TREATING CHRONIC FOOD REFUSAL IN YOUNG CHILDREN: HOME-BASED PARENT TRAINING

We evaluated the effects of a behavioral parent training program on parent and child feeding-related behaviors in the home. We trained mothers to initiate regular offerings of previously rejected (target) foods and to provide contingent attention (i.e., specific prompts, positive reinforcement) to increase their child's acceptance of nonpreferred foods. For 1 subject, we also directed training at increasing self-eating. Results of a nonconcurrent multiple baseline design across 3 mother-child dyads demonstrated that, with training, all mothers increased offerings of target foods and use of specific prompts, and 2 mothers increased levels of positive attention. In turn, children increased their acceptance of target foods and self-eating, thus demonstrating the functional effects of parent training on in-home mealtimes. Temporary increases in food refusals occurred when treatment was initiated but declined as treatment continued. We discuss the results in terms of the potential benefits and limitations of a home-based treatment model.     

A laboratory model for evaluating relapse of undesirable caregiver behavior

The success of behavioral treatments like functional communication training depends on their continued implementation outside of the clinical context, where failures in caregiver treatment adherence can lead to the relapse of destructive behavior. In the present study, we developed a laboratory model for evaluating the relapse of undesirable caregiver behavior that simulates two common sources of disruption (i.e., changes in context and in treatment efficacy) believed to affect caregiver treatment adherence using simulated confederate destructive behavior. In Phase 1, the caregiver's delivery of reinforcers for destructive behavior terminated confederate destructive behavior in a home‐like context. In Phase 2, the caregiver implemented functional communication training in a clinical context in which providing reinforcers for destructive or alternative behavior terminated confederate destructive behavior. In Phase 3, the caregiver returned to the home‐like context, and caregiver behavior produced no effect on confederate destructive or alternative behavior, simulating an inconsolable child. Undesirable caregiver behavior relapsed in three of four treatment‐adherence challenges.     

Parental Guidance and Children's Executive Function: Working Memory and Planning as Moderators During Joint Problem‐Solving

Cognitive aspects of children's executive function (EF) were examined as moderators of the effectiveness of parental guidance on children's learning. Thirty‐two 5‐year‐old children and their parents were observed during joint problem‐solving. Forms of guidance geared towards cognitive assistance were coded as directive or elaborative, and children's responses were recorded. Children were then assessed on an independent version of the same task. A parent‐rated composite of working memory and planning was used as a measure of EF. Directive guidance by parents was associated with more child errors during the joint activity, whereas elaborative guidance was associated with better performance. Parent‐rated EF moderated the relation, such that the relation between elaborative guidance and better performance was only significant for children with low EF. During the independent task, EF again moderated the relation between parent guidance and children's performance, such that children with low EF did worse when parents had provided more directive guidance; for children with high EF, directive guidance was associated with better independent performance. These findings suggest that the extent to which children's performance relates to different forms of parents' guidance varies, and elaborative assistance may be more helpful for children with low EF. Copyright © 2016 John Wiley & Sons, Ltd.     

A comparison of methods for assessing child compliance during behavioral parent training

The purpose of the present study was to compare four methods of computing child compliance to parental instructions. Four noncompliant boys, ages 2.5 to 7 years, participated with their mothers in behavioral parent training. In order to evaluate the training, observers recorded the boys' compliance responses in continuous 10-sec intervals. The boys' rates of compliant responding were then computed by considering behavior (A) only in the first interval following the instruction, (B) in the first three intervals following the instruction, (C) in all intervals while the instruction was ongoing, and (D) only in the final interval of the instructional trial. The findings indicated that the first three methods were correlated strongly with each other, although there were occasional differences in the levels of compliance indicated by these three methods. The implications of the findings and the merits of each of the four methods are discussed.     

