COVID-19 and the Acceleration of Behavioral Parent Training Telehealth: Current Status and Future Directions

The SARS-COV-2 (COVID-19) pandemic and associated social distancing guidelines have accelerated the telehealth transition in mental health. For those providing Behavioral Parent Training (BPT), this transition has called for moving sessions that are traditionally clinic-based, active, and directive to engaging, supporting, and treating families of children with behavior disorders remotely in their homes. Whereas many difficulties accompany this transition, the lessons learned during the current public health crisis have the potential to transform BPT service delivery on a large scale in ways that address many of its long-standing limitations. We describe both challenges and opportunities and consider the possibilities inherent in a large scale BPT service delivery model capable of increasing the reach and impact of evidence-based treatment for all families.     

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.     

Behavioral Parent Training Engagement Among Young Children With Autism Spectrum Disorder

The purpose of the current study was to examine engagement with Behavioral Parent Training (BPT) for families of children with Autism Spectrum Disorder (ASD) and assess openness to novel delivery formats for BPT (e.g., telehealth, group). Participants were caregivers of 501 children with ASD (ages 2–6) enrolled in the SPARK (Simons Foundation Powering Autism Research for Knowledge) online national registry. The study assessed: (1) rates of child disruptive behavior diagnoses, (2) engagement and satisfaction with BPT, (3) parent and child factors (e.g., diagnostic history), and (4) openness to novel delivery formats. Almost 25% of young children with ASD in this sample had disruptive behavior problems rising to the level of a diagnosis of ADHD or ODD and thus would benefit from BPT. However, only one third of these families had actually been referred to BPT. Families indicated high level of interest in participating in BPT, with a particular interest in Parent Child Interaction Therapy (PCIT) as well as novel delivery formats such as telehealth and group. Specific components of the therapy and delivery formats were indicative of parent satisfaction (e.g. groups, longer treatment sessions, longer treatment length). Specific parent and child characteristics were predictive of openness to novel formats (e.g. parental depression, more severe behavioral challenges, lower verbal skills). Results underscore the need for increased referrals and access to BPT programs the ASD population. Both parent and child characteristics are important for determining appropriate delivery formats.     

Measuring Change During Behavioral Parent Training Using the Parent Instruction-Giving Game with Youngsters (PIGGY): A Clinical Replication

This is the second study to investigate the clinical use of the Parent-Instruction Game with Youngsters (PIGGY) which is a structured observation system derived from the Dyadic Parent-Child Interaction Coding System II (DPICS-II; Eyberg, Bessmer, Newcomb, Edwards, & Robinson, 1994) and the Behavior Coding System (BCS; Forehand & McMahon, 1981 Forehand , R. L. , & McMahon , R. J. ( 1981 ). Helping the noncompliant child . New York , NY : Guilford Press . [Google Scholar]). In a previous study, the PIGGY demonstrated strong reliability and validity as well as clinical utility (Hupp, Reitman, Forde, Shriver, & Kelley, 2008). The present study is a replication of the previous research on clinical utility by using the PIGGY to monitor changes in parent and child behavior during and after behavioral parent training.     

Enhancements to the Behavioral Parent Training Paradigm for Families of Children with ADHD: Review and Future Directions

Behavioral parent training (BPT) is one of the empirically supported psychosocial treatments for ADHD. Over many years and in many studies, BPT has been documented to improve both child ADHD behavior and maladaptive parenting behavior. In some studies, BPT has also been found to result in benefits in additional domains, such as parenting stress and child classroom behavior. However, the BPT literature on children selected as having ADHD lags behind research conducted on BPT for children selected as having oppositional defiant and conduct disorders (ODD and CD, respectively) with regard to examination of factors that may limit treatment attainment, compliance, and outcomes, such as single parenthood, parental psychopathology, and child comorbidity. Because of the high degree of comorbidity between ADHD and ODD/CD, it is difficult to separate the two BPT literatures. The parameters of BPT (e.g.. format and setting), parent factors, and child factors that may contribute to treatment outcomes for families of children with ADHD are reviewed here and recommendations for future BPT research in the area of ADHD are made.     

Behavioral Skills Training With Teachers: Booster Training for Improved Maintenance

Behavioral skills training (BST) has been employed within many different populations for the reduction of problem behaviors and acquisition of new skills; however, these changes have not always maintained over time. This study evaluated the effects of a booster training for re-establishing the classroom management proficiencies that teachers had acquired previously, but had declined over a 12-month period. The single-subject experimental results showed the booster training to be effective in re-establishing teacher performance of skills as measured by both analogue role-play and in situ postassessments within the classroom. These findings suggest that a booster training utilizing BST may be an important strategy for maintaining skill performance over time.     

Impact of Child and Parent Motivation on Social Skills Training Outcome

This study explores child and parent motivation at the start of a social skills training group program and its relationship with treatment outcome. A total of 59 children (aged 7–12) participated. Parents were more aware of, distressed by, and motivated to change the presenting problem than were their children. Greater parent awareness of their child’s difficulty making and keeping friends and perceived importance of their child learning ways to make and keep more friends significantly predicted more improved social skills. Increasing parents’ awareness and perceived importance of treating the presenting problem at the start of therapy may increase treatment effectiveness.     

