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

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

Parent Training for Children With or at Risk for Developmental Delay: The Role of Parental Homework Completion

This study investigated the extent to which parental homework completion during behavioral parent training (BPT) for children with or at risk for developmental delay contributed to parenting and child outcomes. Parents of 48 children (M_age = 44.17 months, SD = 14.29; 73% male; 72% White) with developmental delay (IQ < 75) or at risk for developmental delay (due to premature birth) with co-occurring clinically elevated externalizing behavior problems received Parent-Child Interaction Therapy (PCIT) as part of two previously completed randomized controlled trials. Parental homework completion was measured using parental report of home practice of treatment skills collected weekly by therapists. Parents also reported on child externalizing behavior problems and levels of parenting stress, while parenting skills were observed during a 5-min child directed play and child compliance was observed during a 5-min cleanup situation. Results indicated that higher rates of parental homework completion predicted parenting outcomes (i.e., increased positive parenting skills and decreased levels of parenting stress) and child outcomes (i.e., lower levels of externalizing behavior problems). Additionally, although limited by temporal precedence, there was an indirect effect of reductions in parenting stress on the negative association between parental homework completion and child externalizing behavior problems. These findings highlight the importance of parents practicing skills learned during BPT for optimizing treatment outcome. Parenting stress was also identified as a potential mechanism by which high levels of parental homework completion contributed to reductions in child externalizing behavior problems.     

Does Practice Make Perfect? The Relationship Between Self-Reported Treatment Homework Completion and Parental Skill Acquisition and Child Behaviors

The purpose of the current study was to examine whether the rate and type of parent-reported homework completion is associated with parent-report of child behavior outcomes, number of sessions to master parental skills as measured by therapist observation, and length of treatment in Parent–child Interaction Therapy (PCIT). Sixty-two parent–child dyads (primary caregiver: M_age = 36.35 years, female 95.20%, 81.60% White, 59.57% Hispanic; child M_age = 4.22 years; child gender male 64.50%) who completed PCIT were included in the study. A within-subjects hierarchical regression statistical design was used to examine the impact of parent report of homework completion on treatment processes and outcomes. A higher rate of self-reported homework completion was predictive of parental mastery of skill acquisition in fewer sessions and treatment completion in fewer sessions. Parent report of homework completion rate was not related to changes in child disruptive behavior after controlling for child behavior at baseline. Current study findings reinforce the importance of having parents regularly practice PCIT skills outside of session in order to decrease treatment length and facilitate the acquisition of parenting skills, which may reduce family burdens associated with attending a weekly treatment.     

Psychometric Properties of the Parent Cognition Scale in a Clinical Sample of Parents of Children With Disruptive Behavior

The Parent Cognition Scale (PCS; Snarr, Slep, & Grande, 2009) is a self-report measure of parental attributions of child behavior that has demonstrated validity in community samples. However, its psychometric properties have not been examined in a clinical sample of parents of children with disruptive behavior. Examining the psychometric properties of the PCS in this population is important given research linking parent attribution with childhood disruptive behavior. The present study aimed to: (a) examine the psychometric properties of the PCS in a sample of parents whose children were clinic-referred for disruptive behavior problems; and (b) investigate the concurrent validity of the PCS and its factors using correlations with parent reports of children’s emotional and behavioral difficulties, and parenting skills (i.e., discipline, supervision). A confirmatory factor analysis was run on 225 parents’ responses on the PCS, and revealed that a two-factor structure of the PCS fit the data well. Significant correlations were found between Parent Causal Attributions (Factor 1) and parent-reported parenting difficulties. Child Responsible Attributions (Factor 2) were correlated with elevations in children’s emotion, attention, and conduct difficulties. The results provide information on the utility of the PCS for parents of children with disruptive behavior and its potential clinical relevance.     

Improving Parental Competencies: Subjectively Perceived Usefulness of a Parent Training Matters

As parental competencies are of importance for the development of children, these competencies are often fostered in parent training programs. Research suggests that a lack of fit between training contents and parental perceptions and expectations might result in a lower effectiveness of a parent training. Consequently, parents’ subjective perceptions of trainings should be in the focus of research on the effects of parent trainings. The present study evaluated the effectiveness of a parent training (MonteBaRo-Training) and analyzed pre-post-test changes. Parents who participated in the program (N = 117) and a waiting list control group (N = 88) were surveyed about children’s behavior problems, parenting sense of competence and dysfunctional parenting at two measurement occasions. Results indicated that the training was effective in improving parenting sense of competence, the perceptions of child problem behavior and dysfunctional parenting. Subjectively perceived usefulness of the training was associated with a change in children’s behavior problems and the parenting sense of competence after the completion of the course.     

