Journal of Abnormal Child Psychology

, Volume 37, Issue 5, pp 591–609 | Cite as

Community vs. Clinic-Based Modular Treatment of Children with Early-Onset ODD or CD: A Clinical Trial with 3-Year Follow-Up

  • David J. Kolko
  • Lorah D. Dorn
  • Oscar G. Bukstein
  • Dustin Pardini
  • Elizabeth A. Holden
  • Jonathan Hart


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.


Treatment of disruptive behavior disorders Conduct disorder Oppositional defiant disorder Callous-unemotional Behavior problems Outcome studies Clinical trials 


  1. Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: University of Vermont, Department of Psychiatry.Google Scholar
  2. Attkisson, C. C., & Greenfield, T. K. (1996). The Client Satisfaction Questionnaire (CSQ) Scales and the Service Satisfaction Scale-30 (SSS-30). In L. I. Sederer, & B. Dickery (Eds.), Outcomes Assessment in Clinical Practice (pp. 120–127). Baltimore: Williams & Wilkins.Google Scholar
  3. August, G. J., Realmuto, G. M., Joyce, T., & Hektner, J. M. (1999). Persistence and desistance of oppositional defiant disorder in a community sample of children with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1262–1270. doi: 10.1097/00004583-199910000-00015.PubMedCrossRefGoogle Scholar
  4. Bickman, L., & Mulvaney, S. (2005). Large-scale evaluations of children’s mental health services: The Ft. Bragg and Stark County studies. In R. G. Steele, & M. C. Roberts (Eds.), Handbook of mental health services for children, adolescents, and families (pp. 371–386). New York, NY: Kluwer Academic/Plenum Publishers.CrossRefGoogle Scholar
  5. Bird, H., Shaffer, D., Fisher, P., & Gould, M. S. (1993). The Columbia impairment scale (CIS): Pilot findings on a measure of global impairment for children and adolescents. International Journal of Methods in Psychiatric Research, 3, 167–176.Google Scholar
  6. Birmaher, B., Bridge, J., Williamson, D., Brent, D., Dahl, R. E., Axelson, D., et al. (2004). Psychosocial functioning in youths at high risk to develop major depressive disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 839–846. doi: 10.1097/01.chi.0000128787.88201.1b.PubMedCrossRefGoogle Scholar
  7. Brown, T. L., Henggeler, S. W., Schoenwald, S. K., Brondino, M. J., & Pickrel, S. G. (1999). Multisystemic treatment of substance abusing and dependent juvenile delinquents: Effects on school attendance at posttreatment and 6-month follow-up. Children’s Services (Mahwah, N.J.), 2, 81–93. doi: 10.1207/s15326918cs0202_2.CrossRefGoogle Scholar
  8. Burns, B. J., Farmer, E. M. Z., Angold, A., Costello, E. J., & Behar, L. (1996). A randomized trial of case management for youths with serious emotional disturbance. Journal of Clinical Child Psychology, 25, 476–486. doi: 10.1207/s15374424jccp2504_12.CrossRefGoogle Scholar
  9. Chorpita, B. F., Becker, K. D., & Daleiden, E. L. (2007). Understanding the common elements of evidence-based practice: Misconceptions and clinical examples. Journal of the American Academy of Child and Adolescent Psychiatry, 46, 647–652. doi: 10.1097/chi.0b013e318033ff71.PubMedCrossRefGoogle Scholar
  10. Cotter, R. B., Burke, J. D., Loeber, R., & Navratil, J. L. (2002). Innovative retention methods in longitudinal research: A case study of the developmental trends study. Journal of Child and Family Studies, 11, 485–498. doi: 10.1023/A:1020939626243.CrossRefGoogle Scholar
  11. Efron, B. (1980). Biostatistics casebook. Stanford, Il.: Standford University Press.Google Scholar
  12. Eyberg, S. M., Nelson, M. M., & Boggs, S. R. (2008). Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. Journal of Clinical Child and Adolescent Psychology, 37, 215–237. doi: 10.1080/15374410701820117.PubMedCrossRefGoogle Scholar