Preventative Behavioral Parent Training: A Preliminary Investigation of Strategies for Preventing At-Risk Children From Developing Later Conduct Problems

Children exhibiting conduct problems comprise the largest source of referrals to children's mental health services. The treatment for conduct problems that possesses the greatest amount of empirical support is behavioral parent training. Unfortunately, a cogent approach to the identification of risk factors and prevention of chronic conduct problem display has not been developed. This project was an initial longitudinal assessment examining the merits of preventative behavioral parent training as a primary prevention strategy for at-risk children. Results demonstrated that prevention participants were engaging in normative rates of disruptive behaviors at 6-month follow-up, whereas comparison children showed a behavioral decline over time.     

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

To scale up evidence-based treatment of conduct problems, parent management training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.     

父母养育压力对儿童问题行为的影响:养育方式的中介作用

本追踪研究旨在考察父母养育压力对儿童问题行为的影响方式是否存在差异。被试为364名。6个月时, 父母报告各自的养育压力;24个月时, 父母报告各自的养育方式;48个月时, 父母分别报告儿童的问题行为。结果发现, 母亲养育压力可直接显著正向预测学前期儿童的外显问题行为;父亲的养育方式在其养育压力与学前期儿童的内隐和外显问题行为之间起到了完全中介作用。这表明, 母亲早期养育压力可直接影响学前期儿童的外显问题行为;而父亲养育压力完全通过其养育方式影响学前期儿童的内隐和外显问题行为, 且严厉起主要作用。     

Maternal Emotional Distress,Abuse Risk,and Children's Symptoms: Child Gender as a Moderator of Parent Sensitivity as a Mediator

Mothers' distress is a correlate of their children's elevated behaviour problems and symptoms. Parenting practices have been shown to mediate these associations, but few studies have observed parenting or focused on parents at risk of child abuse. In this study of 269 high‐risk mothers and their young children (M = 4.2 years), structural equation modelling was used to test associations between mothers' distress and child externalizing and internalizing symptoms. Associations were expected to be partly indirect via mothers' observed low sensitivity, and child gender was expected to moderate associations. Also, mothers' child abuse risk was examined as a unique correlate of sensitivity and children's symptoms, and a moderator of associations of distress with sensitivity and symptoms. Associations showed a pattern of gender‐moderated mediation with the link between mothers' distress and internalizing mostly direct for boys, and equally direct and indirect via sensitivity for girls. The association of mothers' distress with externalizing was mostly direct for boys and girls. Mothers' child abuse risk was not uniquely associated with sensitivity or symptoms and did not moderate any associations. There were no differences in model paths between mothers referred from child welfare/mental health compared with other sources or self‐referred. Copyright © 2013 John Wiley & Sons, Ltd.     

An Examination of the Relationship Between Parent Language and Child Anxiety

Research suggests that parents of anxious children behave differently when interacting with their children than do parents of nonanxious children. However, the relationship between parent language use in this context and child anxiety remains unclear. The present study investigates how parent language use relates to child anxiety during parent–child interactions using a community sample recruited to participate in a study of familial anxiety. Results indicate that parent language use varies in relation to child anxiety. Further, this idiosyncratic pattern of parent linguistic activity uniquely predicts child anxiety diagnostic status. Implications of this study and future directions for research are discussed.     

The Impact of Children's Language Ability on Parent Cognitions and Harsh Discipline Practices

This study examined associations between children's language ability and maternal cognitions about the intentionality and aversiveness of child behaviour, and mothers' reported harsh discipline responses to child misbehaviour. We tested associations with each type of cognition separately as well as in a single model to explore their unique associations. Participants included 69 mothers and their 18‐ to 37‐month‐old children. Mothers completed the Parenting Scale and were asked to rate the aversiveness and intentionality cognitions in response to eight common toddler problem behaviours. The Preschool Language Scale was administered to the children by an objective evaluator. A path analysis demonstrated that children's language ability was associated with maternal intentionality cognitions about their children's behaviour, which, in turn, was associated with mothers' harsh discipline. These findings highlight the importance of examining developmental markers of harsh parenting. Copyright © 2013 John Wiley & Sons, Ltd.     

The Role of Parent Education and Parenting Knowledge in Children's Language and Literacy Skills among White,Black, and Latino Families

This study investigated the role of parenting knowledge of infant development in children's subsequent language and pre‐literacy skills among White, Black and Latino families of varying socioeconomic status. Data come from 6,150 participants in the Early Childhood Longitudinal Study–Birth Cohort. Mothers' knowledge of infant development was measured when children were 9 months old, and child language and pre‐literacy skills were measured during the fall of the preschool year prior to Kindergarten when children were approximately four years old. Mothers' knowledge of infant development was uniquely related to both maternal education and race/ethnicity. Reported sources of parenting information/advice also varied by education and race/ ethnicity and were related to parenting knowledge. Further, controlling for demographic factors, parenting knowledge partially mediated the relation between parent education and child language and pre‐literacy skills, and this relation differed by race/ethnicity. One way to eliminate socioeconomic status achievement gaps in children's early language and literacy skills may be to focus on parents' knowledge of child development, particularly in Latino families. Copyright © 2015 John Wiley & Sons, Ltd.     