Effects of PMTO in Foster Families with Children with Behavior Problems: A Randomized Controlled Trial

The present randomized controlled trial examined the effectiveness of Parent Management Training Oregon for foster parents with foster children (aged 4–12) with severe externalizing behavior problems in long-term foster care arrangements. Foster children’s behavior problems are challenging for foster parents and increase the risk of placement breakdown. There is little evidence for the effectiveness of established interventions to improve child and parent functioning in foster families. The goal of Parent Management Training Oregon, a relatively long and intensive (6–9 months, with weekly sessions) parent management training, is to reduce children’s problem behavior through improvement of parenting practices. We specifically investigated whether Parent Management Training Oregon is effective to reduce foster parenting stress. A significant effect of Parent Management Training Oregon, compared to Care as Usual was expected on reduced parenting stress improved parenting practices, and on reduced child behavior problems. Multi-informant (foster mothers, foster fathers, and teachers) data were used from 86 foster families (46 Parent Management Training Oregon, 40 Care as Usual) using a pre-posttest design. Multilevel analyses based on the intention to treat principle (retention rate 73?%) showed that Parent Management Training Oregon, compared to Care as Usual, reduced general levels of parenting stress as well as child related stress and parent-related stress (small to medium effect sizes). The clinical significance of this effect was, however, limited. Compared to a decrease in the Care as Usual group, Parent Management Training Oregon helped foster mothers to maintain parental warmth (small effect size). There were no other effects of Parent Management Training Oregon on self-reported parenting behaviors. Child behavior problems were reduced in both conditions, indicating no additive effects of Parent Management Training Oregon to Care as Usual on child functioning. The potential implication of reduced foster parenting stress for placement stability is discussed.     

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.     

A Community Mental Health Implementation of Parent–Child Interaction Therapy (PCIT)

Parent–Child Interaction Therapy (PCIT) has been identified as an evidence-based practice in the treatment of externalizing behavior among preschool-aged youth. Although considerable research has established its efficacy, little is known about the effectiveness of PCIT when delivered in a community mental health setting with underserved youth. The current pilot study investigated an implementation of PCIT with primarily low-socioeconomic status, urban, ethnic minority youth and families. The families of 14 clinically referred children aged 2–7 years and demonstrating externalizing behavior completed PCIT initial assessment, and 12 began treatment. Using standard PCIT completion criteria, 4 families completed treatment; and these families demonstrated clinically significant change on observational and self-report measures of parent behavior, parenting stress, and child functioning. Although treatment dropouts demonstrated more attenuated changes, observational data and parent-reported problems across sessions indicated some improvements with lower doses of intervention. Attendance and adherence data, referral source, barriers to treatment participation, and treatment satisfaction across completers and dropouts are discussed to highlight differences between the current sample and prior PCIT research. The findings suggest that PCIT can be delivered successfully in an underserved community sample when families remain in treatment, but that premature dropout limits treatment effectiveness. The findings suggest potential directions for research to improve uptake of PCIT in a community service setting.     

Community-delivered infant–parent psychotherapy improves maternal sensitive caregiving: Evaluation of the Michigan model of infant mental health home visiting

The current study evaluated the effectiveness of a home-based psychotherapeutic Infant Mental Health Home Visiting (IMH-HV) intervention for enhancing parenting sensitivity; a secondary aim was to evaluate whether the use of video feedback was associated with greater treatment response. Participants were N = 78 mothers and their children (age at entry ranged from prebirth to 24-month old (M = 9.8, SD = 8.4), who were initiating IMH-HV services with community mental health-based therapists (N = 51). Dyads were assessed during extended home visits via standardized interviews and observational and questionnaire methods within the first month of treatment (baseline), and again 6 and 12 months thereafter. Following each of these extended home visits, study evaluators completed a standard Q-sort to capture observations of maternal sensitivity during the visit. Therapists completed fidelity checklists used to derive the total number of IMH-HV sessions received (i.e., dosage) and frequency with which therapists provided video feedback. Results indicated a dose–response relationship between number of sessions and maternal sensitivity, and that video review with parents independently contributed to improved maternal sensitivity. Discussion focuses on the effectiveness of this community-based psychotherapeutic home visiting model for enhancing parenting, as well as the value of video feedback as a specific therapeutic strategy.     