  13. Feindler, E. L., Ecton, R. B., Kingsley, D., & Dubey, D. R. (1986). Group anger-control training for insitutuionalized psychiatric male adolescents. Behavior Therapy, 17, 109–123. doi: 10.1016/S0005-7894(86)80079-X.CrossRefGoogle Scholar
  14. Fleischman, M. J., Horne, A. M., & Arthur, J. L. (1983). Troubled families: A treatment program. Champaign, IL: Research Press.Google Scholar
  15. Fonagy, P., & Target, M. (1994). The efficacy of psychoanalysis for children with disruptive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 45–55. doi: 10.1097/00004583-199401000-00007.PubMedCrossRefGoogle Scholar
  16. Frick, P. J. (1994). Family dysfunction and the disruptive behavior disorders: A review of recent empirical findings. Advances in Clinical Child Psychology, 16, 203–226.Google Scholar
  17. Garland, A. F., Hawley, K. M., Brookman-Frazee, L., & Hurlburt, M. (2008). Identifying common elements of evidence-based psychosocial treatments for children’s disruptive behavior problems. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 505–514. doi: 10.1097/CHI.0b013e31816765c2.Google Scholar
  18. Greenhill, L. L., Abikoff, H. B., Arnold, L. E., & Cantwell, D. P. (1996). Medication treatment strategies in the MTA study: Relevance to clinicians and researchers. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1304–1313. doi: 10.1097/00004583-199610000-00017.PubMedCrossRefGoogle Scholar
  19. Hawes, D. J., & Dadds, M. R. (2007). Stability and malleability of callous-unemotional traits during treatment for childhood conduct problems. Journal of Clinical Child and Adolescent Psychology, 36, 347–355.PubMedGoogle Scholar
  20. Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York: Guilford.Google Scholar
  21. Henggeler, S. W., Clingempeel, W. G., Brondino, M. J., & Pickrel, S. G. (2002). Four-year follow-up of multisystemic therapy with substance-abusing and substance-dependent juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 868–874. doi: 10.1097/00004583-200207000-00021.PubMedCrossRefGoogle Scholar
  22. Hoagwood, K., Horwitz, S., Stiffman, A., Weisz, J. R., Bean, D., Rae, D., et al. (2000). Concordance between parent reports of children’s mental health services and records: The services assessment for children and adolescents (SACA). Journal of Child and Family Studies, 9, 315–331. doi: 10.1023/A:1026492423273.CrossRefGoogle Scholar
  23. Hodges, K. (1996). Utilization of the child and Adolescent Functional Assessment Scale (CAFAS) for assessing program and clincical outcomes. Paper presented at the Annual System of Care Research Conference, Tampa, Fl.Google Scholar
  24. Hollingshead, A., & Redlich, F. (1958). Social class and mental illness: A community study. New York, NY: Wiley.CrossRefGoogle Scholar
  25. Kaufman, A. S., & Kaufman, N. L. (1990). Kaufman Brief Intelligence Test. Circle Pines, MN: American Guidance Service, Inc.Google Scholar
  26. Kaufman, J., Birmaher, B., Brent, D. A., Rao, U., & Ryan, N. D. (1996). KIDDIE-SADS-present and lifetime version (K-SADS-PL). Instrument developed at Western Psychiatric Institute and Clinic, Pittsburgh, PA.Google Scholar
  27. Kazdin, A. (1996). Combined and multimodal treatments in child and adolescent psychotherapy: Issues, challenges, and research directions. Clinical Psychology: Science and Practice, 3, 69–100.CrossRefGoogle Scholar
  28. Kazdin, A. (2005). Child, parent, and family-based treatment of aggressive and antisocial child behavior. In E. D. Hibbs, & P. S. Jensen (Eds.), Psychosocial treatments for child and adolscent disorders: Empirically based strategies for clincial practice (pp. 445–476, 2nd ed.). Washington, DC: American Psychological Association.Google Scholar
