Barriers to treatment participation and therapeutic change among children referred for conduct disorder.

Examined predictors of therapeutic change among children seen in outpatient therapy. Children (N = 200) referred for oppositional, aggressive, and antisocial behavior and their families participated. The major findings were that (a) socioeconomic disadvantage, parent psychopathology and stress, and child dysfunction predicted therapeutic change from pretreatment to posttreatment; (b) barriers to participation in treatment also were significantly associated with therapeutic change and this effect was not explained by the other family, parent, and child predictors; (c) as the level of perceived barriers to participation in treatment increased among families, the amount of therapeutic change decreased; and (d) among children at risk for relatively little therapeutic change, the perception of few barriers to treatment increased the degree of child improvement. The implications for further work on predictors of therapeutic change and the role of barriers in the treatment process are discussed.     

Controversies in Family Preservation Programs

Summary

This paper examines the controversies over the use of family preservation policies to prevent and treat child abuse and neglect. Policies that aim to preserve families in which child maltreatment has occurred are at least a century old. However, there is renewed interest in such policies, given the dramatic rise in child abuse and neglect reports and a large number of children who spend time in out-of-home placements. New intensive family preservation services were advanced as able to assure the safety of children while working toward a lasting preservation of the family unit. The paper summarizes the research on intensive family preservation services and reports that such programs do not reduce placements nor do they appear to enhance child safety. The paper concludes by proposing that risk assessments and assessments of readiness to change could improve decision-making regarding which families might be aided by family preservation and which children should be protected by terminating their parents' rights.     

Is There a Stronger Association Between Children and Happiness Among the Religious? Religion as a Moderator in the Relationship Between Happiness and Child Number

The literature on child number and happiness has progressed beyond simple associations and has begun to explore the roles of various attitudinal and environmental factors that moderate the relationship. Here the role of religiosity as a moderator in the relationship between happiness and child number is tested. This effect has not been examined before, which is surprising given the role that religion has been shown to play in child number more generally. I draw on both the psychology and demography literature to make a theoretical case that, as religiosity in the United States tends to be associated with pronatalist norms and culture, and as happiness is positively associated with fulfilling sociocultural imperatives, then, all things being equal, the more religious will have a higher happiness effect (or lower unhappiness effect) from their children than the less religious. Using General Social Survey data, my empirical analysis empirically confirmed this hypothesis, showing a positive and significant interaction term between self-identifying as very religious and child number. This interaction is partially mediated by another interaction term between higher ideal family size (measuring pronatalist tendencies) and number of children.     

Race/Ethnic Differences in Social Resources as Cognitive Risk and Protective Factors

Overall social network size, often the sum of common lifetime relationships, including children, family, and friends, has been linked to cognitive impairment and Alzheimer’s Disease. However, little research has examined the association between network size composition and cognitive function in middle-aged and older adults in the context of race/ethnicity. We investigated the associations between the number of close children, family, and friends independently with executive function (EF) and memory across a subsample of non-Hispanic Black, Hispanic, and non-Hispanic White participants who completed the Health and Retirement Study Harmonized Cognitive Assessment Protocol (N = 2,395). We found that network size composition was more closely linked to EF than memory and that these associations varied by race/ethnicity. Specifically, the strongest associations existed between EF and quadratic estimates of the number of close children of non-Hispanic Black participants, and number of close family members for Hispanic participants. Among Black participants, a curvilinear relationship indicated that two close children were associated with greater EF, while a smaller or larger number of close children were associated with lower EF. On the other hand, among Hispanic participants, higher EF was associated with fewer (0–1) and greater (4-5+) numbers of family member contacts. Overall, these results indicate that examining children, family, and friends independently may be more useful than the common practice of aggregation of overall network size, especially in the context of race/ethnicity.     

Family Assisted Contingency Management within the Context of Evidence-Supported Treatment for Child Neglect and Drug Abuse

Contingency management (CM) has extensively been shown to be effective in reducing substance use disorders, but its effects in reducing child maltreatment have yet to be determined. The current study provides preliminary support for the utilization of an innovative family-assisted CM component in 18 mothers who were referred to an evidence-supported behavioral treatment for concurrent child neglect and drug abuse by Child Protective Service caseworkers. In the examined CM, participants were invited to indicate from a list of common actions incompatible with child neglect (i.e. positive parenting actions), the extent to which these actions had been experienced utilizing a 3-point scale (almost never, sometimes, almost always). For each item that was indicated to be almost never or sometimes experienced, the participants were queried to indicate if the neglect incompatible action should be targeted as a therapeutic goal. Contingencies were subsequently established in which the participants were rewarded by involved family members for their completion of therapeutic goals. At baseline, results indicated that there was a negative association between the number of neglect incompatible parenting actions that were infrequently experienced and child abuse potential. A hierarchical multiple regression analysis showed that the number of neglect incompatible actions targeted as therapeutic goals at baseline, but not the number of positive parenting actions experienced infrequently at baseline, predicted reduced child maltreatment potential following treatment. These findings suggest the examined CM may assist evidence supported behavioral treatment specific to child neglect and drug abuse.     

