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Assessing the Impact of Childhood Interventions
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skip navigation About the Conference
Agenda
Commissioned Papers
Barbara J. Burns, Ph.D.
Scott N. Compton, Ph.D.
Helen L. Egger, M.D.
Elizabeth M.Z. Farmer, Ph.D.
E. Jane Costello
Tonya D. Armstrong
Alaattin Erkanli
Paul E. Greenbaum
Chi-Ming Kam
Linda M. Collins
Selected Bibliography
Program Contacts
An Annotated Review of the Evidence Base for Psychosocial and Psychopharmacological Interventions for Children with Attention-Deficit/Hyperactivity Disorder, Major Depressive Disorder, Disruptive Behavior Disorders, Anxiety Disorders, and Posttraumatic Stress Disorder

Burns, Compton, Egger & Farmer

Part 4: Studies of Childhood Disruptive Behavior Disorders

Links to other parts of this paper:


Studies of Childhood Disruptive Behavior Disorders

The evidence base for nonresidential interventions for disruptive behavior disorders is presented in table 3. It excludes interventions that require an out-of-home placement (e.g., therapeutic foster care, group homes, residential treatment centers, or hospitalization).

Interventions must be applicable to school age preadolescent youth (defined as approximately 6–12). Studies were included if they covered this age range, but also included youth who were younger or older. Interventions that are designed exclusively for adolescents were not included. The review includes prevention and treatment studies. Therefore, programs that identify youth who are "at risk" for developing conduct problems are included. Studies in which ADHD was the primary diagnostic label were excluded (and are included in the ADHD section of this report). Studies could be included if they focused on youth with a definable psychiatric diagnosis (e.g., conduct disorder, oppositional defiant disorder) or on youth with externalizing behaviors that may contribute to these types of disorders. The review includes a number of interventions designed to be delivered via schools. However, we did not search the education literature for education-specific interventions (e.g., special education).

Searches were conducted in PsycINFO and Medline electronic databases, beginning with key words "behavior disorders," "conduct disorder," or "disruptive." The query was limited to (1) refereed journal articles, (2) English language, (3) 1985-1999, (4) school age (6–12), and (5) empirical studies. This net was intended to be broad to prevent omission of relevant articles. This search resulted in 314 articles. The final set was selected by reading abstracts or articles. Articles were excluded if they: had a total sample size of less than 30; did not include a comparison group; did not include youth younger than 13; were focused on program descriptions or epidemiologic topics; or had insufficient data to examine outcomes at the completion of intervention. In addition to this search, we also included older citations from the frequently cited review by Brestan and Eyberg (1998) of the literature on treating disruptive disorders. This resulted in a total of 30 included articles.

Brestan and Eyberg’s review summarized research through 1995. This review has been cited extensively in many recent publications related to treatment for disruptive behaviors. The current review extends, rather than duplicates, the Brestan and Eyberg article.

Results from the present review are discussed within five heuristic categories: parent training; community-based interventions; clinic-based treatments; prevention programs; and psychopharmacological treatments. These categories were developed to provide structure in a field with quite diverse approaches to intervention. In contrast to the research literature for other disorders in this review, adjunctive studies examining combined psychosocial and pharmacological interventions were not found.

Parent training is highlighted because it is a generic heading that captures both of the "well established" treatments identified by Brestan and Eyberg. Support seems to be particularly strong for Webster-Stratton’s Parents and Children Series. Most of the research on this intervention has been conducted with parents of youth in the preschool and early school years.

Community-based interventions primarily include treatments that are delivered in the child and family’s natural ecology and that focus on meeting the individualized needs of youth and their families. Multisystemic therapy (MST) has the strongest evidence base within this section. However, most studies of MST have focused on adolescents, rather than youth under the age of 13. Various approaches to case management appear to have positive effects, particularly on treatment-related outcomes but large direct effects on symptoms have not been found.

Clinic-based interventions included a heterogeneous set of individual and family-based interventions. Overall, this set of interventions showed improvements over time for youth. However, differential improvement between groups was not always significant. This section provides findings that suggest possible effectiveness of several interventions (e.g., day treatment, Problem Solving combined with Parent Management Training, Family Effectiveness Training). However, the research base is not particularly strong.

