Mindfulness Training for Parents and Their Children With ADHD Increases the Children’s Compliance

Children with ADHD are often non-compliant with parental instructions. Various methods have been used to reduce problem behaviors in these children, with medication and manipulation of behavioral contingencies being the most prevalent. An objection often raised by parents is that these management strategies require them to impose external control on the children which not only results in the children not learning self-control strategies, but also does not enhance positive interactions between them and their parents. Studies have shown that providing mindfulness training to parents, without a focus on reducing problem behaviors, can enhance positive interactions with their children and increase their satisfaction with parenting. We were interested to see what effects giving mindfulness training to two mothers, and subsequently to their children, would have on compliance by the children. Using a multiple baseline across mothers and children design, we found that giving a mother mindfulness training enhanced compliance by her child. When the children were subsequently given similar training, compliance increased even more markedly, and was maintained during follow-up. The mothers reported associated increases in satisfaction with the interactions with their children and happiness with parenting. We suspect that the mindfulness training produces personal transformations, both in parents and children, rather than teaching strategies for changing behavior.     

Health-Related Quality of Life and Perceived Need for Mental Health Services in Adolescent Solid Organ Transplant Recipients

The purpose of the current investigation was to assess interest in mental health services among parents of adolescent solid organ transplant recipients and the relationship between parent perceived need for mental health services and patient health-related quality of life (HRQOL). Sixty-three parents rated interest in receiving 10 mental health services, and patient HRQOL ratings were gathered from adolescent transplant recipients and their parents. Ninety-four percent of parents expressed some level of interest in at least one of the proposed services, with over 40 % indicating maximum interest. Parents’ perceived need for mental health services was inversely related to adolescent and parent reports of HRQOL on the behavior, mental health, family cohesion, and parental impact-emotional domains. Results suggest that parents of adolescent solid organ transplant recipients are interested in receiving mental health services for their families. Assessment of need for mental health services and HRQOL may inform the medical team of families requiring intervention.     

Anorexia nervosa: treatment satisfaction

Patient satisfaction plays a central role in treatment alliance and outcome. Investigating patient expectations and experiences of treatment sheds light on its importance. This study examines adolescent anorexia nervosa patients and their parents' satisfaction with family‐based treatment. Patients and parents answered a questionnaire at the eighteen‐month follow‐up focusing on expectations and experiences of treatment, therapists, aims of treatment and accomplishment. The results show that 73 per cent of the patients and 83 per cent of the parents felt that their pre‐treatment expectations had been fulfilled. The majority agreed that individual patient sessions and parental sessions were of great help, while the patients valued family therapy sessions as being less helpful than did parents. In overall terms, parents were more pleased with the therapists than were the patients. These data suggest that family‐based treatment with individual sessions for patients, in parallel with parental sessions combined with family sessions, corresponds well to patients' and parents' treatment expectations.     

Path model of multidimensional compliance with cancer therapy

Patients newly diagnosed with hematologic malignancies were followed for a 6-month treatment period to assess compliance with three regimen requirements for cancer therapy: anti-neoplastic medication self-administered intermittently, supportive medication self-administered daily, and monthly clinic appointments. The effect on compliance of three intervention "packages" (some combination of education, shaping of pill-taking behavior, and home restructuring) and the extent that patient satisfaction, knowledge, and uncertainty about illness-related events mediated the effects of the interventions were also examined. Blood levels of the drugs and self-report measures indicated that compliance with daily pill taking was higher for each intervention group compared to a control group. Similar results were obtained for compliance with clinic appointments. No improvement in intermittent self-medication was found. Although each intervention package increased patient knowledge and satisfaction, path analyses demonstrated that knowledge did not affect any aspect of compliance, whereas satisfaction was associated with increased appointment keeping only. Daily pill taking was influenced directly by the behavioral components of the interventions. Uncertainty did not influence compliance but was associated with depression, which was negatively correlated with intermittent self-medication.     

Breast Cancer Risk Assessment at the Time of Screening Mammography: Perceptions and Clinical Management Outcomes for Women at High Risk

The purpose of this study was to evaluate the utility of a breast cancer risk assessment (BCRA) at the time of screening mammogram. Women whose BCRA indicated a high risk for cancer received a letter with instructions for breast health care and genetic counseling if appropriate. After 6 months this group received surveys to evaluate their risk perception and their recall of, and compliance with, recommendations. We also explored the impact of other variables such as a recommendation for genetic counseling and physician communication with the women. After the BCRA, the majority of high risk women reported no change in their perceived risk of cancer. A woman’s perceived risk of cancer after a BCRA was significantly associated with her recall of recommendations for breast health care, but not with compliance. A recommendation for genetic counseling was not significantly related to women’s perceived risk of cancer after the BCRA. Ten percent of women who should have obtained genetic counseling actually completed an appointment. Women who discussed their BCRA results with their physicians were more compliant with a six month breast exam with a doctor (53% vs 17%, p = 0.018). Overall, women felt that the BCRA was helpful and did not cause undue stress or anxiety. Although the cohort’s compliance with recommendations was suboptimal, physicians’ interactions with their patients may have a positive influence on their compliance.     

