A Review of: “Fairburn,C. G. (2008). Cognitive Behavior Therapy and Eating Disorders.”

Successful reports of behavioral treatment of encopresis describe interventions as unpleasant as the disorder: hospitalization, laxatives, prompted toileting, aversive consequences. The focus on soiling rather than on the constant constipation that precedes encopresis, on the reduction of soiling rather than on the acquisition of effective toilet use. Five normal chronically constipated children (four of whom were encopretic) were treated at home with combinations of: preparatory instructions, rewards for clean pants, reward for appropriate toileting (bowel movement in toilet). Once soiling was eliminated and appropriate bowel movements occured regularly, all families were taught to fade treatment contingencies. To determine the contribution of the toileting reward to treatment effectiveness, this reward was added to the other two treatment components in a multiple baseline across four cases; it provided a significant ingredient in short-term success. A fifth child achieved short-term success with only the instructions and the clean pants reward. Long-term results (11-20 months) revealed that the fifth child, who never received the toileting reward, was the only one who relapsed.     

Home-School Communication in the Treatment of Childhood Behavior Problems

There is a shortage of intervention strategies for children with behavior disorders which incorporate both home and school influences. To address this need, a service delivery model was evaluated for public school children (Pre-K through G2) who were at risk for educational failure on account of behavior problems, family dysfunction, and poverty and social disadvantage. Interventions based on eco-behavioral principles were delivered by home-visitors in consultation with clinical child psychologists. A primary goal of all treatment plans was to enhance parent-teacher communication. Children in the experimental group (N = 34) showed overall improvement (as judged by parents) and decreases in targeted problems (as reported by teachers and parents), relative to control students (N = 15). The program decreased the number of children placed in special education. There was indication that better communication between home and school related to academic improvement. The protocol provides a possible behavioral consultation model of early intervention for behavior disorders and demonstrates how clinical services can be integrated with systems-wide dropout prevention efforts.     

Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD,Predominantly Inattentive Presentation

We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.     

The Use of Acceptance and Commitment Therapy to Promote Mental Health and School Engagement in University Students: A Multisite Randomized Controlled Trial

The aim of this multisite randomized controlled trial was to determine whether an intervention based on Acceptance and Commitment Therapy (ACT) was efficacious in improving university students’ psychological flexibility, mental health, and school engagement. Students were recruited in four Canadian universities and randomly assigned to an intervention (n = 72) or a wait-list control group (n = 72). Students in the intervention group took part in four 2.5-hour workshops during a 4-week period and were asked to do exercises at home (e.g., meditation, observation grids). Wait-list students received the intervention soon after the post measurements. MANCOVAs and ANCOVAs revealed that students in the intervention group showed greater psychological flexibility at postintervention than those in the control group. They also reported greater well-being and school engagement, and lower stress, anxiety, and depression symptoms. Taken together, results of this study suggest that an ACT-based intervention offers a valuable way to promote mental health and school engagement in postsecondary settings.     

The systematic use of positive and negative consequences in managing classroom encopresis

An 11-year-old male with a history of chronic encopresis was successfully treated by his teachers. Through the contingent application of a combination of positive (i.e., social reinforcers, token reinforcers, activity reinforcers) and negative consequences (i.e., required to wash himself and denied access to activity reinforcers), the subject's soiling behavior was reduced from an 80% daily occurrence level during Baseline to just two occasions during the final five-month treatment phase. A six-month follow-up conducted during the next school year revealed no incidences of soiling. The investigation utilized and ABACD type behavior modification design.     

Preventing conduct problems, promoting social competence: a parent and teacher training partnership in head start

Studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the "highest risk" at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.     

Reducing stereotypic behavior through discrimination training,differential reinforcement of other behavior,and self‐monitoring

The effect of a treatment package designed to reduce stereotypic body rocking was examined in a child diagnosed with autism. After baseline, the participant was taught to discriminate between inappropriate (e.g. sitting in a chair and rocking) and appropriate (e.g. sitting in a chair without rocking) behavior. During intervention, both a therapist and the participant himself monitored the occurrence of rocking behavior. A non‐resetting 5 min differential reinforcement of other behavior (DRO) schedule was also introduced. A multiple baseline across behaviors (sitting and standing) design was used to evaluate the effects of the intervention package. The results indicated that the intervention was effective in eliminating body rocking. In addition, the DRO schedule was successfully increased to 20 min for sitting and 17 min for standing and the treatment was successfully introduced at the child's school. Copyright © 2001 John Wiley & Sons, Ltd.     

