Studies of comorbidity between depression and conduct problems suggest that each of these disorders is associated with increased risk for the other. Despite the strong association between these disorders, integrated treatments that target these co-occurring problems in youth have not been tested. The importance of treating this comorbid presentation is heightened by the elevated risk for negative outcomes in adolescents with both disorders including suicide, substance abuse, and antisocial behavior. The primary purpose of this proposal is to develop a family based cognitive behavioral treatment protocol for youths with comorbid conduct problems and depression. This intervention is based on developmental psychopathology research and integrates existing cognitive behavioral techniques in an innovative fashion using an adaptive treatment strategy and a set of decision rules to enhance the delivery of the protocol in a community setting. The protocol will teach problem solving, cognitive restructuring, affect regulation skills, and parenting techniques needed to remediate skill deficits that underlie these disorders. The resultant product will be an 18-session manual, comprised of individual sessions, family sessions, and parent training sessions, that will be delivered over the course of six months. The integrated treatment allows for ongoing attention to both disorders and a synthesis of treatment principles. There are four primary aims in this project: 1) conduct stage 1a work to develop the manualized cognitive behavioral therapy protocol for young adolescents diagnosed with conduct problems and co- occurring depression;2) to test the treatment protocol with 6 families through an open pilot trial to assess the manual for clarity, completeness, and feasibility;3) conduct a small pilot randomized controlled trial to examine feasibility, treatment adherence, and reductions in symptoms of conduct problems and depression;and 4) develop and refine decision rules used to guide selection of treatment modules. In addition, this project will explore potential process variables that may account for treatment effects. To accomplish these aims, thirty 11- 14 year olds with comorbid conduct problems and depression will be assigned to the experimental condition or treatment as usual in a community care setting. The treatment manual will be revised using an iterative approach. Outcome will be assessed at post-acute treatment, postmaintenance treatment, and 6 months post- treatment. The long-term objective of this research is to yield a more effective yet feasible outpatient treatment approach for youth with comorbid conduct problems and depression.
The cumulative prevalence of major depression in adolescence is estimated at almost 30%. Similarly, approximately 16% of children and adolescents are diagnosed with conduct problems. This study addresses the co-occurrence of these two major public health issues in adolescence by developing an intervention that addresses both problems in an integrated protocol.