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. This study was supported by grants to the first author from the National Institute of Mental Health (MH 57727) and to the second author by the National Institute of Nursing Research (NR 07615). The fourth author was supported by grant K01 MH078039 from the National Institute of Mental Health. The authors acknowledge the research and clinical staff of the Resources to Enhance the Adjustment of Children (REACH) program, and Drs. David Brent, Tammy Chung, William Gardner, John Lochman, and Wayne Osgood. Reprints may be obtained from Dr. Kolko, WPIC, 3811 O’Hara St., Pittsburgh, PA 15213.     

Parent management training for reducing oppositional and aggressive behavior in preschoolers

This article provides an overview of parent management training (PMT) for preschool-age children with aggressive and oppositional behaviors. Assessment strategies and basic concepts of PMT are provided. Theoretical underpinnings and research outcomes are highlighted for some variations of PMT programs that have strong empirical support. These programs include Helping the Noncompliant Child, Parent–Child Interaction Therapy, Incredible Years Training Series, Triple P-Positive Parenting Program, and Oregon Early Intervention Foster Care.     

Child's behaviour in mother–child interaction predicts later emotional and behavioural problems

The aims were to examine the association of maternal or child interactive behaviour with emotional and behavioural problems of the child simultaneously and 3 years later, and to assess whether there is continuity in children's emotional and behavioural symptoms from 2 to 5 years. Sixty‐five 2‐year‐old children with their mothers were videotaped during a feeding situation. Their mothers completed the CBCL at 2 years and when the children were 5. Simultaneously, there were no strong correlations between child's emotional and behavioural problems and maternal or child interactive behaviour. Subsequently, mothers' higher sensitivity and more optimal structuring, as well as child's higher involvement of the mother, were associated with lower levels of child externalizing and total problem scores. Also, less responsive children showed more externalizing symptoms 3 years later. There was continuity of emotional and behavioural problems from 2 to 5 years. Problems in mother–child interaction may predict behavioural problems in the child subsequently. Besides maternal behaviour, it is important to consider the interactive behaviour of the child. Children who are less responsive and who show less involvement of the mother are more likely to subsequently present more externalizing symptoms, and these children should be recognized and treated early. Copyright © 2009 John Wiley & Sons, Ltd.     

影响9点问题解决的关键行为

在已有研究的基础上,作者提出划出第三条线是解决9点问题关键行为的假设,并设计了三个实验来验证假设.结果表明:任意两条线的提示训练使9点问题的解决率接近或达到100%,因而,提示两条线不能被看成是解决9点问题的关键行为;而提示划出第三条线的训练使9点问题的解决率明显高于提示其它任何一条线训练的效果,可以被认为是解决9点问题的关键行为;能够引导被试划出第三条线的训练使9点问题的解决率明显提高.     

Social Cognition and Externalizing Psychopathology: An Investigation of the Mediating Role of Language

The present study integrates findings from three lines of research on the association of social cognition and externalizing psychopathology, language and externalizing psychopathology, and social cognition and language functioning using Structural Equation Modeling (SEM). To date these associations have been examined in pairs. A sample of 354 clinic-referred children (aged 7 to14 years) recruited from a children’s mental health centre were tested on measures of language, social cognition, working memory, and child psychopathology. We compared a hypothesized model presenting language functioning as a mediator of the association between social cognition and externalizing psychopathology to a model presenting the independent contribution of language and social cognition to externalizing psychopathology. As hypothesized, we found that the mediation model fits the data better than the alternative model. Our findings have implications for developing and modifying intervention techniques for children with dual language and externalizing psychopathology. This research was supported by a grant from Health Canada (NHRDP, 6606-4835) to the third author.     

Building an active citizenry: the role of neighborhood problems, readiness, and capacity for change

Community-building initiatives strive to involve residents as the drivers of the change process, involving them in an array of activities including collective action efforts. Recent evaluations of many of these initiatives, however, suggest that developing the levels of resident involvement needed in such efforts is challenging. This study examines the neighborhood conditions that are related to whether and how much residents become involved in individual activism and collective action efforts. A random-digit-dial phone survey of 460 residents in 7 distressed neighborhoods suggested that while demographic variables were relatively unimportant, resident perceptions of neighborhood readiness (i.e., hope for the future and collective efficacy) and capacity for change (i.e., social ties and neighborhood leadership), and the level of neighborhood problems were strongly related to whether and how much residents were involved in individual and collective action efforts. Moreover, different elements of these neighborhood conditions were more or less important depending on the type and level of resident involvement. For example, while perceptions of neighborhood problems was the strongest predictor of whether an individual became involved at all, perceived strength of neighborhood leadership was the strongest predictor of an individual's level of activity. The implications of these findings for practitioners and scientists are discussed.     

Maintenance of Treatment Gains: A Comparison of Enhanced,Standard, and Self-directed Triple P-Positive Parenting Program

This report describes the 3 year outcomes of three different variants of the Triple P-Positive Parenting Program, a behavioural family intervention. Families were randomly assigned to one of three intervention conditions or to a waitlist condition. At 1 year follow-up there were similar improvements on observational and self-report measures of preschooler disruptive behaviour for Enhanced, Standard and Self Directed variants of Triple P. At 3 year follow-up (completed by 139 families), each condition showed a similar level of maintenance of intervention effects. Approximately 2/3 of preschoolers who were clinically elevated on measures of disruptive behaviour at pre-intervention moved from the clinical to the non-clinical range. Across conditions, there was a comparable preventive effect for each intervention for these high risk children. The implications of the findings for the development of brief, cost effective parenting interventions within a public health framework are discussed.     

Impact of neighborhood disadvantage on overt behavior problems during early childhood

Researchers have yet to examine the impact of neighborhood disadvantage on early child behavior problems (BPs) longitudinally. We examined the impact of neighborhood disadvantage on overt BPs in a low-income, urban sample of 281 African American and European American boys followed longitudinally from toddlerhood to school entry. Measures included census data and maternal report of BPs, sociocultural factors, parental criminality, and maternal depressive symptomatology. After controlling for age 2 overt BPs, family selection variables, and residential instability, neighborhood effects on boys' behavior emerged, but only at age 6 and only at the extreme of neighborhood disadvantage (i.e., underclass). Findings suggest boys in underclass neighborhoods are at risk for overt BPs as they make the transition to elementary school.     

对我国肝移植现状的系统化思考

阐述了我国肝移植的现状及新时期肝移植的新特点,用系统的观点分析了我国肝移植实施中存在的问题,提出了今后如何系统化发展我国肝移植事业的几点设想。