Predictors and Trajectories of Response to the Homework,Organization, and Planning Skills (HOPS) Intervention for Adolescents With ADHD

The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; M_age = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students’ acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills postintervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.     

PRIMARY ENCOPRESIS: EVALUATION AND TREATMENT

Cathartic and behavioral treatment procedures for eliminating diurnal and nocturnal primary encopresis were investigated using a multiple-baseline design across four children. The dependent and independent variables measured were appropriate bowel movements, soiling accidents, independent toiletings, and cathartic use. Over 177 reliability observations (home visits) were conducted. For two of the children, treatment with cathartics and child-time remedied their soiling accidents and increased their independent toiletings in 8 to 11 weeks. While the cathartics and child-time increased the rate of appropriate bowel movements, they did not eliminate the soiling accidents with the other two children. Independent toiletings for these two children were achieved after 32 to 39 weeks of treatment when punishment procedures (positive practice, time-out, and hourly toilet sits) were incorporated and the suppositories were faded systematically.     

The development of a systemic school-based intervention: Marte Meo and coordination meetings

Antisocial behavior is often persistent, and in addition to causing suffering to children and their families, it also poses considerable costs for society. Children who display externalizing behavior in their early years run a high risk of having severe problems later in life. There is a need for treatment methods that may be used in various settings because these children constitute a group that is hard to reach with conventional treatment methods. In addition, the dropout rate from ordinary treatment is often high. In the present study, a systemic school-based model for early detection and intervention among 4-12-year-old children who displayed externalizing behavior problems was developed and examined in a nonrandomized study in the county of Skaraborg in Sweden. The intervention was collaborative and included a combination of the Marte Meo model and coordination meetings based on systemic theory and practice. Treatment effects in the group who had received the intervention were compared with a group who had received treatment as usual in their ordinary school setting. Assessments were carried out before, and 2 years after, the intervention. For the intervention group (N = 33), there was a significant decrease in the children's reported symptoms in school and in the home. No decrease in externalizing behavior was found in the comparison group (N = 16). There were no dropouts in the intervention group after the intervention had begun. The results are promising; the study demonstrates that it is possible to work effectively with many children who display externalizing behavior problems in a nonclinical setting.     

A multidisciplinary treatment for encopresis in children with developmental disabilities

Achieving continence of one's bowel movements is a key step in development and failure to do so leads to many negative consequences. Treatments for encopresis appearing in the literature have employed behavioral strategies; medications such as suppositories, laxatives, or enemas; and in some studies a combination of these approaches. To date, attempts to extend successful treatments for encopresis in typically developing children to those with developmental disabilities have been limited. The current study included three participants diagnosed with developmental disabilities who had a history of encopresis. None of the participants had a continent bowel movement under baseline conditions. Continent bowel movements increased during treatment that included the addition of suppositories to elicit continent bowel movements. Two participants began having independent continent bowel movements (i.e., without requiring suppositories) and medication was successfully faded out for the remaining participant. Treatment took between 13 and 21 days.     

A Parent-Teen Collaborative Treatment Model for Academically Impaired High School Students With ADHD

The current study pilots a low-intensity behavioral intervention for parents and high school students with ADHD that promotes parent-teen collaboration at home and in session (Supporting Teens’ Academic Needs Daily-Group; STAND-G). Twenty-three high school students with ADHD and their parents were randomly assigned to receive an 8-week behavioral treatment beginning in October, January, or March. Weekly data were collected from students’ online grade books for 37 weeks of the school year to monitor changes in academic functioning through baseline, posttreatment, and follow-up phases. Students who had not yet received the treatment served as a control group for students who completed treatment. Qualitative and quantitative ratings of satisfaction, improvement, and parent implementation of home-based behavioral strategies were collected. Results indicated parent and teen satisfaction with STAND-G, parent compliance with intervention strategies, and a range of parent-rated therapeutic benefits (i.e., organization and time-management skills, academic conscientiousness, parent-teen communication, adolescent autonomy). Findings for the objective grade book data were mixed, with Group 2 (January), but not Group 1 (October), displaying identifiable acute improvements relative to control students. However, both groups evaluated at follow-up displayed meaningful improvements in the percentage of work turned in up to 2 months out of treatment. With these results in mind, we discuss the importance of tailoring interventions to the lives of high school students with ADHD and the future of treatment development and delivery for this often underserved population.     

