Predicting Treatment Success in Child and Parent Therapy Among Families in Poverty

Behavior problems are prevalent in young children and those living in poverty are at increased risk for stable, high-intensity behavioral problems. Research has demonstrated that participation in child and parent therapy (CPT) programs significantly reduces problematic child behaviors while increasing positive behaviors. However, CPT programs, particularly those implemented with low-income populations, frequently report high rates of attrition (over 50%). Parental attributional style has shown some promise as a contributing factor to treatment attendance and termination in previous research. The authors examined if parental attributional style could predict treatment success in a CPT program, specifically targeting low-income urban children with behavior problems. A hierarchical logistic regression was used with a sample of 425 families to assess if parent- and child-referent attributions variables predicted treatment success over and above demographic variables and symptom severity. Parent-referent attributions, child-referent attributions, and child symptom severity were found to be significant predictors of treatment success. Results indicated that caregivers who viewed themselves as a contributing factor for their child's behavior problems were significantly more likely to demonstrate treatment success. Alternatively, caregivers who viewed their child as more responsible for their own behavior problems were less likely to demonstrate treatment success. Additionally, more severe behavior problems were also predictive of treatment success. Clinical and research implications of these results are discussed.     

Parent Beliefs about Treatment Credibility and Effectiveness: Assessment and Relation to Subsequent Treatment Participation

We assessed parents’ beliefs about treatment credibility and effectiveness and examined the influence of these beliefs on subsequent treatment participation. Seventy-six parents completed the Credibility/Expectancies Questionnaire—Parent Version (CEQ-P), and subsequently participated in treatment for their child's clinically referred conduct problems. The key findings were that: (a) the CEQ-P is composed of two components that measure parents’ treatment credibility and expectancies; (b) the total scale and each component are internally consistent and have strong test-retest reliability; (c) scores on the CEQ-P are significantly associated with scores on a measure of parent motivation for treatment, supporting the construct validity of this measure; and (d) scores on the CEQ-P at the first clinic visit significantly predict subsequent adherence to treatment procedures above and beyond demographic variables and parent motivation for treatment. This study provides an efficient and psychometrically sound measure of parent beliefs about treatment and demonstrates the importance of such beliefs for subsequent treatment adherence.     

Therapist, Parent, and Youth Perspectives of Treatment Barriers to Family-Focused Community Outpatient Mental Health Services

This exploratory qualitative study describes treatment barriers to receiving family-focused child mental health services for youths with disruptive behavior problems from multiple perspectives. Data were collected during a series of focus groups and interviews, including: 4 therapist focus groups (n = 26), 3 parent focus groups (n = 14), and 10 youth (10–13 years) semi-structured interviews. Data analysis followed inductive, iterative processes typical of qualitative research using an editing style and thematic content analysis approach. Therapist, parent, and youth stakeholder participants discussed perceived barriers to effective treatment, the problems with current child outpatient therapy, and desired changes (i.e., policy, intervention, etc.) to improve mental health services. Results indicate similar themes around treatment barriers and dissatisfaction with services within and across multiple stakeholder groups, including inadequate service system support, lack of family involvement and feeling overwhelmed with the complexities of families’ needs; however, parents and therapists, in particular, identified different contributing factors to these barriers. Therapists highly endorse using family-focused therapy and desire parent participation; however, parents feel unsupported by their child’s therapist. Parents’ report feeling blamed and not heard by service providers which negatively impacts their attitude about service delivery, causing discomfort and resistance to participation in their youth’s treatment. Youth also discussed dissatisfaction with mental health services, specifically related to their direct experiences in therapy, and desired more active, directive family-focused approaches. Overall, stakeholders reported much frustration and dissatisfaction with current community-based outpatient child therapy services. Study findings can inform service provision, intervention development, and future research.     

The Efficacy of Child Parent Relationship Therapy for Adoptive Families: A Replication Study

This randomized controlled replication study examined the effectiveness of child parent relationship therapy (CPRT) with 49 adoptive families. Statistically significant improvement and large treatment effects for child behavior problems, parent–child relationship stress, and parents' empathic interactions with their children indicated the effectiveness of CPRT over treatment as usual. Findings confirm Carnes‐Holt and Bratton's ( 2014 ) results and provide strong support for CPRT as a responsive intervention for adoptive families.     