Parent Training for Childhood Anxiety Disorders: The SPACE Program

Anxiety disorders are the most prevalent disorders of childhood and adolescence. Cognitive behavioral therapy (CBT) for anxiety poses a challenge for clinicians as it requires active client participation, and many children either decline or do not adequately comply with treatment. In addition, even after treatment with CBT, up to 50% of children remain symptomatic, and many still meet diagnostic criteria. Parent-directed clinical work has been advocated as a potential enhancer of treatment outcomes, and exclusively parent-based interventions might replace child treatment when the child is reluctant. However, parent involvement has yet to be shown to significantly improve outcomes, relative to child-only therapy. Studies so far have focused mainly on including parents in children’s therapy, training parents as lay therapists, or teaching parenting skills. Parent training focused on parental behaviors specific to childhood anxiety, such as family accommodation, may be more effective. In this treatment development report we present the theoretical foundation, structure, and strategies of a novel parent-based intervention for childhood anxiety disorders. We will also present the results of an open trial of the treatment, with an emphasis on feasibility, acceptability, and initial outcomes. Participants in the trial were parents of 10 children, aged 9 to 13. Children had declined individual child treatment. Multiple excerpts from the treatment manual are included with the hope of “bringing the treatment to life” and conveying a rich sense of the therapeutic process. Parents participated in 10 weekly sessions. Significant improvement was reported in child anxiety and family accommodation as well as in the child’s motivation for individual treatment. No parents dropped out and satisfaction was high. The SPACE Program (Supportive Parenting for Anxious Childhood Emotions) is a novel, manualized parent-based intervention that is feasible and acceptable and may be effective in improving childhood anxiety.     

The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

There is a paucity of research considering the effect of behavioral family intervention (BFI) on parenting knowledge and the relative importance of both knowledge and parent confidence in reducing parenting dysfunction and problematic child behavior is unclear. In this study ninety-one parents (44 mothers, 47 fathers) of children aged 2–10?years completed an evidence-based BFI and were assessed at pre and post-intervention on knowledge of effective parenting strategies, parenting confidence, parent dysfunction, and reported intensity of externalised child behavior. Results showed that at pre-intervention parents higher in education (N?=?57) demonstrated greater knowledge than those lower in education (N?=?34). Relative to baseline, parents in both groups significantly improved their knowledge and confidence, reduced their dysfunction and reported less externalised child behavior. Effect sizes for the latter two variables were similar for both groups, however for parents higher in education the effect for confidence was larger than knowledge. Change in level of dysfunction explained the largest amount of unique variance in change to externalised child behavior. Results suggest that for optimal outcomes for parenting and child behavior management more knowledgeable parents may benefit from interventions that focus on practice and consolidation of already learned skills in order to increase confidence whereas for less knowledgeable parents the teaching of new skills and strategies, alongside increasing confidence, are important.     

Therapeutic Assessment With Children: A Pilot Study of Treatment Acceptability and Outcome

Therapeutic Assessment (TA) with children is a hybrid of psychological assessment and short-term intervention. It uses the ongoing process and results of psychological assessment to enhance parents' understanding of their child and to facilitate change. Clinical reports and single case studies suggest that TA with children is an acceptable and effective brief intervention. However, no aggregate data have been published to support this claim. This pilot study investigated the acceptability and preoutcome–postoutcome of TA with 14 clinically referred children with emotional and behavior problems and their parents. Results indicated high treatment acceptability as well as significantly decreased child symptomatology and enhanced family functioning as reported by children and mothers. In addition, mothers demonstrated a significant increase in positive emotion and a significant decrease in negative emotion pertaining to their children's challenges and future. The findings, although limited due to the design and small sample size, support assertions from published single case studies that TA is possibly an efficacious child and family intervention for children with emotional and behavioral problems and should be studied in a larger, comparison design.     

