Using a Self-Management Intervention to Increase Compliance in Children With ASD

This two-study series examined the effectiveness of self-management in increase compliance with parental requests. Three boys diagnosed with Autism Spectrum Disorder and their parents participated. The intervention involved self-monitoring combined with parent-delivered reinforcement. A multiple baseline design was used. The intervention was successful in increasing rates of compliance and reducing problem behavior in training and generalization settings with each participant. Social validity was high and treatment integrity data indicated that the intervention could be readily implemented by parents. Study 2 also provided evidence of a strong treatment effect for the self-management beyond a small effect for effective instructional delivery.     

Problem-solving skills training: Social validation and generalization

This study developed and evaluated a program for teaching a verbal problem-solving strategy to mildly mentally handicapped adults. Six general areas were targeted for training: Community Awareness, Authority Figures, Peer Issues, Stating One's Rights, Emergencies and Injuries, and Safety. The program features response-specific feedback, modeling, self-monitoring, positive reinforcement, response practice, self-correction, and individualized performance criterion levels. The experimental group (N = 3) received baseline, training, probes, and pre/posttraining generalization assessments, whereas the control group (N = 3) received only the pre/posttraining assessments. The generalization and probe assessments contained situations that were both similar and dissimilar to the training situations. The three month posttraining results revealed that the experimental subjects' problem-solving skills had generalized to both types of situations, whereas the control group showed little overall change. Furthermore, the experimental group's three month scores were comparable to those of a group of nonhandicapped individuals. Issues related to these results and suggestions for future research are discussed.     

An intervention that increases parental sensitivity in families referred to Child Protective Services also changes toddlers’ parasympathetic regulation

Experiencing maltreatment in early childhood predicts poor parasympathetic regulation, characterized by low baseline parasympathetic activity and strong withdrawal of parasympathetic influence in response to tasks. The Promoting First Relationships^® (PFR) program improves parental sensitivity toward young children in families identified as maltreating. Using a subsample from a randomized control trial, we examined whether parental participation in PFR had lasting effects on toddlers’ parasympathetic regulation, as measured by respiratory sinus arrhythmia (RSA), relative to a resource and referral control condition. In addition, we examined whether parental sensitive and responsive behavior mediated or moderated associations between parent treatment group and children's RSA. More than 6 months after completing treatment, 29 families in the PFR condition and 30 families in the control condition were visited at home, and toddlers’ RSA was assessed at baseline and during five moderately challenging tasks. Groups did not differ in baseline RSA, but differed in RSA reactivity to the tasks. Across tasks, toddlers of parents in the control condition manifested significantly larger RSA decreases than toddlers of parents in the PFR condition. Parental behavior showed divergent associations with RSA change for toddlers of parents in the PFR versus control condition, with PFR treatment predicting RSA change ranging from small decreases to increases in toddlers of parents who showed the most sensitive, responsive behavior in the 6 months following treatment. This preliminary study showed that the same intervention that improved parenting also improved toddlers’ parasympathetic regulation in response to everyday activities, warranting further experimental investigation.     

SEQUENTIAL APPLICATION OF MAJOR HABIT-REVERSAL COMPONENTS TO TREAT MOTOR TICS IN CHILDREN

In this study, we sequentially administered up to four components of the habit-reversal treatment to 4 children with motor tics within a multiple baseline design. The habit-reversal components included (a) awareness training; (b) awareness training and self-monitoring; (c) awareness training, self-monitoring, and social support; and (d) awareness training, social support, and the use of a competing response. Results demonstrated that the combined use of awareness training, social support, and competing response training was effective in eliminating motor tics in 2 of 4 children, that awareness training alone was effective for 1 child, and that a combination of awareness training and self-monitoring was effective for the 4th child. The treatment and ensuing improvement were found to be socially valid. We discuss possible explanations for these results and recommend directions for future research.     

COMPETENCE IN ASPECTS OF BEHAVIORAL TREATMENT AND CONSULTATION: IMPLICATIONS FOR SERVICE DELIVERY AND GRADUATE TRAINING

This study examined the extent to which competence in applying behavioral procedures (timeout from positive reinforcement) was sufficient to establish competence in teaching others to apply the same procedures. During baseline, graduate students attempted to instruct parents with a history of child abuse and neglect in the use of time-out. Students were then instructed in the use of time-out until they achieved proficiency in a role-play context. They then reattempted to instruct the parents. Finally, the students were instructed in certain consultation skills (i.e., teaching others to apply behavioral procedures) and again attempted to instruct parents in the application of time-out. Observations of students' consultation skills, parents' proficiency at administering time-out, and children's compliance to parental instructions revealed that explicit training in behavioral consulting skills was necessary to produce improvements in these behaviors. Students' proficiency at administering time-out was insufficient to enable them to instruct others in its application. These results were corroborated by surveys of both students and staff. The implications for graduate training and service delivery are discussed.     