  29. Kazdin, A., & Wassell, G. (1999). Barriers to treatment participation and therapeutic change among children referred for conduct disorder. Journal of Clinical Child Psychology, 28, 160–172. doi: 10.1207/s15374424jccp2802_4.PubMedCrossRefGoogle Scholar
  30. Kazdin, A., & Whitley, M. K. (2006). Comorbidity, case complexity, and effects of evidence-based treatment for children referred for disruptive behavior. Journal of Consulting and Clinical Psychology, 74, 455–467. doi: 10.1037/0022-006X.74.3.455.PubMedCrossRefGoogle Scholar
  31. Kazdin, A., Esveldt-Dawson, K., French, N. H., & Unis, A. S. (1987). Problem-solving skills training and relationship therapy in the treatment of antisocial child behavior. Journal of Consulting and Clinical Psychology, 55, 76–85. doi: 10.1037/0022-006X.55.1.76.PubMedCrossRefGoogle Scholar
  32. Kazdin, A., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60, 733–747. doi: 10.1037/0022-006X.60.5.733.PubMedCrossRefGoogle Scholar
  33. Kolko, D. J. (1995). Multimodal partial/day treatment of child antisocial behavior: Service description and multilevel program evaluation. Continuum, 2, 3–24.Google Scholar
  34. Kolko, D. J. (1996). Individual cognitive-behavioral treatment and family therapy for physically abused children and their offending parents: A comparison of clinical outcomes. Child Maltreatment, 1, 322–342. doi: 10.1177/1077559596001004004.CrossRefGoogle Scholar
  35. Kolko, D. J. (2001). Efficacy of cognitive-behavioral treatment and fire safety education for firesetting children: Initial and follow-up outcomes. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 359–369. doi: 10.1111/1469-7610.00729.PubMedCrossRefGoogle Scholar
  36. Kolko, D. J., & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage.Google Scholar
  37. Kolko, D. J., Loar, L. L., & Sturnick, D. (1990). Inpatient social-cognitive skills training groups with conduct disordered and attention deficit disordered children. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 31, 737–748. doi: 10.1111/j.1469-7610.1990.tb00814.x.PubMedCrossRefGoogle Scholar
  38. Kolko, D. J., Bukstein, O. G., & Barron, J. (1999). Methylphenidate and behavior modification in children with ADHD and comorbid ODD or CD: Main and incremental effects across settings. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 578–586. doi: 10.1097/00004583-199905000-00020.PubMedCrossRefGoogle Scholar
  39. Kolko, D. J., Dorn, L. D., Bukstein, O. G., & Burke, J. D. (2008). Clinically referred ODD children with or without CD and healthy controls: Comparisons across contextual domains. Journal of Child and Family Studies, 17, 714–734.CrossRefGoogle Scholar
  40. Kovacs, M. (1985). The children’s depressive inventory (CDI). Psychopharmacology Bulletin, 21, 995–998.PubMedGoogle Scholar
  41. Lahey, B. B., Loeber, R., Burke, J. D., Rathouz, P. J., & McBurnett, K. (2002). Waxing and waning in concert: Dynamic comorbidity of conduct disorder with other disruptive and emotional problems over 17 years among clinic-referred boys. Journal of Abnormal Psychology, 111, 556–567. doi: 10.1037/0021-843X.111.4.556.PubMedCrossRefGoogle Scholar
  42. Lavori, P. W. (1992). Clinical trails in psychiatry. Should protocol deviation censor patient data. Neuropsychopharmacology, 6, 39–48.PubMedGoogle Scholar
  43. Lochman, J. E., & Wells, K. C. (2003). Effectiveness of the Coping Power Program and of classroom intervention with aggressive children: Outcomes at a 1-year follow-up. Behavior Therapy, 34, 493–515. doi: 10.1016/S0005-7894(03)80032-1.CrossRefGoogle Scholar
  44. Lochman, J. E., Lampron, L. B., Gemmer, T. C., & Harris, S. R. (1987). Anger-coping interventions for aggressive children: Guide to implementation in school settings. In P. A. Keller, & S. Heyman (Eds.), Innovations in Clinical Practice: A Source Book (vol. Vol. 6, (pp. 339–356)). Sarasota, FL: Professional Resource Exchange.Google Scholar
