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Treating Oppositional Defiant Disorder in primary care: A comparison of three models

Lavigne, J. V., LeBailly, S. A., Gouze, K. R., Cicchetti, C., Pochyly, J., Arend, R., et al. (2008). Treating oppositional defiant disorder in primary care: A comparison of three models. Journal of Pediatric Psychology, 33(5), 449-461.

Objective: To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care.

Methods: Twenty-four practices were randomized to conditions in which parents of 117, 3- to 6.11-year-olds with ODD received the 12-session Webster-Stratton Incredible Years program led by primary care nurses or clinical psychologists, or to a minimal intervention group in which parents received only the companion book to the treatment program.

Results: There was improvement across posttreatment and 12-month follow-up for all groups, but no overall treatment group effects. There was a dose effect, with a reliable, clinically significant gain after seven sessions on the Eyberg intensity scale, and nine sessions on the Child Behavior Checklist externalizing scale.

Conclusions: There is little advantage to the therapist-led treatment over bibliotherapy unless parents attend a significant number of sessions.

The present study compared three models of intervention: an office model, with primary care nurses providing a moderately intensive parent training program; a referral model, with clinical child psychologists providing the same parent training, and a minimal intervention treatment without therapist contact. The Webster-Stratton parent training program we used has considerable empirical support and its videotape-based program seemed suitable for use by nonmental health professionals.

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