PCIT-Health: Preventing Childhood Obesity by Strengthening the Parent–Child Relationship

Childhood obesity is a costly, yet preventable, public health concern. Strengthening the parent–child relationship and teaching parents strategies to manage children’s general and health-related behaviors has the potential to reduce childhood obesity risk. Selective prevention interventions may help parents of young children establish positive parenting and feeding practices to actively reduce risk factors. We review the existing literature on childhood obesity interventions and describe an adaptation to a behavioral parent training program—parent–child interaction therapy (PCIT)—to address children’s behaviors in obesity-salient (e.g., mealtime, screen time, bedtime) contexts. In a case example, we describe how PCIT-Health can be effectively implemented.     

Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions

Assessing treatment fidelity is a core methodological consideration in the study of treatment outcome; it influences both the degree to which changes can be attributed to the intervention and the ability to replicate and disseminate the intervention. Efforts to increase access to evidence-based psychological treatments are receiving unprecedented support; but pressures exist to adapt treatments to service settings, running the risk of compromising fidelity. However, little evidence is available to inform the necessary conditions for the transportation of interventions to service provision settings, and the degree to which fidelity is even evaluated or emphasized in dissemination and implementation programs varies dramatically. Moreover, adaptation is associated with several benefits for dissemination efforts and may address relevant barriers to adoption. A particularly promising strategy for maximizing the benefits of both fidelity and adaptation is the use of transdiagnostic interventions. Such treatments allow for greater flexibility of the pacing and content of treatment, while still providing structure to facilitate testing and replication. Preliminary evidence supports the efficacy of this strategy, which may be particularly conducive to dissemination into service provision settings. At this time, further research is needed to evaluate the relationships among fidelity, adaptation, and outcome, and to determine the potential for transdiagnostic treatments to facilitate dissemination.     

An evaluation of positive psychology intervention effectiveness trials using the re-aim framework: A practice-friendly review

Meta-analyses indicate the efficacy of positive psychology interventions in promoting well-being. But, despite accumulating empirical and anecdotal evidence of these interventions’ implementation in real-world settings, no review of effectiveness research exists. Accordingly, we identified 40 positive psychology intervention effectiveness trials targeting adults, and scored their reporting using the practice-friendly RE-AIM tool which assesses five dimensions of intervention utility: Reach, Efficacy, Adoption, Implementation and Maintenance. Reporting levels varied substantially: reporting on Reach scored 64%; Efficacy scored 73%; Adoption scored 84%; Implementation scored 58%; and Maintenance scored 16%. Within these five dimensions, reporting on participation rates, methods to select delivery agents, differences between participants and non-participants, programme maintenance and costs, was particularly sparse. The studies involved 10,664 participants, approximately half required specialist delivery, and 12 were researcher delivered. To maximize the potential of PPIs for population health promotion, expanded reporting on effectiveness trials is required. Recommendations to assist this process are offered.     

Fidelity Failures in Brief Strategic Family Therapy for Adolescent Drug Abuse: A Clinical Analysis

As evidence‐based family treatments for adolescent substance use and conduct problems gain traction, cutting edge research moves beyond randomized efficacy trials to address questions such as how these treatments work and how best to disseminate them to community settings. A key factor in effective dissemination is treatment fidelity, which refers to implementing an intervention in a manner consistent with an established manual. While most fidelity research is quantitative, this study offers a qualitative clinical analysis of fidelity failures in a large, multisite effectiveness trial of Brief Strategic Family Therapy (BSFT) for adolescent drug abuse, where BSFT developers trained community therapists to administer this intervention in their own agencies. Using case notes and video recordings of therapy sessions, an independent expert panel first rated 103 cases on quantitative fidelity scales grounded in the BSFT manual and the broader structural‐strategic framework that informs BSFT intervention. Because fidelity was generally low, the panel reviewed all cases qualitatively to identify emergent types or categories of fidelity failure. Ten categories of failures emerged, characterized by therapist omissions (e.g., failure to engage key family members, failure to think in threes) and commissions (e.g., off‐model, nonsystemic formulations/interventions). Of these, “failure to think in threes” appeared basic and particularly problematic, reflecting the central place of this idea in structural theory and therapy. Although subject to possible bias, our observations highlight likely stumbling blocks in exporting a complex family treatment like BSFT to community settings. These findings also underscore the importance of treatment fidelity in family therapy research.     

