Abstract
Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress partially mediated improvements in child aggression. Improved emotion regulation skills partially mediated treatment-related child anxious-depressed outcomes. Improvements in parenting behaviors did not differ between treatment conditions. The results suggest that independent processes may drive affective and behavioral outcomes, with some specificity regarding the mechanisms related to differing treatment outcomes.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Our a prior selection of outcomes was driven by an intention to test mechanisms potentially related to specific outcomes. However, it may have been of interest to consider broader constructs as outcomes. We therefore ran models testing the CBCL Externalizing and Internalizing scales as outcomes. The Externalizing scale includes Aggression and Rule Breaking behavior. The pattern of results – that is, which mechanisms were significantly predictive and which were not - was the same for Externalizing as was observed for Aggression as an outcome. Prediction to the Internalizing scale (which includes Somatic Complaints, Withdrawn-Depressed and Anxious-Depressed subscales) did vary from the results described above for the Anxious-Depressed outcome. Specifically, emotion regulation skills did not predict changes in Internalizing scores. Details on these analyses are available upon request from the first author.
References
Abidin, R. R. (1995). Parenting stress index, third edition: professional manual. Odessa: Psychological Assessment Resources, Inc.
Achenbach, T. M., & Rescorla, L. (2001). Manual for the ASEBA school-age forms & profiles. Burlington: University of Vermont.
Allison, P. D. (2012). Handling missing data by maximum likelihood. Unpublished manuscript. Retrieved from http://www.statisticalhorizons.com/wp-content/uploads/MissingDataByML.pdf .
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57–87.
Augimeri, L. K., Jiang, D., Kogel, C. J., & Carey, J. (2006). The Under 12 Outreach Project: effect of a community-based program for children with conduct problems. Toronto: Center for Child Committing Offences, Child Development Institute.
Augimeri, L. K., Farrington, D. P., Koegl, C. J., & Day, D. M. (2007). The SNAP™ Under 12 Outreach Project: effects of a community based program for children with conduct problems. Journal of Child and Family Studies, 16, 799–807.
Bauer, D. J., Sterba, S. K., & Hallfors, D. D. (2008). Evaluating group-based interventions when control participants are ungrouped. Multivariate Behavior Research, 43, 210–236. doi:10.1080/00273170802034810.
Burke, J. D., & Loeber, R. (in press). The effectiveness of the Stop Now and Plan (SNAP) Program for boys at risk for violence and delinquency. Prevention Science.
Burke, J. D., Loeber, R., & Birmaher, B. (2002). Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1275–1293.
Burke, J. D., Boylan, K., Rowe, R., Duku, E., Stepp, S. D., Hipwell, A. E., & Waldman, I. D. (2014). Identifying the irritability dimension of ODD: application of a modified bifactor model across five large community samples of children. Journal of Abnormal Psychology, 123, 841–851.
Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566–579. doi:10.1037/A0014565.
Chorpita, B. F., Daleiden, E. L., Ebesutani, C., Young, J., Becker, K. D., Nakamura, B. J., & Starace, N. (2011). Evidence-based treatments for children and adolescents: an updated review of indicators of efficacy and effectiveness. Clinical Psychology-Science and Practice, 18, 154–172.
Conduct Problems Prevention Research Group. (1995). Psychometric properties of the social competence scale - teacher and parent ratings. (fast track project technical report). University Park: Pennsylvania State University.
Dishion, T. J., Patterson, G. R., & Kavanagh, K. A. (1992). An experimental test of the coercion model: Linking theory, measurement, and intervention. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: Interventions from birth through adolescence (pp. 253–282). New York: Guilford.
Duckworth, A. L., Tsukayama, E., & May, H. (2010). Establishing causality using longitudinal hierarchical linear modeling: an illustration predicting achievement from self-control. Social Psychological and Personality Science, 1, 311–317. doi:10.1177/1948550609359707.
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.
Gadow, K. D., & Sprafkin, J. (1994). Child symptom inventories manual. Stony Brook: Checkmate Plus.
Henggeler, S. W., Letourneau, E. J., Chapman, J. E., Borduin, C. M., Schewe, P. A., & McCart, M. R. (2009). Mediators of change for multisystemic therapy with juvenile sexual offenders. Journal of Consulting and Clinical Psychology, 77, 451.
Hinshaw, S. P. (2002). Intervention research, theoretical mechanisms, and causal processes related to externalizing behavior patterns. Development and Psychopathology, 14, 789–818.
Kazdin, A. E. (2011). Evidence-based treatment research: advances, limitations, and next steps. American Psychologist, 66, 685–698.
Koegl, C. J., Farrington, D. P., Augimeri, L. K., & Day, D. M. (2008). Evaluation of a targeted cognitive behavioural program for children with conduct problems - the SNAP™ Under 12 Outreach Project: service intensity, age and gender effects on short and long term outcomes. Clinical Child Psychology and Psychiatry, 13, 441–456.
Krull, J. L., & MacKinnon, D. P. (2001). Multilevel modeling of individual and group level mediated effects. Multivariate Behavioral Research, 36, 249–277. doi:10.1207/S15327906mbr3602_06.
La Greca, A. M., Silverman, W. K., & Lochman, J. E. (2009). Moving beyond efficacy and effectiveness in child and adolescent intervention research. Journal of Consulting and Clinical Psychology, 77, 373.
Landenberger, N., & Lipsey, M. (2005). The positive effects of cognitive–behavioral programs for offenders: a meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1, 451–476. doi:10.1007/s11292-005-3541-7.
Lochman, J. E., & Wells, K. C. (2002). Contextual social–cognitive mediators and child outcome: a test of the theoretical model in the Coping Power program. Development and Psychopathology, 14, 945–967.
MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York: Lawrence Erlbaum.
Pardini, D. A., Lochman, J. E., & Frick, P. J. (2003). Callous/unemotional traits and social-cognitive processes in adjudicated youths. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 364–371. doi:10.1097/01.Chi.0000037027.04952.Df.
Patterson, G. R., & Forgatch, M. S. (1995). Predicting future clinical adjustment from treatment outcome and process variables. Psychological Assessment, 7, 275.
Perry, D. G., Perry, L. C., & Rasmussen, P. (1986). Cognitive social learning mediators of aggression. Child Development, 57, 700–711.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Spence, S. H. (2003). Social skills training with children and young people: theory, evidence and practice. Child and Adolescent Mental Health, 8, 84–96.
StataCorp. (2009). Stata statistical software: release 11. College Station: StataCorp LP.
Webster-Stratton, C., Reid, M. J., & Hammond, M. (2001). Preventing conduct problems, promoting social competence: a parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology, 30, 283–302.
Acknowledgments
This work was supported by a grant (07-365-01) from the Department of Health of the Commonwealth of Pennsylvania to Drs. Loeber and Burke, and by a grant to Dr. Burke (MH 074148) from the National Institute of Mental Health.
Conflict of Interest
Drs. Burke and Loeber have no conflicts of interest to report.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Burke, J.D., Loeber, R. Mechanisms of Behavioral and Affective Treatment Outcomes in a Cognitive Behavioral Intervention for Boys. J Abnorm Child Psychol 44, 179–189 (2016). https://doi.org/10.1007/s10802-015-9975-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-015-9975-0