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- Clinical handbook of assessing and treating conduct problems in youth
- Clinical handbook of assessing and treating conduct problems in youth
- Conduct disorder
Her research and clinical interests include the assessment and treatment of youth with conduct problems, callous-unemotional traits in youth, cyber bullying and indirect bullying, and Cognitive Behavioral Therapy for early psychosis. Antony D. Kidman, PhD. Dr Kidman has had a long-term clinical and research interest in adolescent mental health including anxiety, depression and psychosis.
He is a frequent guest speaker on radio and television and writes for the media on mental health. He was made a Member of the Order of Australia in for his contributions to clinical psychology. Thomas H. Ollendick, PhD. He is the author of several research articles, book chapters, and books. A frequent speaker at national and international conferences, he is the recipient of several NIH grants. Murrihy , Antony D. Kidman , Thomas H. Discrepancies were resolved through a dialogue overseen by the supervising doctoral-level clinical psychologist.
T -tests also addressed whether retained children showed significant changes in ODD symptoms from pre- to post-treatment and whether these changes were significantly different between treatments. Bivariate and partial correlations indicated the direct associations between study variables before and after accounting for pre-treatment reports of ODD symptoms. This strategy is suggested by Vickers and Altman to control for pretreatment measures when assessing treatment outcomes.
Regressions were conducted in three steps: demographic factors, pre-treatment scores, and treatment type CPS, PMT were entered on the first step; main effects of conduct problems and perceived relationship quality were entered on the second step; and the interaction term between conduct problems and relationship quality was entered on the third step. Variables were centered to control for possible collinearity in forming the interaction term. FIML was used to address missing data in regression models and is appropriate when data is missing completely at random.
This approach does not impute missing data, but provides estimates based on all available model data Arbunkle, See Table 1 for descriptive statistics and the original counts available for each variable. See Table 2 for bivariate correlations and for partial correlations regarding post-treatment outcomes, controlling for pre-treatment reports of ODD symptoms and severity, respectively. These effect sizes suggest that items such as reported conduct problems were expectedly related to, but not heavily overlapping with, other indices of ODD. For Child Gender, girls are coded as the higher value.
Regressions concerning change in mother-reported ODD symptoms were tested first. See Table 3. Treatment type did not contribute significantly.
Relations with Parents and Conduct Problems were mean-centered. Regressions concerning change in clinician-reported ODD severity were then tested. See Table 4. When relationships with parents were viewed as being more positive, children showed greater reductions in ODD severity, across levels of conduct problems. When the relationship with parents was viewed as being more negative, children showed smaller reductions in ODD severity as conduct problems became more elevated.
See Figure 1 for the simple slopes of this interaction. The region of significance indicated that when mean-centered values for perceived relations with parents were below 0. When mean-centered values for perceived relations with parents were equal to or greater than 0. Consistent with our earlier findings Ollendick et al. On the other hand, mother reports of conduct problems at pre-treatment were associated with poorer treatment response and a smaller decrease in ODD symptoms as reported by mothers and ODD severity as determined by blinded clinicians.
In addition, child reports of relationship quality with parents showed trends of greater reductions in ODD symptoms following treatment. An interaction effect was observed between these variables on reductions of ODD severity. When children reported better relations with their parents, conduct problems did not attenuate treatment response; hence, they showed similarly robust symptom severity improvement regardless of the level of conduct problems.
In contrast, when children reported poorer relations with their parents, they failed to show improvements in ODD severity when pre-treatment conduct problems were higher.
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This moderation effect was not significant for mother-reported improvements in ODD symptoms. The perception of relationship quality with parents has been understudied among youth with ODD. Yet, with community samples, positive behaviors between parents and children e. As noted earlier, in our sample, only Thus, slightly more than half Thus, a considerable number of children reported positive relations with their parents even though they were exhibiting argumentative, negativistic, and oppositional behaviors.
Even if this were the case in the current study, there was a trend for reports of parent-child relations to predict better treatment response from a third-party, the clinician. In terms of clinical relevance, these findings suggest that treatment of ODD behaviors is more difficult when the initial relationship between child and parent is viewed negatively by oppositional children. This appears to be the case independent of treatment type, at least for the two treatments examined in the current study.
It is possible that, in spite of problematic ODD behaviors, some family members are able to maintain relatively positive relations with each other. In other words, oppositional behavior does not define the totality of interactions between children diagnosed with ODD and their parents, and conflictual interactions may be confined to certain specific demands and expectations. Thus, one possible interpretation of the current findings is that treatment is more difficult when parent-child conflict has come to color a higher number of parent-child interactions, or at least when such conflict has come to color perceptions of the parent-child relationship.
These are more likely to be families which exhibit warmth and better emotion regulation across interactions Beauchaine et al.
For oppositional children in treatment, viewing the relationship with parents as something worth maintaining and improving further may encourage greater cooperation and collaboration during and after treatment, enhancing investment and willingness to follow instructions or work with parents when distressed. For oppositional children who do not initially hold the relationship with parents in high regard, investment in treatment may, initially at least, be lower.
Finally, in transactional terms, it is possible that ODD behaviors are the byproduct of pre-existing difficulties that could hinder relations between parent and child e. With each of these possibilities, the parent-child relationship remains an important consideration, with implications for family cooperation and treatment response in both PMT and CPS treatment approaches. Our findings also emphasize the importance of assessing broader conduct problems among oppositional youth. As noted above, these conduct problems differ from the predominantly reactive problems frequently associated with ODD, and often reflect forethought and intentional manipulation of others in the achievement of relationship goals e.
