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Improving behavioral treatment for children with disruptive behavior

Projectomschrijving

Doel

Wanneer kinderen met gedragsproblemen, zoals opstandig en agressief gedrag, geen behandeling krijgen, kunnen hun problemen uitgroeien tot chronische stoornissen met negatieve uitkomsten in hun latere leven. Dit project beoogt behandeling voor kinderen met gedragsproblemen te verbeteren door het onderzoeken van een korte, flexibele training-op-maat voor hun ouders, met het bieden van vervolgbehandeling om terugval te voorkomen. Ook heeft het project als doel inzicht te krijgen in welke gezinnen profiteren van oudertraining door wereldwijd uitkomsten van studies samen te voegen.

Zorg op maat

Er wordt verwacht dat de korte oudertraining met vervolgbehandeling beter werkt dan gebruikelijke zorg en de behoefte aan langere, intensievere en duurdere behandelingen vermindert. Daarnaast wordt er verwacht dat er beter kan worden voorspeld welke kinderen beter of juist minder goed op oudertraining reageren. De projectresultaten zullen helpen om toegankelijke zorg op maat voor kinderen met gedragsproblemen te bieden.

Verslagen


Samenvatting van de aanvraag

When children with disruptive (i.e., oppositional, impulsive, hyperactive, and aggressive) behaviors are left untreated, their problems often grow into chronic disorders and subsequent adverse outcomes, such as school drop-out, delinquency, substance use, anti-social personality disorder, and depression. Ideally, treatment should prevent the escalation of problems, reduce the need for long and intensive or potentially harmful treatments (such as antipsychotics), and lower societal costs. Parent training has the strongest effects on disruptive behaviors. However, only few families receive empirically-supported parent training, because programs often require certified therapists, who are scarce. Waiting lists are therefore common. Also, programs are typically long and experienced as rigid and not tailored to individual parental needs. There is thus an urgent need for brief, accessible, and individually-tailored programs. Another problem is that parent training does not work for all children with disruptive behaviors. However, it is largely unknown for whom parent training works, because most studies lack the statistical power to adequately investigate moderators of treatment response. This knowledge is needed for clinicians to decide which families to refer to parent training. This project aims to increase the effective use of parent training for children with disruptive behaviors by (1) examining short- and long-term effectiveness and cost-effectiveness of a new, brief, individually-tailored parent training program with optional booster sessions in a randomized controlled trial; (2) identifying subgroups of families who respond better or worse to parent training using a large individual participant database (IPD) that enables exceptionally well-powered moderator analyses; and (3) assessing how drop-out and responses rates, short- and long-term effect sizes, and cost-effectiveness of the brief parent training corroborate with those of full-scale parent training as found in the IPD. The trial will be embedded in routine mental health care. Referred children (aged 2-12, N=110) with disruptive behaviors will be randomly assigned to 1) three individual sessions of brief, individually-tailored parent training, with optional booster sessions up to one year after the training or 2) care as usual (CAU), as regularly provided by five participating representative mental health centers. The training is tailored to the specific disruptive behaviors that parents want to change. Primary outcomes will be these target behaviors and parent reported disruptive behaviors on the Intensity scale of the Eyberg Child Behavior Inventory (ECBI-I). Secondary outcomes include child well-being, parenting behaviors and stress, parental attitude, and parents’ and therapists’ satisfaction with the program. To assess cost-effectiveness, costs of the brief parent training with optional booster sessions will be compared to those of CAU, relative to their effects. We already laid the foundation for the IPD as our project members established two IPD databases that we can combine in the current project. One consists of 33 trials (N=3534 children) on behavioral treatments for children with attention-deficit/hyperactivity disorder (ADHD, often comorbid with disruptive behaviors), and one of 15 trials (N=1,799 children) on a parent training program for children with disruptive behaviors. The latter is currently being extended with the help of an NWO Vidi grant to 41 European trials (N=5,149). For the current project we will include other eligible trials not yet covered in our current IPDs. The primary outcome will be child disruptive behavior. Secondary outcomes and candidate moderators will include children’s comorbid problems, impairment and callous-unemotional traits, parental mental health (depression, stress), parenting self-efficacy, parenting behaviors, and quality of the parent-child relation. To assess how the brief parent training stands up against full-scale parent training programs, we will compare its dropout rate, reliable change indices based on the ECBI-I, cost of the interventions, and effect-sizes, with traditional parent training as present in the IPD. Our project group is involved in all stages of the project and consists of researchers, clinicians, parents of our parent advisory board, and representatives of the participating mental health centers and parent association ‘Balans’. We have extensive experience regarding the development and implementation of treatments for children with disruptive behaviors. Our results and materials will be disseminated and implemented to relevant parties: (1) parents; (2) mental health care institutions and professionals; (3) mental health care policy; (4) the (inter)national (scientific) community. This proposal is of utmost importance for clinical practice and society, as there is such high need for easily-applicable, cost-saving personalized treatments for children with disruptive behaviors.

Onderwerpen

Kenmerken

Projectnummer:
06360312110001
Looptijd: 45%
Looptijd: 45 %
2021
2026
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
van den Hoofdakker
Verantwoordelijke organisatie:
Accare