Internet-based parent management training: a randomized controlled study

ObjectiveThe current study evaluated the efficacy of an Internet-based parent-training program for children with conduct problems. Dose–response ratio and costs for the program were also considered.MethodParents of 104 children (aged 3–12 years) were randomly allocated to either parent training or a waitlist control condition. Diagnostic assessment was conducted at baseline and parent ratings of child externalizing behaviors and parent strategies were completed before and after treatment and at 6-month follow-up.ResultsAt post-treatment assessment, children whose parent(s) had received the intervention showed a greater reduction in conduct problems compared to the waitlist children. Between group intent-to-treat effect sizes (Cohen’s d) on the Eyberg Intensity and Problem scales were .42 and .72, respectively (study completers .66 and 1.08). In addition, parents in the intervention group reported less use of harsh and inconsistent discipline after the treatment, as well as more positive praise. Effects on behavior problems were maintained at 6-month follow-up.ConclusionsThe results support the efficacy of parent training, administered through Internet, with outcomes comparable to many of the group-based parent training programs. The efficacy, low cost, and higher accessibility make this intervention a fitting part in a stepped-care model.     

The Severely Impaired Do Profit Most: Differential Effectiveness of a Parent Management Training for Children with Externalizing Behavior Problems in a Natural Setting

We investigated the differential effectiveness of a parent management training program for children with externalizing problem behavior. The parent management training was tested using a within-subject control group design. 270 families with children aged 3–10 years were included and assessments were made at 3 months before treatment, immediately before treatment, immediately after treatment, and at 12 months follow-up. We analyzed data using growth mixture modeling. For attention problems, we obtained a two-subgroup solution. One subgroup started with high initial values indicating more severe impairment, and the other subgroup had low initial values. The more impaired group showed stronger treatment effects. For disruptive behavior problems, our analyses revealed a three-subgroup solution. Two subgroups exhibited high initial levels of disruptive behavior problems and the third subgroup had low initial levels. One of the more impaired groups exhibited a strong decrease in problem behavior during treatment, while the other two groups only showed moderate decreases. For attention problems and disruptive behavior problems, some of the most impaired children gained the most from parent training.     

Evaluation of "the incredible years" in Sweden: the transferability of an American parent-training program to Sweden

Structured parent training has been proven to be effective in reducing disruptive behavior problems (DBP) in children. Most of the programs that are used in Sweden have their origin in North America, and there is an ongoing debate over the transferability to Sweden of manual-based programs developed in other contexts. The goal of the present study was to study effectiveness of the Incredible Years parent-training program (IY), developed in the US, in regular clinical work in Sweden, using a randomized controlled design. Parents of 62 four to eight-year-old children diagnosed with Oppositional Defiant Disorder participated in the study. Parents of 38 children were assigned to parent training (PT) and 24 to a waiting list (WL). The results indicate that the IYS retains the positive effects on children's disruptive behavior problems when translated and transferred to Swedish. There was a statistically significant difference in reduction of DBP in children between the groups in favor of the PT. The improvement in the PT group was sustained at the one-year follow-up. The improvement also, at least to some extent, generalized over time to the school context. There was also a statistically significant difference in mothers' report of pre to post change in parenting alliance between the PT and WL groups. The IYS program was appreciated and well received by the participating mothers.     

The Effectiveness of Group Parent–Child Interaction Therapy with Community Families

Parent–Child Interaction Therapy (PCIT) is a behavioral, parent-training program that incorporates both operant learning and play therapy techniques to treat child disruptive behavior problems. The present pilot study examined the use of a group PCIT protocol with a mixed clinical sample of primarily low-socioeconomic status community families. Forty families with a child between the ages of 2 and 8 years old were either self-referred to the group or referred by child protective services, and 27 began treatment. Following a standard group PCIT protocol, 17 families completed treatment. Caregivers who completed the PCIT group reported a significant decrease in child disruptive behavior and parenting stress following completion of the 12-week group. Behavior observations of the treatment completers revealed a significant increase in parent prosocial behavior and a decrease in inappropriate parent behavior from pre- to post-treatment. As there have been no demonstrations, to date, of group PCIT in a community-based setting, this study presents evidence that PCIT is a promising treatment format for dissemination research and practice. The benefits and challenges of using a group PCIT format for delivery of clinical services are discussed.     

