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.     

Effect of Make Parenting a Pleasure on Parenting Skills and Parental Depression

Abstract

This paper explores a feasibility trial examining the effects of the Make Parenting A Pleasure (MPAP), a 12-week parent training program designed to promote family resilience by strengthening the following factors: parental resilience, social connections, concrete support in times of need, knowledge of parenting and child development, and social and emotional competence in children. Fifty-nine (59) participants were assigned to either a treatment group (n?=?32) or a waitlist control group (n?=?27). Results showed that participants in the MPAP treatment group demonstrated an increase in parenting skills and child development knowledge as well as a decrease in parental depression when compared to waitlist control group participants. Results emphasize the importance of promoting resiliency by supporting parents through direct instruction and skill development.     

Using Behavioral Skills Training to Promote the Generalization of Parenting Skills to Problematic Routines

Research has demonstrated the efficacy of a behavioral parent training program for skills acquisition; however, few studies have examined the extent to which those skills generalize to the home or the effect that they have on child behavior. A multiple baseline across participants design was used to assess (a) caregiver accuracy with implementation of three parenting skills, and (b) the effects of the parenting skills on child behavior. Results demonstrated that three caregiver participants successfully generalized parenting skills taught during behavioral skills training (BST) to naturally occurring routines, and the behavior of each caregiver's child improved following BST.     

Does parental mental health moderate the effect of a telephone and internet‐assisted remote parent training for disruptive 4‐year‐old children?

This study explores the moderators affecting the success of an Internet‐based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4‐year‐old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self‐reported parenting skills. The measures were completed at baseline, six and 12‐months follow‐up. The 232 families randomized to active treatment received 11 Internet‐based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45‐minute phone‐call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.     

Testing the long-term efficacy of a prevention program for improving marital conflict in community families

Family-focused prevention programs for community samples have potentially broad, clinically relevant implications but few studies have examined whether any program benefits continue to be observed over the long term. Although benefits of a marital conflict focused parent education program, the Happy Couples and Happy Kids (i.e., HCHK) program, were supported in a study based on pre-test, post-test, 6-month follow-up, and 1-year follow-up assessments, the longer-term stability of treatment effects has not been established. Couples with children between 4 and 8 years of age who had previously participated in the HCHK study completed a two-year follow-up, including a parent-only group (PO, n = 12); parent-child group (PC, n = 15); and a self-study group (SS, n = 12). Greater knowledge about the effects of marital conflict on families and behavioral improvements in constructive conflict, and specifically in problem-solving behaviors, were observed at the two-year follow-up for couples who received the HCHK program. Reflecting an innovative analysis of mediating mechanisms, change-to-change analyses showed that these changes were linked with improvements in other family processes over time, including marital satisfaction, parenting and child adjustment. The findings support the relatively long-term efficacy of brief, psychoeducational programs for educating community samples about marital conflict and family processes.     

Parent predictors of changes in child behavior problems

The present study examined whether ineffective discipline, single parent status, social support, parent involvement, and parent depression predicted changes in preschoolers' (N = 129) behavior problems. This study also evaluated whether child sex and ethnicity moderated the relations between these variables and changes in problem behavior. Parents completed questionnaires at the beginning of the study, and parent, teacher, and observational ratings of children's behavior problems were collected twice during the school year. Parents' own social support predicted improvement for boys and parent depression was associated with worsening symptoms for girls. Single parenthood and parent involvement predicted changes in behavior problems for the sample as a whole. Several significant ethnic differences emerged, highlighting the importance of considering cultural context in studies of parenting and child externalizing behavior.     

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

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

Predicting Response to an Internet-Delivered Parenting Program for Anxiety in Early Childhood

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3–6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules.     

Observations of families in structured interactions: Parenting therapists provide reliable ratings of mothers' parenting

The reliability of observations of parenting by parenting therapists was assessed. An important predictor of externalizing behavior in children is quality of parenting. Data were videotapes of structured interactions in families with a child age 8–12 years referred to the evidence based Parent Management Training Oregon (PMTO) treatment program for child behavior problems. The therapists had clinical PMTO training but no training in systematic observation. PMTO observational coders with specific coder training were included as a reference for the therapists. Five therapists and two coders observed videotapes of 10 families and performed global evaluations of mothers' parenting skills. They used the coder's impression measure used in PMTO research. Scores were analyzed in a generalizability theory framework for the two groups of observers separately. Both observer types reliably rank‐ordered the mothers and assessed the level of parenting skills. PMTO therapists without coder training provided reliable ratings of parenting constructs relevant to the clinical PMTO program in a manner comparable to that of the trained reference coders.     

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.     