Cumulative parenting stress across the preschool period: relations to maternal parenting and child behaviour at age 5

Despite increasing interest in the effects of parenting stress on children and families, many questions remain regarding the nature of parenting stress and the mechanism through which stress exerts its influence across time. In this study, cumulative parenting stress was assessed across the preschool period in a sample of 125 typically developing children and their mothers. Indices of parenting stress included both major life events stress‐assessed annually from age 3 to 5, and parenting daily hassles assessed every 6 months across the same period. Naturalistic home observations were conducted when children were age 5, during which measures of parent and child interactive behaviour as well as dyadic pleasure and dyadic conflict were obtained. Mothers also completed the CBCL to assess children's behaviour problems. Results indicated that parenting daily hassles and major life stress are relatively stable across the preschool period. Both cumulative stress indices also proved to be important predictors of parent and child behaviour and dyadic interaction, although the predictions were somewhat differential. Despite meaningful relations between the stress factors and child well being, no evidence was found to support the premise that parent behaviour mediates the association between parenting stress and child outcomes. Results are discussed within a developmental framework to understand the stability and complexity of cumulative stress associations to early parent–child relationships. Copyright © 2005 John Wiley & Sons, Ltd.     

Families of Children With Attention-Deficit/Hyperactivity Disorder: Review and Recommendations for Future Research

This review integrates and critically evaluates what is known about family characteristics associated with childhood Attention-Deficit/Hyperactivity Disorder (ADHD). Evidence suggests that the presence of ADHD in children is associated to varying degrees with disturbances in family and marital functioning, disrupted parent–child relationships, specific patterns of parental cognitions about child behavior and reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology, particularly when ADHD is comorbid with conduct problems. However, the review reveals that little is known about the developmental mechanisms that underlie these associations, or the pathways through which child and family characteristics transact to exert their influences over time. In addition, the influence of factors such as gender, culture, and ADHD subtype on the association between ADHD and family factors remains largely unknown. We conclude with recommendations regarding the necessity for research that will inform a developmental psychopathology perspective of ADHD.     

Bidirectional influences in mother–toddler dyads: an examination of the relative influence of mothers' and children's behaviours

This study examined bidirectional relationship between mothers' lax and overreactive discipline and children's misbehaviour and negative effect. We examined the moment‐to‐moment stability of mothers' and children's behaviours (actor effects) and mothers' and children's influence on their partners' subsequent behaviours (partner effects). Participants were 71 mothers and their 24‐ to 48‐month‐old children observed during a 30‐min interaction. Both children and mothers exhibited stability in their own behaviours and influenced the subsequent behaviours of their partners. Additionally, a comparison of partner effects indicated that overreactive discipline more strongly predicted child's negative effect than child's negative effect predicted overreactive discipline. In contrast, although a child's negative effect predicted lax discipline, lax discipline did not predict subsequent child's negative effect. Copyright © 2010 John Wiley & Sons, Ltd.     

Early impact of the BEST intervention for parents stressed by adolescent substance abuse

Youth involvement in substance abuse can be a source of considerable distress for their parents. Unilateral family interventions have been advocated as one means by which concerned family members can be supported to assist substance‐abusing family members. To date there has been little research examining the impact of unilateral family interventions on the directly participating family members. In this study the early impact of an 8‐week parent‐group programme known as Behavioural Exchange Systems Training (BEST) was evaluated using a quasi‐experimental, waiting list control design. The professionally led programme had been developed to support and assist parents in their efforts to cope with adolescent substance abuse. Subjects were 66 parents (48 families) accepted for entry into the programme between 1997 and 1998. Comparison was made between 46 parents offered immediate entry into the programme and 20 parents whose entry to the programme was delayed by an 8‐week waiting list. At the first assessment 87% of parents showed elevated mental health symptoms on the General Health Questionnaire. Evidence suggested exposure to the intervention had a positive impact on parents. Compared to parents on the waiting list, parents entered immediately into the intervention demonstrated greater reductions in mental health symptoms, increased parental satisfaction, and increased use of assertive parenting behaviours. Copyright © 2001 John Wiley & Sons, Ltd.     

Young children's television viewing and the quality of their interactions with parents: A prospective community study

Television is one of the most commonly viewed forms of media by children throughout the world. Excessive television viewing can influence the quality of children's relationships and interactions with their parents. We examined the emotional availability (EA ) of children toward their parents by assessing child responsiveness and child involvement , using a cross‐sectional and longitudinal design. We employed a large and representative community sample of Norwegian 4‐year‐olds (n = 995) who were followed up at 6 years old (n = 795). The results illustrate that, when viewing excessive amounts of television, children are less likely to be involved with their parents in ordinary toy‐play. We argue in favor of the displacement hypothesis, stating that time‐demanding technologies are negatively related to the quality of parent–child relationships because spending more time watching television will leave less time for developing nurturing social relationships.     