Continuities in maternal reports and child behaviors over time in hyperactive and comparison groups

Maternal reports, observations of nursery and elementary school behavior, and teacher ratings of problems were available for hyperactive and control children who had participated in a longitudinal study. This paper examines consistencies in maternal reports and child behaviors over time, and their relationship to teacher ratings in elementary school. Maternal reports of infant sleep difficulties were related to maternal ratings of hyperactivity at 41/2 and 61/2 years. Maternal ratings of activity at 41/2 were predictive of 61/2-year ratings of hyperactivity and conduct problems. In addition, behavior in a research nursery at 41/2 predicted teacher ratings of problems and classroom behavior in grade two. Hyperactive preschoolers who left the table most during structured activities were more often out-of-seat and off-task in school. Controls who were more aggressive in the nursery were more disruptive in the classroom. These data indicate continuities in both maternal reports and child behaviors.Collection of follow-up data were supported by Grant No. MA-4505 from the Medical Research Council of Canada to Dr. Campbell and were collected when she was at McGill University and the Montreal Children's Hospital. Portions of these data were presented at the American Psychological Association, Washington, D.C., September 1976.     

Changes in adolescent and parent hopefulness in psychotherapy: effects on adolescent outcomes as evaluated by adolescents,parents, and therapists

We examined the role of hope in the behavioral and socioemotional outcomes of adolescents referred to psychotherapy. Adolescents (n = 3517), aged 12–17 years, and their parents rated adolescents’ behavior problems, adolescents’ adaptive behavior, and their own subjective experience of hopefulness at intake and at 3-month follow-up. Therapists also rated adolescents’ behavior problems and adaptive behavior at intake and follow-up. Adolescents who reported increased hopefulness during treatment showed significantly fewer problems and significantly greater adaptive behavior at follow-up than adolescents who reported stable or decreased hopefulness. Similarly, adolescents’ outcomes were significantly associated with parents’ change in hopefulness during treatment. Results were consistent for adolescent, parent, and therapist ratings of outcomes. Our findings provide some of the first empirical evidence for the importance of hopefulness in the psychosocial treatment of adolescents and highlight the need to attend to hopefulness in both youths and their parents.     

Performance-based and parent ratings of attention in children treated for a brain tumor: The significance of radiation therapy and tumor location on outcome

Children are at increased risk for cognitive difficulties following the diagnosis and treatment of a brain tumor. Radiation therapy (RT) and tumor location are commonly-cited predictors of neurocognitive functioning. Disruptions to foundational neurocognitive processes such as attention, working memory, and processing speed underlie declines on measures of general intellectual functioning. While several studies have examined visual sustained attention in pediatric brain tumor patients, auditory sustained attention has yet to be examined. This study employs a longitudinal design to examine performance-based and parent ratings of attention in children undergoing surgical resection of a brain tumor (n = 29) and treated with (n = 11) or without (n = 18) RT at 6.79 months post-surgery (baseline) and then again at 30.56 months post-surgery (follow-up). The measures include an auditory continuous performance test (CPT) and parent ratings of attention and hyperactivity on a behavior rating scale. Ultimately, children treated with and without RT performed similarly on performance-based and parent ratings of attention. However, the performance on the auditory CPT differed according to tumor location, with children with infratentorial tumors committing more inattention and inhibitory control errors compared to children with supratentorial tumors. Parent ratings did not differ according to tumor location, and parent ratings and auditory sustained attention performance are not significantly correlated. The findings are interpreted in the context of neurocognitive and brain development.     