Parent Motivation to Participate in Treatment: Assessment and Prediction of Subsequent Participation

Treatment motivation is required for virtually all psychosocial treatments because clients must participate actively in the treatment process. In child and family treatments, it is the parent who must be motivated to manage treatment participation; however, no measures are currently available for evaluating parent motivation for treatment. The authors developed and evaluated a brief rating scale, the Parent Motivation Inventory (PMI), to measure parent motivation to participate in treatment. Results supported a uni-dimensional measure with strong internal consistency and test-retest reliability. Increases in parent motivation predicted the perception of fewer barriers to treatment participation, which was significantly associated with greater treatment attendance. The PMI provides a reliable and valid method of assessing parents’ motivation to participate in treatment and has implications for the prediction and potential modification of barriers to treatment and treatment participation.     

Parent Participation Within Community Center or In-Home Outreach Delivery Models of the Early Risers Conduct Problems Prevention Program

A variety of predictors of parent participation in prevention programming have been identified in past research, but few studies have investigated how those predictors may vary by implementation context. Patterns of parent participation were examined in the Early Risers Conduct Problems Prevention Program using two family-focused service delivery models: a community center model (Center) and an in-home outreach-based model (Outreach). An ethnically diverse sample of Kindergarten through second grade students (n = 246) displaying elevated levels of aggression were recruited for the study and randomly assigned to either the Center (n = 121) or Outreach (n = 125) models. In both delivery models, participants and their families completed an assortment of baseline measures and received family skills and child skills intervention components and family- and school-based case management. Parents in the Center model demonstrated greater overall participation in family-focused components of the intervention. Parent motivation with parent-focused expectancies for the intervention represented the strongest predictor of parent participation across both delivery models. Family income differentially predicted parent participation across the two models, with low income predicting greater participation in the Center model and lower participation in the Outreach model. A qualitative finding emerged showing that parents receiving parent skills in the Center model via groups preferred to learn skills related to facilitating overall family relationships, whereas parents receiving parent skills via individual Outreach meetings preferred to improve a child’s behavior and emotion skills. Implications are discussed for the design of prevention programming in order to maximize parent participation in high risk populations.     

Interpretation of Ambiguity in Children: A Prospective Study of Associations With Anxiety and Parental Interpretations

Interpretation of ambiguity is consistently associated with anxiety in children, however, the temporal relationship between interpretation and anxiety remains unclear as do the developmental origins of interpretative biases. This study set out to test a model of the development of interpretative biases in a prospective study of 110 children aged 5–9 years of age. Children and their parents were assessed three times, annually, on measures of anxiety and interpretation of ambiguous scenarios (including, for parents, both their own interpretations and their expectations regarding their child). Three models were constructed to assess associations between parent and child anxiety and threat and distress cognitions and expectancies. The three models were all a reasonable fit of the data, and supported conclusions that: (i) children’s threat and distress cognitions were stable over time and were significantly associated with anxiety, (ii) parents’ threat and distress cognitions and expectancies significantly predicted child threat cognitions at some time points, and (iii) parental anxiety significantly predicted parents cognitions, which predicted parental expectancies at some time points. Parental expectancies were also significantly predicted by child cognitions. The findings varied depending on assessment time point and whether threat or distress cognitions were being considered. The findings support the notion that child and parent cognitive processes, in particular parental expectations, may be a useful target in the treatment or prevention of anxiety disorders in children.     

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.     

The Archaic Personality Structure of Alcoholics and Its Implications for Group Therapy

The purpose of this investigation was to obtain a better understanding of the nature of expectations about group psychotherapy, given a consistent body of research pointing to the relationship between specific treatment expectancies and premature termination. The Group Therapy Survey was developed and utilized to assess the predominant beliefs, attitudes, and expectations of 206 clinical and nonclinical subjects toward group therapy. The results of the investigation reflected three major categories of expectations: (1) Group therapy is unpredictable, (2) group therapy is not as effective as individual therapy, and (3) group therapy can be detrimental to participants. Possible explanations for the origin and development of such expectations are entertained, including the publicizing of the more radical aspects of the encounter group movement and other negative portrayals of group therapy in the media and the film industry. Recommendations are offered concerning the use of the survey prior to intake or a pregroup orientation interview in order to tailor a discussion to the prospective client's personality, expectations, and problems.     

Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples

This study investigated the psychometric properties of a newly developed 20-item instrument that assesses one's anticipation of being able to change anxiety: the Anxiety Change Expectancy Scale (ACES). Study 1 evaluated the ACES in undergraduate university students, self-identified as experiencing difficulties with anxiety. Study 2 examined the ACES in a community sample of persons with anxiety difficulties. Study 3 tested the utility of the ACES in predicting treatment change in a group of individuals with generalized anxiety disorder participating in group cognitive behavioral therapy for anxiety. Across these samples, the ACES demonstrated excellent internal reliability (coefficient alphas=.89–.92) as well as good convergent, divergent, and factorial validity. The ACES was also significantly predictive of treatment-related changes in somatic anxiety symptoms and worry. The results of these studies provide strong support for the ACES as a reliable and valid measure of expectancies for changing anxiety.     