Childhood Overweight and Obesity: Maternal and Family Factors

Treatment programs for childhood overweight and obesity have highlighted the importance of the family in treatment. Considering this, it is surprising that few studies have examined the role of family factors in the development of childhood overweight and obesity. The objective of this study was to examine which family and maternal factors predict increases in weight in boys and girls during middle to late childhood. This study used longitudinal data from the childhood growth and development (GAD) Study. The GAD Study involved 286 healthy weight, overweight and obese children, aged 6–13 years at baseline, who completed baseline, 1-year follow-up and 2-year follow-up assessments. Overweight/obese children were recruited from clinical and community settings. A broad range of maternal and family factors were assessed. Linear mixed models were used to identify which factors predicted child Body Mass Index (BMI) z-scores over time. For community-based children, maternal BMI and single-parent family structure were significant longitudinal predictors of child BMI z-scores. For the clinical participants, low family income was the only significant multivariate predictor of child BMI z-scores. The strong association between child BMI, maternal BMI and family structure confirms the need to target prevention and intervention efforts for childhood overweight and obesity towards families with overweight parents, particularly single-parent families.     

Establishing Treatment Fidelity in Evidence-Based Parent Training Programs for Externalizing Disorders in Children and Adolescents

The current review evaluates the use of treatment fidelity strategies in evidence-based parent training programs for treating externalizing disorders. We used a broad framework for evaluating treatment fidelity developed by the National Institutes of Health Treatment Fidelity Workgroup that includes the aspects of treatment design, treatment delivery, training providers, and assessment of participant receipt of treatment and enactment of treatment skills. Sixty-five articles reporting outcome trials of evidence-based parent training programs met inclusion criteria and were coded for treatment fidelity strategies. The mean adherence to fidelity strategies was .73, which was higher than two previous review studies employing this framework in the health literature. Strategies related to treatment design showed the highest mean adherence (.83), whereas training of providers and enactment of treatment skills had the lowest (.58). In light of an increasing emphasis on effectiveness and dissemination trials, the broader treatment fidelity framework as applied in this review focuses needed attention on areas often overlooked in fidelity practices, such as training providers and generalization of treatment skills. We discuss the strengths and limitations of fidelity practices in parent training studies, implications of these findings, and areas for future research.     

Innovations in the treatment of anxiety psychopathology: introduction

Behavioral and cognitive interventions have an established history of efficacy for the treatment of anxiety disorders. The majority of patients receiving these empirically supported interventions for anxiety exhibit improvement and these changes tend to be maintained following treatment. Moreover, emerging data suggest that cognitive-behavioral protocols can be effectively transferred to real-world settings such as primary care practices. On the other hand, historical reviews indicate that the relative efficacy of treatments for anxiety have not substantially improved over time. A further concern is that there are relatively few innovations in the treatment of anxiety during the past 20years. Thus, we appear to have reached somewhat of a plateau with regard to treatment response, which would suggest a need to consider novel methods and approaches. This special series will describe new and innovative approaches to the treatment of anxiety psychopathology.     

Moving from efficacy to effectiveness trials in prevention research

Efficacy trials test whether interventions work under optimal, highly controlled conditions whereas effectiveness trials test whether interventions work with typical clients and providers in real-world settings. Researchers, providers, and funding bodies have called for more effectiveness trials to understand whether interventions produce effects under ecologically valid conditions, which factors predict program effectiveness, and what strategies are needed to successfully implement programs in practice settings. The transition from efficacy to effectiveness with preventive interventions involves unique considerations, some of which are not shared by treatment research. The purpose of this article is to discuss conceptual and methodological issues that arise when making the transition from efficacy to effectiveness research in primary, secondary, and tertiary prevention, drawing on the experiences of two complimentary research groups as well as the existing literature. We address (a) program of research, (b) intervention design and conceptualization, (c) participant selection and characteristics, (d) providers, (e) context, (f) measurement and methodology, (g) outcomes, (h) cost, and (i) sustainability. We present examples of research in eating disorder prevention that demonstrate the progression from efficacy to effectiveness trials.     