Comparing Traditional and Ebook-Augmented Parent-Child Interaction Therapy (PCIT): A Randomized Control Trial of Pocket PCIT

Disruptive behavior in young children is one of the most common referrals to behavioral health providers. While numerous effective parenting programs, such as parent–child interaction therapy (PCIT), exist for improving children’s behaviors, challenges with treatment engagement and retention limit the intended positive impact on child and caregiver outcomes, particularly for racial and ethnic minority families. In an effort to address barriers contributing to poor engagement and retention in traditional PCIT service delivery and among ethnic and racial minority families, a multimedia PCIT ebook was developed and evaluated. In a sample of the general public that utilized the ebook, users were found to be more engaged in viewing embedded videos within the ebook that were related to expert skill explanations and skill demonstrations than caregiver testimonies. A randomized controlled trial was also conducted to evaluate the extent that the ebook + PCIT improved treatment engagement, retention, parenting skills, skill acquisition efficiency, and child behavior above and beyond traditional PCIT. Participating families were randomly assigned to either the traditional PCIT (n = 71) or ebook + PCIT (n = 107) group using an online random number generator. Forty-nine caregivers (traditional PCIT n = 24, ebook + PCIT n = 25) were excluded from analyses because they were lost to follow-up during the intervention. Families in both the traditional PCIT and ebook + PCIT groups demonstrated generally equivalent positive outcomes in treatment engagement (i.e., attendance, treatment length, completion rate) and caregiver skill acquisition efficiency at midtreatment, posttreatment, and 3-month follow-up. The addition of the ebook to PCIT also reduced child disruptive behavior at midtreatment, above and beyond traditional PCIT, but not at posttreatment or follow-up. Clinical implications and future directions are discussed.     

Association of Positive and Negative Parenting Behavior with Childhood ADHD: Interactions with Offspring Monoamine Oxidase A (MAO-A) Genotype

Relatively little is known about the potential interplay between genetic and environmental influences on attention-deficit/hyperactivity disorder (ADHD), including gene-environment interaction (G×E). There is evidence that parenting behavior interacts with offspring genotype in the development of externalizing problems, but studies have largely focused on explicit maltreatment rather than differentiated measures of parenting behavior, including positive and negative parenting. We tested the interactive effects of the 30-base pair variable number tandem repeat (VNTR) polymorphism of the monoamine oxidase A gene (MAO-A) with positive and negative parenting behavior on parent- and teacher ratings of inattention and hyperactivity symptoms among 150 6–9 year-old boys with and without ADHD. Negative parenting predicted parent and teacher ratings of inattention symptoms, but only among boys with high-activity MAO-A genotype. MAO-A genotype did not moderate the association of positive parenting and parent- and teacher ratings of ADHD. We discuss the potential role of interactive exchanges between parenting behavior and child genotype in the development and persistence of ADHD and related behavior problems.     

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.     

The Association of Parent Mindfulness with Parenting and Youth Psychopathology Across Three Developmental Stages

The primary purpose of the current study was to test a model examining the process by which parent dispositional mindfulness relates to youth psychopathology through mindful parenting and parenting practices. The universality of the model across youth at three developmental stages was examined: young childhood (3–7 years; n?=?210), middle childhood (8–12 years; n?=?200), and adolescence (13–17 years; n?=?205). Overall, participants were 615 parents (55 % female) and one of their 3-to-17 year old children (45 % female). Parents reported on their dispositional mindfulness, mindful parenting, positive and negative parenting practices and their child’s or adolescent’s internalizing and externalizing problems. Consistent findings across all three developmental stages indicated that higher levels of parent dispositional mindfulness were indirectly related to lower levels of youth internalizing and externalizing problems through higher levels of mindful parenting and lower levels of negative parenting practices. Replication of these findings across families with children at different developmental stages lends support to the generalizability of the model.     

Group Cognitive Behavioral Treatment for Parents and Children At-Risk for Physical Abuse: An Initial Study

To compare the relative efficacy of two types of group cognitive-behavioral therapy for treating the traumatized child and at-risk or offending parent in cases of child physical abuse (CPA), 24 parents and their children were treated with Combined Parent-Child Cognitive Behavioral Therapy (CPC-CBT) and 20 parents were treated with Parent-Only CBT. Outcome measures assessing children's emotional and behavioral functioning and parents' parenting skills were administered to both parent and child participants before treatment, after 15 sessions of treatment, and 3 months after the completion of treatment. A series of correlated t tests and analyses of covariance were used to compare the scores on the outcome measures. The children and parents in the CPC-CBT group demonstrated greater improvements in total posttraumatic symptoms and positive parenting skills, respectively, compared to those who participated in the Parent-Only CBT group. The parents in the Parent-Only CBT group reported using less corporal punishment to manage their children's behavior at posttest than the parents in the CPC-CBT group. The differential benefits of including the child in treatment are discussed.     

