Child and parental self-monitoring as determinants of success in the treatment of morbid obesity in low-income minority children

OBJECTIVE: To examine self-monitoring by children and parents as related to weight control over 6 months within a long-term multidisciplinary program for low-income minority children with morbid obesity. METHODS: The weight changes of 228 children with obesity were evaluated according to frequency of child and parental self-monitoring. Predictors of self-monitoring were also evaluated. RESULTS: Children who self-monitored on most days lost more weight over 6 months of treatment compared with less-consistent self-monitors. Children whose parents self-monitored were also more likely to self-monitor and lose weight. CONCLUSIONS: Self-monitoring seems just as critical for successful weight control among low-income minority children with obesity as it is in the middle-class populations. Although lower education and higher levels of psychosocial stress may decrease self-monitoring and participation by these families, they might still benefit from targeting highly consistent self-monitoring (by parents and children) as a primary goal in weight-control programs.     

Reanalysis of Weight Changes in Behavior Modification and Nutrition Education for Childhood Obesity

Changes in percentage overweight for children who were providedbehavior modification were 1.7 times as great as those providednutrition education during treatment, and 2.7 times as greatby the end of follow-up. The superiority of behavior modificationto nutrition education was shown for comparisons of means inthree separate analyses. However, examination of the three studieswhich have studied parent and child weight changes when bothare offered treatment, in general, show that differential effectsof treatments are observed more reliably for the parents thanthe children. Possible reasons for these results are discussed.     

Parents have both implicit and explicit biases against children with obesity

Weight bias (negative attitudes towards individuals with obesity) has been widely observed, but not examined in parents. In this study, we measured parents’ (N?=?658; 74.2% female) explicit and implicit weight bias against children with obesity. Many parents (n?=?612; 93%) endorsed some moderate explicit weight bias. Fathers had greater explicit bias than mothers and parents with overweight/obesity had less bias than those with healthy-weight. Other parent/child variables (i.e., parent age, child sex, child weight, child age) were not significantly associated with explicit bias. Parents also demonstrated implicit weight bias. No parent or child variables were significantly associated with implicit bias. Parents may contribute, among many others, to the stigmatizing environment experienced by youth with overweight/obesity, which has been associated with negative child psychosocial functioning and health. Clinical research into strategies to reduce parental weight bias against children with obesity or increase children’s resilience to weight discrimination is needed to improve children’s health and well-being.     

Modifying Problematic Mealtime Interactions of Children with Cystic Fibrosis and Their Parents Via Behavioral Parent Training

Implemented behavioral parent training targeting maladaptivemealtime behavior with two children with cystic fibrosis (CF)and their parents. Treatment was implemented in multiple baseline fashion across the two families. Primary dependent measurewas coding of parent and child behaviors from videotaped dinners.Data were also collected on the children's daily calorie intakeand weight. During treatment and at the posttreatment follow-ups,parents' attention to disruptive behavior decreased, attentionto appropriate eating increased, and parental control at mealsincreased. The children showed an increase in appropriate behaviorand a decrease in disruptive behavior; caloric intake and weightalso improved. Results are discussed in terms of the applicabilityof behavioral intervention with feeding problems in childrenwith CF.     

Observation of family functioning at mealtime: a comparison between families of children with and without overweight

OBJECTIVE: To examine differences between families of children with and without overweight on parental control and support. METHODS: Twenty-eight families with an overweight child and a control group of 28 families with a normal weight child (age range 7-13 years) participated in the study. Observations and self-reports of mealtime family functioning were administered and analyzed. RESULTS: Parents of children with overweight reported to exert more control on their children's feeding behavior and an equal amount of parental support in comparison with parents of children without overweight. However, observations at mealtime indicated that in families with an overweight child, maladaptive control strategies were twice as prevalent, and less parental support was displayed. CONCLUSIONS: Self-reports and observations provide complementary information on how parents interact with their overweight children. Family-based treatment programs should include discussions on the adequate amount of parental control and support.     