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.     

Mindfulness Training for Parents and Their Children With ADHD Increases the Children’s Compliance

Children with ADHD are often non-compliant with parental instructions. Various methods have been used to reduce problem behaviors in these children, with medication and manipulation of behavioral contingencies being the most prevalent. An objection often raised by parents is that these management strategies require them to impose external control on the children which not only results in the children not learning self-control strategies, but also does not enhance positive interactions between them and their parents. Studies have shown that providing mindfulness training to parents, without a focus on reducing problem behaviors, can enhance positive interactions with their children and increase their satisfaction with parenting. We were interested to see what effects giving mindfulness training to two mothers, and subsequently to their children, would have on compliance by the children. Using a multiple baseline across mothers and children design, we found that giving a mother mindfulness training enhanced compliance by her child. When the children were subsequently given similar training, compliance increased even more markedly, and was maintained during follow-up. The mothers reported associated increases in satisfaction with the interactions with their children and happiness with parenting. We suspect that the mindfulness training produces personal transformations, both in parents and children, rather than teaching strategies for changing behavior.     

Does parental mental health moderate the effect of a telephone and internet‐assisted remote parent training for disruptive 4‐year‐old children?

This study explores the moderators affecting the success of an Internet‐based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4‐year‐old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self‐reported parenting skills. The measures were completed at baseline, six and 12‐months follow‐up. The 232 families randomized to active treatment received 11 Internet‐based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45‐minute phone‐call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.     

Effects of Self-Monitoring Intervention on Independent Completion of a Daily Living Skill for Children With Autism Spectrum Disorders in China

Abstract

The purpose of this study was to investigate the effect of a self-monitoring intervention on the independent completion of dishwashing for three boys with autism (ages 6, 7, and 8) in China. The self-monitoring intervention included visual task analysis, in vivo modeling, self-recording, video self-feedback, and reinforcement. A multiple probe across subjects design was used. Prior to the study, the children had limited or no dishwashing skills, nor did they receive any training on self-monitoring. All three children acquired dishwashing and performed the task independently without supervision one week after the intervention. Their parents were very satisfied with this intervention.     

Early Postpartum Parental Preoccupation and Positive Parenting Thoughts: Relationship with Parent–Infant Interaction

Parenting behaviors and parent–infant emotional bonding during the early postpartum months play a critical role in infant development. However, the nature and progression of parental thoughts and their relationship with interactive behaviors have received less research. The current study investigated the trajectory of parental thoughts and behaviors among primiparous mothers (n = 18) and fathers (n = 15) and multiparous mothers (n = 13) and fathers (n = 13), which were measured at the first and third postpartum month. At the third postpartum month, the relationship between parental thoughts and parental interactive behaviors also was tested. Mothers and fathers showed high levels of preoccupations and caregiving thoughts during the first postpartum month that significantly declined by the third postpartum month. In contrast, positive thoughts about parenting and the infant increased over the same time interval. Mothers presented higher levels of preoccupations and positive thoughts than did fathers, and first‐time parents reported more intense preoccupations than did experienced parents. Although maternal sensitivity was inversely related to maternal anxious thoughts, paternal sensitivity was predicted by higher levels of anxious as well as caregiving and positive thoughts.     

Autonomy Support and Structure Enhance Children's Memory and Motivation to Reminisce: A Parental Training Study

Thirty parents observed their preschoolers (M _age = 4;2) experience a standardized laboratory event and discussed the event with their child later that day. Children's memory for this event was subsequently tested at two delay intervals. Prior to the laboratory event, parents were randomly assigned to receive either autonomy-support training (Condition A) or elaborative-structure training (Condition B); training followed the event. Autonomy support-trained parents became more autonomy-supportive following the training; structure-trained parents became more structurally elaborative. Short-term experimenter–child memory interviews took place 2 weeks after the laboratory event; children of autonomy support-trained parents appeared more engaged in this memory interview, while children of structure-trained parents provided more recall and more thematically coherent memory narratives. Long-term experimenter–child interviews took place 8 months after the laboratory event; children of autonomy support-trained parents provided more information in the directed phase of this interview and appeared more engaged in the interview. The effects of high parental autonomy support and high elaborative structure for children's memory and motivation to reminisce are discussed.     

