When two are a family: looking backward and looking forward in a group intervention with single‐by‐choice mothers

Objective: We describe a preventive short‐term group intervention with nine single‐by‐choice (SBC) mothers to provide maximal support for parental functioning and to minimize possible emotional and/or developmental difficulties in their children. Method: Dynamically oriented group work (fifteen one‐and‐a‐half‐hour sessions) focused on: elaboration of painful experiences in the peri‐natal period; reducing stress, tension and guilt; helping mothers with problematic aspects of parenting through work on parental self‐image and perceptions of the child and the dyadic interaction; and strengthening their acceptance of the chosen family model. Results: Therapeutic gains described by mothers and facilitators include: reduced tension, anxiety and guilt; improved integration of the mother's parental self‐image and perception of the child; reduced ambivalence in dyadic relationships; strengthening the mother's fantasized triadic relationships; better acceptance of chosen family pattern; mothers' willingness to tell children their birth story. Conclusion: Dynamically oriented preventive group intervention with SBC mothers can identify potential psychological risk factors and help mothers with sensitive aspects of parenting.     

Randomized controlled trial of parental responsiveness intervention for toddlers at high risk for autism

This study tested the effects of a parent-mediated intervention on parental responsiveness with their toddlers at high risk for an autism spectrum disorder (ASD).Participants included caregivers and their 66 toddlers at high risk for ASD. Caregivers were randomized to 12 sessions of an individualized parent education intervention aimed at improving parental responsiveness or to a monitoring control group involving 4 sessions of behavioral support. Parental responsiveness and child outcomes were measured at three time points: at beginning and end of the 3-month treatment and at 12-months post-study entry. Parental responsiveness improved significantly in the treatment group but not the control group. However, parental responsiveness was not fully maintained at follow up. There were no treatment effects on child outcomes of joint attention or language. Children in both groups made significant developmental gains in cognition and language skills over one year. These results support parental responsiveness as an important intervention target given its general association with child outcomes in the extant literature; however, additional supports are likely needed to fully maintain the treatment effect and to affect child outcomes.     

A Child Trauma Treatment Pilot Study

We examined outcomes of a promising 21-session trauma treatment model for children aged 3 to 17 and their caregivers. All children in treatment had experienced at least one traumatic event. The treatment intervention was rooted in theories of trauma and attachment and combines parent training with cognitive behavioral therapy to form a comprehensive trauma treatment program. We report on 27 families who completed the program. Results reflect significant reductions in conduct disorder, problems in social relations, and caregiver depression at an average of a one-year post-treatment follow-up. Results from our preliminary study offer support for further evaluation of the model.     

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.     

Enhancing parental reflective functioning through early dyadic interventions: A systematic review and meta‐analysis

Parental reflective functioning (PRF) is an important predictor of infant attachment, and interventions that target parent–infant/toddler dyads who are experiencing significant problems have the potential to improve PRF. A range of dyadic interventions have been developed over the past two decades, some of which explicitly target PRF as part of their theory of change, and some that do not explicitly target PRF, but that have measured it as an outcome. However, no meta‐analytic review of the impact of these interventions has been carried out to date. The aim of this review was to evaluate the effectiveness of dyadic interventions targeting parents of infant and toddlers, in improving PRF and a number of secondary outcomes. A systematic review and meta‐analysis was conducted in which key electronic databases were searched up to October 2018. Eligible studies were identified and data extracted. Data were synthesised using meta‐analysis and expressed as both effect sizes and risk ratios. Six studies were identified providing a total of 521 participants. The results of six meta‐analyses showed a nonsignificant moderate improvement in PRF in the intervention group (standardised mean difference [SMD]: –0.46; 95% confidence interval [CI] [–0.97, 0.04]) and a significant reduction in disorganised attachment (risk ratio: 0.50; 95% CI [0.27, 0.90]). There was no evidence for intervention effects on attachment security (odds ratio: 0.71; 95% CI [0.19, 2.64]), parent–infant interaction (SMD: –0.10; 95% CI [–0.46, 0.26]), parental depression (SMD: –1.55; 95% CI [–3.74, 0.64]) or parental global distress (SMD: –0.19, 95% CI [–3.04, 22.65]). There were insufficient data to conduct subgroup analysis (i.e. to compare the effectiveness of mentalisation‐based treatment with non‐mentalization‐based treatment interventions). Relational early interventions may have important benefits in improving PRF and reducing the prevalence of attachment disorganisation. The implications for future research are discussed.     

