Community and Clinic-Based Modular Treatment for Children with Disruptive Behavior Disorders: Exploration of Predictors, Moderators, and Treatment Parameters

Child disruptive behavior disorders (DBD), characterized by oppositionality, disruptiveness, aggression, and rule-breaking behavior, are the most common reason for child mental health referrals. The efficacy of interventions for child DBD has been demonstrated in both clinic and community settings.  However, a significant minority of cases show limited initial response or an initial response that is not maintained. Therefore, it is important to explore predictors and moderators of effectiveness to better understand for whom treatments are more or less effective.  It is also important to identify elements of the treatment process (treatment parameters) that influence response. This study examines predictors, moderators, and treatment parameters in a clinical trial comparing effects of treatment applied by study clinicians in the community (COMM) or a clinic (CLINIC) for children with Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD).  This study differs from other moderator/predictor studies in comparing setting type (COMM versus CLINIC) rather than treatment versus control.

Participants included 144 children (ages 6 – 11; 53% African American) with ODD (n = 115) or CD (n = 29) randomly assigned to treatment in the community (COMM; n = 72) or clinic (CLINIC; n = 72). Variables across child, parent, and family domains were examined in relation to changes in child externalizing behaviors or number of ODD and CD symptoms endorsed at pretreatment, posttreatment, and 36-month follow-up. Associations between treatment parameters (e.g., hours of child, parent, and parent-child treatment received, treatment completion, referral for additional services) and child outcomes were also explored.  Four significant moderators were found.  Higher baseline child impairment among those in COMM was associated with higher posttreatment symptoms whereas in CLINIC, baseline impairment was not differentially related to outcomes. In addition, those with no ADHD diagnosis in COMM had lower DBD symptoms at posttreatment whereas those with no ADHD diagnosis in CLINIC had higher symptoms. At 36-month follow-up, those with lower baseline family conflict in COMM had higher externalizing behavior whereas those with lower baseline family conflict in CLINIC had lower externalizing behavior.  Several predictors were also found: children who had no history of interpersonal violence and whose parents had lower depressive symptoms, higher incomes, and were employed had lower posttreatment symptoms. Response was also related to a few treatment parameters (e.g., hours of child and parent treatment, treatment completion, referral for services). We discuss implications of these findings for maximizing the benefits of modular treatment by personalizing approaches for children with DBD.