The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Multimethod Psychoeducational Intervention for Preschool Children with Disruptive Behavior: Two-Year Post-Treatment Follow-up

This paper describes the 2-year post-treatment follow-up of preschool children identified as having high levels of disruptive behavior at kindergarten entry. They were assigned to four treatment conditions: A no-treatment group, parent-training only, treatment classroom only, and the combination of parent training with the treatment classroom. Interventions lasted the entire kindergarten academic year. Initial post-treatment results reported previously indicated no effects for the parent-training program but some efficacy for the classroom intervention program. For this report, the disruptive behavior (DB) children were subdivided into those who did (n = 74) and did not (n = 77) receive the treatment classroom. Two-year post-treatment follow-up results indicated no differences between the classroom treated and untreated DB groups. These groups also failed to differ in the percentage of children using available treatments across the follow-up period. The DB children in both groups had significantly more symptoms of ADHD and ODD than a community control group (N = 47) at follow-up. They also received higher ratings of externalizing problems on the parent Child Behavior Checklist, more severe ratings of behavior problems at home, and ratings of more pervasive behavior problems at school, and had poorer academic skills. Results suggested that early intervention classrooms for DB children may not produce enduring effects once treatment is withdrawn, and that better approaches are needed for identifying those DB children at greatest risk for later maladjustment.     

Treatment Effectiveness of a Brief Behavioral Intervention for Preschool Disruptive Behavior

Parent management training is an evidence-based treatment for disruptive behavior. However, the number of treatment sessions can be high, contributing to high attrition rates. The purpose of this study was to examine post-treatment, 6-month, and 1-year treatment outcomes of the Brief Behavioral Intervention. One hundred twenty children aged 2–6.5 years demonstrating clinically significant disruptive behavior were referred to an outpatient clinic for treatment and participated in the study. Attrition was below reported rates in the literature. Significant decreases in child disruptive behavior and parent stress were found from pre-to-post intervention, and improvements were maintained at follow-ups. Significant pre-to-post intervention teacher reported decreases in behavior were reported.     

Brief Behavioral Intervention for Young Children with Disruptive Behaviors

Parent reported behavioral difficulties in young children are relatively common. Without adequate intervention, some children will later present with more severe problem behaviors. Parent management training is one of the best methods of treatment for behavior problems; however, existing treatments can be lengthy and difficult to conduct outside of a research setting. The Brief Behavioral Intervention was designed as a briefer version of a manualized parent management training treatment package. Thirty-one parents of children aged 2–6.5 presenting with behavior problems were included in this initial study of treatment effectiveness. Based on parent and teacher report, treatment was effective in a mean of 7.2 sessions.     

Parents Plus Systemic,Solution‐Focused Parent Training Programs: Description,Review of the Evidence Base,and Meta‐Analysis

Parents Plus (PP) programs are systemic, solution‐focused, group‐based interventions. They are designed for delivery in clinical and community settings as treatment programs for families with child‐focused problems, such as behavioral difficulties, disruptive behavior disorders, and emotional disorders in young people with and without developmental disabilities. PP programs have been developed for families of preschoolers, preadolescent children, and teenagers, as well as for separated or divorced families. Seventeen evaluation studies involving over 1,000 families have shown that PP programs have a significant impact on child behavior problems, goal attainment, and parental satisfaction and stress. The effect size of 0.57 (p < .001) from a meta‐analysis of 10 controlled studies for child behavior problems compares favorably with those of meta‐analyses of other well‐established parent training programs with large evidence bases. In controlled studies, PP programs yielded significant (p < .001) effect sizes for goal attainment (d = 1.51), parental satisfaction (d = 0.78), and parental stress reduction (d = 0.54). PP programs may be facilitated by trained front‐line mental health and educational professionals.     

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.     