The Efficacy of Child Parent Relationship Therapy for Adopted Children With Attachment Disruptions

This pilot study examined the effectiveness of child parent relationship therapy (CPRT; Landreth & Bratton, 2006 ) with 61 adoptive families. Statistically significant findings and large treatment effects on all measures indicated the effectiveness of CPRT over the wait‐list control condition on reducing child behavior problems and increasing parental empathy. The results provide preliminary support for CPRT as a responsive intervention for adoptive families with children presenting with attachment difficulties.     

Effects of parent and child characteristics on participation and outcome of an individualized booster parent intervention for children with externalizing behaviour

In this study, we examined whether a booster parent training, offered after a cognitive behavioural child intervention, is effective in reduction of aggressive behaviour and changes in parenting. A second aim was to identify parent and child characteristics that influence parental participation. Children (73% boys, 40% immigrants, mean age = 10.1 (.53)) were randomly assigned to the child (n = 97 children) or child and parent intervention (n = 94 children) condition. Results of both intention-to-treat and completers only analyses indicated no extra effects of the parent intervention for the total group. Parents who participated (47%) did not differ from non-participants in demographic characteristics. However, mother's perceived level of child's aggression at the end of the child intervention was of significant meaning for the decision to participate in the parent intervention. Participation seemed to interrupt the development of more aggressive behaviour and less appropriate parenting skills for those children in highest need and resulted in increased maternal involvement.     

Emotionally Based Expectancies and Willingness To Use Aversive Therapy

Intellectually based expectancies are beliefs about the world that are subjectively perceived as true. Emotionally based expectancies are beliefs that have an "as if" quality to them. The two types of expectancies derive from different sources and are influenced by different variables. This study examined the relationship between these two types of expectancies and willingness to use aversive therapy. Forty-seven undergraduate subjects were first given a brief lecture on childhood autism and the treatment of self-injurious behavior by aversive therapy. Afterwards, they indicated on a brief questionnaire their intellectually and emotionally based expectancies about how effective aversive therapy would be. Finally, they indicated their willingness to use aversive therapy themselves with autistic children. The partial correlation of emotionally based expectancies with stated intentions was .48, that of intellectually based expectancies with stated intentions was .10. As predicted, the emotionally based expectancy correlation was significantly higher.     

Keeping an “I” on PRIDE: Measuring Imitation in Parent-Child Interaction Therapy

In parent–child interaction therapy (PCIT), therapists encourage parents to imitate child behaviors in order to convey approval of the child’s actions and promote the development of linguistic and social–cognitive skills. However, the Dyadic Parent-Child Interaction Coding System (DPICS-IV), used to measure skills taught during PCIT, does not include guidelines for coding parent–child imitation, making it difficult to determine how PCIT affects it. The current study addresses this problem by developing guidelines for coding imitation, which were then used to code DPICS-IV segments from 58 Mexican American families that participated in a past clinical trial. Results suggest that these coding guidelines can be used to reliably measure parent and child imitation. A series of additional analyses supported the construct validity of the codes. Specifically, there was a trend for parent imitation, but not child imitation, to increase more from pre–post treatment in PCIT relative to treatment as usual. In addition, parents who imitate their children were found to have children who imitate them more in return. Finally, improvement in parent imitation, but not child imitation, was significantly related to a decrease in child behavior problems. Further study is needed to determine the optimal frequency of imitation, and findings suggest that additional attention to coaching imitation may be warranted.     

Total number of MMPI-2 clinical scale elevations predicts premature termination after controlling for intake symptom severity and personality disorder diagnosis

Premature termination of therapy by patients is a common phenomenon that can be deleterious to treatment outcome for patients and also negatively affect therapists, treatment centers, and research programs. Therefore, a method of identifying patients at risk for premature termination could have widespread benefits. This study investigated whether patients’ MMPI-2 profiles, including clinical scale elevations and Negative Treatment Indicator (TRT) scores, could predict premature termination in an outpatient sample, controlling for personality disorder diagnosis and symptom severity at intake. Results indicated that while TRT scores were not incrementally predictive of premature termination, the total number of clinical scale elevations was significantly incrementally predictive of dropout. Clinical implications are discussed.     