Responsiveness in Interactions of Mothers and Sons with ADHD: Relations to Maternal and Child Characteristics

We observed mother–child interactions, at baseline, in 136 families of 7–10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.     

Parent–Child Interaction Therapy and Chronic Illness: A Case Study

We examined the outcome of parent–child interaction therapy (PCIT) for a child diagnosed with Oppositional Defiant Disorder (ODD) and cancer. Robert, a 4-year-old Caucasian male, showed significant and meaningful changes in his behavior over the course of 13 weeks of PCIT, and Robert no longer met diagnostic criteria for ODD following treatment. His scores on the Eyberg Child Behavior Inventory and the Achenbach Child Behavior Checklist were in the clinical range before treatment and in the normal range at the conclusion of treatment. His mother also reported dramatic improvements in Robert's behavior during medical visits. Physician and social worker reports were consistent with her report. Such anecdotal data may have implications for the generalization of compliance to the medical setting for children with chronic illnesses. The results of this case study should prompt further investigation of parent-training interventions for children with chronic illnesses and disruptive behavior.     

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

There have been impressive, recent advances in the development of efficacious treatments for child and adolescent behavior problems. However, specific methods for delivering these treatments in a way that amplifies their efficacy have not been well articulated. Although many factors may be involved, attendance and adherence to treatment are arguably the most basic necessities for effective treatment delivery. We provide a conceptual and empirical review of past research on attendance and adherence to child and adolescent therapy, with a special focus on the importance of parents/guardians in managing treatment participation. Our review demonstrates that attendance and adherence are associated with a range of significant methodological, clinical, and financial outcomes. Several pretreatment predictors of attendance and adherence have been identified; however, to date only 12 controlled, clinical trials have evaluated strategies for enhancing attendance and adherence to child therapy. We conclude with an agenda for advancing research on the prediction and enhancement of attendance and adherence to child therapy as a means of improving the efficiency and effectiveness of child treatments.     

Psychosocial Impact of Predictive Testing for Illness on Children and Families: Challenges for a New Millennium

Predictive testing for adult- and child-onset diseases is becoming widely available. The identification of individuals prone to develop certain illnesses is often medically advantageous in that it may afford opportunities to engage in risk reduction behaviors to detect or delay disease onset. However, sometimes the knowledge gained from these tests can be ambiguous, generate distress, and potentially affect several generations of family members. Overall, these factors create a challenging set of circumstances for persons considering genetic and other forms of predictive testing, particularly parents and children. In this article, we (1) address conceptual issues involved in determining the impact of predictive testing on child and family well-being, (2) review empirical data on this topic, and (3) provide a case example to illustrate these findings. Recommendations are made for additional psychological research on child- and family-focused outcomes associated with participation in testing, highlighting their clinical implications.     

Objective and subjective assessments of parenting in hyperactive preschoolers

Objective: To evaluate whether the mother–child interactions of hyperactive preschool children and their typically developing peers differentially vary as a function of situational demands, and whether groupwise differences exist with respect to disciplinary practices and family lifestyles (e.g. level of parental investment, strategies for responding to child‐initiated provocation). Methods: Parenting practices were assessed via videotaped parent–child interactions and self‐report methods in mother–child dyads of 21 hyperactive preschoolers and 48 age‐matched control dyads. Results: Hyperactive preschoolers were significantly more non‐compliant during parent–child interactions. Mothers of hyperactive preschoolers exhibited more negative behaviour and less encouragement with heightened situational demands. Although few significant differences were reported regarding disciplinary practices, parents of hyperactive preschoolers reported greater levels of anger and child rearing difficulty, and perceived their children as more bothersome. Conclusions: Parents of hyperactive preschoolers may profit from interventions that are sensitive to the impact of situational changes on their behaviour and which address possible attributional biases regarding the source of parent–child discord. Copyright © 2006 John Wiley & Sons, Ltd.     

