Delivering Parent-Teen Therapy for ADHD through Videoconferencing: a Preliminary Investigation

Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (N = 20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.     

A Web-based family problem-solving intervention for families of children with traumatic brain injury

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.     

A web-based family problem-solving intervention for families of children with traumatic brain injury.

We developed a Web-based intervention for pediatric traumatic brain injury (TBI) and examined its feasibility for participants with limited computer experience. Six families, including parents, siblings, and children with TBI, were given computers, Web cameras, and high-speed Internet access. Weekly videoconferences with the therapist were conducted after participants completed on-line interactive experiences on problem solving, communication, and TBI-specific behavior management. Families were assigned to videoconference with NetMeeting (iBOT cameras) or ViaVideo. Participants ranked the Web site and videoconferences as moderately to very easy to use. ViaVideo participants rated videoconferencing significantly more favorably relative to face-to-face meetings than did NetMeeting participants. Both the Web site and videoconferencing were rated as very helpful. All families demonstrated improved outcomes on one or more target behaviors, including increased understanding of the injury and improved parent-child relationships. All parents and siblings and all but 1 child with TBI said they would recommend the program to others. We conclude that a face-to-face intervention can be successfully adapted to the Web for families with varied computer experience.     

Working From Home: An Initial Pilot Examination of Videoconferencing-Based Cognitive Behavioral Therapy for Anxious Youth Delivered to the Home Setting

Progress in evidence-based treatments for child anxiety has been hampered by limited accessibility of quality care. This study utilized a multiple baseline design to evaluate the pilot feasibility, acceptability, and preliminary efficacy of real-time, Internet-delivered, family-based cognitive-behavioral therapy for child anxiety delivered to the home setting via videoconferencing. Participants included 13 anxious youth (mean age = 9.85) with a primary/co-primary anxiety disorder diagnosis. Eleven participants (84.6%) completed treatment and all study procedures. Consistent with hypotheses, the intervention was feasible and acceptable to families (i.e., high treatment retention, high client satisfaction, strong therapeutic alliance, and low barriers to participation). Moreover, the novel videoconferencing treatment format showed preliminary efficacy: 76.9% of the intention-to-treat (ITT) sample and 90.9% of treatment completers were treatment responders (i.e., Clinical Global Impressions-Improvement Scale = 1 or 2 at posttreatment), and 69.2% of the ITT sample and 81.8% of treatment completers were diagnostic responders (as per the Anxiety Disorders Interview for Children). Gains were largely maintained at 3-month follow-up evaluation. Outcome patterns within and across subjects are discussed, as well as limitations and the need for further controlled evaluations. With continued support, videoconferencing treatment formats may serve to meaningfully broaden the reach of quality care for youth anxiety disorders.     

Applicant reactions to face-to-face and technology-mediated interviews: a field investigation

This field study examined applicant reactions (N = 802) toward face-to-face as compared with technology-mediated interviews (through videoconferencing or by telephone) for 346 organizations. Face-to-face interviews were perceived as more fair and led to higher job acceptance intentions than were videoconferencing and telephone interviews. Perceived interview outcomes were higher with face-to-face and telephone interviews over videoconferencing. Self-monitoring moderated the relationship between interview medium and perceptions of fairness. Specifically, this relationship was (a). positive for face-to-face, (b). negative for telephone, and (c). nonsignificant for videoconferencing interviews. Moreover, the number of offers an applicant received moderated the relationship between interview medium over, and perceived fairness. The relationship between number of offers and perceived fairness was positive for face-to-face and negative for technology-mediated interviews.     

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.     

Parent Training Adapted to the Needs of Children With Callous–Unemotional Traits: A Randomized Controlled Trial

Callous–unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent–child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4–0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.     

Nonmaternal care in infancy and emotional/behavioral difficulties at 4 years old: moderation by family risk characteristics

The authors examined the role of familial risk and child characteristics in the association between the type of child care in infancy (maternal care [MC]) versus nonmaternal care [NMC]) and emotional/behavioral difficulties at 4 years old. Canadian families (N=1,358) with children between 1 and 12 months old were followed over 4 years. Family risks were found to moderate the association between type of child care and physical aggression. MC in infancy was associated with lower levels of physical aggression among children from a low-risk family background but not among those from a high-risk family background. The effect size was small (d=-0.16; confidence interval [CI]=-0.3, -0.01). Family risk and the sex of the child moderated the association between child care and emotional problems. MC in infancy was associated with a lower level of emotional difficulties among girls from low-risk families but not among boys or among children from high-risk families. The effect size was moderate (d=-0.44; CI=-0.65, -0.23). The study indicates that the effect of child care type in infancy varies by family and child characteristics.     