The unique impact of parent training for separation anxiety disorder in children

This investigation examined the preliminary efficacy of an integrated cognitive-behavioral parent-training protocol for six families of separation-anxious children (7 to 10 years of age) using a multiple baseline design across participants. Although families were assessed on child, parent, and clinician ratings at pre- and posttreatment as well as 6-month follow-up, only parents received education and training. Although the parent-training protocol was largely effective and treatment gains were maintained at 6-month follow-up, only those child participants whose parents experienced clinically significant improvement on parental process measures (i.e., enhanced efficacy or satisfaction, reduced stress) achieved high end-state functioning. Implications regarding the importance of individualized family-based interventions for treating anxious youth are discussed.     

Utility of teacher behavior ratings for identifying special needs students

The purpose of this study was to explore the efficacy of a teacher behavior rating instrument for identifying special needs students. Using a modified form of theDevereux Elementary School Behavior Rating (DESB)Scale 35 kindergarten through grade 6 regular classroom teachers completed ratings on all of their 876 students. Subsequently, extensive aptitude, academic, social, and behavioral assessment was conducted and those students were identified who were in need of supportive educational programming to function adequately within the regular class setting. Analysis of the teacher behavior ratings indicated a highly significant difference between those students identified for special supportive services and their regular classroom peers on 9 of 11 behavioral factors. The findings lend clear support for the use of classroom teachers' behavior ratings in the identification process.     

Evaluation of the First 3 Years of the Fast Track Prevention Trial with Children at High Risk for Adolescent Conduct Problems

Fast Track is a conduct-problem prevention trial that derives its intervention from longitudinal research on how serious and chronic adolescent problem behaviors develop. Over 9,000 kindergarten children at 4 sites in 3 cohorts were screened, and 891 were identified as high risk and then randomly assigned to intervention or control groups. Beginning in Grade 1, high-risk children and their parents were asked to participate in a combination of social skills and anger-control training, academic tutoring, parent training, and home visiting. A multiyear universal classroom program was delivered to the core schools attended by these high-risk children. By the end of third grade, 37% of the intervention group was determined to be free of serious conduct-problem dysfunction, in contrast with 27% of the control group. Teacher ratings of conduct problems and official records of use of special education resources gave modest effect-size evidence that the intervention was preventing conduct problem behavior at school. Parent ratings provided additional support for prevention of conduct problems at home. Parenting behavior and children's social cognitive skills that had previously emerged as proximal outcomes at the end of the 1st year of intervention continued to show positive effects of the intervention at the end of third grade.     

Targeting self-regulation and academic functioning among preschoolers with behavior problems: Are there incremental benefits to including cognitive training as part of a classroom curriculum?

The purpose of this study was to examine the additional benefit of an adaptive Cogmed working memory training (CWMT) to a social-emotional/self-regulation classroom curriculum for preschoolers with externalizing behavior problems (EBP). Participants for this study included 49 children (71% boys, M_age = 4.52) with at-risk or clinically elevated levels of EBP. Children participated in an 8-week summer treatment program for Pre-Kindergarteners (STP-PreK), where they were randomly assigned to either adaptive CWMT (n = 24), or nonadaptive CWMT (n = 25). Multiple repeated measures analyses were conducted to examine the impact of adaptive versus nonadaptive CWMT on pre and posttreatment parent-/teacher-reported behavioral functioning, parent-/teacher reported and child task performance of executive functioning, and standardized academic achievement measures. Repeated measures analyses found that children in both groups improved on all measures (d’s = .23-.86). However, there were no significant time X condition effects for parent or teacher-reported behavior, reported or observed executive functioning, or standardized academic measures. These findings suggest that CWMT does not appear to provide any incremental benefits to children’s executive functioning, behavior, or academics when implemented within a comprehensive behavioral modification intervention.     