Systematic Review and Meta‐analysis of Stepping Stones Triple P for Parents of Children with Disabilities

The aim of this systematic review and meta‐analysis was to examine the effectiveness of Stepping Stones Triple P (SSTP) parent training programs on child behavior problems and parenting outcomes in families of children with developmental disabilities. Sixteen suitable studies including data from over 900 families were identified in a search for English language published and unpublished controlled outcome studies. SSTP has five levels on a graded continuum of increasing intensity targeting families with differing degrees of treatment need from low intensity media‐based parenting information campaigns at level 1, through brief interventions at levels 2 and 3, to more intensive parent training and family therapy interventions at levels 4 and 5. Analyses were conducted on the combination of all levels of SSTP and separately for each level. For combined levels, significant overall effect sizes were found for parent‐reported child problems (d = 0.46), researcher observed child behavior (d = 0.51), parenting style (d = 0.70), parenting satisfaction/self‐efficacy (d = 0.44), parental adjustment (d = 0.27), and coparental relationship (d = 0.26), but not researcher‐observed parent behavior. Strong support was found for level 4 SSTP as an effective intervention for improving child and parent outcomes in families of children with disabilities who have clinically significant problems. Less intensive SSTP interventions for cases with circumscribed difficulties yielded fewer significant treatment effects, and there were relatively few studies of such interventions.     

Preventative Behavioral Parent Training: A Preliminary Investigation of Strategies for Preventing At-Risk Children From Developing Later Conduct Problems

Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Unfortunately, a cogent approach to the identification of risk factors and prevention of chronic conduct problem display has not been developed. This project was an initial longitudinal assessment examining the merits of preventative behavioral parent training as a primary prevention strategy for at-risk children. Results demonstrated that prevention participants were engaging in normative rates of disruptive behaviors at 6-month follow-up, whereas comparison children showed a behavioral decline over time.     

Therapist Focus on Parent Involvement in Community-Based Youth Psychotherapy

Parent involvement in the treatment of childhood disruptive behavior problems is a critical component of effective care. Yet little is known about the amount of time therapists are involving parents in treatment and factors that predict therapists' efforts to involve parents in routine care. The purpose of this study is to examine therapists' within-session involvement of parents in community-based outpatient mental health treatment. The data are from a larger longitudinal observational study of psychotherapy for children ages 4-13 with disruptive behavior problems and include videotaped psychotherapy sessions coded for the therapeutic strategies delivered as well as measures of child, parent/family, and therapist characteristics at baseline. Parent involvement is defined as the proportion of time in the session that therapists direct treatment strategies towards parents. Results indicated that therapists directed treatment strategies towards parents an average of 44% of the time within a session. Multilevel modeling was used to examine client-level (child, parent, and family functioning) and provider-level (therapist experience and background) predictors of parent involvement. Therapists involved parents more when the child had higher levels of behavior problems, when the parent reported higher levels of internalized caregiver strain, and when the therapist was more experienced. The results highlight potential areas to target in efforts to increase parent involvement, including training less experienced therapists to increase their focus on directing strategies towards parents.     

Effects of parent enhancement therapy on the treatment outcome and generalization of a parent training program

The purpose of the present study was to examine the effectiveness of parent enhancement training in facilitating treatment and maintenance effects of a parent training program. Seventeen mothers and their clinic-referred noncompliant children were assigned to either a parent training alone group or a parent training plus parent enhancement therapy group. Fifteen mothers and their nonclinic children served as a quasi-control group. All clinic-referred mother-child dyads were treated individually by teaching the mother to reward compliance and other prosocial behavior and to use time-out for noncompliance. In addition, mothers in the parent training plus parent enhancement group also received treatment related to the following areas: parent's perception of their child's behavior, parent's personal adjustment, parent's marital adjustment, and parent's extrafamilial relationships. Assessment consisted of four home observations by independent observers prior to treatment, after treatment, and at a 2-month follow-up. The data indicated that the parent training plus parent enhancement therapy was more effective than parent training alone in changing child deviant behavior at posttreatment and in maintaining child compliance, child deviant behavior, parental rewards and parent contingent attention at follow-up. The control group did not change over the three assessment periods.     