Child Psychosocial Functioning and Parent Quality of Life Among Clinically Referred Children

We examined factors that account for quality of life among parents of clinically referred children. Families (N = 201) of children (ages 3-14) referred for oppositional, aggressive, and antisocial behavior participated. Parent and family contextual factors and child psychosocial functioning (symptoms and impairment) were predicted to influence parents' quality of life. As predicted, socioeconomic disadvantage, parent stress and psychopathology, poor interpersonal relations, and limited social support were related to lower levels of quality of life. Once these factors were controlled, child psychosocial functioning also contributed positively to quality of life. Further research on quality of life in the family can have important implications for understanding the context of both child and parent functioning.     

Family functioning and involvement in home visiting: Examining program characteristics as moderators to support retention in services

Developing strategies to improve retention in home visiting programs is critical to their success. The purpose of the study is to examine how the content provided during home visits moderates the association between family risks (economic, household functioning, and conflict) and retention in services. Parents (n = 1,322) voluntarily enrolled in Healthy Families America (n = 618) and Parents as Teachers (n = 704). Family characteristics were collected using the Family Map Inventories. Multilevel analyses showed a moderating impact of the time home visitors spent supporting parent–child interaction for all family risks examined. Moderating effects demonstrated a stronger positive association between focusing on the parent–child relationship and retention at 6 and 12 months for parents demonstrating greater needs. There were no moderating effects of child development content or case management activities with retention at 6 and 12 months. Together, families were more likely to stay in services when home visitors focused on parent–child interaction and child development, but less likely retained with more case management. Parents with greater risks were more likely to remain in services with more time focused on supporting parent–child interactions. Findings suggest the need to support our home visiting workforce in their work to promote healthy parent–child relationships.     

The influence of family skills programmes on violence indicators: Experience from a multi-site project of the United Nations Office on Drugs and Crime in low and middle income countries

Families can be one of the most protective forces in the lives of children and youth. Family skills interventions have been found to be effective in encouraging safe and nurturing relationships between parents (or caregivers) and children in their early years and as such preventing many problem behaviours including violence. Most of the evidence in this regards is generated from high income countries. In this article UNODC reports on variables associated with violence (including conduct problems, stress management, pro-social behaviours, family aggression and conflict) generated from a multisite project aimed at piloting family skills programmes in low and middle income countries. The countries of concern are Panama, Honduras, Guatemala, Serbia, Kazakhstan, Kyrgyzstan, Turkmenistan, Tajikistan and Uzbekistan. The family skills piloted were Strengthening the Families Programme 10-14 (SFP 10-14) and Families And Schools Together (FAST). The data generated indicates high level of replicability with fidelity, affinity and need for such programmes in low and middle income countries with very encouraging in preventing violence. Significant changes at the post-test level, assessed through multi-sources, were recorded across most of the violence indicators assessed related to youth violence and child maltreatment at least on a comparable level to high-income countries.     

Telemedicine and adherence to national guidelines for ADHD evaluation: A case study

The pilot project evaluated a telemedicine clinic's adherence to American Academy of Pediatrics (AAP) guidelines for attention-deficit/hyperactivity disorder (ADHD) evaluation. Real-time videoconferencing linked the patients, the families, and the specialty mental health team. The ADHD Telemedicine Clinic adherence to AAP guidelines was tracked using chart data. The study included 22 patients (Mean age = 9.3 years, SD = 2.3 years) participating in 69 telemedicine visits across 13 different school-related sites. The ADHD Telemedicine Clinic reached extremely high adherence rates across the AAP evaluation guidelines for ADHD, ranging from 95-100% across the six guidelines. No factor inherent to the telemedicine service delivery mechanism impeded adherence to national guidelines for ADHD evaluation. Telemedicine-based outreach had the greatest impact on AAP Guideline #4, stating that information should be obtained from the child's academic setting. The school-based telemedicine clinic allowed increased communication across the school and specialty mental health systems and facilitated greater input across child, parent, school personnel, and mental health professionals. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Preparing Interventionists via Telepractice in Incidental Teaching for Children with Autism

Telepractice has emerged as a potentially effective means of preparing parents and educators as interventionists for children with autism spectrum disorder (ASD). The purpose of this study was to evaluate the use of telepractice to train interventionists to implement incidental teaching with preschool children with ASD. Three interventionists were taught to implement incidental teaching using a telepractice training package consisting of an online module, self-evaluation, and delayed performance feedback delivered via videoconferencing. A single-case multiple-baseline across-participant design was employed to evaluate the effects of the telepractice training package on interventionist acquisition and maintenance of incidental teaching. The distal effects of interventionist implementation of incidental teaching on child mands were also evaluated. Results showed that following the telepractice training program, interventionist implementation fidelity improved and child mands increased. Within six telepractice sessions, all interventionists reached the preset performance criteria of four consecutive sessions above 90 % fidelity. Changes in interventionist and child behaviors maintained at 2- and 4-week follow-up sessions. Taken together, these results suggest that telepractice is a promising method of providing instruction in incidental teaching to interventionists of young children with ASD.     