A longitudinal study of school adjustment in urban,minority adolescents: Effects of a high school transition program

Described an intervention program designed to prepare elementary school (K-8) eighth-grade students for their transition to high school the following year. Participants in the study were 145, predominantly Hispanic, inner-city public school adolescents. The experimental group received an augmented condition, consisting of Education and Peer Support Components. The control group received a minimal condition consisting of only the Education Component. While no group effects were observed, time effects indicated experimental and control students' improved perceptions of school readiness, but deteriorated perceptions of support from both home and school and diminished grade-point averages and attendance. Time effects also revealed variable changes in school perceptions. Findings are discussed in terms of a developmental perspective of the school transition process. Implications for high school transition programming with the target population and directions for future research are also addressed.     

Research to Practice: Implementation of Family School Success for Parents of Children With ADHD

“Family-School Success” (FSS) is an efficacious intervention improving the home and school functioning of children with ADHD in grades 2–6. An extension of this intervention designed for a younger population also showed positive effects for kindergarten and first grade students in a pilot study. Following the completion of these trials, FSS was implemented in a fee-for-service tertiary care ADHD center. The implementation process included adapting the manual and treatment procedures to be feasible outside the structure and support of a federally funded randomized control trial (RCT). The current study examines the process of adapting the treatment protocol and examines the acceptability and effectiveness of the adapted FSS, as well as predictors of family treatment response including parent engagement in treatment (as measured by attendance and homework adherence). A case study illustrates the adaptations to the intervention and its implementation in the clinic-based setting. In line with findings from clinical trials, families reported high satisfaction with the adapted FSS intervention and showed significant improvement in parental self-efficacy, child academic homework performance, and reduction in child impairment. Additionally, as in the initial FSS RCT, parental attendance in the adapted FSS program predicted child attention to academic homework, controlling for parental adherence to between-session homework. Furthermore, controlling for attendance at FSS sessions, parent adherence to between-session homework assignments predicted improvements in parent self-efficacy as well as child’s homework productivity. These results replicate those of the original RCT and confirm that both session attendance and between-session homework completed are important for improvement during the program. Overall, this study provides support for the acceptability and effectiveness of this treatment model and suggests that future work toward dissemination to community-based settings would be worthwhile.     

Parent education home visitation program: adolescent and nonadolescent mother comparison after six months of intervention

This study examined the effect of an intervention over a 6-month period to improve first time mothers knowledge about parenting and safety in the home. The sample included 61 mothers who completed a baseline and follow-up survey. Mothers were first time adolescent (38) and nonadolescent (22) mothers recruited from rural county health departments for participation in a voluntary home visitation intervention program. Four hypotheses were tested that associated home visitation with greater parenting skill and child development knowledge and safety. Adolescent mothers were expected to make greater gains but to lag behind nonadolescent mothers in child development knowledge, parenting skills knowledge, household safety, and use of community resources. The sample included 32% with a high school degree and 12% African American. 83% were in school. 85% lived at or below the US federal poverty level. Parent Educators provided weekly in-home education based on a manual and individualized curriculum. Parenting skills knowledge was measured by the Adolescent-Adult Parenting Inventory (Bavolek, 1984). Home safety was measured by Culp's Home Safety Checklist. Educators recorded use of 13 community services. Analysis of variance revealed that infant knowledge increased to the same level among all mothers regardless of adolescents' lesser knowledge at baseline. Parenting skill knowledge of child roles increased for both ages, but older mothers scored higher. Parenting skill knowledge of alternatives to corporal punishment increased similarly for both ages. No age or interactive effects were related to improvement in safety or use of community services.     