Although children with oppositional and conduct problems may be particularly difficult to treat, they may be more engaged in and responsive to treatments if they value their relationships with their parents and believe their parents value them as well Pasalich et al. The current study possesses several weaknesses. First, the correlational nature of our study precludes making causal inferences. Second, a major limitation concerns the extent of family dropout during treatment or before the post-treatment assessment. We used full information maximum likelihood to incorporate all available data and reduce the impact of attrition.
Other weaknesses include our largely middle-class, Caucasian sample of children and the lack of longer-term follow-up on intervention effects. In addition, we recognize that considering only the perspective of the child concerning the quality of the parent-child relationship is limiting, and fails to incorporate important and possibly discrepant views from the parent. Importantly, our study also possesses strengths. This is the first study to examine child perceptions of relationship quality with parents alongside the level of conduct problems in children with ODD and to explore their associations with treatment outcomes.
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As noted above, we also used FIML approaches to handle missing data in analyses and we used multiple informants child, parent, clinician. Each of these approaches strengthens the present results. Further, while ODD was the principal reason of referral for all youth, nearly all of our youth met criteria for another disorder, most frequently ADHD or an anxiety disorder, and over half met criteria for a third disorder. Our findings suggest important leads for future research and possible treatment. For example, in future studies it will be important to assess for conduct problems in children diagnosed with ODD and to examine pre-treatment levels of positive parent-child relations.
Oppositional children with co-occurring conduct problems — even in the absence of a clinical diagnosis of CD — may require an augmented treatment that addresses these additional features. Our findings suggest this will be especially important for youth who are less positive about the support they will receive from their parents.
Indeed, perhaps the most clinically relevant conclusion to be drawn from our findings is that, in some families, successful treatment of youth with ODD may benefit from improving the relationships between these youths and their caregivers to enhance reduction in ODD symptoms. It is possible that focusing solely on reduction of ODD symptoms may not address other factors contributing to dysfunctional interactions between youth with ODD and their caregivers. We wish to express appreciation to the graduate students and research scientists who assisted us with various aspects of this project, including data reduction, assessment, and treatment of these youth.
In this study, children ages 7 - 14 years, Elevated reports of children's conduct problems were associated with attenuated reductions in both ODD symptoms and their severity. The current findings underscore the importance of children's perspectives in treatment response and reductions in externalizing child behaviors.
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Clinical handbook of assessing and treating conduct problems in youth
This may be because the snippet appears in a figure legend, contains special characters or spans different sections of the article. J Child Fam Stud. Author manuscript; available in PMC May 1. PMID: Jordan A.
Clinical handbook of assessing and treating conduct problems in youth
Booker , 1 Thomas H. Ollendick , 2 Julie C. Dunsmore , 3 and Ross W. Greene 2. Thomas H.
Julie C. Ross W. Please address correspondence to Jordan A. Copyright notice. The publisher's final edited version of this article is available at J Child Fam Stud. See other articles in PMC that cite the published article.
Abstract Our objective in this study was to examine the moderating influence of parent-child relationship quality as viewed by the child on associations between conduct problems and treatment responses for children with oppositional defiant disorder ODD. Procedure Children and parents initially participated in two pre-treatment assessment sessions. Results See Table 1 for descriptive statistics and the original counts available for each variable. Table 1 Descriptive Statistics for Study Variables. Open in a separate window. T indicates the variable is T -scored.
Bivariate Correlations 1. Review Text From the reviews: "Overall, the combination of the traditional subjects, updated and enriched by clinically vivid portraits of the topics, with a healthy infusion of fresh, innovative material, makes this book for now the preferred reference on this topic for practicing clinical psychologists. It also details practical, evidence-based assessment and intervention options that can be applied across a range of settings and is tailored to meet individual needs, such as parent management strategies, family therapy and cognitive behaviour therapy.
Review quote From the reviews: "Overall, the combination of the traditional subjects, updated and enriched by clinically vivid portraits of the topics, with a healthy infusion of fresh, innovative material, makes this book for now the preferred reference on this topic for practicing clinical psychologists. About Rachael C. Murrihy Rachael C. Murrihy, PsyD. Dr Murrihy's specialty is in the area of clinical adolescent psychology.
She has extensive experience lecturing, training, and supervising professionals in this field, including clinical psychologists, psychiatrists, family physicians, nurses, educators, and interns. She also provides mental health lectures for members of the general public.
As a practicing clinician, Dr Murrihy works with youth experiencing both internalizing and externalizing disorders across a diverse range of settings, including the university clinic, private practice, inpatient wards, and in mainstream and alternative schools. She has published research on adolescent mental health and has presented this work at conferences, both nationally and internationally. Her research and clinical interests include the assessment and treatment of youth with conduct problems, callous-unemotional traits in youth, cyber bullying and indirect bullying, and Cognitive Behavioral Therapy for early psychosis.
Antony D. Kidman, PhD. Dr Kidman was a member of the National Executive of the Australian college of clinical psychologists for 10 years and was the founder and inaugural Editor for 6 years of the College's journal, The Clinical Psychologist. Dr Kidman has had a long-term clinical and research interest in adolescent mental health including anxiety, depression and psychosis. He is a frequent guest speaker on radio and television and writes for the media on mental health.
He was made a Member of the Order of Australia in for his contributions to clinical psychology. Thomas H. Ollendick, PhD.