Exploring the factors affecting child and adolescent psychotherapists' and counsellors' decision‐making in clinical work with parents

This study examined interventions with parents/carers in child and adolescent counselling and psychotherapy (CAP). The aim was to investigate clinicians' rationale behind their decision to work with parents and what types of interventions they use. Furthermore, the nature of clinicians' core training with regard to interventions with parents was investigated. The study used both quantitative data and qualitative textual data from an online survey of 110 CAP clinicians. There was significant agreement, regardless of previous training or level of experience, that clinical work with parents in CAP is beneficial, but little consensus for a rationale or model for best practice. There was a relationship between training, theoretical orientation and whether CAPs felt competent to work with parents. Unexpectedly, a significant number (83%) of integrative practitioners said that there had been ‘little’ to ‘none at all’ focus on working with parents on their core training course. Other unforeseen findings were in the domain of working outside generally accepted boundaries for CAP, with a notable number of clinicians making home visits—24.1% with parents alone and 38.9% with parent and child together—along with 47.2% using phone calls and/or email for coaching and support with parents. Many clinicians were candid about their sense of a lack of competence in working with parents, even though at least half were senior, experienced clinicians. A number of these practitioners made specific reference to the wish for further specialist training, with many asking for signposting to where further training could be obtained.     

TRAINING FAMILY THERAPISTS: AN EXPERIMENTAL ANALYSIS

This study implemented and evaluated a training program (a written manual, videotaped models, rehearsal, role plays, and performance feedback) designed to teach five subjects the skills to become effective family therapists. The study examined the therapists' use of three target behaviors: instructing, informing, and praising. The therapists, each paired with a parent and a preschool-aged child (2 1/2–4 1/2 yr old), were trained in the clinic to use, and to teach to the parents, several behavioral skills (e.g., praising, planned ignoring, and time-out) relevant to teaching children compliance to parental instructions. A multiple-baseline design across triads (therapist/parent/child) demonstrated that after the training program was instituted, the therapists increased their rates of instructing, praising, and informing the parents; all parents increased attention to compliance, decreased attention to noncompliance, and increased rates of praise to their children; and all children increased their compliance and decreased their noncompliance.     

The "REST" program: a new treatment system for the oppositional defiant adolescent

This study compared the REST (Real Economy System for Teens) program with traditional talk therapy in the treatment of oppositional defiant adolescents. The REST program uses rules for five target behaviors: room care, personal hygiene, completion of chores, abusiveness, and safety violations. Objective measures and subjective parental ratings were taken. Twenty-five adolescents were assigned to each therapy group. In the REST program the adolescent was provided with only food and shelter. The adolescent had to earn money through the REST allowance program to pay for everything else. Earning the allowance was made contingent upon compliance with all rules for the five target behaviors. The results showed significantly greater improvement on all target behaviors for the REST program than for traditional therapy. In addition, parents of adolescents in the REST group reported that their adolescents seemed happier, more relaxed, and closer to them.     

Negative and Positive Disability-related Events and Adjustment of Parents with Acquired Physical Disabilities and of their Adolescent Children

This study merged stress-and-coping research with the social model of disability to describe the most frequently experienced disability-related events experienced by 19 parents with acquired physical disabilities and their adolescent children, and examined the relations between these events, severity of disability, and psychological adjustment. Parents and adolescents reported many more positive than negative disability-related events, although parents reported significantly more negative events than did their children. Frequency of parents’ experienced negative disability-related events correlated significantly with self-reported anxiety, depression, and weaker feelings of parental self-efficacy, with their reports of adolescents’ internalizing and externalizing problems, and with adolescents’ self-reports of depression, anxiety, and lower self-esteem. Frequency of adolescents’ negative disability-related events correlated significantly with self-reported depression and lower self-esteem, and approached significance with self-reported anxiety. There were no significant associations between parents’ positive events and self-reported or adolescent adjustment. Total frequency of adolescents’ positive events correlated significantly with less parent-reported anxiety. There were several significant associations between parental rating of severity of disability and number of physical limitations with their and their children’s adjustment. Implications for understanding the daily effects of parental physical disability on parents and their adolescent children are discussed, and recommendations are suggested for prevention interventions.     