Lessons learned: the effect of prior technology use on Web-based interventions.

This study examined the role of regular prior technology use in treatment response to an online family problem-solving (OFPS) intervention and an Internet resource intervention (IRI) for pediatric traumatic brain injury (TBI). Participants were 150 individuals in 40 families of children with TBI randomly assigned to OFPS intervention or an IRI. All families received free computers and Internet access to TBI resources. OFPS families received Web-based sessions and therapist-guided synchronous videoconferences focusing on problem solving, communication skills, and behavior management. All participants completed measures of depression, anxiety, and computer usage. OFPS participants rated treatment satisfaction, therapeutic alliance, and Web site and technology comfort. With the OFPS intervention, depression and anxiety improved significantly more among technology using parents (n = 14) than nontechnology users (n = 6). Technology users reported increasing comfort with technology over time, and this change was predictive of depression at followup. Satisfaction and ease-of-use ratings did not differ by technology usage. Lack of regular prior home computer usage and nonadherence were predictive of anxiety at followup. The IRI was not globally effective. However, controlling for prior depression, age, and technology at work, there was a significant effect of technology at home for depression. Families with technology experience at home (n = 11) reported significantly greater improvements in depression than families without prior technology experience at home (n = 8). Although Web-based OFPS was effective in improving caregiver functioning, individuals with limited computer experience may benefit less from an online intervention due to increased nonadherence.     

Long-term Outcomes of Children and Youth accessing Residential or Intensive Home-based Treatment: Three year follow up

In this study the long-terms outcomes of children and youth with severe mental health problems receiving residential treatment (RT) or an intensive home-based treatment (IHT) were reported. RT is 24-hour mental health intervention in a highly supervised and structured group living setting where individualized and related therapies are provided. Youths attend a day school within the residential environment. IHT developed as an alternative to residential treatment for youth and comprises the same therapeutic interventions provided in the home as opposed to the residential setting. Youths attend their regular school which could be within a specialized setting, such as a day school. At discharge, there were statistically and clinically significant improvements in psychosocial functioning for children and youth in RT and IHT. There were also statistically significant improvements in scores on symptom severity from admission to 12 to 18 months post-discharge, and these improvements were maintained at 36 to 40 months post-discharge. Differences in demographic data between the two groups suggest that the programs may serve two different populations, and that both programs are important components of a comprehensive mental health plan for children and youth.     

Promoting healthy food consumption among young children: Evaluation of a multi-component nutrition education program

This study was an outcome evaluation of a multi-component nutrition education program for African American kindergarten and first grade students attending an under-resourced urban school. The program focused on increasing fruit and vegetable knowledge and vegetable consumption during school lunch. It included a classroom-based knowledge change component, a lunchtime-based behavior-change component, and a home component. This program was unique in that natural helpers in the school (i.e., paraprofessionals) were enlisted as agents of behavior change. Findings indicated that the program was considered socially valid from the perspectives of students, teachers, and paraprofessional community assistants. Implementation integrity was acceptable for the classroom intervention, but highly variable for the lunchtime intervention. Program outcomes demonstrated that knowledge change was high, but behavior change was variable. Inconsistent behavioral effects appeared to be related in part to the variable level of intervention integrity. The challenges of promoting intervention integrity with paraprofessionals were discussed, and strategies for improving integrity were outlined.     

Parent-tutoring procedures: Experimental analysis and validation of generalization in oral reading across passages,settings, and time

A study that involved parents as reading tutors was carried out at home during the summer with four elementary children, three with learning disabilities. One purpose was to determine the effects of tutoring in the basal reader on reading rates at home. Another purpose was to determine potential generalization effects as a result of parent tutoring on different academic tasks at home and, later at school, on different and similar tasks. A combination multiple-baseline and reversal design tested for replication and generalization effects. Increases in correct rates were noted for the targeted variables across conditions. The results indicated that parents tutoring with school basal texts during the summer produced marked increases in reading rates that generalized at home to different academic tasks and at school to different and similar tasks. This suggests that parents, when using specific tutoring procedures, can increase their children's academic skills.