Sudden gains as a long-term predictor of treatment improvement among children in community mental health organizations

ObjectiveSudden gains have been described as rapid, sizeable changes observed between treatment sessions and have been associated with improved treatment outcome in adults. The current study examined weekly sudden gains among children seeking treatment in the community mental health setting.MethodParticipants were 161 children (age M = 10.58, SD = 1.73; 69.6% male; 47.8% Caucasian) and their parents who were randomized to one of three treatment modalities and were administered weekly and quarterly assessments throughout treatment.ResultsWhen idiographic (youth- and parent-identified “top problems”) and nomothetic measures (standardized checklists) were used to calculate sudden gains (i.e., gain must be large: in absolute terms, relative to prior session, and relative to changes in prior and subsequent sessions), 20–42% of participants experienced at least one sudden gain during treatment. Most sudden gains occurred early in treatment, and session content of relaxation was associated with sudden gain presence. Using a modified Bonferonni correction, sudden gains predicted overall symptom levels at final assessment (i.e., last assessment obtained following post-treatment) even after controlling for pre-treatment symptom levels and magnitude of the overall gain from pre- to post-treatment.ConclusionsSuddenness of gains may have a direct effect on long-term treatment outcome among children in the community.     

Promoting Optimal Parenting and Children’s Mental Health: A Preliminary Evaluation of the How-to Parenting Program

Parenting quality is widely accepted as a primary predictor of children’s mental health. The present study examined the effectiveness of a parenting program in fostering optimal parenting and child mental health. The selected program was How to talk so kids will listen & listen so kids will talk (How-to Parenting Program). This program was selected because its content corresponds closely to what the parenting style literature suggests is optimal parenting (i.e., includes structure, affiliation and autonomy support). Eleven groups of six to twelve parents were conducted in 7 local grade schools. The program, offered by two trained leaders, consisted of eight weekly sessions and taught a total of 30 skills. A total of 82 parents completed questionnaires both prior to and after the program. Participants’ children between eight and 12 years old (N = 44) completed questionnaires at school, at both assessment points. Repeated measures ANOVAs using parent reports indicated that structure, affiliation and autonomy support were increased after the program, compared to baseline. The level of child internalizing and externalizing problems also decreased significantly. Importantly, children reports confirmed that parental autonomy support increased from pre to post-test and child-reported well-being improved as well. The preliminary evidence from this pre-test versus post-test repeated measures design suggests that the How-to Parenting Program is effective in improving parenting style and in promoting children’s mental health and that future evaluation research examining the potential of this program is warranted.     

Parent influences on early childhood internalizing difficulties

Children's internalizing problems are a concerning mental health issue, due to significant prevalence and continuity over time. This study tested a multivariate model predicting young children's internalizing behaviors from parenting practices, parents' anxiety–depression and family stressors. A community sample of 2 year old children (N = 112) was followed longitudinally to 4 years. Parents completed questionnaires and playroom observations provided independent measures of parenting and child variables. Predictors of early childhood internalizing difficulties were over-involved/protective parenting, low warm-engaged parenting, and parental anxiety–depression. Family life-stress and parental anxiety–depression also predicted problematic parenting practices. These findings were discussed within the context of the design of early childhood parenting programs to prevent anxiety and depression in children.     

Child Adjustment and Parent Efficacy Scale: Development and Initial Validation of a Parent Report Measure

This study examined the psychometric characteristics of the Child Adjustment and Parent Efficacy Scale (CAPES). The CAPES was designed as a brief outcome measure in the evaluation of both public health and individual or group parenting interventions. The scale consists of a 30‐item intensity scale with two subscales measuring children's behaviour problems and emotional maladjustment and a 20‐item self‐efficacy scale that measures parent's self‐efficacy in managing specific child problem behaviours. A sample of 347 parents of 2–12‐year‐old children participated in the study. Psychometric evaluation of the CAPES revealed that both the intensity and self‐efficacy scales had good internal consistency, as well as satisfactory convergent and discriminant validity. Potential uses of the measure and implications for future validation studies are discussed.     

Behavioral Parent Training:

Parents of 42 conduct disordered children were randomly allocated to either contingency management training, communication skills training or a waiting list control condition. The two treatments were conducted with the problem child either present or absent during sessions. Assessment devices included the Behavior Problem Checklist, Becker Adjective Checklist, Parent Attitude Survey, Piers-Harris Self-Concept Scale, and Daily observations made by parents. In comparison to waiting list controls, significant treatment effects were found on the Behavior Problem Checklist and on one attitude subscale (Understanding). More subjects in the contingency management condition met a criterion of clinical success than in the other conditions. No differential effect was associated with the conduct of treatment under conditions where the child was either present of absent form the sessions.     