Classroom Behavior and the Ability to Decode Nonverbal Cues in Boys With Severe Emotional Disturbance

Abstract

Nonverbal decoding skills are important for successful social functioning, particularly for emotionally disturbed children. Boys with severe emotional disturbance (n = 25) and a control group of boys (n = 22) were compared regarding the relationship between ratings of classroom social behaviors and nonverbal decoding skills. Participants were predominantly African American. The Diagnostic Analysis of Nonverbal Accuracy (Nowicki, 2001; Nowicki & Duke, 1994) was administered individually to the boys while teachers completed ratings of their social behavior in the classroom. The 2 groups of boys did not differ in nonverbal skills. However, aggressive classroom behaviors were associated with specific nonverbal skills only for the boys with severe emotional disturbance. These findings suggest that nonverbal abilities may have a greater impact on the social behavior of emotionally disturbed boys. Future research is needed to better understand the social difficulties of boys with severe emotional disturbance.     

Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

The purpose of this study was to examine whether callous–unemotional (CU) traits moderated the effects of intensive behavior therapy in elementary school-age children with varying levels of conduct problems (CP). Both treatment response (magnitude of change between pre- and posttreatment) and treatment outcomes (likelihood of normalization from treatment) were examined. Participants were 67 children (n = 49 boys, M_age = 9.6 years) with varying levels of CP and CU who participated in an intensive 8-week summer treatment program (STP) in which behavior therapy was delivered to children in recreational and classroom settings and to parents via weekly parent training sessions. Effects of treatment were measured using parent and teacher ratings of oppositional defiant disorder (ODD), conduct disorder (CD), callous behavior, and impairment. Results showed that CU moderated treatment effects for CD and callous behavior but not ODD or impairment. The moderating effects showed some evidence that participants with high CP and high CU before treatment had better treatment responses (larger change between pre- and posttreatment) but worse treatment outcomes (lower likelihood of normalization after treatment). These results suggest that intensive treatment, such as the STP, may be necessary but not sufficient for children with CP and CU traits.     

Treatment Effectiveness of a Brief Behavioral Intervention for Preschool Disruptive Behavior

Parent management training is an evidence-based treatment for disruptive behavior. However, the number of treatment sessions can be high, contributing to high attrition rates. The purpose of this study was to examine post-treatment, 6-month, and 1-year treatment outcomes of the Brief Behavioral Intervention. One hundred twenty children aged 2–6.5 years demonstrating clinically significant disruptive behavior were referred to an outpatient clinic for treatment and participated in the study. Attrition was below reported rates in the literature. Significant decreases in child disruptive behavior and parent stress were found from pre-to-post intervention, and improvements were maintained at follow-ups. Significant pre-to-post intervention teacher reported decreases in behavior were reported.     

The Relation Between Maternal ADHD Symptoms &; Improvement in Child Behavior Following Brief Behavioral Parent Training is Mediated by Change in Negative Parenting

This study examined the extent to which maternal attention-deficit/hyperactivity disorder (ADHD) symptoms predict improvement in child behavior following brief behavioral parent training. Change in parenting was examined as a potential mediator of the negative relationship between maternal ADHD symptoms and improvement in child behavior. Seventy mothers of 6–10 year old children with ADHD underwent a comprehensive assessment of adult ADHD prior to participating in an abbreviated parent training program. Before and after treatment, parenting was assessed via maternal reports and observations and child disruptive behavior was measured via maternal report. Controlling for pre-treatment levels, maternal ADHD symptomatology predicted post-treatment child disruptive behavior problems. The relation between maternal ADHD symptomatology and improvement in child behavior was mediated by change in observed maternal negative parenting. This study replicated findings linking maternal ADHD symptoms with attenuated child improvement following parent training, and is the first to demonstrate that negative parenting at least partially explains this relationship. Innovative approaches combining evidence-based treatment for adult ADHD with parent training may therefore be necessary for families in which both the mother and child have ADHD. Larger-scale studies using a full evidence-based parent training program are needed to replicate these findings.     