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.     

Computer-mediated communication: task performance and satisfaction

The author assessed satisfaction and performance on 3 tasks (idea generation, intellective, judgment) among 75 dyads (N = 150) working through 1 of 3 modes of communication (instant messaging, videoconferencing, face to face). The author based predictions on the Media Naturalness Theory (N. Kock, 2001, 2002) and on findings from past researchers (e.g., D. M. DeRosa, C. Smith, & D. A. Hantula, in press) of the interaction between tasks and media. The present author did not identify task performance differences, although satisfaction with the medium was lower among those dyads communicating through an instant-messaging system than among those interacting face to face or through videoconferencing. The findings support the Media Naturalness Theory. The author discussed them in relation to the participants' frequent use of instant messaging and their familiarity with new communication media.     

Therapist-Led,Internet-Delivered Treatment for Early Child Social Anxiety: A Waitlist-Controlled Evaluation of the iCALM Telehealth Program

Despite recent advances in the treatment of early child social anxiety, the broad accessibility of brick-and-mortar services has been limited by traditional barriers to care, and more recently by new obstacles related to efforts to slow the spread of COVID-19. The present waitlist-controlled trial examined the preliminary efficacy of a family-based behavioral parenting intervention (i.e., the iCALM Telehealth Program) that draws on Parent-Child Interaction Therapy and videoconferencing to remotely deliver clinician-led care for anxiety in early childhood. Young children (3–8 years) with a diagnosis of social anxiety disorder (N = 40; 65% from ethnic/racial minority backgrounds) were randomly assigned to iCALM or waitlist. Intent-to-treat analyses found that at post, independent evaluators classified roughly half of the iCALM-treated children, but only 6% of waitlist children, as “Responders” (Wald test = 4.51; p = .03). By Post, iCALM led to significantly greater reductions than waitlist in child anxiety symptoms, fear, discomfort, and anxiety-related social impairment, and also led to greater improvements in child soothability. By 6-month follow-up, the percentage of iCALM-treated children classified as “Responders” rose to roughly 60%. Exploratory moderation tests found iCALM was particularly effective in reducing life impairments and parental distress among families presenting with higher, relative to lower, levels of baseline parental accommodation. The present findings add to a growing body of research supporting the promise of technology-based strategies for broadening the portfolio of options for delivering clinician-led mental health services.     

Parent–Child Synchrony in Children with Oppositional Defiant Disorder: Associations with Treatment Outcomes

Oppositional defiant disorder (ODD), characterized by angry/irritable mood, and argumentative/defiant behavior, is associated with significant negative outcomes in childhood and beyond. Researchers posit that these behaviors arise from poor parenting and/or an incompatibility between characteristics of the child and the child’s parents, resulting in strained interaction styles. The present study examines parent–child synchrony, the inverse of parent–child incompatibility as a predictor of children’s emotional lability, aggression, and overall functioning following psychosocial treatment. Participants were 75 treatment-seeking families with children diagnosed with ODD (46 boys). Families received one of two empirically supported treatments for ODD (Parent Management Training or Collaborative and Proactive Solutions). Findings indicated that pre-treatment parent–child synchrony was associated with decreased emotional lability and aggression following both treatments, as well as improvement in overall functioning, irrespective of treatment condition. These results reflect the importance of parent–child relations at the onset of treatment in predicting response to treatment and suggest potential treatment targets within parent–child relationships.     

Telemedicine-based alcohol services for rural offenders

Research has consistently shown that alcohol use is a problem in rural communities and access to substance abuse treatment, particularly evidence-based treatment is limited. Because telemedicine has been shown to be effective in delivering services, this article presents a novel and innovative way of using telemedicine technology in the form of videoconferencing to deliver an evidence-based alcohol intervention (motivational enhancement therapy) with at-risk alcohol users in real-world settings (rural probation and parole offices). This article focuses on: (a) creating a profile of an at-risk group of rural alcohol users; (b) describing the evidence-based intervention; and (c) describing the innovative telemedicine-based service delivery approach. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

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.     

Family of Origin: The View from the Parents' Side

Families in which there is increased marital conflict after a relatively stable long-term marriage are a puzzle to the clinician. The author's thesis, based on experience with a group of middle-aged couples whose children's differentiation occurred after having been in individual therapy themselves, is that the differentiated child carried special psychic functions for one parent. The differentiation was experienced as tantamount to ego loss, and that parent's attempt to deal with the inner conflict resulted in a marital crisis.