Say something nice: A meta-analytic review of peer reporting interventions

Peer reporting interventions (i.e., Positive Peer Reporting and tootling) are commonly used peer-mediated interventions in schools. These interventions involve training students to make reports about peers' prosocial behaviors, whether in oral or written form. Although peer reporting interventions have been included in meta-analyses of group contingencies, this study is the first meta-analytic review of single-case research focusing exclusively on peer reporting interventions. The literature search and application of inclusion criteria yielded 21 studies examining the impact of a peer reporting intervention on student behavior compared to baseline conditions. All studies used single-case experimental designs including at least three demonstrations of an effect and at least three data points per phase. Several aspects of studies, participants, and interventions were coded. Log response ratios and Tau were calculated as effect size estimates. Effect size estimates were synthesized in a multi-level meta-analysis with random effects for (a) studies and (b) cases within studies. Overall results indicated peer reporting interventions had a non-zero and positive impact on student outcomes. This was also true when data were subset by outcome (i.e., disruptive behavior, academically engaged behavior, and social behavior). Results were suggestive of more between- than within-study variability. Moderator analyses were conducted to identify aspects of studies, participants, or peer reporting interventions associated with differential effectiveness. Moderator analyses suggested published studies were associated with higher effect sizes than unpublished studies (i.e., theses/dissertations). This meta-analysis suggests peer reporting interventions are effective in improving student behavior compared to baseline conditions. Implications and directions for future investigation are discussed.     

Prevention of eating disorders and obesity via the internet

Internet technology has been expanding rapidly and has had a dramatic impact on how people communicate, learn and share information. This article presents applications of internet technology to the psychological domain, particularly in the prevention and treatment of eating disorders and obesity. Information regarding advantages and disadvantages of computerized interventions are discussed and several examples of randomized controlled trials with this technology are presented. The studies presented are not meant to be comprehensive of psychological interventions in general, but are examples of computerized applications from the eating disorder and obesity literatures. Ethical considerations and areas for future direction are also discussed.     

Executive functions after age 5: Changes and correlates

Research and theorizing on executive function (EF) in childhood has been disproportionately focused on preschool age children. This review paper outlines the importance of examining EF throughout childhood, and even across the lifespan. First, examining EF in older children can address the question of whether EF is a unitary construct. The relations among the EF components, particularly as they are recruited for complex tasks, appear to change over the course of development. Second, much of the development of EF, especially working memory, shifting, and planning, occurs after age 5. Third, important applications of EF research concern the role of school-age children’s EF in various aspects of school performance, as well as social functioning and emotional control. Future research needs to examine a more complete developmental span, from early childhood through late adulthood, in order to address developmental issues adequately.     

The effectiveness of family therapy and systemic interventions for child-focused problems

This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes).     

Methods Used to Document Procedural Fidelity in School-Based Intervention Research

There has been a paucity of guidance on the methodological details needed for measuring and sampling the independent variable or actual intervention occurrences in research and practice. Furthermore, the planning and support necessary to document the independent variable in both circumstances may be considerable. The current study extends prior research by reviewing the methods used to document procedural fidelity in school-based intervention research with student participants published between 2005 and 2012 in journals known for publishing school-related intervention studies. Two hundred sixty-six articles met the inclusion criteria and the majority (70 %) used fidelity data in the analysis of intervention effectiveness. By systematically examining contributions of school-based intervention researchers across targeted variables as well as qualities of interventions and settings, suggestions can be made for (a) planning measurement of fidelity across phases of the intervention, (b) sampling fidelity occurrences, (c) preventing intervention failure by providing needed supports, and (d) responding to patterns of fidelity required for intervention and outcome measurement in both research and practice.     

Effective obesity treatments

To curb the epidemic of obesity in the United States, revised Medicare policy allows support for efficacious obesity treatments. This review summarizes the evidence from rigorous randomized trials (9 lifestyle trials, 5 drug trials, and 2 surgical trials) on the efficacy and risk- benefit profile of lifestyle, drug, and surgical interventions aimed at promoting sustained (= 2 years) reductions in weight. Both lifestyle and drug interventions consistently produced an approximate 7-lb (3.2-kg) weight loss that was sustained for 2 years and was associated with improvements in diabetes, blood pressure, and/or cardiovascular risk factors. Surgical interventions have a less solid empirical base but offer promise for the promotion of significant and sustained weight reduction posttreatment in the morbidly obese but with possible significant short-term side effects. In summary, there is strong and consistent support from rigorous randomized trials that lifestyle or drug interventions result in modest weight loss with minimal risks but disproportionate clinical benefit. Combinations of lifestyle, drug, and, where appropriate, surgical interventions may be the most efficacious approach to achieving sustained weight loss for the widest diversity of patients.     

