Development and description of an empirically based ecobehavioral treatment program for child maltreatment

Victims of child maltreatment and their families evince a myriad of behavioral problems, including deficits in parenting skills, social skills, safety skills, anger, stress, and financial management, mood disorders, and abusive behavior. Controlled treatment outcome studies in child maltreated samples have indicated that many of these problems are responsive to clinical intervention strategies. However, empirically based practitioners who treat child maltreatment are faced with the inevitable task of effectively integrating these treatments into their clinical programs. Therefore, this paper describes the development of an ecobehavioral treatment program for child maltreatment that is founded on a comprehensive integration of previously validated procedures. The program's development, and methods of assessment and intervention, will be underscored, including therapist training strategies, and solutions to problems that sometimes occur. Data in support of the program is examined, but primarily as a means to demonstrate how evaluative components may be utilized in practice settings to guide intervention. Copyright © 1999 John Wiley & Sons, Ltd.     

TRAINING PARENTS IN BEHAVIORAL SELF-MANAGEMENT: AN ANALYSIS OF GENERALIZATION AND MAINTENANCE

This study examined the generalization and maintenance effects of three phases of parent training (Instructions plus Feedback and two Self-management Training phases) on levels of disruptive child behavior and the accuracy with which parents implemented programs. Data were collected from five families in three main settings: the initial training setting (the home), a variety of generalization settings in the community, and the family breakfast. A multiple baseline across subjects design was used. Instructions plus Feedback comprised instructing parents to use a range of behavior management procedures and provided home-based differential feedback concerning accuracy of program implementation. Self-management Training phases involved training parents in goal setting, self-monitoring, and planning skills, specific to their performance of appropriate parenting skills in generalization settings. Results indicated that the Instructions plus Feedback phase was sufficient to produce reduced levels of problem behavior at home and high levels of accurate implementation, but generalization effects out of home were equivocal. Self-management maintained reduced levels of problem behavior at home but, in addition, resulted in generalization effects in community settings for both children and parents. Maintenance probes 3 months following the program revealed the effects had been maintained.     

Psychoeducation and expressed emotion by parents of children with learning disorders

The present study assessed use of a psychoeducation group program on expressed emotion, family functioning, and child behavior by parents of children with learning disorders. 81 parents of children with learning disorders were randomly assigned to a psychoeducation group program (n=46) or to a regular treatment group (n=35). A semistructured interview for parental expressed emotion, self-reports of family functioning, and child behavior were utilized at baseline and after an 8-session psychoeducation group program. Parents who attended the program differed significantly from parents in the regular treatment group on measures of criticism, warmth, and positive remarks, and overall expressed emotion, but not on measures of perceived family functioning and child behavior. Findings indicate a psychoeducation group program could be effective in helping parents to establish a more positive emotional climate in their relationships with their children who have learning disorders.     

The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Motivational Antecedents and Consequences of the Mother–Adolescent Communication

Communication between parents and their children represents an important factor of family socialization. Nevertheless, little is known about why parents communicate in different ways and how these qualitative differences in parent–child communication may affect the child. Building on self-determination theory, the present study focuses on motivational antecedents of need-supportive communication as a function of parental child-related beliefs (i.e., long-term goals that parents have set for their children’s future, and parental child-related behavior expectations in terms of parental dissatisfaction or satisfaction with child behavior). Moreover, the effect of perceived need-supportive communication on children’s prosocial behavior and (externalizing and internalizing) behavioral difficulties will be addressed. Three waves of data from 1125 mothers and adolescents aged between 10 and 17 years were analyzed using growth-curve modeling. We found linearly increasing trajectories in extrinsic parental goals for children and dissatisfaction with child behavior, and decreasing trajectories of need-supportive communication. Individual differences do not vary significantly over time. In addition, holding extrinsic parental goals for children positively predicts parents’ dissatisfaction with their child’s behavior and negatively predicts need-supportive communication. Parents’ dissatisfaction with their child’s behavior also contributes to decreasing need-supportive communication. As expected, need-supportive communication predicts prosocial behavior and externalizing behavioral difficulties. When need-supportive communication decreases over time, both externalizing and internalizing behavioral difficulties increase. Furthermore, the effect of mothers beliefs on adolescents socioemotional development was mediated through perceived mother’s communication quality. These results suggest that parental child-related beliefs are important motivational antecedents of parent–child communication that may prevent behavioral difficulties.     

The effect of self-recording and social reinforcement components of parent training programs

This investigation attempted to assess the effectiveness of two components of parent training programs: (1) the effect of a self-behavior management project prior to intervention with deviant child behaviors, and (2) that of social reinforcement from peers and the consultant. Four groups of parents were exposed to a basic training program and were measured on their success in an intervention program in the inappropriate behavior of their children (ages 7–9 years). Two groups of parents were requested to do a self-modification program prior to the intervention with deviant child behavior; two groups did a child intervention program without a self-management project. One group in the self-management and one group without self-management received verbal social reinforcement from peers and the consultant during interventions. Results obtained indicate that the parent group whose training involved a self-behavior management project prior to intervention with their child's inappropriate behavior and verbal social reinforcement achieved a significantly greater reduction of these behaviors when compared to the groups where either self-management of social reinforcement was used.     

