A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems

ObjectiveThis study examined the efficacy of Triple P Online (TPOL), an eight-module intensive online positive parenting program for parents of children with early-onset disruptive behavior problems.MethodOne hundred and sixteen parents with 2–9-year-old children displaying early-onset disruptive behavior difficulties were randomly assigned to either the intervention condition (N = 60) or an internet-use-as-usual control group (N = 56).ResultsAt post-intervention assessment, parents receiving the internet intervention TPOL had significantly better outcomes on measures of problem child behavior, dysfunctional parenting styles, parents’ confidence in their parenting role, and parental anger. At 6-month follow-up assessment intervention gains were generally maintained, and in some cases enhanced. Consumer satisfaction ratings for the program were high.ConclusionsInternet-delivered self-help parenting programs appear to make a valuable contribution to a comprehensive public health approach to parenting support.     

School-based prevention of anxiety using the “My FRIENDS” emotional resilience program: Six-month follow-up

Anxiety-related problems are common in childhood and adolescence and, if left untreated, may hold short-term and long-term negative consequences for psychosocial functioning and other domains. In addition to having negative individual-level consequences, anxiety-related problems may have a negative impact at the school level. Because almost all children and adolescents attend school, school plays a significant role in development as a socialisation agent and provides an ideal venue for the delivery of prevention and intervention programs. Here, we present the first evidence regarding the effectiveness of the My FRIENDS emotional resilience program as a method of reducing anxiety among students in Slovenia and the feasibility of implementing the program at the national level. Grade 8 students (N = 78) were assigned either the intervention condition, the My FRIENDS program, or a no-treatment control condition. We measured general anxiety and its components using the AN-UD (Lestvica anksioznosti za učence in dijake) anxiety scale and internalising difficulties using the Strengths and Difficulties Questionnaire at preintervention, postintervention, and 6-month follow-up assessments. Students in the intervention condition reported lower amounts of general anxiety and its cognitive component of worrying, and fewer internalising difficulties at the postintervention and follow-up assessments.     

Evaluation of "the incredible years" in Sweden: the transferability of an American parent-training program to Sweden

Structured parent training has been proven to be effective in reducing disruptive behavior problems (DBP) in children. Most of the programs that are used in Sweden have their origin in North America, and there is an ongoing debate over the transferability to Sweden of manual-based programs developed in other contexts. The goal of the present study was to study effectiveness of the Incredible Years parent-training program (IY), developed in the US, in regular clinical work in Sweden, using a randomized controlled design. Parents of 62 four to eight-year-old children diagnosed with Oppositional Defiant Disorder participated in the study. Parents of 38 children were assigned to parent training (PT) and 24 to a waiting list (WL). The results indicate that the IYS retains the positive effects on children's disruptive behavior problems when translated and transferred to Swedish. There was a statistically significant difference in reduction of DBP in children between the groups in favor of the PT. The improvement in the PT group was sustained at the one-year follow-up. The improvement also, at least to some extent, generalized over time to the school context. There was also a statistically significant difference in mothers' report of pre to post change in parenting alliance between the PT and WL groups. The IYS program was appreciated and well received by the participating mothers.     

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.     

Effects of a school-based cognitive-behavioral intervention for ADHD children

Two variations of school-based cognitive-behavioral training (CBT) program were compared to each other and to a waiting-list control condition in the treatment of children with attention-deficit hyperactivity disorder (ADHD). The experimental interventions included a multicomponent condition that provided coordinated training programs for parents, teachers, and children and a teacher-only condition that offered training for classroom teachers only. Evaluation of outcome occurred at pre-intervention, post-intervention and at 6-week followup periods. Depedent measures included classroom behavior observations, teacher ratings of child behavior, child self-report, and teacher ratings of adjustment. The multicomponent CBT condition was significantly better than the other conditions at improving observed off-task/disruptive behavior at post-test. This improvement was maintained at followup, although treatment condition differences were no longer significant. There were no treatment condition differences on any other measures at postintervention or followup. It was concluded that the intervention had minimal short-term effects on the ADHD children. The results are discussed within the context of several methodological limitations of the study which serve as proposals for continued research in this area.The authors gratefully acknowledge the support and assistance of the faculty and staff at Echo Park, Cedar Park and Westview Elementary Schools (Rosemount, MN, Independent School District), and the parents and children who participated in this study. The authors would also like to extent special thanks to the principals of these schools, Mr. Robert Keaton, Mr. William Mack and Mr. Marvin Skinner, and the school psychologists servicing these schools, Ms. Sheila Peterson, Ms. Ann O'Brien, and Mr. Mark Kaloski, for their commitment and service to children with attention-deficit hyperactivity disorder.     