Does dose of early intervention matter for preschoolers with externalizing behavior problems? A pilot randomized trial comparing intensive summer programming to school consultation

The goals of this study were to (a) isolate the ideal length (i.e., 4 or 8 weeks) of the Summer Treatment Program for Kindergarteners (STP-PreK) for improving school readiness and kindergarten success outcomes of preschool children with externalizing behavior problems (EBPs) during the transition to kindergarten; and (b) compare the STP-PreK model to a more standard approach in school settings (i.e., behavioral school consultation). Forty-five preschool children (82% boys; Mage = 5.16 years; 93% Hispanic/Latino background) were randomized to one of three intervention conditions: 1) 8-week STP-PreK (8W); 2) 4-week STP-PreK (4W); or 3) school year behavioral consultation (SC). Both STP-PreK groups included an 8-week parent training component. Baseline, post-intervention, and 6-month follow-up data were collected on children's school readiness and kindergarten success outcomes including parent, teacher, and objective assessment measures. Analyses using linear mixed models indicated that children's behavioral, academic, social-emotional, and self-regulation functioning significantly improved across groups. Few significant differences were found between children receiving the 4W and 8W programs, suggesting that both programs have the potential to prepare preschool children with EBP for the transition to school. Both 4W and 8W groups experienced greater initial growth across time in most domains compared to children in the SC group. However, by the end of the kindergarten year, children in the SC group caught up to children in both 4W and 8W groups on most domains. Overall, these findings suggest that all three intervention doses are effective in improving kindergarten year functioning, with some important considerations for intervention timing in preparation for the transition to elementary school. Clinical implications for school personnel are discussed.     

Science Literacy in School and Home Contexts: Kindergarteners’ Science Achievement and Motivation

We examined science learning and motivation outcomes as a function of children's participation in the classroom and classroom-plus-home components of the Scientific Literacy Project (SLP). The sample was comprised of kindergarten children in 4 low income, neighboring schools. Children in Schools 1 and 2 (n = 120) participated in the SLP science activities. Of these children, 79 participated in the classroom component of the SLP whereas 41 participated in both the classroom and home components. A comparison group of children in schools 3 and 4 (n = 74) participated in regular science activities. We identified science learning, achievement, and motivational benefits for the SLP groups. Additional benefits for children who participated in both the classroom and home components of the SLP were greater gains in general science knowledge, higher levels of positive self-competence beliefs for science, perceived family support for learning science, and independence for learning science.     

Utility of Behavior Ratings by Examiners During Assessments of Preschool Children With Attention-Deficit/Hyperactivity Disorder

This study examines the clinical utility of behavior ratings made by nonclinician examiners during assessments of preschool children with Attention-Deficit/Hyperactivity Disorder (AD/HD). Matched samples of children with (n = 127) and without (n = 125) AD/HD were utilized to test the internal, convergent, concurrent, and incremental validity of ratings completed by examiners on the Hillside Behavior Rating Scale (HBRS). Results indicated that HBRS ratings were internally consistent, possessed sufficient interrater reliability, and were significantly associated with parent and teacher reports of AD/HD when controlling for age, gender, intelligence, and symptoms of other psychopathology. HBRS ratings also were significantly associated with other measures of functioning, and provided a significant increment in the prediction of impairment over parent and teacher report alone. These findings suggest that behavioral ratings during testing provide a unique source of clinical information that may be useful as a supplement to parent and teacher reports.     

The differential validity of teacher ratings of Inattention/Overactivity and Aggression

The ability of school-based measures of child behavior to predict differentially the IOWA Conners teacher rating scale Inattention/Overactivity (IO) and Aggression (A) factors was evaluated in a sample of 71 school-aged boys. Multiple measures and multiple methods of assessment were utilized to provide a comprehensive assessment of social and academic behavior. These included direct observations of children in the classroom and on the playground, examination of the organization of children's desks, measures of academic performance, peer nominations of popularity and rejection, and sociometric ratings using the Pupil Evaluation Inventory. Despite moderately high correlations between the teacher rating factors (r = .60), considerable evidence was provided for differential validity on measures of academic performance, peer rating measures, and measures of disruptive or inappropriate classroom and playground behavior. These differences between IO and A factors indicated that the factors were logically independent in important ways, supporting prior work validating separate hyperactivity and aggression dimensions.     

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.