Randomized Controlled Trial of a Family Intervention for Children Bullied by Peers

This study examined the effects of a family intervention on victimization and emotional distress of children bullied by peers. The intervention, Resilience Triple P, combined facilitative parenting and teaching children social and emotional skills relevant to developing strong peer relationships and addressing problems with peers. Facilitative parenting is parenting that supports the development of children’s peer relationship skills. A randomized controlled trial was conducted with 111 families who reported chronic bullying of children aged 6 to 12 years. Families were randomly allocated to either an immediate start to Resilience Triple P (RTP) or an assessment control (AC) condition. Assessments involving children, parents, teachers, and observational measures were conducted at 0 (pre), 3 (post) and 9 months follow-up. RTP families had significantly greater improvements than AC families on measures of victimization, child distress, child peer and family relationships, including teacher reports of overt victimization (d = 0.56), child internalizing feelings (d = 0.59), depressive symptoms (d = 0.56), child overt aggression towards peers (d = 0.51), acceptance by same sex and opposite sex peers (d = 0.46/ 0.60), and child liking school (d = 0.65). Families in both conditions showed significant improvements on most variables over time including child reports of bullying in the last week reducing to a near zero and indistinguishable from the normative sample. The intervention combining facilitative parenting and social and emotional skills training for children produced better results than the comparison assessment control condition. This study demonstrated that family interventions can reduce victimization and distress and strengthen school efforts to address bullying.     

Testing a Military Family Stress Model

The current study examines a military family stress model, evaluating associations between deployment‐related stressors (i.e., deployment length/number, posttraumatic stress disorder [PTSD] symptoms) and parent, child, parenting, and dyadic adjustment among families in which a parent had previously deployed to Iraq or Afghanistan in the recent conflicts. Married families (N = 293) with at least one child between the ages of 4 and 12 were recruited from a Midwestern state. Service members were from the Reserve Component (National Guard or Reserves); fathers (N = 253) and/or mothers had deployed (N = 45) to the recent conflicts in the Middle East. Multiple‐method (observations of parenting and couple interactions; questionnaires) and multiple informant measures were gathered online and in the homes of participants, from parents, children, and teachers. Findings demonstrated associations between mothers’ and fathers’ PTSD symptoms and a latent variable of child adjustment comprising teacher, parent, and child report. Mothers’ but not fathers’ PTSD symptoms were also associated with dyadic adjustment and parenting practices; parenting practices were in turn associated with child adjustment. The results are discussed in terms of their implications for military family stress research and interventions to support and strengthen parents and families after deployment.     

Parental Overprotection,Perceived Child Vulnerability,and Parenting Stress: A Cross-Illness Comparison

The current study sought to investigate differences in parenting capacity variables across four disease groups. Parents (N = 425), the majority of whom were mothers, of children with either cancer, asthma, Type 1 diabetes, or cystic fibrosis, completed measures of parental overprotection, perceived child vulnerability, and parenting stress. After controlling for significant demographic variables, parents of children with cystic fibrosis and asthma reported higher perceived child vulnerability than parents of children with either diabetes or cancer, while parents of children with asthma and diabetes reported higher parenting stress than parents of children with cancer or cystic fibrosis. No differences between disease groups were found for parental overprotection. The current study provides support for an illness-specific approach to understanding parenting capacity variables in the context of childhood chronic illnesses.     

The long-term effectiveness of the International Child Development Programme (ICDP) implemented as a community-wide parenting programme

Short-term effectiveness of the International Child Development Programme (ICDP) for parents in the general population has been studied. The aim of this paper was to investigate the longer term impact of the ICDP programme on parents looking for sustained changes 6–12 months after the programme. For this, a non-clinical caregiver group attending the ICDP programme (N = 79) and a non-attending comparison group (N = 62) completed questionnaires on parenting, psychosocial functioning, and child difficulties before, on completion and 6–12 months after the ICDP programme. Analyses compare changes in scores over time. The results revealed that the ICDP group showed significantly improved scores on parenting measures, less loneliness, and trends towards improved self-efficacy compared to the comparison group 6–12 months after programme completion. The ICDP group also reported that their children spent significantly less time on television and computer games and a trend towards fewer child difficulties. Key positive effects sustained over time but at a somewhat lower level, supporting community-wide implementation of ICDP as a general parenting programme. It is concluded that more intensive training with follow-up sessions should be considered to sustain and boost initial gains.     

Improving the Emotional Adjustment and Communication Patterns of Incarcerated Mothers: Effectiveness of a Prison Parenting Intervention

Incarcerated mothers at a state prison participated in an eight-session parenting class designed to help them manage the stress of separation from children and to improve communication patterns with children and home-caregivers. In comparison to a waitlist control group (n = 46), inmates who received immediate intervention (n = 60) experienced less parenting distress regarding upcoming visitation experiences; however, waitlist and immediate treatment groups did not differ on other intervention measures. Additional analyses contrasted pre- and post-intervention differences on adjustment measures for inmates from either treatment condition who completed the parenting program (N = 90). After intervention, mothers reported reduced parenting stress, improved alliance with home caregivers, increased letter-writing, and reduction of mental distress symptoms. Large drop-out rates in both subgroups may have reduced the benefits of the random assignment used to form groups. Results support the value of interventions for incarcerated mothers that focus on ways to manage the emotional distress and poor communication patterns associated with being a parent in prison.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.