Parental Efficacy Moderates the Association Between Empathy and Burden Among Parents of Children Admitted to a Psychiatric Ward

Empathy is considered a positive aspect of caregiving, although in certain circumstances, being empathic might increase the burden of caregivers. The current study assessed the associations between empathy, parental efficacy, and family burden among parents of children who were hospitalized in a psychiatric unit. Specifically, we examined whether the association between empathy and family burden was moderated by the parents’ sense of self-efficacy. Seventy parents of children with psychiatric disorders, hospitalized in an inpatient psychiatric unit, filled out questionnaires of empathy, parental efficacy, and family burden. Results supported a moderating role of parental efficacy between empathy and family burden (interaction effect: β = −1.72, p = .0406). Specifically, empathy was positively related to family burden among parents with low self-efficacy (conditional effect = 0.70, p = .032) and negatively related to family burden among parents with high self-efficacy (conditional effect = −0.39, p = N.S). Implications for practice include the importance of self-efficacy and address the possible negative implications of empathy among parents of children treated in a psychiatric hospital.     

STRONG MILITARY FAMILIES INTERVENTION ENHANCES PARENTING REFLECTIVITY AND REPRESENTATIONS IN FAMILIES WITH YOUNG CHILDREN

Military families face many challenges due to deployment and parental separation, and this can be especially difficult for families with young children. The Strong Military Families (SMF) intervention is for military families with young children, and consists of two versions: the Multifamily Group, and a Home‐based psychoeducational written materials program. The Multifamily Group was designed to enhance positive parenting through both educational components and in vivo feedback and support during separations and reunions between parents and children (n = 78 parents). In the present study, we examine parenting reflectivity and mental representations in mothers versus fathers in military families, service members versus civilian spouses/parenting partners, and before versus after participation in the SMF Multifamily Group and Home‐based interventions. Parenting reflectivity and mental representations were coded from the Working Model of the Child Interview (WMCI; C.H. Zeanah & D. Benoit, 1995). Results suggest that neither parenting reflectivity nor WMCI typology differs between mothers and fathers in military families, or between service members and civilian parenting partners. Furthermore, there was substantial stability in parenting reflectivity and WMCI typology from baseline to posttest, but participation in the Multifamily Group, relative to Home‐based, was associated with improvements in both parenting reflectivity and WMCI ratings from baseline to postintervention.     

Strengthening parent well‐being at the work—family interface: A German trial on workplace Triple P

This study examines the efficacy of a parenting training (Workplace Triple P (WPTP)) especially designed for the needs of employed parents. The program aims to reduce stress at the work–parenting interface by targeting family risk and protective factors and assisting parents to manage competing work and family demands. Ninety‐seven part‐ and full‐time working parents (74 mothers and 23 fathers; intervention group: n = 42 parents; waitlist‐control group n = 55 parents) from multiple organizations and multiple occupations with children between 2 and 10 years were randomly assigned to an intervention and a waitlist‐control condition. After the training, parents from the intervention condition, compared to those from the waitlist‐control condition, reported a significant reduction in individual and work‐related stress. Additionally, they reported a significant reduction in dysfunctional parenting and significant higher levels of parental and occupational self‐efficacy. Within the intervention condition all effects were maintained at the 3‐ and 6‐month follow‐up examinations. The findings support the notion that WPTP promotes parental well‐being and reduces stress at the work–parenting interface. Given that strengthening parenting skills has the potential to strengthen work, strategies to implement WPTP in organizational resources and community‐based services are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Prevention of antisocial behaviour: Evaluation of an early intervention programme

The prognosis of children showing antisocial behaviour is not favourable. Longitudinal research shows a high level of stability of antisocial behaviour. The present study aims to evaluate an early intervention project to reduce antisocial behavioural problems in at-risk children (4 – 7 years). Parent Management Training (PMT) was chosen because it was evaluated as a promising intervention in previous research. The training is based on social learning principles and teaches parents to manage their child's behaviour through behaviour modification. Parents were randomly assigned to two conditions: an intervention condition (PMT; n = 34) and a waiting list condition (WL; n = 30). The PMT consists of 11 sessions spread over a 6-month period. Parents were trained in groups of 8 – 10 parents. A multi-method multi-informant methodology was designed to evaluate the programme. Measures were assessed before and after treatment and at 1-year follow-up. Both short- and long-term results revealed positive effects of the intervention with respect to the child's behaviour. In addition, parental stress reduced, whereas parental skills and mother – child interactions improved. However, no time by group interaction effects were found. Implementations and limitations of early intervention and prevention of antisocial behaviour are discussed.     