Examining dosage effects on prevention outcomes: Results from a multi-modal longitudinal preventive intervention for young disruptive boys

The present study examined (a) the predictive effect of disruptive boys' attendance to a prevention program (i.e., dosage) on post-intervention academic achievement and behavior and (b) the potential moderating effects of child and family characteristics in this context. The 3-year intervention program included reading, self-regulation, and social skills training for the boys, parental support and skills training for parents, and teacher support. A multiple-screening procedure selected 58 disruptive, low socioeconomic status boys at the age of 6 years for program participation. Multiple regression analyses and logistic regression analyses showed that the number of program sessions attended did not contribute to the prediction of boys' post-intervention disruptive behavior. However, the number of attended sessions was positively related to boys' post-intervention likability, as well as to their post-intervention writing, reading, math, and human science performances. Interaction terms revealed that family constellation moderated the link between program dosage and likability and math success, respectively, whereas boys' IQ moderated the links between dosage and boys' success in writing and math. The discussion stresses the importance of dosage-effect analysis and the examination of moderating variables in this context.     

Evaluating Triple P Online: A Digital Parent Training Program for Child Behavior Problems

Triple P Online (i.e., TPOL; www2.tripleponline.net) is an online self-help parent training program aimed at reducing child behavior problems through “positive parenting practices”—available at time of review for $79.95. TPOL is comprised of 8 video-based modules that also incorporate in-session activities and homework. Randomized control trials have shown that TPOL effectively reduces child behavior problems. The program’s main strengths include very high-quality content with an abundance of relevant and easily locatable resources, an easy-to-use interface, and a professional look and feel. The program’s main weakness lies in its lack of monitoring and adaptation to the user’s state (e.g., child’s and parent’s behaviors), and real-time reminders for desired actions. Altogether, TPOL is an extremely valuable and important resource for families seeking evidence-based treatment for child behavior problems.     

Experimental Task and Speaker Effects on Parent-Child Interactions of Aggressive and Depressed/Anxious Children

Parent-child interactions of aggressive and depressed/anxious clinic-referred children were observed during two different tasks: planning a vacation and discussing a conflict. Marked group differences were found as a function of the type of task, who was speaking (parent vs. child), and type of child psychopathology. Negative behaviors (e.g., Belittling and Blaming) were especially pronounced in the conflict task, whereas positive behaviors (e.g., Nurturing and Protecting) were more common in the planning task. Parents displayed other-directed behavior (e.g., Watching and Controlling), whereas children showed more self-directed behavior (e.g., Walling Off and Distancing), and patterns of child psychopathology interacted with task and speaker in theoretically important ways; for example, parents of aggressive children showed more Belittling and Blaming than their children in the conflict task, but not in the planning task. The findings highlight key factors that may need to be incorporated into models of parent-child interaction and child psychopathology.     

The Relationship Between Child Behavior and Acceptability of Contingency Management Procedures

Relationships between maternal ratings of treatment acceptability and three predictor variables, change in child noncompliance during treatment, disruptive child behavior associated with treatment procedures, and severity of child behavior problems, were examined in the context of a brief parent training program. Stepwise multiple regression analysis indicated that amount of disruptive behavior and change in child noncompliance were significant predictors of treatment acceptability, with those treatments which produced less disruptive behavior and greater reductions in noncompliance being rated as more acceptable. The combination of these two variables accounted for nearly 40% of the variance in acceptability ratings. These results are discussed in relation to previous findings with treatment analogues.     

Situational consistency in behavioral patterns of aggressive boys: Methodological considerations on observational measures

The issue of situational consistency is of great interest for early intervention with aggressive boys, but efforts to show behavior stability across settings have been unsuccessful to date, due principally to methodological problems. It is argued here that a more appropriate matching of response form, interaction partner, and situations should increase the situation consistency of observed behavior. The results support this proposition in that, more crosssetting behavior consistency was found in the pairing of situations where aggressive boys (age 6–7 years) were interacting with an adult female (mother/child versus baby-sitter/child) than in the pairing of situations where the boys were interacting with an adult male (mother/child versus father/child) or with the teacher in a nondyadic situation (classroom). The implications of using an extreme group are also discussed.This research program was funded by Le Conseil Québécois de la Recherche Sociale, the Quebec Government's FCAR research program, the Social Sciences and Humanities Research Council of Canada, the Canadian Ministry of Employment and Immigration, and the University of Montreal FDR program.     

Birth Planning Values and Decisions: The Prediction of Fertility1

This investigation was a prospective study based upon subjective expected utility theory, of the processes and determinants of birth planning decisions. The hypothesis tested was: Where maximum expected benefit will derive from having a (another) child, a pregnancy will occur and where maximum expected benefit will derive from not having a (another) child a pregnancy will not occur. Values associated with birth planning decisions for 74 married couples were found to be good predictors, one year later, of pregnancy status. The implications of these results were discussed as they related to birth planning counseling and to population policy.     