Examining the Efficacy of Parent–Child Interaction Therapy with Children on the Autism Spectrum

Externalizing behaviors are a common component of the clinical presentation of autism spectrum disorders. Although traditionally used with typically-developing children, parent–child interaction therapy (PCIT) is one behaviorally-based parent training program that has demonstrated success in increasing child compliance, reducing problem behavior, and improving parent–child communication. The study examined the efficacy of PCIT as a treatment for children with autism spectrum disorders by employing a single subject, non-concurrent multiple baseline design across three subjects. Primary findings revealed increases in child compliance, reductions in child disruptive behavior, and improved parenting skills across participants. In addition, each caregiver reported high levels of satisfaction with the intervention. Results suggested that PCIT may be a treatment option for children on the autism spectrum with co-occurring behavioral difficulties. Although the non-concurrent nature of the multiple baseline design is a limitation, this study replicates and extends previous research investigating the efficacy of PCIT with children with autism and their parents.     

Maternal Psychiatric Disorders, Parenting, and Maternal Behavior in the Home During the Child Rearing Years

Data from the Children in the Community Study, a community-based longitudinal study, were used to investigate associations between maternal psychiatric disorders and child-rearing behaviors. Maternal psychiatric symptoms and behavior in the home were assessed in 782 families during the childhood and adolescence of the offspring. Maternal anxiety, depressive, disruptive, personality, and substance use disorders were independently associated with current and subsequent parenting difficulties and other problems in the home during the child rearing years, after co-occurring disorders and offspring behavior problems were controlled statistically. Maternal personality disorders were most consistently associated with problems in the home during the child rearing years. Less than 1 of 3 mothers with disorders reported having received treatment. Those who received treatment were significantly less likely to experience multiple difficulties in the home during the child rearing years. These findings suggest that maternal psychiatric disorder may be an important determinant of problematic maternal behavior in the home during the child rearing years. Improved recognition and treatment of maternal psychiatric disorders may help to reduce the amount of maladaptive parenting behavior that many youths might otherwise be likely to experience.     

Reaching Latino Families Through Pediatric Primary Care: Outcomes of the CANNE Parent Training Program

The lack of culturally adapted parenting programs for Latinos contributes to low engagement in effective parenting programs. Criando a Nuestros Niños Hacio el Éxito (CANNE), a culturally adapted program, improves family dynamics by decreasing problematic child behavior and helping parents manage stress. CANNE was delivered with 12 Latino parents of children (age 3–7). Increased attendance and participation resulted in less child behavior problems and parenting stress from preintervention to postintervention. A culturally relevant adaptation of an evidence-based parenting program improved engagement, child behavioral outcomes, and parenting stress. Implications of mental health services in primary care facilities for Latino families are addressed.     

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.     

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.     

Pathways Triple P‐Positive Parenting Program: Effects on Parent‐Child Relationships and Child Behavior Problems

This study examined the effects of Pathways Triple P (PTP), an early intervention program designed to promote positive parent‐child relationships. Sixty parents met the inclusion criteria of borderline to clinically significant relationship disturbance and child emotional and behavioral problems. They were randomly allocated into PTP or a wait‐list (WL) control group. PTP was delivered in a group format for 9 weeks and consisted of parent skills training and cognitive behavior therapy targeting negative attributions for child behavior. Significant intervention effects were found for improving parent‐child relationships and reducing behavior problems with gains maintained at 3‐month follow‐up. Limitations of the study and implications for future research are discussed.     

Sociocultural differences in the developmental consequences of the use of physical discipline during childhood for African Americans

Given the diverse cultures that can shape parenting behavior, some basic assumptions regarding the links between parenting styles and developmental outcomes may not be universal. Although a positive correlation between the use of physical discipline (i.e., spanking) and disruptive disorders in children is found in studies of European American families, research on African American families has found a negative association or none at all. Moreover, a review of the literature indicates that the positive association between spanking and child behavior problems is bidirectional for White families, whereas it is the product of reverse causation (i.e., negative child behaviors result in spanking) in Black families. The implications of these sociocultural differences for parent training programs and the family study of disruptive behaviors are discussed.     

Parceling Component Effects of a Multifaceted Prevention Program for Disruptive Elementary School Children

This study examined predictors and outcomes of attendance in two standard components of a multifaceted preventive intervention aimed at children with early-onset disruptive behavior after 3 years of intervention. Mean rate of attendance in the Family Program, but not the Summer School Program, differed by level of child disruptiveness (grouping variable). Although predictors of attendance (SES, single-parent status, child IQ) did not differ across high- and low-disruptive groups, predictors of outcome were moderated by level of child disruptiveness for academic achievement and aggression outcomes, but not for social competence. Higher attendance in the Summer Program was associated with higher child social competence at Year 3 for all children. For academic achievement, higher attendance in the Summer Program was associated with higher scores for mild/moderately disruptive children and lower scores for highly disruptive children in Year 3. Higher attendance in the Family Program was associated with lower aggression scores for mild/moderately disruptive children. Findings highlight the importance of matching intervention components to the assessed or expressed needs of client subgroups.     

Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder

The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2–6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.     