Influence of Siblings on Child Health Behaviors and Obesity: A Systematic Review

Family structure plays an important role in childhood obesity but the association between having siblings and childhood obesity is not well established. The purpose of this systematic review was to examine the relationship between sibling factors and child health behaviors and child obesity. CINAHL, Cochrane Reviews, PsycINFO and PubMed were searched to identify relevant publications between 2000 and 2016. Of 141 identified studies, 22 peer-reviewed, primary research reports satisfied inclusion criteria and were included in the review. Findings indicated that children without siblings are more likely to be overweight or obese. Having fewer siblings was associated with decreased physical activity, inadequate sleep, and unhealthy dietary habits. The relationship between the number of siblings and childhood obesity persisted over time. All but two studies reported an association between birth order and childhood obesity. Youngest siblings were at a higher risk of becoming overweight or obese than their older siblings. Overall, the findings emphasize the importance of sibling factors in the development of childhood obesity. Further studies are needed to understand the dynamics underlying the effect of siblings on child’s health-related behaviors in order to develop effective childhood obesity prevention programs. Healthcare professionals should focus on family structure and at-risk children when intervening to prevent childhood obesity.     

Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research

Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.     

Asian Parents’ Perception of Child Weight Status: A Systematic Review

Parental perception of a child’s weight is important in determining parenting and feeding styles, which relate to childhood obesity. Evidence suggests this perception can vary by ethnicity. The purpose of this review was to explore Asian parents’ child weight perception and examine factors related to Asian parents’ child weight misperception. A systematic literature review was conducted on eight studies between 2000 and 2016 through the databases of CINAHL, Cochrane Reviews, PsycINFO, Medline, and PubMed. Searching key words were Asians, Asian-Americans, weight perception, and parents. The review revealed that all eight studies identified child weight misperception, but with highly varying results (ranging from 29.7 to 89.2%). Factors that influenced the accuracy of a parent’s child weight perception included maternal BMI, parental gender and age, child’s BMI, child’s own weight perception, child’s gender and age, and child’s birth order and birth weight. Misperception about their children’s weight is prevalent among Asian parents. Anthropometric measurement of a child, rather than a parent’s reporting of a child’s weight, should be used to educate Asian parents regarding childhood obesity. Health care professionals should be aware of misperceptions when developing and providing a culturally appropriate intervention to address overweight/obesity among Asian children, which might include improving weight perception.     

Implications of Timing of Maternal Depressive Symptoms for Early Cognitive and Language Development

: Statistically, women, particularly pregnant women and new mothers, are at heightened risk for depression. The present review describes the current state of the research linking maternal depressed mood and children's cognitive and language development. Exposure to maternal depressive symptoms, whether during the prenatal period, postpartum period, or chronically, has been found to increase children's risk for later cognitive and language difficulties. The present review considers both the timing of maternal depression and the chronicity of mothers' depression on children's risk for cognitive and language delays. Infancy is frequently identified as a sensitive period in which environmental stimulation has the potential to substantially influence children's cognitive and language development. However, children's exposure to chronic maternal depression seems to be associated with more problematic outcomes for children, perhaps because depression interferes with mothers' ability to respond sensitively and consistently over time. Consistent with this expectation, interventions targeting parenting practices of depressed mothers have been found to increase children's cognitive competence during early childhood. The current review provides a synthesis of the current state of the field regarding the association between maternal depression and children's cognitive and language development during early childhood.     

The evidence base for family therapy and systemic interventions for child‐focused problems

This review updates similar articles published in the Journal of Family Therapy in 2001 and 2009. It presents evidence from meta‐analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family‐based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multi‐modal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, attention deficit hyperactivity disorder, delinquency and drug misuse); emotional problems (including anxiety, depression, grief, bipolar disorder and self‐harm); eating disorders (including anorexia, bulimia and obesity); somatic problems (including enuresis, encopresis, medically unexplained symptoms and poorly controlled asthma and diabetes) and first episode psychosis.