  45. Lochman, J. E., Coie, J. D., Underwood, M., & Terry, R. (1993). Effectiveness of a social relations intervention program for aggressive and nonaggressive, rejected children. Journal of Consulting and Clinical Psychology, 61, 1053–1058. doi: 10.1037/0022-006X.61.6.1053.PubMedCrossRefGoogle Scholar
  46. Loeber, R., Farrington, D. P., Stouthamer-Loeber, M., & Van Kammen, W. B. (1998). Antisocial behavior and mental health problems: Explanatory factors in childhood and adolescence (First volume of the Pittsburgh Youth Study). Mahwah, NJ: Lawrence Erlbaum.Google Scholar
  47. Luborsky, L., McLellan, A. T., Woody, G. E., O’Brien, C. P., & Auerbach, A. (1985). Therapist success and its determinants. Archives of General Psychiatry, 42, 602–611.PubMedGoogle Scholar
  48. Martinez, C. R. J., & Forgatch, M. S. (2001). Preventing problems with boys’ noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69, 416–428. doi: 10.1037/0022-006X.69.3.416.PubMedCrossRefGoogle Scholar
  49. McCart, M. R., Priester, P. E., Davies, W. H., & Azen, R. (2006). Differential effectiveness of behavioral parent-training and cognitive-behavioral therapy for antisocial youth: A meta-analysis. Journal of Abnormal Child Psychology, 34, 527–543. doi: 10.1007/s10802-006-9031-1.PubMedCrossRefGoogle Scholar
  50. McConnaughy, E. A., Prochaska, J. O., & Velicer, W. F. (1983). Stages of change in psychotherapy: Measurement and sample profiles. Psychotherapy: Theory. Research and Practice, 20, 368–375.CrossRefGoogle Scholar
  51. McKay, M. M., Hibbert, R., Hoagwood, K., Rodriguez, J., Murray, L., Legerski, J., et al. (2004). Integrating evidence-based engagement interventions into “real world” child mental health settings. Brief Treatment and Crisis Intervention, 4, 177–186. doi: 10.1093/brief-treatment/mhh014.CrossRefGoogle Scholar
  52. Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychological Methods, 7, 20. doi: 10.1037/1082-989X.7.1.105.CrossRefGoogle Scholar
  53. Nelson-Gray, R. O., Keane, S. P., Hurst, R. M., Mitchell, J. T., Warburton, J. B., Chok, J. T., et al. (2006). A modified DBT skills training program for oppositional defiant adolescents: Promising preliminary findings. Behaviour Research and Therapy, 44, 1811–1820. doi: 10.1016/j.brat.2006.01.004.PubMedCrossRefGoogle Scholar
  54. Nixon, R. D. V., Sweeny, L., Erickson, D. B., & Touyz, S. W. (2003). Parent–child interaction therapy: A comparison of standard and abbreviated treatments for oppositional defiant preschoolers. Journal of Consulting and Clinical Psychology, 71, 251–260. doi: 10.1037/0022-006X.71.2.251.PubMedCrossRefGoogle Scholar
  55. Osgood, D. W., & Smith, G. L. (1995). Applying hierarchical linear modeling to extended longitudinal evaluations. Evaluation Review, 19, 3–38. doi: 10.1177/0193841X9501900101.CrossRefGoogle Scholar
  56. Pardini, D. A., & Loeber, R. (2007). Interpersonal and affective features of psychopathy in children and adolescents: Advancing a development perspective: Introduction to the special section. Journal of Clinical Child and Adolescent Psychology, 36, 269–275.PubMedGoogle Scholar
  57. Patterson, G. R., Reid, J. B., & Dishion, T. (1992). Antisocial boys, vol. 4. Eugene, OR: Castalia.Google Scholar
  58. Pelham, W. E., Milich, R., Murphy, D. A., & Murphy, H. A. (1989). Normative data on the IOWA Conners Teacher Rating Scale. Journal of Clinical Child Psychology, 18, 259–262. doi: 10.1207/s15374424jccp1803_9.CrossRefGoogle Scholar
  59. Raudenbush, S., Bryk, A., Cheong, Y. F., & Congdon, R. (2004). HLM 6: Hierarchical linear and nonlinear modeling. Lincolnwood, IL: Scientific Software International.Google Scholar