Child-Related Interparental Conflict in Infancy Predicts Child Cognitive Functioning in a Nationally Representative Sample

While associations between exposure to marital conflict and child development have been documented extensively in middle childhood and adolescence, few studies have examined the developmental consequences of conflict exposure in infancy. Moreover, those that have examined marital conflict in infancy tended to focus on consequences of conflict exposure on infants’ attachment security, and various aspects of infants’ physiological and emotion regulation. Virtually nothing is known about the longitudinal links between exposure to interparental conflict in infancy and later cognitive development. Using longitudinal data on a subsample of infants (N = 6,019) and their parents who participated in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B), this study examined links between the frequency of interparental conflict at 9 months and child cognitive development 15 months later. Combining data from parent interviews, birth certificates, in-home assessments of child cognitive development, and videotaped parent–child interactions, results showed significant negative associations between the frequency of child-related interparental conflict at 9 months of age and child cognitive ability at 24 months. The negative association reflects a direct effect that was not mediated by parental support or child attachment security measured at 24 months. Associations were calculated while considering children’s prior cognitive functioning (at 9 months), and a wide range of child, parent and household characteristics.     

What happened in kindergarten? Mother-child conversations about life story chapters

ABSTRACT

Research indicates that adults form life story chapters, representations of extended time periods that include people, places and activities. Life chapter memories are distinct from episodic memories and have implications for behaviour, self and mental health, yet little is known about their development during childhood. Two exploratory studies examined parent–child conversations about life chapters. In Study 1, mothers recorded naturalistic conversations with their 5–6 year old children about two chapters in the child’s life. In Study 2, mothers recorded conversations with their 6–7 year old children about a particular life chapter—the child’s kindergarten year—and also about a specific episode of their choice. The results indicated that young children are able to recall and discuss information about life chapters and that parents actively scaffold children’s discussion of general information in chapters as well as specific events. Mothers’ conversational style when discussing chapters (e.g., elaborativeness) predicted children’s memory contributions, and was also positively correlated with their style when discussing specific events. The results suggest new avenues for research on the ontogeny of life chapters, the factors that shape them, and their role in development.     

Parent–Child Informant Discrepancy is Associated with Poorer Treatment Outcome

In child clinical psychology, parent and child reports are typically used to make treatment decisions and determine the effectiveness of treatment. However, there are often moderate to large discrepancies between parent and child reports, and these discrepancies may reflect meaningful information about the parent, the child, and the parent–child relationship. Additionally, parent–child discrepancy may predict treatment outcome. This study examined parent–child discrepancy in a sample of 62 children (10.15±1.26 years old) with prominent social competence deficits and mixed diagnoses who were treated with a resilience-based, cognitive–behavioral group therapy program (the Resilience Builder Program) in a private clinical setting. Further analyses were conducted to investigate whether parent–child discrepancy related to treatment outcome. Consistent with the literature, prominent parent–child discrepancy was found across domains, with parents generally reporting more severe symptomatology. Treatment with the Resilience Builder Program resulted in significant improvement in parent report of multiple domains of functioning, including resilience, social skills, and emotion and behavior regulation. Importantly, larger parent–child discrepancy at the start of therapy was predictive of poorer overall treatment response. Given its impact on therapeutic effectiveness, these results suggest that parent–child disagreement regarding the child’s impairment at the onset of therapy is worthy of assessment prior to treatment, and may itself be a topic worthy of targeting in treatment.     

Countertransference,enactment and sexual abuse

This paper examines the development of a therapeutic relationship with a sexually abused latency girl who, in the course of her two years of four times weekly psychotherapy, was placed in two different foster-homes. It is argued that the child's re-enactment of the abuse in the consulting room allowed her to move from a seductive relationship with the therapist to one characterized by basic trust. This was paralleled by her development of a capacity to think and to tolerate affect states. The use of an imaginary twin by the child and the use of powerful countertransference feelings in the therapist are seen as the main therapeutic tools in the treatment. The premature termination of the treatment – due to the therapist's departure – enabled the child to articulate for the first time her feelings, in the transference, about the trauma and the traumatizing agent. The child's progressing moves in the therapy are also presented.     

Alcohol and Sex Offending: What Do Child Sex Offenders Think About Drinking?

The relationship between general and sex-specific alcohol expectancies and drinking before offending was examined in a sample of child sex offenders. Regression analyses revealed that sex-specific expectancies were the single best predictor of the proportion of times the offenders reported drinking before offending, even when the offenders' (preincarceration) customary drinking behaviors were accounted for. These results highlight the importance of assessing expectancies related to particular social domains. Implications for offender treatment and relapse prevention are discussed.