Teaching self-control to reduce overt food stealing by children with autism and developmental disorders

Food stealing is often a serious behavioral problem among children with diagnoses of autism and other developmental disorders. Very few empirical studies concerning this behavioral challenge have been reported. We applied a correspondence training procedure to teach self-control as replacement behavior to four children with autism and developmental disorders who displayed food stealing in the community. A changing criterion design embedded within a nonconcurrent multiple-probe across participants design was used. The treatment succeeded for all four participants by increasing latency to eating highly preferred food to a predetermined criterion and reducing occurrences of food stealing to zero. Three participants generalized the replacement behavior to natural settings and maintained the behavior for 2 weeks, 1 month, 2 months, 3 months, and 4 months. One participant without expressive language was taught successfully during treatment trials but failed to maintain and generalize the behavior. A functional relation between delaying food eating and Say-Do correspondence training was demonstrated.     

The Relationship Between Child Behavior and Acceptability of Contingency Management Procedures

Relationships between maternal ratings of treatment acceptability and three predictor variables, change in child noncompliance during treatment, disruptive child behavior associated with treatment procedures, and severity of child behavior problems, were examined in the context of a brief parent training program. Stepwise multiple regression analysis indicated that amount of disruptive behavior and change in child noncompliance were significant predictors of treatment acceptability, with those treatments which produced less disruptive behavior and greater reductions in noncompliance being rated as more acceptable. The combination of these two variables accounted for nearly 40% of the variance in acceptability ratings. These results are discussed in relation to previous findings with treatment analogues.     

DISTRACTION: ITS UTILIZATION AND EFFICACY WITH CHILDREN UNDERGOING DENTAL TREATMENT

We investigated the utilization and efficacy of distraction in reducing the anxious and disruptive behavior of 4 children undergoing dental treatment. During the distraction procedure, the children were shown a poster and told a story about it during dental treatment. They earned a prize if they attended to the poster and story and could correctly answer questions about them following each intervention visit. The children's disruptive behavior was assessed via direct observation, and results were analyzed within a multiple baseline design. The children exhibited high levels of anxious and disruptive behavior across baseline visits, regardless of the length of time in treatment or number of visits. Anxious and disruptive behavior decreased upon introduction of the intervention for all children. This was accompanied by the children meeting the criterion for correct answers on the distraction quiz. However, 2 of the children demonstrated an increase in their anxious and disruptive behavior across intervention visits. Results are discussed in terms of the need to evaluate treatment strategies that promote maintenance as well as initial changes.     

Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis

Disruptive behavior disorders are prevalent in youth, yet most children with disruptive behavior do not have access to timely, effective treatment. Distance-delivered service (e.g., via telephone, Internet) can overcome several barriers to care. This study tested the effectiveness of a 12-week parent training program, Strongest Families? Parenting the Active Child, delivered via written material, skill-based videos, and telephone coaching sessions, as compared to usual care in reducing child externalizing behavior. Participants were 172 primary caregivers of a 6- to 12-year-old (29% girls; M age?=?8.5 years) recruited from community children’s mental health clinics. Participants were randomized to either Strongest Families? or usual care and completed measures of child externalizing behavior, parenting practices, parent distress, and intervention services consumed at baseline and 5-, 10-, 16-, and 22-months post-baseline. Growth curve analysis showed significant reductions in externalizing behavior in both conditions over time. Improvements were significantly greater at 10 months in the Strongest Families? condition (d =?0.43). At 22 months, however, the differences were not significant and small in magnitude (d =??0.05). The intervention decreased inconsistent discipline significantly more than usual care. Parents in both conditions showed significant reductions in distress. We also conducted a cost-effectiveness analysis to assess the value for money of the Strongest Families? program versus usual care. Distance parent training is a promising way to increase access to, and reduce costs associated with, mental health care for families with a child with disruptive behavior.     

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.     

Assessing Parental Response Patterns in the Treatment of Noncompliance in Children

Child noncompliance is one of the most frequently reported behavior problems in clinic-referred children. One difficulty with treating noncompliance in the clinic is that the demand characteristics of the situation may alter the rates of child compliance. The observation of parent-child interactions, with an emphasis on parent behaviors, may be a more meaningful way to assess parent training programs. In the current study, the parents of three children each showed a distinctive pattern in their responding to their children's compliant and noncompliant behaviors. An in vivo direct instruction procedure, that involved the therapist working directly with the parent to provide immediate consequences was used. Following training, improvements in correct responding were evident for al parents. Particularly noteworthy was that child compliance was not an accurate indicator when assessing parents' initial skill levels.     