Preventive interventions are unique within this review. This is in part because the risk factors for disruptive disorders have been consistently determined, and therefore, prevention programs have been developed to reduce the probability of later problems in at-risk youth. All interventions in this section include a multifaceted intervention that targets the multiple risk factors for the development of disruptive disorders. An intervention conducted by Tremblay, Vitaro, and colleagues has the longest followup data, and results look promising into early adolescence and beyond. Two of the projects included here are recent additions (e.g., Fast Track, LIFT). Initial outcomes from these projects look promising, but more time is needed to assess their long-term effects.

Pharmacological interventions are relatively rare with disruptive disorders (except for youth with comorbid ADHD). Recent studies suggest potentially positive effects of lithium and methylphenidate hydrochloride. In both cases, the evidence is not yet extensive.

Overall, interventions for disruptive disorders tend to focus on the child’s behavior and significant others (particularly parents). There is some evidence for the effectiveness of a variety of approaches. There is also growing evidence for the effectiveness of multifaceted prevention programs to prevent development of disorder in at-risk youth. In the treatment of disruptive disorders, 6- to 12-year-olds are a relatively understudied population. More attention has been given to youth who are younger (e.g., preschoolers) or older (e.g., adolescents). There is a tremendous need for additional research to build upon the positive interventions listed here and to examine long-term effectiveness.

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Table 3.1 Review of Childhood Disruptive Behavior Disorders Studies
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Brestan & Eyberg, 1998 Review of 82 studies conducted across 29 years (1966-1995)

Included studies based on previous meta-analyses plus additional search for studies during 1993-95; criteria for inclusion: prospective design, peer-reviewed journals; 99% of included studies used a comparison group, 75% used random assignment

Youth with symptoms of ODD or CD; included comorbid cases Not reported in all studies; typical subject was 9 years old, white, lower-middle income Identified 2 well-established treatments, and 10 probably efficacious treatments; well-established are both Parent Training (Patterson & Gullion’s Living with Children; Webster-Stratton’s videotape Parent Training series); probably efficacious include anger control, assertiveness training, parent-child interaction, parent training, problem solving, rational-emotive therapy, delinquency prevention, and multisystemic therapy Not a primary research article, but included here because it forms the basis for many contemporary overviews of the state of the field; outcomes appear to be better with younger children (e.g., preadolescence)

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Table 3.2 Parent Training Studies of Childhood Disruptive Behavior Disorders
Study Citation(s) Study Design/Description Target Population Demographic Characteristics Outcomes Notes
Taylor, Schmidt, Peeler, & Hodgins, 1998 RCT; Webster-Stratton’s Parents and Children Series (PACS; = 46) vs. eclectic atypical treatment (= 46) vs. wait-list control (n = 18) Families of 3- to 8-year-olds with behavior problems Age: 3 – 8

Gender:
73% boys
27% girls

Race/Ethnicity: DK (92% of mothers born in Canada)

PACS and eclectic treatment showed improvements compared to wait-list controls (total problems); PACS showed more pronounced effects in intensity of problems and CBCL total problems score; eclectic showed more pronounced effects in attentional difficulties Sample collected from families who contacted a public mental health clinic for assistance related to behavior problems or parenting issues for child with behavior problems
Webster-Stratton & Hammond, 1997 Quasi-experimental design; child training vs. parent training vs. child training plus parent training vs. wait-list control (n = 97) Families of children with early-onset conduct problems; children met criteria for ODD or CD to be included Age: 4 – 7

Gender:
74% boys
26% girls

Race/Ethnicity:
86% White
14% Other

Assessments at baseline, 2 months' posttreatment and 1 year; all three treatments showed improvements compared to controls; child training plus parent training produced most significant improvements at 1-year followup  
Webster-Stratton, Kolpacoff, & Hollinsworth, 1988 RCT; individually administered videotaped modeling vs. group discussion videotape modeling treatment vs. group discussion treatment vs. wait list control (n = 114) Families with a child with conduct problems Age: 3 – 8