Childhood obesity: parents fail to recognise, general practitioners fail to act

General Practitioners (GPs) have an important role to play in recognition of and intervention against childhood obesity in Ireland. Data were collected prospectively on a cohort of children aged 4-14 and their parents (n = 101 pairs) who attended consecutively to a semi-rural group general practice. Parents estimated their child's weight status. Actual weight status was determined for both parent and child using the United States Centres' for Disease Control's BMI-for-age references. 15 (14.9%) of the children and 49 (51.6%) of the parents were overweight or obese. While 71 (95.5%) of normal weight status children were correctly identified, parents showed poor concordance in identifying their children as overweight 2 (18.2%) or obese 0 (0%). BMI was only evidently recorded in the clinical records of 1 out of 15 cases of overweight children identified. With parents failing to recognise childhood obesity, GPs have a responsibility in tackling this problem at a family level.     

Cognitive-behavioral treatment of recurrent nonspecific abdominal pain in children: an analysis of generalization, maintenance, and side effects

From 10% to 15% of school-aged children experience recurring abdominal pain. This study evaluated the efficacy of a cognitive-behavioral program for the treatment of nonspecific recurrent abdominal pain (RAP) using a controlled group design. The multicomponent treatment program consisted of differential reinforcement of well behavior, cognitive coping skills training, and various generalization enhancement procedures. Multiple measures of pain intensity and pain behavior were conducted, including children's self-monitoring, parent observation, teacher observation, and observation by independent observers. Results showed that both the experimental and the control groups reduced their levels of pain. However, the treated group improved more quickly, the effects generalized to the school setting, and a larger proportion of subjects were completely pain-free by 3-months follow-up (87.5% vs. 37.5%). There was no evidence for any negative side effects of treatment.     

Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire

BackgroundOverweight children are at an increased risk of premature mortality and disease in adulthood. Parental perceptions and clinical definitions of child obesity differ, which may lessen the effectiveness of interventions to address obesity in the home setting. The extent to which parental and objective weight status cut-offs diverge has not been documented.AimTo compare parental perceived and objectively derived assessment of underweight, healthy weight, and overweight in English children, and to identify sociodemographic characteristics that predict parental under- or overestimation of a child’s weight status.MethodParental derived cut-offs for under- and overweight were derived from a multinomial model of parental classification of their own child’s weight status against school nurse measured body mass index (BMI) centile.ResultsMeasured BMI centile was matched with parent classification of weight status in 2976 children. Parents become more likely to classify their children as underweight when they are at the 0.8th centile or below, and overweight at the 99.7th centile or above. Parents were more likely to underestimate a child’s weight if the child was black or South Asian, male, more deprived, or the child was older. These values differ greatly from the BMI centile cut-offs for underweight (2nd centile) and overweight (85th).ConclusionClinical and parental classifications of obesity are divergent at extremes of the weight spectrum.     

Treating children with early-onset conduct problems: intervention outcomes for parent, child, and teacher training.

Families of 159, 4- to 8-year-old children with oppositional defiant disorder (ODD) were randomly assigned to parent training (PT); parent plus teacher training (PT + TT); child training (CT); child plus teacher training (CT + TT); parent, child, plus teacher training (PT + CT + TT); or a waiting list control. Reports and independent observations were collected at home and school. Following the 6-month intervention, all treatments resulted in significantly fewer conduct problems with mothers, teachers, and peers compared to controls. Children's negative behavior with fathers was lower in the 3 PT conditions than in control. Children showed more prosocial skills with peers in the CT conditions than in control. All PT conditions resulted in less negative and more positive parenting for mothers and less negative parenting for fathers than in control. Mothers and teachers were also less negative than controls when children received CT. Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems.     

Social support and treatment outcome in behavioral family therapy for child conduct problems.

This study assessed the role of social support in the outcome of child management training (CMT) for single parents of conduct problem children and assessed the impact of adjunctive ally support training (AST) on treatment outcome. Single parents (N = 22) with a child diagnosed as oppositional or conduct-disordered received CMT or CMT plus AST. Each group received the same 6-week parent training program and the AST group received an extra social support intervention. Measures of parent behavior, child deviance, social support (SS), and parental depression were obtained at pre- and posttreatment and at 6-month follow-up. Both groups improved, and changes maintained at follow-up. AST produced no extra gains. Responders from either group were more likely than nonresponders to report high levels of SS from friends. Results emphasize the importance of SS and the difficulty of incorporating changes in SS into treatment programs.     