The problem of parental nonadherence in clinical behavior analysis: effective treatment is not enough

Applied behavior analysts have developed many effective interventions for common childhood problems and have repeatedly demonstrated that childhood behavior responds to properly managed contingencies. The success of these interventions is dependent upon their basic effectiveness, as demonstrated in the literature, their precise delivery by the clinician to the parent, and adherence to or consistent implementation of the intervention. Unfortunately, arranging the consistent implementation of effective parenting strategies is a significant challenge for behavior analysts who work in homes, schools, and outpatient or primary care clinics. Much has been done to address issues of adherence or implementation in the clinic, but relatively little has been done to increase our understanding of the contingencies that affect parental adherence beyond the supervised clinic environment. An analysis of the contingencies that strengthen or weaken adherence might suggest strategies to improve implementation outside the clinic setting. What follows is an analysis of the variables associated with adherence by parents to recommendations designed to solve common childhood problems.     

Mother-child relationships of children with ADHD: the role of maternal depressive symptoms and depression-related distortions

We investigated the DepressionDistortion hypothesis by examining the effects of maternal depressive symptoms on cross-informant discrepancies in reports of child behavior problems and several measures of parent–child relationship. The sample included ninety-six 6 to 10-year-old children diagnosed with ADHD-Combined Type, and their mothers, who provided baseline data before participating in a randomized clinical trial. Measures incorporated child characteristics, self-reports of maternal depressive symptoms, parenting practices, and laboratory mother–child interactions. Elevations in maternal depressive symptoms were associated with maternal reports of negative parenting style but not with observed laboratory interactions. Mothers' levels of depressive symptoms predicted negative biases in their reports of their child's ADHD symptoms, general behavior problems, and their own negative parenting style. Whereas levels of depressive symptoms did not predict observed parenting behaviors, maternal distortions did predict problematic parent–child interactions. Exploratory analyses showed a marginally significant mediation effect of the relationship between maternal depressive symptomatology and reports of negative parenting by depressive distortions. We discuss implications of linkages between depressive symptoms in mothers, depression-related distortions, and mother–child relationships for research and intervention in developmental psychopathology.     

Sequenced neurocognitive and behavioral parent training for the treatment of ADHD in school-age children

The present study examines the potential of sequencing a neurocognitive intervention with behavioral parent training (BPT) to improve executive functions (EFs), psychiatric symptoms, and multiple indices of functional impairment in school-age children aged 7 to 11 years who have been diagnosed with attention-deficit/hyperactivity disorder (ADHD). Specifically, in a randomized controlled trial design, 85 children were assigned to either Cogmed Working Memory Training (CWMT) followed by an empirically supported, manualized BPT intervention, or to a placebo version of CWMT followed by the same BPT intervention. Working memory maintenance (i.e., attention control/short-term memory), working memory processing and manipulation, ADHD and oppositional defiant disorder (ODD) symptoms, impairment in parent–child dynamics, familial impairment, and overall functional compromise were evaluated as outcomes. The results suggest specific effects of the combined CWMT and BPT program on verbal and nonverbal working memory storage and nonverbal working memory processing and manipulation but no incremental benefits in regard to ADHD symptoms, ODD symptoms, and functional outcomes. The present findings do not support the hypothesis regarding the complementary and augmentative benefits of sequenced neurocognitive and BPT interventions for the treatment of ADHD. These results, the study’s limitations, and future directions for research are further discussed.     

Construction and maintenance of parent–child relationships: Bidirectional contributions from the perspective of parents

The purpose of the present study was to investigate parents' perspectives of parent and child contributions to the construction and maintenance of the parent–child relationship. Twenty‐four mothers and fathers, with a child between 4‐ to 7‐years‐old, completed an open‐ended interview in which they described their parent–child relationship and commented on how they and their child strengthen, damage, and repair the relationship. Findings indicated that parents described their parent–child relationship with relatively similar emphasis on elements of authority, companionship, and intimacy. Parents reported that they were most likely to strengthen the parent–child relationship by interacting with their child in the companionship domain, whereas their overuse of power or authority and non‐responsiveness temporarily created damage in the relationship. Parents reported that their children were most likely to strengthen the relationship by complying with parent requests and engaging in companionate interactions, whereas not complying or challenging parent directives created relational tension. Parents indicated that both they and their children were most likely to repair interactional errors by restoring intimacy (e.g. apology, communication, or affection). Results are discussed from a framework of multiple relationship domains consisting of the interplay of vertical and horizontal dimensions of power. Copyright © 2004 John Wiley & Sons, Ltd.