Gender:
69% boys
31% girls

Race/Ethnicity: DK

Significant changes, relative to controls, for families in all treatment groups; few differences among three interventions, but consistent trend for better outcomes associated with group discussion videotape modeling  
Wiltz & Patterson, 1974 Quasi-experimental design; parent training vs. Living with Children curriculum vs. untreated control group (n = 16) Boys with aggressive behavior Age: M = 9.8

Gender:
100% boys

Race/Ethnicity: DK

Outcomes available at end of 5-week treatment; boys in intervention showed decreased deviant behavior in targeted areas Small sample size; short-term outcomes; included because this is listed as one of Brestan and Eyberg’s (1998) well established treatments


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Table 3.3 Community-Based Studies of Childhood Disruptive Behavior Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Burns, Farmer, Angold, Costello, & Behar, 1996 RCT; treatment team led by a case manager vs. treatment team without a case manager (n = 167) Youth with SED being served by community mental health center (77% had diagnosis of externalizing disorder) Age: 8 – 17

Gender:
53% boys
47% girls

Race/Ethnicity:
13% African American
77% White

Outcomes available for 1-year period following initiation of treatment; youth with case manager remained in services longer, received wider array of services, fewer inpatient days, and more community-based services; symptoms and functioning did not differ between groups Control group also served by multi-agency treatment teams; both groups receiving some version of coordinated care
Clark, Lee, Range, & McDonald, 1996 RCT; regular foster care vs. Fostering Individualized Assistance Program (n = 132) Youth in foster care with externalizing behavior problems Age: 7 – 16

Gender: DK

Race/Ethnicity: DK

Outcomes approximately 2.5 years after program entry; youth in Fostering Individualized Assistance Program showed fewer placement changes, less amount of time spent running away from home, and fewer days incarcerated All findings are only borderline significant; target group focused on foster children who had behavior problems (this definition is less strictly oriented toward disruptive disorders than most other interventions)
Evans, Armstrong, & Kuppinger, 1996 RCT; Treatment Foster Care (n = 15) vs. Family-Centered Intensive Case Management (n = 27); Family-Centered Intensive Case Management uses a team approach (including a parent advocate) to provide intensive support to parents of youth with serious emotional disorder Children referred for placement in Family-Based Treatment (e.g., Treatment Foster Care); 69% had diagnosis of a disruptive behavior disorder Age: 5 – 12

Gender:
91% boys
9% girls

Race/Ethnicity:
33% White
67% African American

Outcomes collected every 6 months and 6 months' postdischarge (duration in services varies, based on needs); improvements in symptoms across time; trend in favor of Family-Centered Intensive Case Management group, but not statistically significant Results very preliminary; many children still in services; suggests that youth referred for out-of-home placements can be served equally well at home, with intensive supports for family
Fraser & Nelson, 1997 Meta-analysis; reviewed findings on Family Preservation Services Youth at risk of out-of-home placement; includes various subgroups (e.g., abuse/neglect, juvenile delinquents, family reunification) DK Outcomes for child welfare are most relevant in terms of age range (<13); results mixed, with some evidence (though small) of effects on out-of-home placements; outcomes for juvenile justice are most relevant in terms of disruptive disorders; tend to focus on somewhat older youth (13–15); effect sizes range from moderate to large (.48 –.92) Mixed findings with many methodological caveats; positive findings for juvenile justice cases come almost exclusively from MST programs
Henggeler, Pickrel, & Brondino, 1999 RCT; multisystemic therapy vs. usual service (n = 118) Juvenile offenders with substance abuse/dependence Age: 12 – 17

Gender:
79% boys
21% girls

Race/Ethnicity:
50% African American
47% White
3% Other

Outcomes: end of treatment and 6 months' posttreatment; some decrease in self-reported alcohol/drug use at end of treatment in favor of multisystemic therapy; difference not apparent in urine tests or at 6 months' post-treatment; MST youth experienced fewer days of out-of-home placement Many other multisystemic therapy sites show positive effects; mostly, MST has been conducted with adolescent populations; smaller effects in this study than in other MST studies may reflect lower treatment adherence by clinicians; age range mostly adolescents; included because it targeted substance use as an outcome
Lochman, Burch, Curry, & Lampron, 1984 RCT; 12-week anger-coping vs. anger-coping plus goal setting vs. goal setting vs. no treatment (n = 76) Boys with aggressive behavior

