Prevention of Oppositional Defiant and Conduct Disorders in Preschool Children

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Brief Title

Prevention of Oppositional Defiant and Conduct Disorders in Preschool Children

Official Title

Parent Management Training to Prevent Oppositional Defiant and Conduct Disorders in Preschool Children

Brief Summary

      Oppositional defiant and conduct disorders are the most frequent bases for referral of
      children and adolescents. These disorders are difficult to treat among school-aged children
      and adolescents. When they become adults they are likely to manifest depressive disorders,
      substance abuse or dependence, and criminal behavior. These disorders are also two of the
      costly childhood disorders. The aim of the study is to assess the preventive effect of parent
      management training in preschool children at risk for oppositional defiant and conduct
      disorders because of high aggression scores on a parent questionnaire. It is hypothesized
      that given the relatively restricted costs of the intervention and the substantial costs of
      burden associated with these children, the intervention will be cost saving.
    

Detailed Description

      Oppositional defiant and conduct disorders are the most frequent bases for referral of
      children and adolescents. These disorders are difficult to treat among school-aged children
      and, even more, among adolescents. When they become adults they are likely to manifest
      depressive disorders, substance abuse or dependence, criminal behavior and social
      maladjustment. As parents they are likely to pass along antisocial behavior to their
      offspring. These disorders are also two of the costly childhood disorders. The children and
      their parents frequently use social and mental health services. The prevention of these
      disorders in preschool children at risk thus is clearly relevant.

      The origins of oppositional defiant and conduct disorders lie in temperamental
      vulnerabilities of the preschool child in interaction with non-optimal characteristics of the
      child's environment. Specifically, ineffective parenting plays a key role in the development
      of the disorders: a predisposing temperament evokes the kinds of coercive, harsh,
      inconsistent and negative parenting behaviors that transform a difficult temperament into
      antisocial behavior. These inadequate parenting behaviors are targeted in parent management
      training.

      In the present study, we will assess the preventive effects of the Incredible Years parent
      program (Webster-Stratton) in preschool children at risk of oppositional defiant and conduct
      disorders. Besides, we will study the moderating effects of psychophysiological (heart rate,
      skin conductance) and neuropsychological variables on intervention outcome. We also will
      study mediation, i.e. whether the positive outcome is caused by favourable changes in the
      parenting skills. Finally, costs and cost-effectiveness will be studied.

      A hundred sixty children aged four and a half years are selected on the basis of high
      aggression scores on the Child Behavior Checklist. The parents of seventy children
      participate in a group parent training. Ninety children serve as care as usual controls and
      are matched on a person to person basis. Assessments are at pretreatment, posttreatment, one
      year follow-up, and two year follow-up. Outcome measures consist of parent questionnaires
      (e.g. CBCL, Eyberg), parent interviews (DDI, DISC), teacher questionnaires (e.g. TRF), and
      observations of parent-child interactions at home (DPICS). Parenting skills are assessed
      using observations of parent-child interactions (DPICS). Detailed information on the costs of
      the intervention and on the costs generated by the conduct problems (medical consumption,
      education) is monitored.

      If the Incredible Years program is shown to be effective, we will have a program in the
      Netherlands to prevent oppositional defiant and conduct disorders from developing in
      high-risk preschool children. Four to five year old children who according to their parents
      or teachers are hard to manage and show high aggression scores on the CBCL or TRF can be
      monitored. If the scores remain high, the parents are invited to participate in the
      Incredible Years parent program.
    


Study Type

Interventional


Primary Outcome

Composite score consisting of DPICS (behavioral observation) and parent questionnaires (CBCL, Eyberg)

Secondary Outcome

 Cost-effectiveness

Condition

Oppositional Defiant Disorder

Intervention

parent management training


Publications

* Includes publications given by the data provider as well as publications identified by National Clinical Trials Identifier (NCT ID) in Medline.

Recruitment Information


Recruitment Status

Behavioral

Estimated Enrollment

160

Start Date

July 2003

Completion Date

November 2008


Eligibility Criteria

        Inclusion Criteria:

          -  Aggression score on Child Behavior Checklist (CBCL) of at least 80th percentile

          -  Age of child: between 4 and 5 years old

        Exclusion Criteria:

          -  Mastery of the Dutch language is sufficient among the parents to participate in the
             parent management training
      

Gender

All

Ages

4 Years - 5 Years

Accepts Healthy Volunteers

Accepts Healthy Volunteers

Contacts

Walter Matthys, M.D., Ph.D., 31-302507045, [email protected]

Location Countries

Netherlands

Location Countries

Netherlands

Administrative Informations


NCT ID

NCT00189189

Organization ID

03-119

Secondary IDs

ZonMw: 2620.0001


Study Sponsor

UMC Utrecht

Collaborators

 ZonMw: The Netherlands Organisation for Health Research and Development

Study Sponsor

Walter Matthys, M.D., Ph.D., Principal Investigator, UMC Utrecht


Verification Date

July 2005