, and was delivered in all three intervention conditions of the MACS study. Subjects for the present study were 287 students at high risk for aggression and 48 teachers randomly assigned by school to control or intervention conditions. Student and teacher behavior was observed prior to and following the intervention. Teacher feedback to students was associated with desirable change in student aggression. Teachers in the intervention condition provided more academic feedback to students, and used less large group lecture and more individualized seat work. Intervention teachers also became more likely than controls to give academic and behavioral feedback to more aggressive students. Other tests suggested that the intervention increased the likelihood that praise for positive behavior would be given to more aggressive students.
Gerald J. August, Elizabeth A. Egan, George M. Realmuto, and Joel M. Hektner, University of Minnesota Medical School Peer nominations for behavioral reputation, likability, and friendship were examined after 4 years of an ongoing randomized, controlled prevention trial designed to interrupt the developmental trajectory of young aggressive children by improving peer relations. Participants included 125 moderately to highly aggressive children (program and control) and their 4th-grade classmates (N = 1,489). Results indicated that program children, as compared to controls, obtained higher reputation scores on leadership and social etiquette and chose friends with lower aggression. Self-reported quality of friendship also differed between groups, with program children reporting more companionship and recreation, program girls reporting more validation and caring, and severely aggressive program children reporting less aggression toward others than their control counterparts. These findings provide evidence for the generalization of program effects to a natural peer setting.
M. Jamila Reid, Carolyn Webster-Stratton, and Mary Hammond, University of Washington This paper presents 2-year follow-up data for a sample of 159, 4- to 8-year-old children with oppositional-defiant disorder (ODD) who were randomly assigned to: parent training (PT), parent plus teacher training (PT + TT), child training (CT), child plus teacher training (CT + TT), parent plus child plus teacher training (PT + CT + TT). At the 2-year follow-up, approximately 75% of children were functioning in the normal range according to parent and teacher reports. Twenty-five percent of children were classified as treatment nonresponders at home and/or at school. Teacher training added significantly to long-term school outcomes for children who had pervasive behavior problems. Baseline, post, and 1-year follow-up parenting practices distinguished between home treatment responders and nonresponders (parents of nonresponders were more critical and less positive). For children with baseline pervasive home-school problems, baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home at the 2-year follow-up. In addition, 80% of pervasive children whose mothers were highly critical immediately posttreatment were classified as school nonresponders at the 2-year follow-up.
John E. Lochman, The University of Alabama, and Karen C. Wells, Duke University Medical Center This study examines key substance use, delinquency, and school-based aggressive behavior outcomes at a one-year follow-up for a cognitive-behavioral intervention delivered to aggressive children and their parents at the time of these children’s transition to middle school. This effectiveness study explored whether a classroom intervention directed at teachers and at all of the parents in the intervention classrooms enhanced the effects of the Coping Power program with at-risk children. The at-risk sample of boys and girls was identified through 4th-grade teacher ratings, and intervention took place during the 5th- and 6th-grade years. The Coping Power child component included school-based groups focusing on anger management and social problem solving skills, and the Coping Power parent component addressed parenting and stress-management skills. The current results indicate that prior findings of postintervention improvement for this sample (Lochman & Wells, 2002b) has led to preventive effects on delinquency and on substance use for older and moderate-risk children. The Coping Power program, in conjunction with a classroom-level intervention, also reduced school aggression 1 year after the intervention was completed. In addition, it appears that the classroom intervention facilitates radiating effects on reduced substance use for other at-risk children in the same classrooms who did not receive Coping Power.
Gloria E. Miller, University of Denver, and Ronald J. Prinz , University of South Carolina This study examined critical pretreatment variables related to the engagement and retention of families in mental health services designed to reduce serious childhood aggression. One hundred and twenty-four families of 5- to 9-year-old boys who met diagnostic criteria for conduct disorder were randomly assigned to receive either parent-only, child-only, or combined parent-child treatments. Premature termination was greatest in the parent-only condition. Pretreatment attributional motivations that were externalizing-oriented showed a clear association with premature termination. Moreover, assignment to a treatment condition that did not match parents’ incoming motivations was predictive of premature termination. Overall, the findings have implications for the further study of barriers and facilitators for the delivery of mental health treatment for childhood conduct problems, especially with regard to pretreatment motivational cognitions and engagement issues.
J. Mark Eddy, John B. Reid, Mike Stoolmiller, and Rebecca A. Fetrow, Oregon Social Learning Center Middle school outcomes for a population-based, randomized preventive intervention trial for conduct problems are reported. Students (n = 361), and their parents from six elementary schools participated in the trial. Randomization into control and preventive intervention conditions occurred at the school level. Schools were located in neighborhoods characterized by high rates of juvenile delinquency. The Linking the Interest of Families and Teachers (LIFT) multimodal preventive intervention, which included behavioral parent management training, child social and problem-solving skills training, a recess behavior management program, and a classroom dedicated phone line and answering machine, was offered to students and parents from all fifth and combined fourth-fifth classrooms within preventive intervention schools. Survival analyses were conducted using logistic regression for substance use outcomes and Cox regression for police arrest. The onset of police arrest and patterned alcohol use during the middle school years was less likely for participants in the preventive intervention condition than for participants in the control condition, but no differences were found in terms of onset of tobacco use or marijuana use.
Thomas J. Dishion, Sarah E. Nelson, and Kathryn Kavanagh, Child and Family Center, University of Oregon The Family Check-Up (FCU) is a brief, family-centered intervention focused on family-management practices. Within the context of a randomly assigned, multilevel family intervention, high-risk youth and families (n = 71) were selected for videotaped home observation that includes an interaction task assessing parent monitoring. Parents in the intervention group were offered annual feedback on the yearly assessment, including their home observation. Using an intention-to-treat design, analyses revealed intervention effects on early-adolescent substance use and observed parent monitoring by the first year of high school (Year 4 of follow-up). As in previous research, parents of high-risk adolescents were observed to decrease monitoring from grades 7 to 9. However, families randomly assigned to the family intervention maintained their monitoring practices. Regression analyses revealed the prevention effect of the FCU on substance use was mediated by changes in parental monitoring. Findings suggest the promise of linking developmental theory with innovation in cognitive behavioral intervention and prevention. |
JOHN E. LOCHMAN AND RANDALL T. SALEKIN. Introduction to the Special Series: Prevention and Intervention With Aggressive and Disruptive Children—Next Steps in Behavioral Intervention Research