Heather M Joseph1, Cristan Farmer2, Heidi Kipp1, David Kolko1, Michael Aman3, James McGinley4, L Eugene Arnold3, Kenneth D Gadow5, Robert L Findling6, Brooke S G Molina1. 1. 1 Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania. 2. 2 Office of the Clinical Director, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland. 3. 3 Department of Psychiatry, The Ohio State University, Columbus, Ohio. 4. 4 Vector Psychometric Group, LLC, Chapel Hill, North Carolina. 5. 5 Department of Psychiatry, Stony Brook University, Stony Brook, New York. 6. 6 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, Maryland.
Abstract
OBJECTIVES: We examined the association of parent training (PT)-related factors with therapeutic success in the Treatment of Severe Childhood Aggression (TOSCA) study. Our aims were (1) to evaluate demographic and clinical characteristics as predictors of parent attendance and engagement in PT and (2) to examine the associations of parent attendance and engagement in PT with study-targeted child behavior outcomes (i.e., attention-deficit/hyperactivity disorder [ADHD] and disruptive behavior symptoms). TOSCA was a randomized clinical trial evaluating the effect of placebo versus risperidone when added to PT and psychostimulant for childhood ADHD with severe aggression. METHODS: Data for 167 parents and children 6-12 years old with ADHD, oppositional defiant disorder (ODD) or conduct disorder, and severe physical aggression were examined. Analyses used generalized linear models. RESULTS: Most parents (72%) attended seven or more of nine sessions. The average parental engagement, that is, the percentage of PT elements fully achieved across participants and sessions, was 85%. The average therapist rating of goal completion was 92%. Parents of non-white and/or Hispanic children (p = 0.01) and children with lower intelligence quotient (p = 0.02) had lower PT attendance; parents with lower family incomes (p = 0.01) were less engaged. Attendance and engagement predicted better scores on the primary child behavior outcomes of disruptive behavior (Nisonger Child Behavior Rating Form Disruptive Behavior Total) and ADHD and ODD symptoms, adjusting for baseline severity. CONCLUSIONS: When the clinical picture is sufficiently severe to warrant prescribing an atypical antipsychotic, PT is feasible for families of children with ADHD and co-occurring severe aggression. The promotion of attendance and engagement in PT is important to enhance clinical outcomes among this challenging population. Methods for overcoming barriers to participation in PT deserve vigorous investigation, particularly for those with low family income, non-white race, Hispanic ethnicity, or when children have lower cognitive level.
RCT Entities:
OBJECTIVES: We examined the association of parent training (PT)-related factors with therapeutic success in the Treatment of Severe Childhood Aggression (TOSCA) study. Our aims were (1) to evaluate demographic and clinical characteristics as predictors of parent attendance and engagement in PT and (2) to examine the associations of parent attendance and engagement in PT with study-targeted child behavior outcomes (i.e., attention-deficit/hyperactivity disorder [ADHD] and disruptive behavior symptoms). TOSCA was a randomized clinical trial evaluating the effect of placebo versus risperidone when added to PT and psychostimulant for childhood ADHD with severe aggression. METHODS: Data for 167 parents and children 6-12 years old with ADHD, oppositional defiant disorder (ODD) or conduct disorder, and severe physical aggression were examined. Analyses used generalized linear models. RESULTS: Most parents (72%) attended seven or more of nine sessions. The average parental engagement, that is, the percentage of PT elements fully achieved across participants and sessions, was 85%. The average therapist rating of goal completion was 92%. Parents of non-white and/or Hispanic children (p = 0.01) and children with lower intelligence quotient (p = 0.02) had lower PT attendance; parents with lower family incomes (p = 0.01) were less engaged. Attendance and engagement predicted better scores on the primary child behavior outcomes of disruptive behavior (Nisonger Child Behavior Rating Form Disruptive Behavior Total) and ADHD and ODD symptoms, adjusting for baseline severity. CONCLUSIONS: When the clinical picture is sufficiently severe to warrant prescribing an atypical antipsychotic, PT is feasible for families of children with ADHD and co-occurring severe aggression. The promotion of attendance and engagement in PT is important to enhance clinical outcomes among this challenging population. Methods for overcoming barriers to participation in PT deserve vigorous investigation, particularly for those with low family income, non-white race, Hispanic ethnicity, or when children have lower cognitive level.
Authors: Scott Kollins; Laurence Greenhill; James Swanson; Sharon Wigal; Howard Abikoff; James McCRACKEN; Mark Riddle; James McGOUGH; Benedetto Vitiello; Tim Wigal; Anne Skrobala; Kelly Posner; Jaswinder Ghuman; Mark Davies; Charles Cunningham; Audrey Bauzo Journal: J Am Acad Child Adolesc Psychiatry Date: 2006-11 Impact factor: 8.829
Authors: Cristan A Farmer; Nicole V Brown; Kenneth D Gadow; L Eugene Arnold; David G Kolko; Robert L Findling; Brooke S G Molina; Kristin A Buchan-Page; Robert R Rice; Srihari S Bangalore; Oscar Bukstein; E Victoria Rundberg-Rivera; Nora McNamara; Michael G Aman Journal: J Child Adolesc Psychopharmacol Date: 2015-04 Impact factor: 2.576
Authors: Angela T Clarke; Stephen A Marshall; Jennifer A Mautone; Stephen L Soffer; Heather A Jones; Tracy E Costigan; Anwar Patterson; Abbas F Jawad; Thomas J Power Journal: J Clin Child Adolesc Psychol Date: 2013-05-20
Authors: Michael G Aman; Oscar G Bukstein; Kenneth D Gadow; L Eugene Arnold; Brooke S G Molina; Nora K McNamara; E Victoria Rundberg-Rivera; Xiaobai Li; Heidi Kipp; Jayne Schneider; Eric M Butter; Jennifer Baker; Joyce Sprafkin; Robert R Rice; Srihari S Bangalore; Cristan A Farmer; Adrienne B Austin; Kristin A Buchan-Page; Nicole V Brown; Elizabeth A Hurt; Sabrina N Grondhuis; Robert L Findling Journal: J Am Acad Child Adolesc Psychiatry Date: 2013-11-18 Impact factor: 8.829
Authors: William E Pelham; Gregory A Fabiano; James G Waxmonsky; Andrew R Greiner; Elizabeth M Gnagy; William E Pelham; Stefany Coxe; Jessica Verley; Ira Bhatia; Katie Hart; Kathryn Karch; Evelien Konijnendijk; Katy Tresco; Inbal Nahum-Shani; Susan A Murphy Journal: J Clin Child Adolesc Psychol Date: 2016-02-16