Interventions for Suicidal Children and Their Parents

ABSTRACT: Five features of the family organization of suicidal children include family inhibition of change, lack of defined generational boundaries, severity of spouse conflict, projection of inappropriate parental feelings onto the child, and a symbiotic parent-child interaction. The treatment of suicidal children must encompass a holistic family technique. The acute phases of treatment include protecting the child from harm, promoting family recognition of the seriousness of the child's suicidal behavior, promoting appropriate parental role responsibilities, and effecting an immediate significant family change. During the long-term process of treatment, attention must be focused on the child's unique psychopathology, the conflicts that preclude appropriate parental response to the child's needs, and the characterological difficulties of each parent.     

Family Change Groups for the Early School Age Child

Children who have recently undergone radical family changes may experience difficulty in coping with the stress that their new situation may evoke. These situations include a recent divorce or separation, joining a foster family, going to live with relative, death or serious illness of a sibling or parent, or incarceration of one of the parents. It may involve living in a non-typical family. The focus of his article is on a family change program which has been found to facilitate the adaptation and the further development of coping skills of the 5-7 year old child who has recently undergone family changes. This article is based on experience with approximately 30 groups over a five year period with this and other age groups. The groups usually consist of 4 to 5 children with one leader. The 8-12 sessions for each group last approximately 40-60 minutes. The treatment goals include coping more effectively with stress evoked by the child's unique living situation, mdfying distorted cognitions associated with the family situation, learning lo relax and resolving sleeping problems. The interventions include reading and discussion of excerpts from children's books, relaxation and imagery training, token reinforcement, modeling, self instructional training, homework, cognitive correction, and interactive games and crafts. Consumer satisfaction and that of parents and teachers referring the child has been high. Most treatment goals appear to have been achieved.     

Increasing access to low‐intensity interventions for childhood anxiety: A pilot study of a guided self‐help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low‐intensity formats of parent‐delivered CBT may improve access to treatment. Our aim was to develop and pilot‐test the acceptability and effect of a low‐intensity therapist‐guided parent‐delivered group program for anxious children (age 7–12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist‐time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre‐ and post‐treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty‐one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent‐to‐treat analyses revealed significant reductions in anxiety and depressive symptoms from pre‐ to post‐treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self‐reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.     

Families and the Origins of Child Behavior Problems

This article reviews recent research into the relationship between family variables and child behavior. Although a diversity of factors may be associated with the development and maintenance of conduct/oppositional disorders in children, of primary importance are the moment-to-moment interactions that the child has with his or her primary caregivers. These are often marked by coercive, aggressive behaviors that may be functional for parents and children within the family system. However, the likelihood that parents will engage in coercive interactions with the child is also related to the latter's personal adjustment, which, in turn, is often dependent upon the parents' perceptions of the quality of marital and social support available to them. The goal for clinicians working with families of oppositional/conduct-disordered children is to retain the demonstrated efficacy of direct intervention into parent-child interactions while developing methods of assessment and treatment that attend to broader family variables, for example, marital disorder, interfering in-laws, and social isolation that may be functionally related to the occurrence of coercive parent-child interactions.     

”Beat-the-Buzzer”:

Dawdling and noncompliance with the morning routine can result in frustration and parent-child conflicts. “Beat-the-Buzzer” is a contingency management procedure which has been anecdotally reported useful for decreasing dawdling and noncompliance. However, its effects on family interactions has not been examined. Thus, the focus of the present study was twofold: (1) to experimentally demonstrate the effectiveness of the concomitant effect on the interactions between parent and child. Two studies were conducted: the first was a multiple baseline design across two subjects; the second study was a single-case replication of the first. Both studies followed the same protocol and contained one week of follow-up data taken one month after formal data collection was completed. The program was assessed by parents' daily reports of their child's compliance with the routine and the number of noncompliant behaviors exhibited and reminders needed that morning. The parents also recorded whether or not the child was ready on time and how long it took the child to get ready. Further, the children were asked to rate daily how well they and their parent got along that morning. Treatment acceptability measures were also taken. The studies demonstrated the effectiveness of the program in increasing on-time behavior and compliance, as well as in decreasing the amount of time taken to prepare to leave and the number of noncompliant behaviors and reminders. Further, a decrease in the number of negative interactions between the parents and children was noted, thus, making mornings a more positive experience for the family. Finally, in terms of treatment acceptability, the parents rated the procedure as easy to use, effective, improving the child's compliance, and as decreasing morning conflicts. Potential problems with the program are discussed, as are future research directions.     