Classroom behavior patterns of EMH, LD and EH students

This investigation determined whether classroom teachers could differentiate among EMH, LD and EH students based on their perception of classroom behavior patterns. Ratings were obtained on 10 scales from the Classroom Behavior Inventory for each of 20 exceptional students from each category of handicap and a comparison child of the same race and sex from the same regular classroom. As predicted from Schaefer's model of adaptive behavior, EMH students were distinguished by low intelligence, creativity and independent functioning. LD and EMH students showed a similar pattern of behavior when compared to typical students in the same classes but EMH students were regarded as more severely handicapped in their behavior. Although poor task-orientation was common to both EMH and EH students, the latter were evaluated as more distractible and were differentiated from both EMH and LD students on ratings of considerateness and hostility. The results are interpreted in relation to implications for screening and program planning based on the Classroom Behavior Inventory.     

Using Behavioral Skills Training to Promote the Generalization of Parenting Skills to Problematic Routines

Research has demonstrated the efficacy of a behavioral parent training program for skills acquisition; however, few studies have examined the extent to which those skills generalize to the home or the effect that they have on child behavior. A multiple baseline across participants design was used to assess (a) caregiver accuracy with implementation of three parenting skills, and (b) the effects of the parenting skills on child behavior. Results demonstrated that three caregiver participants successfully generalized parenting skills taught during behavioral skills training (BST) to naturally occurring routines, and the behavior of each caregiver's child improved following BST.     

Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

FEEDBACK IN CLASSROOM BEHAVIOR MODIFICATION: EFFECTS ON THE TARGET AND HER CLASSMATES1

A behavior modification program that employed feedback with no additional contingencies was initiated and withdrawn in an ABAB design on a target child within a classroom. The disruptive behavior of the target child as well as that of her peers was monitored. Additionally, the sociometric status of the target child was recorded. Finally, the positive and negative comments made to the target by her teacher and her peers were related to initiation and withdrawal of the feedback contingency. Results indicate that (1) feedback alone may be an effective behavior modification procedure, (2) the disruptive behavior of the target's classmates changed, even though they were not directly treated, (3) sociometric status of the target was altered by behavioral contingencies, (4) positive comments by classmates to the target increased, and (5) negative comments from the teacher to the target child decreased.     

A Review of: “Barkley,R. A., & Robin,A. L. (2008). Your Defiant Teen: 10 Steps to Resolve Conflict and Rebuild Your Relationship.”

We report a study that addressed behavior data recording by direct-care staff at a child services program. In response to a decreasing percentage of daily data recording in two community-based group homes, a supervisory intervention was implemented, consisting of a revised data recording form and providing performance feedback to the direct-care staff. The intervention increased and maintained the percentage of daily data recording each month across the two group homes and seven sets of child behavior data. The study represents one approach toward staff performance improvement within child services programs.     

The effects of the Triple P-Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties

Two variants of a behavioral family intervention (BFI) program known as Triple P were compared using 87 preschoolers with co-occurring disruptive behavior and attentional/hyperactive difficulties. Families were randomly allocated to enhanced BFI (EBFI), standard BFI (SBFI), or a waitlist (WL) control group. At postintervention both BFI programs were associated with significantly lower levels of parent-reported child behavior problems, lower levels of dysfunctional parenting, and greater parental competence than the WL condition. The EBFI condition was also associated with significantly less observed child negative behavior in comparison to the WL. The gains achieved at postintervention were maintained at 1-year follow-up. Contrary to predictions, the enhanced program was not shown to be superior to the standard program using any of the outcome measures at either postintervention or follow-up. Each of the programs produced significant reductions in children's co-occurring disruptive behavior and attentional/hyperactive difficulties with 80% of the children showing clinically reliable improvement in observed negative behavior from preintervention to follow-up.     

How Couple- and Parenting-Focused Programs Affect Child Behavioral Problems: A Randomized Controlled Trial

The significance of enhancing parenting skills to reduce child maladjustment is well-established and supports the important role of evidence-based parenting programs. However, the notion that parenting should be the exclusive focus for enhancing child behavior is necessarily limiting. Evidence is growing that relationship-oriented treatments may be another powerful approach to improve child adjustment, albeit the underlying effects in couple- versus parenting-focused programs have been subject to limited study. The aim of this RCT was to compare the treatment effects of (1) a couple-focused program (the Couples Coping Enhancement Training) to (2) a parenting training (Triple P) and (3) a control group on children’s behavioral problems in 150 couples. The parents’ perceptions of relationship quality, parenting behavior, and child’s behavioral problems were assessed by means of questionnaires completed prior to and 2 weeks after the end of the treatment. Multi-group path analyses revealed that in mothers’ perception the couple-focused program reduced child behavioral problems by enhancing the relationship quality whereas improved parenting mediated the benefits in the parenting training. In fathers’ evaluations the couple-focused program reduced dysfunctional parenting which largely accounted for the benefits in child adjustment. The dearth of research on child outcomes in couple-focused intervention studies is a striking gap that should be overcome. It is a promising field because of its evident potential to foster the health of many children.