Age: 9 – 12

Gender:
100% boys

Race/Ethnicity:
53% African American
17% White

Boys in anger coping and anger coping plus goal setting showed more improvement than other two groups (including less disruptive and aggressive off-task behavior, parental reports of aggression, self-esteem); both anger-coping groups showed improvement, but addition of goal setting improved outcomes Very short-term followup; reported in a research note, so there is very little information available on details
Lochman, Lampron, Gemmer, Harris, & Wyckoff, 1989 RCT; 18-session anger coping (n = 11) vs. anger coping plus teacher consultation
(n = 13) vs. no treatment (n = 8)
Boys with aggressive behavior Age: 9 – 13

Gender:
100% boys

Race/Ethnicity:
69% African American
31% White
Posttreatment differences in off-task disruptive-aggressive behavior, perceived social competence, teacher-reported aggressiveness; both intervention groups showed similar improvements Small sample size; consultation was very minimal (6 hours in small groups)
Schoenwald, Ward, Henggeler, & Rowland (in press); Henggeler, et al., 1999 RCT; 4-month multisystemic therapy vs. hospitalization (n = 113) Children presenting for psychiatric emergency hospitalization; 62% had disruptive disorders, 38% had been involved with juvenile justice system Age: 10 – 17

Gender:
65% boys
35% girls

Race/Ethnicity:
64% African American
34% White

Outcomes available through end of multisystemic therapy: 75% of children not hospitalized, fewer days in any out-of-home placement, decreased in externalizing symptoms, and improved family functioning Outcome data available only at end of multisystemic therapy treatment; many youth in study were older than 12

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Table 3.4 Clinic-Based Studies of Childhood Disruptive Behavior Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Fonagy & Target, 1994 Chart-review of youth who received psychoanalysis and psychotherapy at Anna Freud Center; children with disruptive disorders compared to matched sample of children with emotional disorder (n = 135) Children with disruptive disorders Age: M = 9.0

Gender:
75% boys
25% girls

Race/Ethnicity: DK

33% of disruptive youth not diagnosable at completion of treatment; improvement was higher for youth with ODD than with CD; overall, youth with disruptive disorders improved less than youth with emotional disorders Treatment most effective with youth who remained in treatment for full course of psychoanalytic treatment (e.g., 3 years); 31% terminated treatment within first year
Grizenko, Papineau, & Sayegh, 1993; Grizenko, 1997 Quasi-experimental design; day treatment vs. wait list (n = 30) Youth with disruptive disorders who are unable to function in home/school Age: 5 – 12

Gender:
77% boys
23% girls

Race/Ethnicity: DK

At 6-month followup, treatment group more improved than controls on behavior, self-perception, and school reintegration Small sample size; 5-year followup shows some deterioration of outcomes, but still improvements over baseline
Kazdin, Siegel, & Bass, 1992 RCT; 6- to 8-month problem-solving skills training vs. parent management training vs. combination
(n = 97)
7- to 13-year-olds referred for treatment at a psychiatric facility (outpatient branch) Age: 7 – 13

Gender:
78% boys
22% girls

Race/Ethnicity:
31% African American
69% White

All groups improved over time; combination group showed greatest improvement in a variety of areas, including antisocial and delinquent behavior, depression, and family functioning Changes continued during the 1-year followup; only parent management training alone showed no additional gains during followup
Luk, Staiger, Mathai, Field, & Adler, 1998 RCT; modified cognitive-behavioral therapy vs. conjoint family therapy vs. eclectic therapy (n = 32) Outpatient children with at least three definite conduct symptoms (by parent or teacher questionnaire) Age: M = 8.5 years

Gender:
63% boys
37% girls

Race/Ethnicity: DK (13% from non-English- speaking families)

Outcomes measured 6 months postintervention; no significant differences between groups; significant improvements for all groups in parent ratings of internalizing and externalizing behaviors, irritability, aggressiveness Excluded youth who met criteria for ADHD; small sample size
Szapocznik, Santisteban, Rio, Perez-Vidal, Santisteban, & Kurtines, 1989 RCT; 13-session family effectiveness training vs. minimal contact control (n = 79) Outpatient children with behavioral or psychological problems Age: 6 – 12

