This study evaluated the effects of problem-solving skills training (PSST) and parent management training (PMT) on children (JV = 97, ages 7-13 years) referred for severe antisocial behavior. Children and families were assigned randomly to 1 of 3 conditions: PSST, PMT, or PSST and PMT combined. It was predicted that (a) each treatment would improve child functioning (reduce overall deviance and aggressive, antisocial, and delinquent behavior, and increase prosocial competence); and (b) PSST and PMT combined would lead to more marked, pervasive, and durable changes in child functioning and greater changes in parent functioning (parental stress, depression, and overall symptoms). Expectations were supported by results at posttreatment and 1-year follow-up. PSST and PMT combined led to more marked changes in child and parent functioning and placed a greater proportion of youth within the range of nonclinic (normative) levels of functioning. Antisocial child behavior includes aggressive acts, theft, vandalism, fire setting, lying, truancy, running away, and other acts that violate major social rules and expectations. A persistent pattern of antisocial behavior, referred to as conduct disorder, affects diverse domains of current functioning and for many youth portends continued dysfunction in adulthood (see Robins, 1981; Rutter & Giller, 1983). Several characteristics underscore the clinical and social significance of conduct disorder. The prevalence rate is relatively high and encompasses 2 to 6% of school-age children (Institute of Medicine [IOM], 1989). In the United States alone, this translates to between 1.3 and 1.8 million cases. In addition, among children and adolescents, conduct disorder and aggressive and antisocial behaviors encompass one half to one third of all clinic referrals and lead the list of dysfunctions seen in clinical practice (see Kazdin, 1987a). Several longitudinal studies indicate that conduct disorder is relatively stable over time, portends diverse problems in adulthood (e.g., criminal behavior, alcoholism, and poor work adjustment), and often continues across generations (see Pepler & Rubin, 1991; Robins & Rutter, 1990). Among the challenges to treatment is the range of dysfunctions that antisocial youth display. In addition to their antisocial symptoms, youth often evince hyperactivity, cognitive deficits and distortions, poor peer relations, and academic dysfunc

This study was designed to draw on clinical practice as a way of identifying priority areas for child and adolescent psychotherapy research. 1,162 psychologists and psychiatrists described several features of their clinical work and evaluated the effects of alternative treatment approaches, factors that influence therapeutic change, and the priority of alternative types of research. The majority agreed on (a) the importance of several specific child, parent, and therapist factors that contribute to outcome, (b) the utility and effectiveness of alternative treatment approaches, and (c) the high priority of research on therapeutic processes and matching cases to alternative types of treatments. In general, the factors, treatments, and types of studies identified have rarely been examined empirically. The use of practitioner views to identify lines of research may aid not only in reducing the hiatus between research and practice but also in placing clinical work on a stronger empirical footing.Research on psychotherapy for children and adolescents has lagged greatly behind parallel work on the treatment of adults (Institute of Medicine, 1989;Kazdin, 1990). The underdeveloped status of treatment research is evident in the limited number of controlled studies, their uneven methodological quality, and the restricted range of clinical problems and treatment approaches that they embrace (

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The present study evaluated alternative treatments for children (N = 112, ages 7-13) referred for severe antisocial behavior. Children were randomly assigned to one of three treatments: problem-solving skills training (PSST), problem-solving skills training with in vivo practice (PSST-P), which included therapeutically planned activities to extend training to settings outside of treatment, or client-centered relationship therapy (RT). PSST and PSST-P children showed significantly greater reductions in antisocial behavior and overall behavior problems, and greater increases in prosocial behavior than RT children. These effects were evident on measures obtained immediately after treatment and at a 1-year follow-up, and on measures of child performance at home and at school. PSST-P children showed greater changes than PSST children on measures of functioning at school at posttreatment, but these differences were no longer evident at follow-up. Children in both PSST conditions showed significant reductions in deviant behavior and improvements in prosocial behavior from pretreatment to follow-up, whereas RT children tended to remain at their pretreatment level of functioning. Notwithstanding the significant improvements, comparisons with nonclinic (normative) samples revealed that the majority of youth remained outside of the normal range of deviant behavior. Possible directions for improving treatment for antisocial youth are highlighted.

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