Siblings of children with mental retardation: Family characteristics and adjustment

Siblings of children with mental retardation may be at greater risk for adjustment problems because of family stress related to the needs of the child with mental retardation. Family dimensions were investigated to determine their relationship to sibling adjustment. Adjustment of 12 siblings of children with mental retardation was examined in relationship to family dimensions. These relationships were compared to those for children from families without a disabled child. For both groups, self concept was positively associated with family cohesion, and social competence was positively associated with family promotion of independence. For only the siblings of the mentally retarded children, family conflict was inversely related to social competence, and family organization was positively related to sibling self concept. Our results suggest that family conflict and disorganization appear to have a more negative effect in families with a child with mental retardation.     

Family Cohesion and Health-Related Quality of Life of Children with Type 1 Diabetes: The Mediating Role of Parental Adjustment

Despite the increasing number of studies on the health-related quality of life (HRQOL) of children with type 1 diabetes (T1D), little is known about the influence of family and parental factors on this outcome. This study aimed to explore whether family cohesion and children’s HRQOL were connected through three indicators of parental psychological adjustment (parenting stress, depressive symptoms, and anxious symptoms) as well as whether these links varied according to the child’s age. Levels of family cohesion, parenting stress, and depression/anxiety symptoms of parents of children with T1D and parents of healthy children were compared. The sample included 88 child–parent dyads composed of children/adolescents (8–18 years old) with T1D and one of their parents and 121 dyads composed of healthy children/adolescents and one of their parents. The parents completed self-report measures of family cohesion, parenting stress, and emotional adjustment, and the children completed measures of HRQOL. Testing of the hypothesized moderated mediational model showed that higher HRQOL ratings in children were associated with higher levels of cohesion through lower levels of parental stress, regardless of the child’s age. Parents of children with T1D perceived less cohesion and felt more anxiety and stress about parenting tasks compared to parents of healthy children. Our findings suggest that parents of children with T1D are at an increased risk of psychological maladjustment. Moreover, this study highlights the interrelation between family/parental functioning and child adjustment and makes an innovative contribution by identifying a mechanism that may account for the link between family and child variables.     

A Family Therapeutic Approach to Transgenerational Traumatization

The phenomenon of transgenerational traumatization has currently become widely recognized and described, although the task of disentangling the underlying interactional mechanisms remains a difficult one. These transgenerational mechanisms were first detected in families of the survivors of the Holocaust, but they may be equally prominent in families of parents who have been traumatized in other ways, for example, as victims of child neglect and abuse, as orphaned children, or during military service. In cases in which parents have themselves been subjected to early parental deprivation, one or more children may become projectively identified with a parent's (posttraumatic) "bad child"-self, whereas the parent him/herself has identified with — enacts the role of — the idealized internal "martyr" parent. A case study is presented describing the individual and family therapeutic treatment of a woman who, as a child, had been traumatically separated from her parents.     

Childhood Overweight and Obesity: Maternal and Family Factors

Treatment programs for childhood overweight and obesity have highlighted the importance of the family in treatment. Considering this, it is surprising that few studies have examined the role of family factors in the development of childhood overweight and obesity. The objective of this study was to examine which family and maternal factors predict increases in weight in boys and girls during middle to late childhood. This study used longitudinal data from the childhood growth and development (GAD) Study. The GAD Study involved 286 healthy weight, overweight and obese children, aged 6–13 years at baseline, who completed baseline, 1-year follow-up and 2-year follow-up assessments. Overweight/obese children were recruited from clinical and community settings. A broad range of maternal and family factors were assessed. Linear mixed models were used to identify which factors predicted child Body Mass Index (BMI) z-scores over time. For community-based children, maternal BMI and single-parent family structure were significant longitudinal predictors of child BMI z-scores. For the clinical participants, low family income was the only significant multivariate predictor of child BMI z-scores. The strong association between child BMI, maternal BMI and family structure confirms the need to target prevention and intervention efforts for childhood overweight and obesity towards families with overweight parents, particularly single-parent families.     

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.     

The Quality of Home Environment in Brazil: An Ecological Model

Based on Bronfenbrenner's (1999) ecological perspective, a longitudinal, prospective model of individual differences in the quality of home environment (Home Observation for Measurement of the Environment—HOME) was tested in a sample of 179 Brazilian children and their families. Perinatal measures of family socioeconomic status (SES) and child birth weight had direct effects on HOME at preschool age. As either family SES or child birth weight increased, HOME also increased through diminished emotional distress in the mother a month following childbirth. SES had a negative effect on number of children in the household, which in turn had a long-term negative impact on HOME. Compared to mothers who had reported not to plan their pregnancy, those who did were more likely to have fewer children, to report more spouse support during childbearing, and to show less emotional distress a month after childbirth, all of which also influenced HOME at preschool age. These findings are discussed in light of the broader socio-ecological Brazilian context, with direct implications to clinical practice aimed at improving the quality of home environment.