Gender:
71% boys
29% girls

Race/Ethnicity:
76% Cuban
24% Other Hispanic

End of treatment and 6-month followup favored family effectiveness training on family functioning, children's behavior problems, and children’s self-concept Intervention designed to improve family relationships in an effort to strengthen families and prevent future substance use among youth; designed specifically for Hispanic families to address intergenerational and intercultural conflicts

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Table 3.5 Prevention Studies of Childhood Disruptive Behavior Disorders
Study Citation(s) Study Design/
Description
Target Population Demographic Characteristics Outcomes Notes
Conduct Problems Prevention Research Group, 1999 Quasi-experimental design; behaviorally disruptive kindergartners were screened (n = 891); half of the schools designated as intervention and half as control; intervention was multifaceted; universal intervention adapted version of PATHS (Promoting Alternative Thinking Strategies); selective intervention included: parent groups, child social skills training, academic tutoring Kindergartners with early disruptive patterns who are at risk for more substantial behavioral problems Age: Kindergartners

Gender:
69% boys
31% girls

Race/Ethnicity:
51% African American
47% White

Outcomes during 1st grade: intervention group showed improvement in reading, positive peer interaction and peer preference scores, more positive parenting, and behavioral improvement Moderate initial effects for a broad-based universal and selective prevention program; effects similar for boys and girls and for different races
Reid, Eddy, Fetrow, & Stoolmiller, 1999 RCT; 10-week intervention focusing on parents and students (playground and classroom behavior) vs. control; based on variety of previous prevention work, especially that conducted by Oregon Social Learning Center Schools in areas with above-median rates of juvenile arrests Age: 1st and 5th grades

Gender:
50% boys
50% girls

Race/Ethnicity:
85% White
2% African American

Decreases in mother aversive verbal behavior and child physical aggression behavior in playground (in 1st graders) Initial report on Project LIFT (Linking the Interests of Families and Teachers); new project, longer term outcomes not available; attempting to incorporate a theoretical model of prevention with universal intervention; not targeted to identified or diagnosed children
Vitaro & Tremblay, 1994; McCord, Tremblay, Vitaro, & Desmarais-Garvais, 1994; Tremblay, Pagani-Kurtz, Masse, Vitaro, & Pihl, 1995 RCT; parent, social skills, and cognitive problem-solving training (n = 46) vs. control (n = 58) Children with elevated aggression and risk of later conduct problems; selected on the basis of teacher report Age:
6 (at selection)
8 – 9 at intervention

Gender:
100% boys

Race/Ethnicity:
100% French-speaking,
White, Canadians

Outcomes (assessed by teacher, peer, and self-report) included aggression, delinquency, and characteristics of friends when students were 10-12 years old; at age 12, teachers reported less aggressiveness for treatment group; nonsignificant trends toward less self-reported delinquency and less disruptive friends Eligibility based on scoring above 70th percentile on the Preschool Behavior Questionnaire during kindergarten; all parents had less than 15 years of schooling
Walker, Kavanagh, Stiller, Golly, Severson, & Feil, 1998 RCT; 3-month First Step to Success program (n = 46) vs. wait-list controls
(n = 46); intervention screening, school intervention, and parent/caregiver training
Kindergartners with early signs of antisocial behavior patterns Age: Kindergartners

Gender:
74% boys
26% girls

Race/Ethnicity:
93% White
7% Minority

Outcomes assessed during 1st or 2nd grade showed improved adaptive behavior, less maladaptive behavior, and less aggression (as measured by teacher report); results remained fairly constant at longer followup Because of delayed intervention design, true comparison group not reported


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Table 3.6 Psychopharmacological Studies of Childhood Disruptive Behavior Disorders
Study Citation(s) Study Design/Description Target Population Demographic Characteristics Outcomes Notes
Campbell, Adams, Small, Kafantarix, Silva, Shell, Perry, & Overall, 1995 Double-blind, placebo-controlled, within-subject alternating treatments experimental design; 6-week lithium vs. 2-week placebo (n = 50); four treatment cycles Hospitalized children with conduct disorder Age: 5 – 12