Bending the Curve: A Community-Based Behavioral Parent Training Model to Address ADHD-Related Concerns in the Voluntary Sector in Denmark

Limited access to evidence-based behavioral parent training (BPT) for addressing attention deficit/hyperactivity disorder (ADHD) has been a growing concern internationally. Models to improve access to BPT are needed, particularly those that can be readily implemented in community settings and that leverage the potential workforce to increase capacity to deliver BPT. The purpose of this study was to evaluate a BPT model which included oft-used content, methods, processes of BPT (common-elements), non-professionally delivered (task-shifted/shared) BPT intervention, and an efficient ancillary support system (training, fidelity, and supervision methods) for families of youth with parental concerns about ADHD. In a randomized controlled trial of 161 families of children (79% male; mean age 7.04 [1.55]), the Caring in Chaos (CiC) BPT model, delivered by community volunteers across 12 community-based sites in Denmark, was compared to a wait-list control condition on key child and parent outcomes at immediate post-treatment and 4-month follow-up assessment points. Results suggested that the CiC model led to significantly greater improvement in parenting behavior, parenting sense of competence, child functional impairment, parental stress and parental depressive symptoms compared to the wait list condition at immediate post-treatment, with maintenance of gains in most of these areas at follow-up assessment. No effect of intervention was found on ADHD symptoms. The results of this study suggest that developing efficient BPT intervention models, such as the CiC model, can result in readily implemented interventions by a variety of individuals in community settings. Such models are necessary to bend the curve on addressing unmet needs of families of youth with concerns about ADHD.     

Parent psychopathology and family functioning among childhood firesetters

The purpose of this study was to identify parent and family characteristics related to juvenile firesetting and antisocial behavior among severely disturbed children. Hospitalized children (ages 6–12) identified as firesetters (n=27) and nonfiresetters (n=27) were compared in terms of parental psychopathology, dyadic adjustment, and family environment. To separate the impact of conduct disorder in contributing to group differences, diagnosis and firesetting status were separated in the data analyses. The results indicated that parents of firesetters showed significantly greater dysfunction in terms of psychiatric symptoms, and higher levels of depression, and reported lower levels of affectional expresssion, consensus, and overall adjustment in their dyadic relationships. The findings suggest that among a clinical sample, specific parent and marital characteristics delineate firesetters. The contribution of parental and marital influences to antisocial behavior more generally and the need to focus specifically on firesetting in relation to these variables are discussed.Completion of this research was supported by grants (MH39976, MH35408) and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors appreciate the assistance of Debra Colbus and Antoinette Rodgers and the clinical research team of the Child Psychiatric Treatment Service.     

Brief cognitive therapy for social phobia: a case series

Social phobia is a common and disabling anxiety disorder. The most effective psychological treatments for social phobia are cognitive therapy and exposure. However, the degree of improvement across these treatments is variable, and their implementation is costly and time-consuming. This study aimed to conduct a preliminary clinical evaluation of the effectiveness of a brief, new form of cognitive therapy based on a recent cognitive model of social phobia. Six consecutively referred patients with social phobia were treated using established single case series methodology. Brief cognitive therapy was effective with all patients demonstrating clinically significant improvements in all measures. Treatment gains were maintained at follow-up. The mean number of treatment sessions delivered was 5.5 and improvements compare favourably with previous treatment studies. Brief cognitive therapy for social phobia appears promising and it is potentially cost-effective. Future randomised and controlled evaluations of this brief treatment are warranted.     

Parent–child interaction: Does parental language matter?

Although parental language and behaviour have been widely investigated, few studies have examined their unique and interactive contribution to the parent–child relationship. The current study explores how parental behaviour (sensitivity and non‐intrusiveness) and the use of parental language (exploring and control languages) correlate with parent–child dyadic mutuality. Specifically, we investigated the following questions: (1) ‘Is parental language associated with parent–child dyadic mutuality above and beyond parental behaviour?’ (2) ‘Does parental language moderate the links between parental behaviour and the parent–child dyadic mutuality?’ (3) ‘Do these differences vary between mothers and fathers?’ The sample included 65 children (M_age = 1.97 years, SD = 0.86) and their parents. We observed parental behaviour, parent–child dyadic mutuality, and the type of parental language used during videotaped in‐home observations. The results indicated that parental language and behaviours are distinct components of the parent–child interaction. Parents who used higher levels of exploring language showed higher levels of parent–child dyadic mutuality, even when accounting for parental behaviour. Use of controlling language, however, was not found to be related to the parent–child dyadic mutuality. Different moderation models were found for mothers and fathers. These results highlight the need to distinguish parental language and behaviour when assessing their contribution to the parent–child relationship.     

Interoceptive Exposure Therapy Combined with Trauma‐related Exposure Therapy for Post‐traumatic Stress Disorder: a Case Report

Trauma‐related exposure therapy is a useful but not universally effective treatment for post‐traumatic stress disorder. Anxiety sensitivity may play an important role in this disorder, as it does in panic disorder. Studies have shown that interoceptive exposure therapy reduces anxiety sensitivity in panic disorder. The present case study was a preliminary investigation of the merits of including interoceptive exposure therapy in the treatment of post‐traumatic stress disorder, in order to improve treatment outcome for a patient who had no history of panic disorder or panic attacks. Interoceptive exposure therapy (4 sessions) was one component of treatment, combined with trauma‐related exposure therapy (4 sessions of imaginal exposure followed by 4 sessions of in vivo exposure). Treatment outcome was assessed with the Clinician‐Administered Post‐traumatic Stress Disorder Scale, a self‐report measure of post‐traumatic stress disorder symptoms, and measures of symptoms and cognitions commonly associated with post‐traumatic stress disorder. Scores on all outcome measures decreased over the course of treatment, with gains maintained at 1‐ and 3‐month follow‐up. Symptoms of anxiety sensitivity and post‐traumatic stress disorder decreased during interoceptive exposure therapy. The results indicate that interoceptive exposure therapy is a promising adjunctive intervention for post‐traumatic stress disorder. Further research is needed into the merits of combining interoceptive exposure therapy and trauma‐related exposure therapy as a means of boosting treatment efficacy.     

The Association Between Therapeutic Alliance and Treatment Outcomes in a Group Triple P Intervention

A growing literature has examined the association between therapeutic alliance and treatment outcomes in child therapy. Few studies, however, have specifically investigated the role of therapeutic alliance within evidence-based parenting programs for children with externalizing behavioural difficulties. The current study prospectively collected measures of therapeutic alliance for 117 families completing a Triple P parenting program in a community children’s mental health center. Higher levels of mother and father rated therapeutic alliance were associated with greater gains in parenting skills and parental sense of competence. Parental rated therapeutic alliance was also associated with greater improvements in child conduct problems for mothers, but not fathers. However, therapist ratings of therapeutic alliance had limited associations with treatment improvement. The implications of the findings for clinical practice are discussed.     

Predicting treatment response for childhood attention-deficit/hyperactivity disorder: Introduction of a heuristic model to guide research

Efficacious treatments for childhood attention-deficit/hyperactivity disorder (ADHD) have been clearly documented in the extant literature. However, significant challenges remain in delivering these treatments to the children and families they were developed to benefit. With the aim of better understanding the obstacles that impede delivery of treatments for ADHD, this paper reviews what is known regarding predictors of treatment acceptance, adherence, and success among families of children with ADHD. We identify several gaps in this literature, including the need for a strong, theoretically-driven model that encompasses parental cognitive variables in understanding the treatment experiences of these families.     

A friendship intervention for children with Attention-Deficit/Hyperactivity Disorder: preliminary findings

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are known to experience difficulty in peer relationships. Neither standard interventions for ADHD nor peer acceptance-oriented interventions fully remedy this problem. We propose that interventions targeting ADHD children's dyadic friendships may be more realistic strategies for improving peer relationships. Hence, a friendship intervention, implemented within the context of an intensive behavioral treatment program with 209 ADHD children, is described. A model is proposed in which the friend's antisocial behavior relates to parental compliance with the friendship intervention, and both the friend's antisocial behavior and parental compliance predict friendship quality and treatment response. Results indicate that children paired with peers lower on antisocial behavior and children whose parents had higher levels of compliance with the friendship intervention achieved higher quality friendships and were rated by teachers as more improved.     

Acquiring dyadic coping: Parents and partners as models

Using self‐reported data on dyadic coping from 153 premarital couples and their parents, this study investigates (a) how similar individuals are to their parents and partner and (b) whether parent–child similarities in dyadic coping vary as a function of child's gender and the type of dyadic coping model parents represent. Similarities were computed using an idiographic approach, and 2 components of dyadic similarity—unique and stereotypical—were distinguished. Results indicate that internalization of parental models and partner's reciprocation are relevant sources of dyadic coping acquisition, that different processes are implicated in the acquisition of positive versus negative dyadic coping, and that children's gender and their ability to discriminate between parental models influence such an acquisition.     

Family characteristics as mediators of the influence of problem drinking and multiple risk status on child mental health

Structural equation modeling was used to test a theoretical model in which family cohesion and family reframing coping were hypothesized as mediators between family drinking problems, multiple risk factors, negative life events, and child mental health (conduct disorder, depression, anxiety) in two-parent families. Family cohesion mediated the relationships of family drinking problems and negative life events to child conduct disorder and depression. Negative life events mediated the relationships of family drinking problems and family multiple risk to child conduct disorder. Family reframing coping did not function as a mediator nor was it related to child mental health when other factors were considered simultaneously. Results indicate that increasing family cohesion and reducing sources of stress within the family (negative life events) represent promising areas for interventions for children with problem-drinking parents. Work on this study was funded in part by the National Institute for Mental Health Grant 2-P50-MH39246-06 to support a Preventive Intervention Research Center. The authors gratefully acknowledge contributions made by Rita Shell, Marcia Michaels, Joanne Gersten, George Knight, and Carolyn Berg.     

A Cognitive-Behavioral-Based Workshop Intervention for Maladaptive Perfectionism

Maladaptive perfectionism (MP) can have adverse consequences for mental and physical health and can interfere with treatment success for various conditions. Theoretical conceptualizations of MP largely surround overly rigid and self-critical thinking as well as excessively high standards. Treatment for MP thus often focuses on these cognitive aspects and has been successful, albeit lengthy. The present study evaluated a brief cognitive-behavioral workshop for those with high, moderate, and low MP, which was defined as a composite of perfectionism subscales that included concern over mistakes, doubting of actions, parental criticism, parental expectations, and discrepancy. Workshop components focused on psychoeducation about MP, setting high standards, fearing mistakes and doubting oneself, and preventing distress and maintaining gains. Ratings of MP as well as anxiety, depression, and distress were significantly lower from pre-treatment across post-treatment and 3-week and 3-month follow-up assessments for those with high and moderate MP. Participants with low MP showed no significant change over time, as expected. The workshop thus provided a useful, brief, and cost-effective intervention for MP and related distress. Clinical implications are discussed, including routine assessment of MP in clinical practice, intervention for MP early in the clinical process, specific focus on self-criticism and setting high standards, and implementation in university counseling centers. Recommendations for future research are also discussed, including dismantling of workshop components, identifying treatment mechanisms, expanding to clinical populations, evaluating more diverse samples, and understanding the possible preventative aspects of a workshop approach.     

The Early Risers Preventive Intervention: Testing for Six-year Outcomes and Mediational Processes

We examined effects of the Early Risers “Skills for Success” early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. We also examined if intervention effects on proximally-targeted variables found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants included 151 at-risk children (106 males and 45 females) followed from first through sixth-grade, from 23 semi-rural schools in Minnesota. After 6 years, program children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Program children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results of the mediation analysis indicated that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. The study provides support for the early-starter model of conduct problems development that provides the framework for the Early Risers intervention. The study’s implications for prevention and limitations are discussed.     

Collective fit increases team performances: extending regulatory fit from individuals to dyadic teams

People experience “regulatory fit” when they pursue a goal in a manner that suits their chronic regulatory orientation. This regulatory fit impacts performance positively. The present research extends performance gains due to fit from individuals to dyadic team performance. Study 1 manipulated team fit of 32 table football participants (i.e., promotion vs. prevention orientation and offense vs. defense positions). Team fit significantly predicted team success in an experimental tournament beyond team skill level. Study 2 replicated this result with data from a real‐life tournament including 66 highly experienced competitors. These findings broaden the concept of regulatory fit from individual to dyadic teams, and suggest collective fit as a possible important predictor for team success.     

A component model for diagnosing and treating children who stutter

Nine components of stuttering and their distribution among 54 children who stutter are described. The components are arranged into a model that includes four neurologic components (attending disorder, auditory-processing disorder, sentence-formulation disorder, and oral-motor disorder) and five traditional components (high self-expectations, manipulative stuttering, disruptive communication environment, unrealistic parental expectations, and abnormal parental need for the child to stutter). Diagnostic and treatment usefulness of the model are discussed. Thirty-two of the children have been followed through component-based treatment and 12 mo post termination. Results indicate that treatment was successful with 27 (84%) of the 32 children. Only one child regressed during the 12 mo after treatment ended. These results suggest that treating the neurologic and traditional factors which disrupt fluency improves maintenance and carry-over.     

The Role of Trauma in Conduct Disorder

Summary

Trauma is proposed as a key to understanding the development and persistence of conduct disorder, in conjunction with other contributing factors. Trauma history is ubiquitous in the conduct disordered population, and trauma effects can help to account for many features of conduct disorder, including lack of empathy, impulsivity, anger, acting-out, and resistance to treatment. The current standard of care fails to fully address trauma, which may partially explain the low success rate of extant treatment approaches. A trauma-informed perspective is introduced to current models of conduct disorder. Research, prevention, and treatment implications are discussed.