4 - (SYM 42) Parental Predictors and Moderators of Treatment Outcome in Children with Oppositional Defiant Disorder

Background:  Identifying with whom and under what conditions a treatment works has been identified as an important goal of outcome research (Weersing & Weisz, 2002). Treatment predictors and moderators address these questions. In the treatment of disruptive behaviour disorders, Parent Management Training (PMT) has been extensively studied and its effectiveness has been demonstrated in a number of controlled studies (e.g., Eyberg, Nelson, & Boggs, 2008; Ollendick et al., 2015). So too, Collaborative and Proactive Solutions (CPS), a newer therapy, has accumulated evidence for its effectiveness with disruptive behavior disorders  (e.g., Ollendick et al., 2015). Although these treatments have impressive outcomes, they do not work satisfactorily for all children and adolescents. While our understanding of predictors and moderators in the treatment of externalizing disorders is more advanced than other disorders (e.g., internalizing disorders) a large gap in knowledge exists as to why some participants do not benefit from these evidence based therapies. A lot of the research to date has focused on child characteristics as well as sociodemographic factors. Parental characteristics that predict or moderate treatment outcome has not been extensively examined. The goal of the current study is to address this gap and specifically examine parental characteristics that predict or moderator treatment outcomes in the treatment of ODD.

Methods: One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms.

Results: Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions - mothers who were more likely to attribute their child's problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.

Conclusion: CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD.