Abstract
In this study, we examined trajectories of symptom reduction and family engagement during the modular treatment phase of a clinical trial for early-onset disruptive behavior disorders that was applied either in community settings or a clinic. Participants (N = 139) were 6–11 year-old children with diagnoses of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). Symptoms of ODD/CD and level of engagement were assessed at every session during the course of treatment. Overall, symptom reduction was characterized by a gradual decline in symptoms over the first 11 sessions followed by a flatter slope beginning with session 12. Clinic participants evidenced a greater decline in symptoms after session 11 compared to participants in community settings. Overall, engagement remained stable during the course of treatment. However, clinic participants had higher levels of engagement throughout treatment compared to participants in the community settings. These setting differences in level of engagement did not account for the differences in trajectories of symptom reduction across the treatment settings.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Achenbach, T. M. (1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington: University of Vermont, Department of Psychiatry.
Beck, A. T., & Steer, R. A. (1987). Beck depression inventory manual. San Antonio: Harcourt Brace.
Burlingame, G. M., Wells, M. G., & Lambert, M. J. (1996). The youth outcome questionnaire. Stevenson: American Professional Credentialing Services.
Burlingame, G. M., Wells, M. G., Lambert, M. J., & Cox, J. C. (2004). The youth outcome questionnaire. In M. Maruish (Ed.), The use of psychological tests for treatment planning and outcome assessment (3rd ed., Vol. 2, pp. 235–274). Mahwah: Earlbaum.
Gaynor, S. T., Weersing, V. R., Kolko, D. J., Birmaher, B., Heo, J., & Brent, D. A. (2003). The prevalence and impact of large sudden improvements during adolescent therapy for depression: a comparison across cognitive-behavioral, family, and supportive therapy. Journal of Consulting and Clinical Psychology, 71(2), 386–393. doi:10.1037/0022-006X.71.2.386.
Girio, E. L., Richerson, L., & Owens, J. S. (2009). Treatment of refractory cases of attention-deficit/hyperactivity disorder in children. In D. McKay & E. A. Storch (Eds.), Cognitive-behavior therapy for children: Treating complex and refractory cases (pp. 393–420). New York: Springer.
Hayes, A. M., Laurenceau, J., Feldman, G., Strauss, J. L., & Cardaciotto, L. (2007). Change is not always linear: the study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27(6), 715–723. doi:10.1016/j.cpr.2007.01.008.
Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy: efficacy, effectiveness, and patient progress. American Psychologist, 51(10), 1059–1064. doi:10.1037/0003-066X.51.10.1059.
Ilardi, S. S., & Craighead, W. E. (1994). The role of nonspecific factors in cognitive behavior therapy for depression. Clinical Psychology: Science and Practice, 1(2), 138–156.
Kaufman, J., Birmaher, B., Brent, D. A., Rao, U., & Ryan, N. D. (1996). KIDDIE-SADS present and lifetime version (K-SADS-PL). Pittsburgh: Instrument developed at Western Psychiatric Institute and Clinic.
Kazdin, A. E. (2005). Evidence-based assessment for children and adolescents: issues in measurement development and clinical application. Journal of Clinical Child and Adolescent Psychology, 34(3), 548–558.
Kolko, D. J. (1996). Clinical monitoring of treatment course in child physical abuse: psychometric characteristics and treatment comparisons. Child Abuse & Neglect, 20(1), 23–43.
Kolko, D. J. (1998a). Progress of treatment (POT). Unpublished instrument, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic.
Kolko, D. J. (1998b). Weekly report of Behavior (WROB)—parent. Unpublished instrument, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic.
Kolko, D. J., Dorn, L. D., Bukstein, O. G., Pardini, D., Holden, E. A., & Hart, J. (2009). Community vs. clinic-based modular treatment of children with early-onset ODD or CD: a clinical trial with 3-year follow-up. Journal of Abnormal Child Psychology, 37, 591–609. doi:10.1007/s10802-009-9303-7.
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002). Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry, 59(10), 877–884. doi:10.1001/archpsyc.59.10.877.
Lambert, M. J., & Finch, A. E. (1999). The outcome questionnaire. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment (2nd ed., pp. 831–870). Mahwah: Earlbaum.
Lambert, M. J., Hansen, N. B., & Finch, A. E. (2001). Patient-focused research: using patient outcome data to enhance treatment effects. Journal of Consulting and Clinical Psychology, 69(2), 159–172. doi:10.1037/0022-006X.69.2.159.
Lambert, M. J., Whipple, J. L., Hawkins, E. J., Vermeersch, D. A., Nielsen, S. L., & Smart, D. W. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10(3), 288–301. doi:10.1093/clipsy/bpg025.
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.
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.
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.
Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks: Sage.
Singer, J. D., & Willett, J. B. (2003). Applied longitudinal data analysis: Modeling change and event occurrence. New York: Oxford University Press.
Tang, T. Z., & DeRubeis, R. J. (1999). Sudden gains and critical sessions in cognitive behavioral therapy for depression. Journal of Consulting and Clinical Psychology, 67(6), 894–904. doi:10.1037/0022-006X.67.6.894.
Author information
Authors and Affiliations
Corresponding author
Additional information
This study was supported by a grant to the second author from the National Institute of Mental Health (MH57727) and by a T32 Fellowship to the first author (MH18951; PI: David Brent, MD). The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.
Rights and permissions
About this article
Cite this article
Lindhiem, O., Kolko, D.J. Trajectories of Symptom Reduction and Engagement During Treatment for Childhood Behavior Disorders: Differences Across Settings. J Abnorm Child Psychol 38, 995–1005 (2010). https://doi.org/10.1007/s10802-010-9416-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-010-9416-z