EFFECTS OF RESPONDING TO A NAME AND GROUP CALL ON PRESCHOOLERS' COMPLIANCE

We assessed teacher—child relations with respect to children's name calls, instructions, and compliance in a preschool classroom. The most frequent consequence to a child's name being called was the provision of instructions. We also observed a higher probability of compliance when children attended to a name call. Next, we evaluated the effects of teaching preschoolers to attend to their names and a group call on their compliance with typical instructions. We used a multiple baseline design across subjects and a control‐group design to evaluate whether gains in compliance were a function of treatment or routine experience in preschool. Results showed that compliance increased as a function of teaching precursors for all children in the experimental group, and the effects on compliance were maintained despite a reduction of the occurrence of precursors. Moreover, it appeared that precursor teaching, not routine preschool experience, was responsible for the changes in compliance.     

The association between parenting stress, depressed mood and informant agreement in ADHD and ODD

OBJECTIVE: In Attention Deficit Hyperactivity Disorder (ADHD) agreement between parents and teachers is often low. Parental depressed mood and parenting stress are considered to decrease informant agreement. This study examined informant agreement in children with ADHD and the association between parental depressed mood, parenting stress and agreement in the ratings of ADHD, ODD and CD symptoms. METHOD: 65 parents completed questionnaires on ADHD behavior of their child, parenting stress and depressed mood, teachers reported on ADHD behavior. RESULTS: Low agreement was found for hyperactive and moderate agreement for inattentive, ODD and CD symptoms. Stepwise regression analyses showed that parenting stress, and not parental depressed mood accounted for 12% of the variance in inattention symptoms disagreement, 14% of the variance in hyperactive symptoms disagreement and 9% in oppositional behavior disagreement. No significant predictors were found for CD disagreement. The found effect was independent of stimulant medication use. CONCLUSION: Parenting stress, but not parental depressed mood, was associated with the disagreement between parents and teachers on both ADHD and ODD symptoms. These results emphasize the importance of considering parenting stress in diagnosing ADHD and comorbid ODD.     

Predictors of perceived satisfaction with parental control in Chinese adolescents: a 3-year longitudinal study

Over three consecutive years, 2,559 Chinese adolescents (mean age = 12.65 years at Wave 1) responded to instruments assessing their trust of parents, perceived parental trust of the children, readiness to communicate with the parents, and satisfaction with parental control. Results showed that mutual trust between the parents and their adolescent children and the children's readiness to communicate with the parents were related to perceived satisfaction with parental control at Time 1, Time 2, and Time 3. Although readiness to communicate with the parents and mutual trust between the parents and their adolescent children predicted perceived satisfaction with parental behavioral control and its change over time, trust of the parent was the strongest predictor. While the influence of trust of the father on satisfaction with paternal control was stronger for adolescent girls than for adolescent boys, influence of paternal trust on satisfaction with paternal control was stronger for adolescent boys than for adolescent girls.     

Patients’ and Parents’ Perceptions of Appearance in Scoliosis Treated with a Brace: A Cross-Sectional Analysis

The perspective of trunk deformity is a matter of special concern for adolescent idiopathic scoliosis (AIS) patients. No research group has ever reported interviewing patients and their parents regarding differences in perception of body appearance in the course of Cheneau brace treatment. We aimed to investigate the level of agreement in the field of concerns and perceptions of spinal appearance in relation to brace- and scoliosis-related data between parents and female patients with AIS, treated with a Cheneau brace, by means of the Spinal Appearance Questionnaire-pl (SAQ-pl). In this cross-sectional study forty-one pairs of parents and female patients with AIS were asked to separately complete the Polish versions of the Spinal Appearance Questionnaire-pl patient form (SAQ-pl patient form) and the SAQ-pl parent form. Age of patients was 13.60 years SD 1.60 (range 10–17). Patients scored 2.70 (SD 0.60) and parents scored 2.70 SD 0.60 in the total score of the SAQ-pl. The study groups do not differ significantly in regards to the SAQ-pl results. The percentage of consistent answers on SAQ-pl items ranges from 34.10 % (item 20) to 78 % (item 8). Height, age and brace-wearing time per day, were significantly related to the differences in the patient-parent General perception of body shape (r _s  = ?0.51, r _s  = ?0.34, r _s  = 0.36, respectively). Parents and female patients with AIS have similar concerns and perceptions of spinal appearance. The discrepancies in General perception of spinal appearance between parents and AIS females decrease with age of patient. Parental emotional support may contribute to minimizing the risk factors of psychological impairment, especially in late adolescents with AIS.     

