Marital discord and treatment outcome in behavioral treatment of child conduct disorders.

Research assessing the role of marital variables in the treatment of childhood conduct disorders is scarce. The aim of this study was (a) to assess the role of marital discord in the overall outcome of a program training parents in behavioral techniques (behavioral parent training) and (b) to assess the effects of an adjunctive treatment (partner support training [PST]) on outcome. The latter treatment focused on marital conflict, communication, and problem solving. Twenty-four families with a child diagnosed as oppositional or conduct disordered were assigned to either a marital-discord group ( n = 12) or a no-marital-discord group ( n = 12). Families within each group were then randomly assigned to either child management training (CMT) alone or CMT with PST. Measures of child deviance, parenting behavior, and marital satisfaction were collected at preand posttraining and at a 6-month follow-up. Results indicated a significant interaction between marital discord and treatment type on most measures at follow-up but not at posttraining. Although PST added little to the maintenance of change for the nondiscordant group, it produced significant gains over those who received CMT only for the discordant group. Further results highlighting the interaction of marital and treatment variables are discussed. Considerable research has indicated that marital discord and child behavior problems, particularly conduct disorders in boys, covary in clinical samples and, to a lesser extent, in the general population (Emery, 1982). However, the role of marital variables in the treatment of conduct disorders has received far less attention. A number of authors have argued that, based on their clinical impressions, marital discord interferes with behavioral parent training programs (Cole & Morrow, 1976 ; Ferber, Keeley, & Shemberg, 1974 ; Kent & O'Leary, 1976 ; Patterson, Cobb, & Ray, 1973). Conceptual approaches, emphasizing the reciprocal relations between child and family variables, would certainly predict that marital discord will negatively effect behavioral treatment, with its emphasis on parents as agents of behavior change in the home. We know of only two studies that have attempted to directly assess the role of marital discord in treatment outcome. Oltmanns, Broderick, and O'Leary (1977) found no correlation between marital satisfaction level and treatment outcome. However, their study suffers from a lack of observational measures of parent-child interaction and from the utilization of a mixed sample of childhood behavior disorders. Brody and Forehand (1985) compared treatment outcome across groups of maritally distressed and nondistressed mothers. Results indicated that although the distressed group performed more poorly on one measure of deviant child behavior, overall the groups were equally responsive to the behavioral treatment. However, the absence of husbands in this study could have minimized marital effects. Furthermore, the lack of a follow-up assessment raises questions about the durability of change for the two groups. Thus, although it appears certain that treatment dropout or failure is associated with negative parental perceptions of child behavior (Wahler & Afton, 1980), low socioeconomic status (SES), inadequate social support and single parenting (Dumas & Wahler, 1983 ; Journal of Consulting and Clinical Psychology (1987) 55 (3):. 396-403 doi: 10.1037/0022-006X.55.3.396 Wahler, 1980 ; Webster-Stratton, 1985), and personal adjustment (e.g., depression; Greist & Wells, 1983), this association has not been demonstrated for parents' marital interactions and perceived marital satisfaction. Although there are at present no strong data, some evidence suggests that extra training procedures may enhance the treatment effects of behavioral parent training. Early studies have utilized training in marital conflict resolution (Kelley, Embrey, & Baer, 1979) and self-management and self-control procedures (Sanders, 1982 ; Sanders & Glynn, 1981 ; Wells, Griest, & Forehand, 1980). Griest, Forehand, Rogers, Breiner, Furey, and Williams (1982) compared the effects of parent training alone with parent training plus parent enhancement training on parent and child behavior at posttreatment and at a 2-month follow-up. The adjunctive training focused on parents' perceptions of child behavior, personal and marital adjustment, and extrafamilial relationships. The results showed that the extra training was associated with better implementation of child management techniques by parents and with decreased levels of child noncompliance after treatment and at follow-up. This study supported the previous finding that focusing on broader parental variables such as marital adjustment, problem solving, and self-control would enhance long-term treatment effects. All of these studies contain limitations that make their findings tentative. First, no study provided measures of parent implementation of the extra training procedures. Second, all studies used families that had no documented problems other than child management difficulties. Thus, it is possible that these families would have shown durable change without the extra training. Third, the Griest et al. (1982) study did not report whether the two groups were matched in therapist contact. Fourth, followup was limited to 3 months or less, which may not have been long enough to show a lack of durability. A number of these problems were overcome in a recent study. Dadds, Sanders, Behrens, and James (in press) provided four families displaying marital discord as well as child behavior problems with child management training (CMT) plus partner support training (PST). The latter treatment was a structured program that focused on parents' immediate responses to problems and on communication and problem-solving skills. Direct observations of parent-parent interactions in the home revealed that parents were able to implement the partner support skills, which resulted in a decrease in aversive parental interchanges and an increase in problem-solving behaviors that were unaffected by child management training alone. Training effects were maintained at the 6-month follow-up. However, the omission of a control group and the small sample used make it impossible to attribute durable effects to the partner support training. The aim of the present study was to evaluate the interacting effects of two factors (marital discord and brief marital therapy) on the durability of treatment gains in a behavioral parent training program. Families of conduct-disordered children were classified into either marital-discord or no-maritaldiscord groups prior to treatment to evaluate the effects of this factor on treatment outcome. Families within each group were randomly assigned to CMT alone or to CMT plus a brief marital intervention (PST) in order to evaluate the effects of the extra training. On the basis of previous research, the following hypotheses were made: (a) that maritally discordant and nondiscordant families would respond equally to behavioral parent training for their conduct-disordered child and (b) that the addition of PST would produce stronger treatment effects at posttreatment and at follow-up than the provision of CMT alone.