  60. Reid, M. J., Webster-Stratton, C., & Hammond, M. (2003). Follow-up of children who received the Incredible Years Intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome. Behavior Therapy, 34, 471–491. doi: 10.1016/S0005-7894(03)80031-X.CrossRefGoogle Scholar
  61. Robin, A. L., & Foster, S. L. (1989). Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach. New York, NY: Guilford.Google Scholar
  62. Sanders, M. R., Markie-Dadds, C., Tully, L. A., & Bor, W. (2000). The Triple P-Positive Parenting Program: A comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. Journal of Consulting and Clinical Psychology, 68, 624–640. doi: 10.1037/0022-006X.68.4.624.PubMedCrossRefGoogle Scholar
  63. Shaw, D. S., Dishion, T., Supplee, L., Gardner, F., & Arnds, K. (2006). Randomized trial of a family-centered approach to the prevention of early conduct problems: 2 year effects of the family check-up in early childhood. Journal of Consulting and Clinical Psychology, 74, 1–9. doi: 10.1037/0022-006X.74.1.1.PubMedCrossRefGoogle Scholar
  64. Sheldrick, R. C., Kendall, P. C., & Heimberg, R. G. (2001). The clinical significance of treatments: A comparison of three treatments for conduct disordered children. Clinical Psychology: Science and Practice, 8, 418–430. doi: 10.1093/clipsy/8.4.418.CrossRefGoogle Scholar
  65. Stambaugh, L. F., Mustillo, S. A., Burns, B. J., Stephens, R. L., Baxter, B., Edwards, D., et al. (2007). Outcomes from wraparound and multisystemic therapy in a center for mental health services system-of-care demonstration site. Journal of Emotional and Behavioral Disorders, 15, 143. doi: 10.1177/10634266070150030201.CrossRefGoogle Scholar
  66. Walker, H. M., Horner, R. H., Sugai, G., Bullis, M., Sprague, J. R., Bricker, D., et al. (1996). Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. Journal of Emotional and Behavioral Disorders, 4, 194–209.CrossRefGoogle Scholar
  67. Webster-Stratton, C., Reid, J. B., & Hammond, M. (2001a). Preventing child conduct problems, promoting social competence: A parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology, 30, 283–302. doi: 10.1207/S15374424JCCP3003_2.PubMedCrossRefGoogle Scholar
  68. Webster-Stratton, C., Reid, J. B., & Hammond, M. (2001b). Social skills and problem-solving training for children with early-onset conduct problems: Who benefits? Journal of Child Psychology and Psychiatry, and Allied Disciplines, 42, 943–952. doi: 10.1111/1469-7610.00790.PubMedCrossRefGoogle Scholar
  69. Webster-Stratton, C., Reid, M. J., & Hammond, M. (2004). Treating children with early-onset conduct problems: Intervention outcomes for parent, child, and teacher training. Journal of Clinical Child and Adolescent Psychology, 33, 105–124. doi: 10.1207/S15374424JCCP3301_11.PubMedCrossRefGoogle Scholar
  70. Weissberg, R. P., Gesten, E. L., Caplan, M., & Jackson, A. S. (1990). Social problem-solving training for fourth graders: An abridged revision of the Rochester social problem-solving program. New Haven, CT: Yale University.Google Scholar
  71. Weisz, J. R., Weiss, B., & Donenberg, G. R. (1992). The lab versus the clinic: Effects of child and adolescent psychotherapy. The American Psychologist, 47, 1578–1585. doi: 10.1037/0003-066X.47.12.1578.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • David J. Kolko
    • 1
  • Lorah D. Dorn
    • 2
  • Oscar G. Bukstein
    • 1
  • Dustin Pardini
    • 1
  • Elizabeth A. Holden
    • 1
  • Jonathan Hart
    • 1
  1. 1.Western Psychiatric Institute and ClinicUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.University of Cincinnati College of MedicineCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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