Parental Contributions to Preschoolers' Emotional Competence: Direct and Indirect Effects

The present study examines the contributions of (1) parental socialization of emotion and preschoolers' emotional interaction with parents to their emotional competence, and (2) parental socialization and child emotional competence to their general social competence. Both observational and self-report techniques were used to measure emotion socialization, emotional competence, and social competence of preschoolers (average age = 49.8 months) from 60 middle-socioeconomic-status families. Data were collected in both classroom and home settings. In general, the results suggest that parental modeling of expressive styles and emotional responsiveness to child emotions are important predictors of preschoolers' emotional competence and their overall social competence. Children whose parents were more affectively positive tended to display more positive emotion with peers, whereas children whose parents were more negative appeared less socially competent in the preschool. Parents who were better coaches of their children's emotions had children who understood emotions better. Age and sex moderated several of the study's key findings. The results are consistent with earlier research indicating that parental socialization of emotion impacts the child's emotional and social functioning both at home and in the preschool.     

The Relation of Parental Emotionality and Related Dispositional Traits to Parental Expression of Emotion and Children's Social Functioning

The purpose of this study was to test relations between parental temperamental emotionality and regulation or related personality characteristics and parental behavior, children's regulation, and children's social functioning. Mothers and fathers reported on their own personality and/or temperament and expressivity in the family (mothers only); parents and teachers rated children (71 girls and 99 boys; M age = 73 months) on their temperamental regulation, social competence, and problem behavior. Mothers also were observed interacting with their child, and behavioral measures of children's regulation were obtained. In general, high parental regulation and low negative emotionality were associated with positive developmental outcomes in children and more positive parental behaviors, and mothers' expression of positive emotion in the family mediated some of the relations of their dispositions to children's socioemotional functioning.     

Changing the Speech of Autistic Children and Their Parents

The parents of nine autistic preschool children were trained in behavior modification and operant techniques of teaching speech. The study used a multiple baseline design with Group 1 completing behavior modification training while Group 2 remained on the waiting list. Then, Group 1 entered speech training while Group 2 began behavior modification. Finally, Group 2 received speech training. Videotape assessments of parents and child were made pretreatment and after each stage of training. The tapes were coded reliably for the parents' speech oriented and non-speech oriented language and the childrens' speech and non-speech behaviors. There was no change in parental speech oriented language following behavior modification but a substantial rise in such language was noted after speech training. Both mothers and fathers changed after training, although mothers were consistently more active than fathers. Both before and after training, the parents of the more verbal children emitted more speech oriented language than the parents of the mute children. The children showed changes which paralleled those of the parents. There was no significant change in child speech after behavior modification, but a rise in children's speech was obvious when their parents completed the speech training. The verbal children accounted for the changes in the two groups since the mute children showed Iittle evidence of change. The results suggest that parents of nonverbal chiIdren can learn to modify their language behavior and that this parent training can be done in an economical group setting.     

Impact of Incredible Years® on teacher perceptions of parental involvement: A latent transition analysis

The purpose of the present study was to examine the impact of the Incredible Years® Teacher Classroom Management (IY TCM) training on teacher perceptions of parental involvement. A cluster randomized design was used to assign 42 classroom teachers to either an IY TCM training (n = 19) or a control condition (n = 23). Teachers rated parental involvement (i.e., bonding with teacher, parental involvement at school) for the families of 805 low income students (IY TCM = 504, control = 301). A latent profile transition analysis framework was used to model the effect of IY TCM on teacher perceptions of parental involvement from pre to posttest. Four profiles consisting of various patterns of high, medium, and low teacher perceptions of bonding with and involvement of parents emerged. Analyses of teacher profiles at baseline revealed teachers who felt parental involvement and bonding was low were also likely to rate students as having more externalizing behaviors, fewer social competencies, more attention deficit symptoms, and disruptive behaviors towards adults and peers compared to teachers with more adaptive profiles. Further analysis revealed that parents of teachers randomly assigned to IY TCM were more likely to transition to a more adaptive view of parental involvement at follow-up compared to teachers in the control condition. Because teacher perceptions of parental involvement may adversely impact teacher attitudes towards difficult students, findings from the present study support the promise of teacher training as an avenue for conferring protections for struggling students.     

The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents

This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8–12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child’s ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.