Gender:
92% boys
8% girls

Race/Ethnicity:
48% Hispanic
38% African American
8% White
6% Other

During lithium period, children showed moderate or marked improvement (68% vs. 40%); other measures of behavior showed nonsignificant trends in favor of lithium Lithium associated with increases on measures of tension-anxiety and confusion-bewilderment; short followup period
Cueva & Overall, 1996 Double-blind, placebo-controlled RCT; 6-week carbamazepine (n = 22) vs. placebo (n = 22) included 2-week placebo baseline, randomized assignment for 6 weeks, 1-week posttreatment placebo Children with conduct disorder Age: 5 – 12

Gender:
91% boys
9% girls

Race/Ethnicity:
41% African American
46% Hispanic
9% White
4% Asian

Changes in aggressive behavior did not differ between groups Small sample size; short followup period; noted several side effects of carbamazepine (transient leukopenia, rash, dizziness, pilopia)
Klein, 1998; results also reported in Klein, Abikoff, Klass, Ganeles, Seese, & Pollack, 1997 RCT; 5-week methylphenidate vs. placebo (n = 84) Children with conduct disorder Age: 6 – 15

Gender:
89% boys
11% girls

Race/Ethnicity:
29% African American
65% White
6% Hispanic

Improved ratings on a range of behavioral outcomes by parent and teacher report; significantly more youth in treatment group rated as improved by all informants Two-thirds of children met criteria for ADHD (in addition to CD); controlling for ADHD did not affect findings; representativeness of sample is not known


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References
Studies of Childhood Disruptive Behavior Disorders

Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. Journal of Clinical Child Psychology, 27, 180-189.

Burns, B. J., Farmer, E. M. Z., Angold, A., Costello, E. J., & Behar, L. B. (1996). A randomized trial of case management for youths with serious emotional disturbance. Journal of Clinical Child Psychology, 25, 476-486.

Campbell, M., Adams, P. B., Small, A. M., Kafantaris, V., Silva, R. R., Shell, J., Perry, R., & Overall, J. E. (1995). Lithium in hospitalized aggressive children with conduct disorder: A double blind and placebo controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 445-453.

Clark, H. B., Lee, B., Prange, M. E., & McDonald, B. A. (1996). Children lost within the foster care system: Can wraparound service strategies improve placement outcomes? Journal of Child and Family Studies, 5, 39-54.

Conduct Problems Prevention Research Group. (1999). Initial impact of the Fast Track Prevention Trial for Conduct Problems: I. The high-risk sample. Journal of Consulting and Clinical Psychology, 67, 631-647.

Cueva, J. E., Overall, J. E., Small, A. M., Armenteros, J. L., Perry, R., & Campbell, M. (1996). Carbamazepine in aggressive children with conduct disorder: A double-blind and placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 480-490.

Evans, M. E., Armstrong, M. I., & Kuppinger, A. D. (1996). Family-centered intensive case management: A step toward understanding individualized care. Journal of Child and Family Studies, 5, 55-65.

Fonagy, P., & Target, M. (1994). The efficacy of psychoanalysis for children with disruptive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 45-55.

Fraser, M. W., & Nelson, K. E. (1997). Effectiveness of family preservation services. Social Work Research, 21, 138-154.

Grizenko, N. (1997). Outcome of multimodal day treatment for children with problems: A five year follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 987-997.

Grizenko, N., Papineau, D., & Sayegh, L. (1993). A comparison of day treatment and outpatient treatment for children with disruptive behaviour problems. Canadian Journal of Psychiatry, 38, 432-435.

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Henggeler, S. W., Pickrel, S. G., & Brondino, M. J. (1999). Multisystemic treatment of substance abusing and dependent delinquents: Outcomes, treatment fidelity, and transportabilty. Mental Health Services Research, 1, 171-184.

Henggeler, S. W., Rowland, M. D., Randall, J., Ward, D. M., Pickrel, S. G., Cunningham, P. B., Miller, S. L., Zealberg, J. J., Hand, L. D., & Santos, A. B. (1999). Home-based multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis: Clinical outcomes. Journal of Clinical Child Psychology, 38, 1381-1389.

