Resources to Enhance the Adjustment of Children (REACH)
Condition: Oppositional Defiant Disorder; Conduct Disorder; Attention Deficit Hyperactivity Disorder
MeSH terms: Attention Deficit Disorder with Hyperactivity; Conduct Disorder; Attention Deficit and Disruptive Behavior Disorders
Study type: Interventional

Summary: 
      This continuation study evaluates the long-term outcomes of multimodal, modular interventions
      with early-onset behavior disordered children and innovative methods to promote the
      maintenance and extension of treatment effects relating to ODD and CD. All participants
      originally enrolled in the "parent" clinical trial are being followed and those who initially
      received clinic or community based intervention from a study clinician were randomly assigned
      to either Booster or No-booster treatment condition. The treatment-as-usual (TAU) and Healthy
      Control participants were also followed through long-term follow-up assessments paralleling
      clinically referred participants. The study examines the short and long-term efficacy of
      booster treatment on clinical outcome, contextual variables, and service satisfaction/use.
    

Detailed description: 
      Child Conduct problems (CP), as found in Conduct Disorder (CD) and Oppositional Defiant
      Disorder (ODD), are common and chronic. Although laboratory research studies have yielded
      promising initial outcomes, follow-up effects are often not studied and, when they are
      evaluated, are often limited. Maintenance procedures have been generally administered after
      acute treatment in the form of periodic booster sessions to enhance long-term outcomes
      (Whisman, 1990). Although the conceptualization and application of maintenance therapies has
      been described frequently with adults, there is limited information regarding the role of
      maintenance treatment in child and adolescent psychotherapy (see Eyeberg, 1998). A few
      studies of booster treatments have reported the return of behavioral improvements (Baer,
      Williams, Osnes, & Stokes, 1984; McDonald & Budd, 1983; Patterson, 1974) and other
      improvements in conduct-disordered children (Lochman, 1992) and depressed adolescents (Clark
      et al., 1999), suggesting potential benefits in extending the durability of treatment
      effects. What is not yet known is the extent to which patients respond positively to a
      booster (maintenance) treatment condition that is administered after long-term (i.e.,
      three-year) follow-up, one that is designed to reduce recurrence of behavioral dysfunction
      and the development of new forms of dysfunction during adolescence. The justification for
      this additional intervention derives from our initial findings and the young age of our
      sample, which, in most instances, has yet to traverse the period of heightened risk for
      delinquency.

      Literature reviews highlight the importance of addressing at least three primary objectives
      in understanding the clinical response and long-term adjustment of children with ODD or CD.
      First, there is a need to document empirically the long-term effects of both specialty
      treatments and routine services during repeated follow-up assessments in an effort to
      document the maintenance of all initial treatment gains (Eyberg et al., 1998). Our
      preliminary findings suggesting the presence of both similarities and differences in the
      initial outcomes of our two specialty treatments (Community vs. Clinic protocols) supports
      the conduct of a long-term evaluation in order to determine whether these effects continue or
      change.

      Second, our initial findings underscore the importance of determining the extent to which
      booster treatment sessions help to promote long-term maintenance or produce long-term
      preventive effects on some of the more common sequelae of ODD and CD. Booster treatment may
      be needed to deflect such children from unfolding trajectories toward increased antisocial
      behavior and multi-system impairments (Loeber et al., 1993). Thus, efforts to promote the
      long-term outcomes of follow-up in this population must be evaluated in an effort to
      understand the degree to which they show improvements in serious clinical dysfunction
      (recovery from Disruptive Behavior Disorders (DBD)) and/or show reductions in the development
      of new forms of dysfunction (deviant and delinquent activities) that may place these children
      at-risk for other adverse adolescent outcomes. The young age of this patient sample at the
      start of this competing continuation(8-16 yrs) may make it easier to demonstrate preventive
      effects.

      Finally, the availability of only modest empirical evidence provides a compelling argument
      for evaluating potential predictors of each of the above-mentioned long-term follow-up
      outcomes based on a comprehensive battery of psychosocial (e.g., child, parent, and family
      adjustment) and biological (e.g., testosterone, cortisol) measures obtained upon study intake
      and treatment termination. Key predictors of treatment response include lower levels of
      child, parent, and family dysfunction, barriers to treatment, and SES (Kazdin, 1995; Kazdin &
      Wassell, 2000). We will also evaluate the role of contextual or other life changes in
      understanding treatment effects over the follow up period. Among the important contextual
      variables to be evaluated include changes in parental and family functioning, peer
      relationships, and school adjustment. Clearly, these variables may influence continued
      antisocial behavior at this young age. Thus, we will examine how contextual factors affect
      how well treatment effects hold as well as the real world impact of treatment on various life
      changes.
    

Intervention name(s): Booster Treatment; No-Booster; No intervention; Treatment As Usual
Intervention type(s): Behavioral; Behavioral; Other; Other
Intervention description(s): Based on this collective evidence, booster treatment was designed to address three general goals: a) clarify key child and parent/family problems and family preferences regarding target problems, b) directly target and resolve these existing problems using the eight domains contained in the existing treatment protocol administered in the initial outcome study, and c) provide the family with clinical recommendations and information to promote the maintenance of skill developments in targeted domains or adaptive routines designed to prevent any further deterioration in clinical functioning. Thus, the clinician may provide a review of prior content or administer new material specifically for older adolescents, as needed, and will attempt to apply these skills to specific problematic situations identified by the family.; All cases randomized to this condition will simply participate in all of the proposed routine assessments and will receive assessment feedback. Specifically, these families will be provided with a brief summary of the significant clinical findings obtained in their 36-month follow-up assessment (assessment feedback). Such an assessment was provided to clinicians in the original study in order to highlight specific areas in need of clinical attention based on a review of the normative data and clinical cutoffs available for each instrument. Selected information will be conveyed by phone to the participating parent/guardian in a straightforward manner followed by a discussion of some clinical recommendations designed to address these clinical problems. In addition, the parent/guardian will be provided with a listing of professionals who provide services appropriate for this age group and for children with similar problems.; No intervention was administered with this arm. Saliva samples were collected 2 times in the lab and 2 times at home (once at bedtime, once at wake-up time) per initial voluntary saliva protocol at each timepoints to measure endocrine levels.; All cases assigned to this arm simply participated in all of the proposed routine assessments.
Other intervention name(s): Modular Cognitive Behavior Therapy; No-Booster Comparison condition; Healthy Control Comparison Group; Treatment As Usual clinical comparison.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Cognitive Behavioral Therapy; Multimodal Treatment; Physiological Parameters; Hormone Concentration in pubertal development; Treatment as usual comparison