Effectiveness of Child-Directed Interaction Training for Young Japanese Children With Autism Spectrum Disorders

Abstract

This study examined the efficacy of Child-Directed Interaction Training (CDIT), the first phase of Parent-Child Interaction Therapy (PCIT), for Japanese children with autism spectrum disorders. The participants were 21 mother-child dyads with children aged 4–7 years; participants were assigned to an Immediate Treatment (IT) group or to a Waitlist (WL) control group. Across eight training sessions, mothers learned positive attention skills that were adapted from traditional PCIT training. Results showed CDIT not only improved social cognition skills and decreased disruptive behavior in Japanese children, but also reduced stress/distress among their mothers, particularly in relation to their own parenting skills and their child’s problem behaviors.     

The Role of Perspective Taking and Self-Control in a Preventive Intervention Targeting Childhood Disruptive Behavior

Prevention studies typically focus on outcome variables such as reductions in problem behavior, rather than targeted factors (e.g., cognitions), or the relation between change in targeted factors and outcomes. Therefore, the current study examined the effect of a targeted prevention program for childhood disruptive behavior on targeted factors (i.e., perspective taking and self-control) and associations between change in targeted factors and outcomes (i.e., aspects of disruptive behavior). The sample consisted of 173 children (Mage?=?10.2 years) who were randomly assigned to an intervention condition (n?=?70) or waitlist control condition (n?=?103). Assessment took place at pre-, post- and follow-up measurements. For ethical considerations, follow-up data was not available for children on the waitlist. Findings revealed a direct intervention effect on self-control. From pre-test to follow-up, children who received the intervention improved in perspective taking and self-control. Moreover, improvements in self-control were associated with and predicted reductions in teacher-reported symptoms of oppositional defiant disorder. No associations were found between changes in perspective taking and disruptive behavior. These findings suggest that self-control may be an important target factor in reducing childhood disruptive behavior in targeted prevention.

     

Two-Year Findings from a National Effectiveness Trial: Effectiveness of Behavioral and Non-Behavioral Parenting Programs

Long-term follow-up studies of selective parent training (PT) programs are scarce, particularly in the case of effectiveness trials conducted within regular care settings. This study evaluated the 2-year effects of 4 programs: Comet, Incredible Years, Cope, and Connect and differences in the rate of change among programs were investigated using Latent Growth Modeling (LGM). Participants were parents who had sought help at 30 local service sector units (e.g., child psychiatric clinics and social services centers) for major problems in managing their children’s externalizing behavior. Parents of 749 children (63 % boys) with moderate levels of externalizing behavior, aged 3–12, were randomized to one of the 4 PT programs. Assessments included parent-reported measures of child externalizing, hyperactivity and inattention, as well as parenting practices, sense of competence, and parents’ stress and depressive symptoms. At 2-year follow-up, there were no differences in any of the child outcomes among the programs. All programs had reduced externalizing behaviors with large effect sizes (d = 1.21 to d = 1.32), and negative parenting practices with moderate to large effect sizes (d = 0.49 to d = 0.83). LGM analyses showed that the 2 behavioral programs, Comet and Incredible Years, produced more rapid reductions in externalizing behavior during the course of the intervention than the non-behavioral program, Connect. Connect, however, was the only program where children continued to improve after the intervention. Overall, the results indicate that the 4 programs were equally effective in a clinical setting, despite differences in their theoretical origin.     

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.     

Drop Out from Behavioral Management Training Programs for ADHD: A Prospective Study

To investigate dropout from parenting programs for disruptive behavior disorders, we followed 18 clients prospectively from the beginning of a manualized treatment program to three month follow-up. Using qualitative and quantitative methods, we then compared those who dropped out of the program with those who completed it. We found that in general, those participants who dropped out of the program were parents of children with more disturbed behavior, who perceived their children to be more difficult than others, and who experienced more subjective parenting stress. Those who dropped out were also not convinced that the strategies proposed in the program to help manage their children were useful. On the other hand, those who completed the program reported a determination to persevere with the strategies which they saw as assisting them to re-establish positive relationships with their adolescent children. The findings are discussed in the context of how manualized programs might be modified to increase retention.     

Empirically Derived Subtypes of Child Academic and Behavior Problems: Co-Occurrence and Distal Outcomes

The aim of this study was to identify classes of children at entry into first grade with different patterns of academic and behavior problems. A latent class analysis was conducted with a longitudinal community sample of 678 predominantly low-income African American children. Results identified multiple subclasses of children, including a class with co-occurring academic and behavior problems. Gender differences were found in relation to the number of identified classes and the characteristics of academic and behavior problems for children. Several of the identified classes, particularly the co-occurring academic and behavior problems subclass for both genders, predicted negative long-term outcomes in sixth grade, including academic failure, receipt of special education services, affiliation with deviant peers, suspension from school, and elevated risk for conduct problems. The finding that subclasses of academic and behavior problems predict negative long-term outcomes validates the importance of the identified classes and the need to target interventions for children presenting with the associated class characteristics. Implications for early identification, prevention, and intervention for children at risk for academic failure and disruptive behavior problems are discussed.