Kazdin, A. E., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of Consulting and Clinical Psychology, 60, 733-747.

Klein, R. B. (1998). Clinical efficacy of methylpehnidate in conduct disorder with and without attention-deficit/hyperactivity disorder. Journal of the American Medical Association, 279, 1073-1080.

Klein, R., Abikoff, H., Klass, E., Ganeles, D., Seese, L., & Pollack, S. (1997). Clinical efficacy of methylphenidate in conduct disorder with and without attention deficit hyperactivity disorder. Archives of General Psychiatry, 54, 1073-1080.

Lochman, J. E., Burch, P. R., Curry, J. F., & Lampron, L. B. (1984). Treatment and generalization effects of cognitive-behavioral and goal-setting interventions with aggressive boys. Journal of Consulting and Clinical Psychology, 52, 915-916.

Lochman, J. E., Lampron, L. B., Gemmer, T. C., Harris, S. R., & Wyckoff, G. M. (1989). Teacher consultation and cognitive-behavioral interventions with aggressive boys. Psychology in the Schools, 26, 179-188.

Luk, E. S., Staiger, P., Mathai, J., Field, D., & Adler, R. (1998). Comparison of treatments of persistent conduct problems in primary school children: A preliminary evaluation of a modified cognitive-behavioural approach. Australian and New Zealand Journal of Psychiatry, 32, 379-386.

McCord, J., Tremblay, R., Vitaro, F., & Desmarais-Gervais, L. (1994). Boys' disruptive behaviour, school adjustment, and delinquency: The Montreal prevention experiment. International Journal of Behavioral Development, 17, 739-752.

Reid, J. B., Eddy, J. M., Fetrow, R., & Stoolmiller, M. (1999). Description and immediate impacts of a preventive intervention for conduct problems. American Journal of Community Psychology, 27, 483-517.

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Schoenwald, S. K., Ward, D. M., Henggeler, S. W., Rowland, M. D., & Brondino, M. J. (in press). Multisystemic therapy versus hospitalization for crisis stabilization of youth: Out-of-home placement four months post-referral. Mental Health Services Research.

Szapocznik, J., Dantisteban, D., Rio, A., Perez-Vidal, A., & Santisteban, D. (1989). Family effectivenesss training: An intervention to prevent drug abuse and problem behaviors in Hispanic adolescents. Hispanic Journal of Behavioral Sciences, 11, 4-27.

Taylor, T. K., Schmidt, F., Pepler, D., & Hodgins, C. (1998). A comparison of eclectic treatment with Webster-Stratton's Parents and Children Series in a children's mental health center: A randomized controlled trial. Behavior Therapy, 29, 221-240.

Tremblay, R. E., Pagani-Kurtz, L., Masse, L. C., Vitaro, F., & Pihl, R. O. (1995). A bimodal preventive intervention for disruptive kindergarten boys: Its impact through mid-adolescence. Journal of Consulting and Clinical Psychology, 63, 560-568.

Vitaro, F., & Tremblay, R. (1994). Impact of a prevention program on aggressive children's friendships and social adjustment. Journal of Abnormal Child Psychology, 22, 457-475.

Walker, H. M., Kavanagh, K., Stiller, B., Golly, A., Stevenson, H. H., & Feel, E. G. (1998). First Step to Success: An early intervention approach for preventing school antisocial behavior. Journal of Emotional and Behavioral Disorders, 6, 66-80.

Webster-Stratton, C., & Hammond, M. (1997). Treating children with early-onset conduct problems: A comparison of child and parent training interventions. Journal of Consulting and Clinical Psychology, 65, 93-109.

Webster-Stratton, C., Kolpacoff, M., & Hollinsworth, T. (1988). Self-administered videotape therapy for families with conduct-problem children: Comparison with two cost effective treatments and a control group. Journal of Consulting and Clinical Psychology, 56, 558-566.

Wiltz, N. A., & Patterson, G. R. (1974). An evaluation of parent training procedures designed to alter inappropriate aggressive behavior of boys. Behavior Therapy, 5, 215-221.

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