Interactions Between Maternal Parenting and Children’s Early Disruptive Behavior: Bidirectional Associations across the Transition from Preschool to School Entry

This study was a prospective 2-year longitudinal investigation of associations between negative maternal parenting and disruptive child behavior across the preschool to school transition. Our main goals were to 1) determine the direction of association between early maternal negativity and child disruptive behaviors across this important developmental transition and 2) examine whether there would be different patterns of associations for boys and girls. Participants were 235 children (111 girls; T1; M = 37.7 months, T2; M = 63.4 months) and their mothers and teachers. Observational and multi-informant ratings of child disruptive behavior showed differential patterns of stability and associations with measures of parenting risk. Results indicated bidirectional and interactive contributions of externalizing behavior and negative parenting across time. Results also indicated that risk mechanisms operate similarly for both sexes. Findings support transactional models of disruptive child behavior that highlight the joint contributions of parents and children.     

Parent Reports and Laboratory Assessments of Child Temperament: A Comparison of Their Associations With Risk for Depression and Externalizing Disorders

Parent reports and laboratory assessments of child temperament traits were compared in terms of their associations with 2 indices of risk for future maladjustment: maternal history of depression and disruptive school behavior. A community sample of 99 pre-school-aged children completed a standardized battery of laboratory tasks designed to tap positive emotionality (PE) and anger. Parent reports of child temperament were collected, and maternal history of depression was assessed using structured clinical interviews. An average of 18.5 months after the initial laboratory assessment, teacher reports of disruptive school behavior were collected. Structural equation models were used to test the association between the 2 assessment approaches of child temperament and maternal history of depression and disruptive school behavior. Laboratory measures and parent reports of anger were equally good at predicting disruptive school behavior, while laboratory measures of PE showed stronger associations with maternal history of depression than parent report.     

Common mechanisms of executive attention underlie executive function and effortful control in children

Executive Function (EF) and Effortful Control (EC) have traditionally been viewed as distinct constructs related to cognition and temperament during development. More recently, EF and EC have been implicated in top‐down self‐regulation ‐ the goal‐directed control of cognition, emotion, and behavior. We propose that executive attention, a limited‐capacity attentional resource subserving goal‐directed cognition and behavior, is the common cognitive mechanism underlying the self‐regulatory capacities captured by EF and EC. We addressed three related questions: (a) Do behavioral ratings of EF and EC represent the same self‐regulation construct? (b) Is this self‐regulation construct explained by a common executive attention factor as measured by performance on cognitive tasks? and (c) Does the executive attention factor explain additional variance in attention deficit hyperactivity disorder (ADHD) problems to behavioral ratings of self‐regulation? Measures of performance on complex span, general intelligence, and response inhibition tasks were obtained from 136 preadolescent children (M = 11 years, 10 months, SD = 8 months), along with self‐ and parent‐reported EC, and parent‐reported EF, and ADHD problems. Results from structural equation modeling demonstrated that behavioral ratings of EF and EC measured the same self‐regulation construct. Cognitive tasks measured a common executive attention factor that significantly explained 30% of the variance in behavioral ratings of self‐regulation. Executive attention failed to significantly explain additional variance in ADHD problems beyond that explained by behavioral ratings of self‐regulation. These findings raise questions about the utility of task‐based cognitive measures in research and clinical assessment of self‐regulation and psychopathology in developmental samples.     

The Balancing Act—Ethical Issues in Parent Training Research: Confidentiality,Harm Reduction,and Methodology

Attention and disruptive behavior disorders present considerable challenges for children and their parents. These challenges have led to the development of parenting programs; however, there is a paucity of literature that discusses the ethical dilemmas parent training researchers face. This article reviews ethical principles and professional standards relevant to parent training research and provides case material to illustrate the challenge of balancing ethical adherence and empirical rigor using three ethical issues that commonly arise in parent training research. In particular, this article focuses on ethical issues surrounding confidentiality in a group setting, use of control groups, and limiting changes in medication/treatment status outside of the treatment protocol.