Examining Influences on Problem Recognition and Help-Seeking for Child Externalizing Behaviors Among African American Mothers

Childhood behavior problems are one of the most common clinical referrals. If left untreated, these behaviors can result in detrimental consequences to the child’s development (Wehmeier et al., 2010; Scholtens et al., 2012). Behavior parent training has been identified as first-line treatment for oppositional behavior; however, many racial minority families fail to enroll in behavior parent training. The current study examines maternal help-seeking for children displaying oppositional behavior in hopes to delineate variables that might influence parent training enrollment among African American families. Participants were 112 African American mothers who were provided child behavior vignettes and completed measures assessing factors related to problem recognition, parental attributions, child rearing values, mental health stigmatization, racial identity, and treatment utilization. Results found that when presented with a child displaying clinically significant externalizing child behaviors, slightly more than half of African American mothers recognized clinically significant child behavior problems. Mothers were more likely to engage in behavioral parent training if problematic behavior was recognized. Additionally, mothers’ attributions of child behavior, cultural values, and mental health stigmatization were influential to help seeking. This study supports the importance of considering cultural variables that impact problem recognition and subsequent treatment utilization among African American families.     

Parenting Wisely: Parent Training via CD-ROM with an Australian Sample

The effectiveness of a parenting program was examined with an Australian sample regarding improved parent knowledge, parental sense of competence, and child behavior. One hundred and sixteen parents and their children were randomly assigned to three conditions: a two-session group based intervention, a two-session self-administered individual intervention, or to a waitlist control group. Across both treatment modalities results reveal a significant increase in parental satisfaction, efficacy, and a reduction in child problem behavior. Improvements were maintained at 3-months follow-up. Results indicate the individual self-administered format enhanced treatment gains relative to the group format.     

Combined Individual Cognitive Behavior Therapy and Parent Training for Childhood Depression: 2- to 3-Year Follow-Up

Fourteen children with significant depressive symptoms from an open clinical trial of Primary and Secondary Control Enhancement Training augmented with Caregiver–Child Relationship Enhancement Training, participated in a 2- to 3-year follow-up assessment. The results suggested that the significant decreases in depressive symptoms observed at posttreatment were maintained at 2- to 3-year follow-up. Mothers' reports of significant improvement of child psychosocial functioning were also maintained, providing social validation of the effects. Pretreatment child-rated mother-child relations predicted depressive symptoms at 2- to 3-year follow-up. These long-term data support the use of the combined intervention and suggest the need for further research on caregiver involvement in treatment.     

The Effects of Parent Training and Ritalin on the Parent-Child Interactions of Hyperactive Boys

Using a multiple baseline across subjects design, the present study assessed the effects of parent training alone and combined with methylphenidate on the social interactions of three mothers with their hyperactive boys. Two mothers received instruction in child behavior management while their sons remained off medication. Subsequently, these boys returned to medication to evaluate whether the drug further enhanced the effects of parent training. The third child received the drug treatment first and then remained on medication while his mother underwent the same parent training program. Results indicated that both treatments alone decreased the amount of commands given by the mother as well as parent ratings of deviant child behavior in the home, but produced variable improvements in child compliance to commands. More reliable improvements in child compliance to commands. More reliable improvements from each treatment occurred in the duration of compliance per command. the combination of treatments failed to produce any further improvements in mother-child interactions than that achieved by either treatment alone. Contrary to earlier research, only parent training resulted in increases in the mothers' use of positive attention following child compliance.     

Parent Management of Attendance and Adherence in Child and Adolescent Therapy: A Conceptual and Empirical Review

There have been impressive, recent advances in the development of efficacious treatments for child and adolescent behavior problems. However, specific methods for delivering these treatments in a way that amplifies their efficacy have not been well articulated. Although many factors may be involved, attendance and adherence to treatment are arguably the most basic necessities for effective treatment delivery. We provide a conceptual and empirical review of past research on attendance and adherence to child and adolescent therapy, with a special focus on the importance of parents/guardians in managing treatment participation. Our review demonstrates that attendance and adherence are associated with a range of significant methodological, clinical, and financial outcomes. Several pretreatment predictors of attendance and adherence have been identified; however, to date only 12 controlled, clinical trials have evaluated strategies for enhancing attendance and adherence to child therapy. We conclude with an agenda for advancing research on the prediction and enhancement of attendance and adherence to child therapy as a means of improving the efficiency and effectiveness of child treatments.     

A Family Systems Approach to Behavioral Training with Parents of Autistic Children

This paper reviews briefly the use of behavioral procedures and parent training techniques with parents of autistic children. Potential hazards that may arise when the clinician fails to be sensitive to the family context are examined. Behavioral clinicians are urged to undertake behavioral parent training from a family systems context and thereby enhance the likelihood of more enduring changes for the autistic child and the family as a whole. Case illustrations are provided.