The Interface between Mental Health Providers, Families, and Schools: Parent and Child Attitudes about Information-Sharing

Youth with emotional and behavioral disorders (EBD) are at an increased risk for school problems and negative consequences into adulthood, increasing the need for collaboration between families, school personnel and mental health providers. Current treatment guidelines emphasize the importance of information-sharing between providers and schools, yet few studies have addressed parents’ or students’ attitudes and preferences about this process or about the disclosure of mental health-related information to school professionals. Using a sample of 73 pairs of parents and their adolescents seeking outpatient treatment, this study assessed parental and adolescent attitudes about disclosure of mental health treatment information to school personnel. The majority of parents reported that the school should be informed that their adolescent was receiving counseling or medication for EBD, and that they should be the primary informant, rather than providers. By comparison, adolescents preferred more discretion about their involvement in treatment. Taken together, the study results highlight a number of implications relevant to the therapeutic relation and the process of obtaining and sharing mental health-related treatment information with various school personnel. Future research directions regarding the consultative and collaborative process with school personnel are also discussed.     

A method to establish stimulus control and compliance with instructions

We evaluated a unique procedure to establish compliance with instructions in four young children diagnosed with autism spectrum disorder (ASD) who had low levels of compliance. Our procedure included methods to establish a novel therapist as a source of positive reinforcement, reliably evoke orienting responses to the therapist, increase the number of exposures to instruction–compliance–reinforcer contingencies, and minimize the number of exposures to instruction–noncompliance–no reinforcer contingencies. We further alternated between instructions with a high probability of compliance (high‐p instructions) with instructions that had a prior low probability of compliance (low‐p instructions) as soon as low‐p instructions lost stimulus control. The intervention is discussed in relation to the conditions necessary for the development of stimulus control and as an example of a variation of translational research.     

Discrepancies Between Parent and Adolescent Beliefs About Daily Life Topics and Performance on an Emotion Recognition Task

Parents and children and adolescents commonly disagree in their perceptions of a variety of behaviors, including the family relationship and environment, and child and adolescent psychopathology. To this end, numerous studies have examined to what extent increased discrepant perceptions—particularly with regard to perceptions of the family relationship and environment—predict increased child and adolescent psychopathology. Parents’ and children and adolescents’ abilities to decode and identify others’ emotions (i.e., emotion recognition) may play a role in the link between discrepant perceptions and child and adolescent psychopathology. We examined parents’ and adolescents’ emotion recognition abilities in relation to discrepancies between parent and adolescent perceptions of daily life topics. In a sample of 50 parents and adolescents ages 14-to-17 years (M?=?15.4 years, 20 males, 54 % African-American), parents and adolescents were each administered a widely used performance-based measure of emotion recognition. Parents and adolescents were also administered a structured interview designed to directly assess each of their perceptions of the extent to which discrepancies existed in their beliefs about daily life topics (e.g., whether adolescents should complete their homework and carry out household chores). Interestingly, lower parent and adolescent emotion recognition performance significantly related to greater parent and adolescent perceived discrepant beliefs about daily life topics. We observed this relation whilst accounting for adolescent age and gender and levels of parent-adolescent conflict. These findings have important implications for understanding and using informant discrepancies in both basic developmental psychopathology research and applied research in clinic settings (e.g., discrepant views on therapeutic goals).     

Praising child compliance: Reinforcement or ritual?

Praising child compliance is a common therapeutic recommendation to parents with noncompliant children. There are currently no studies documenting the independent contribution of the praise component to successful parent training programs. Three projects were designed to evaluate the hypotheses underlying the use of contingent praise routines. Namely, it has been suggested that conduct-disordered children are relatively unresponsive to adult approval at pretreatment, yet become responsive by posttreatment. In contrast to the hypotheses, data indicated that child compliance levels were not associated with child responsivity to maternal social reinforces; noncompliant children were responsive to maternal praise both before and after treatment; child responsivity to maternal praise did not covary with successful treatment; previously noncompliant but successfully treated children continued to comply to maternal instructions after contingent praise was withdrawn; a nonclinic child demonstrated extensive compliance persistence in the absence of contingent praise. Praising child compliance appeared to be more of a polite ritual than an active therapeutic component for altering noncompliance.The author is grateful to the many students who have participated in these projects. Special thanks go to Lynn McIsaac, Lisa Grange, and Dan Anderson for their assistance with Project 3.     

Cognitive control and consistency in compliance

Abstract

The purpose of this prospective study was two-fold. First, three modes of compliance assessment were used to examine whether renal dialysis patients comply consistently across medical regimens (fluid, potassium, phosphorous, protein) and whether compliance is consistent across mode of assessment (patient self assessment, medical staff ratings, physiological data). Second. a cognitive model predicting fluid compliance was tested to see if it would generalize to predict dietary compliance and medication taking. Patients' self-control perceptions of compliance, staff assessments of compliance, and physiological data were collected prospectively for 85 end-stage renal disease (ESRD) patients. Results indicated substantial consistency across medical regimen depending on the mode of assessment; staff assessment showed the most consistency, followed by patients' self-assessments and lastly by physiological data. Despite this consistency across medical regimens, the cognitive-control model only predicted fluid compliance; the model failed to explain dietary and medication compliance. Reasons and implications for these results are discussed.