The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

There is a paucity of research considering the effect of behavioral family intervention (BFI) on parenting knowledge and the relative importance of both knowledge and parent confidence in reducing parenting dysfunction and problematic child behavior is unclear. In this study ninety-one parents (44 mothers, 47 fathers) of children aged 2–10?years completed an evidence-based BFI and were assessed at pre and post-intervention on knowledge of effective parenting strategies, parenting confidence, parent dysfunction, and reported intensity of externalised child behavior. Results showed that at pre-intervention parents higher in education (N?=?57) demonstrated greater knowledge than those lower in education (N?=?34). Relative to baseline, parents in both groups significantly improved their knowledge and confidence, reduced their dysfunction and reported less externalised child behavior. Effect sizes for the latter two variables were similar for both groups, however for parents higher in education the effect for confidence was larger than knowledge. Change in level of dysfunction explained the largest amount of unique variance in change to externalised child behavior. Results suggest that for optimal outcomes for parenting and child behavior management more knowledgeable parents may benefit from interventions that focus on practice and consolidation of already learned skills in order to increase confidence whereas for less knowledgeable parents the teaching of new skills and strategies, alongside increasing confidence, are important.     

Brief Parenting Interventions for Children at Risk of Externalizing Behavior Problems: A Systematic Review

We systematically reviewed the evidence for the efficacy and effectiveness of brief parenting interventions, defined as <8 sessions in duration, in reducing child externalizing behaviors. While there is significant evidence to support the efficacy of parenting interventions of 8–12 sessions in duration, the public health benefit of these interventions is limited by low participation rates, high attrition rates and the lack of implementation by a wide range of practitioners. Brief parenting interventions have the potential to extend the reach and impact of parenting interventions and steer children away from a trajectory of life course persistent behavior problems. A search of four electronic databases was undertaken to identify RCTs conducted on brief parenting interventions. The primary outcome was child externalizing behaviors and secondary outcomes included parenting skills, parental self-efficacy, parental mental health and partner relationship functioning. The heterogeneity of included studies prevented a meta-analysis but characteristics of the studies were described. Nine papers summarising the results of eight studies with 836 families in five countries met inclusion criteria. All studies found significant improvements in parent-rated child externalizing behaviors, parenting skills and parenting self-efficacy, relative to control or comparison groups, with findings maintained at follow-up. Less consistent findings emerged for parental mental health and partner relationship functioning. This review provides initial evidence that brief parenting interventions may be sufficient to reduce child externalizing behavior problems for some families, however further research is needed.     

An Evaluation of a Parenting Class Curriculum for Parents of Young Children: <Emphasis Type="Italic">Parenting the Strong-Willed Child</Emphasis>

Young children with high levels of acting out behaviors present a challenge for families, caregivers, and the childcare system. The Parenting the Strong-Willed Child (PSWC) parenting class curriculum program is a 6-week, group based parent education program designed for parents of children with noncompliance problems (ages 2–8). The PSWC program was offered at no cost to parents enrolled in 8 Head Start centers, and parents were invited to participate in a program evaluation study. Seventy-one families enrolled in the study and completed at least one PSWC session. From pre- to post-test, parents reported significant improvements in both the frequency and intensity of child behavior problems. Parents also reported significant reductions in parenting stress, as well as improvements in their parenting behaviors, including a reduction in the use of lax discipline techniques and emotional reactivity in the context of discipline encounters. All improvements were sustained six months later. These preliminary results are encouraging, and point to the need for a more rigorous, controlled evaluation of the PSWC parenting class curriculum.     

The Effects of Mother Participation in Relationship Education on Coparenting,Parenting, and Child Social Competence: Modeling Spillover Effects for Low‐Income Minority Preschool Children

Although suggestions are that benefits of relationship and marriage education (RME) participation extend from the interparental relationship with parenting and child outcomes, few evaluation studies of RME test these assumptions and the relationship among changes in these areas. This quasi‐experimental study focuses on a parallel process growth model that tests a spillover hypothesis of program effects and finds, in a sample of low‐income minority mothers with a child attending a Head Start program, that increases in mother reports of coparenting agreement for RME participants predict decreases in their reports of punitive parenting behaviors. Although improvements in parenting behaviors did not predict increases in teacher reports of children's social competence, improvements in coparenting agreement were associated with increases in children's social competence over time. In addition, comparative tests of outcomes between parents in the program and parents in a comparison group reveal that RME program participants (n = 171) demonstrate significant improvements compared to nonparticipants (n = 143) on coparenting agreement, parenting practices, and teachers' reports of preschool children's social competence over a 1 year period. The findings are offered as a step forward in better understanding the experiences of low‐resource participants in RME. Implications for future research are discussed.