Empirical Support for a Treatment Program for Families of Young Children With Externalizing Problems

We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children. Families were assigned randomly to an immediate 12-week parent and child treatment condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction with treatment, and increased knowledge of behavior management principles. Relative to the waitlist condition, treatment parents reported statistically and clinically significant reductions in child behavior problems, improved parenting practices (i.e., increased consistency, decreased power assertive techniques), an increased sense of efficacy, and reduced parenting stress. There was a trend toward parents improving their attitudes toward their children. In considering the process of change, we found evidence that improved parenting practices mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress. Five months following treatment, teachers reported significant improvements in child behaviors, whereas parents reported that reductions in child behavior problems and parenting stress were maintained.     

Cognitive‐Behavioral Treatment of Hoarding in Youth: A Case Illustration

Hoarding in children is associated with more severe ancillary psychopathology, and has poor treatment outcome. At present, there are no empirically established procedures for treating hoarding in youth. The present case illustration is of a 10‐year old child (“Grace”) who presented for treatment with significant hoarding related to academic concerns and additional unrelated symptoms of obsessive‐compulsive disorder (OCD). Grace was treated with cognitive behavior therapy (CBT) primarily comprising exposure with response prevention, behavioral experiments, and cognitive therapy, along with a program of reinforcement delivered by her parents to maintain her motivation for therapy. After 23 sessions and one booster session, Grace's symptoms improved significantly, with gains maintained at 1‐year follow‐up. In addition to the benefits of the specific interventions chosen, the role of therapist–patient/parent alliance as a contributory factor for good outcome is emphasized. As hoarding is underinvestigated in youth, suggestions for further investigation are offered.     

Problem solving in the treatment of childhood obesity

This study randomized obese children from 67 families to groups that received a 6-month family-based behavioral weight-control program plus parent and child problem solving, child problem solving, or standard treatment with no additional problem solving. The standard group showed larger body mass index (BMI) decreases than the parent + child group through 2 years, with significant differences in the percentage of children who showed large BMI changes. Significant statistical and clinical improvements were observed over time in child behavior problems and parental distress. Parent problem solving increased in the parent + child condition relative to the other conditions, whereas child problem solving increased equally in all conditions. The bulk of evidence suggests that problem solving did not add to treatment effectiveness beyond the standard family-based treatment.     

A Longitudinal Look at Parent–Child Diagnostic Agreement in Youth Treated for Anxiety Disorders

This study examined diagnostic agreement between children and their parents for seventy 9- to 13-year-olds (45 boys and 25 girls) who had received cognitive–behavioral treatment for anxiety disorders. Parent-child diagnostic rates and agreements for generalized anxiety disorder, separation anxiety disorder, and social phobia were evaluated at 3 time points: pretreatment, posttreatment, and 7.4-year follow-up. Results indicate that parent–child diagnostic agreement was typically poor to moderate (κ = –.03 to .64) and that estimates of agreement remained relatively unchanged (a) following treatment and (b) as the children enter adolescence and young adulthood. Parent–daughter agreement was better than parent–son agreement in some cases. Although it remains unclear whether parent or child diagnostic information is most accurate, positive treatment outcome appears to be possible despite poor parent–child diagnostic agreement.     

Treatment of child anxiety: an exploratory study of the role of maternal anxiety and behaviours in treatment outcome

Anxiety disorders are common among parents of anxious children and have been found to impede child treatment outcomes, yet it is unclear whether it is parental anxiety that needs to be targeted in therapy or associated parental behaviours. Twenty‐two children (6–12 years) with a current anxiety disorder and their mothers received cognitive–behavioural treatment (CBT) for child anxiety. In addition, of the 12 mothers who met criteria for a current anxiety disorder, 6 received CBT for their own disorder. Assessments were made of the mother–child interaction. The main findings were: (1) children did less well from treatment where their mothers had a current anxiety disorder; (2) treatment of maternal anxiety disorder did not improve child treatment outcome; and (3) maternal overinvolvement and expression of fear was associated with child treatment outcome. The results suggest that in the context of maternal anxiety disorder, child treatment outcome may be improved by specifically targeting parenting behaviours. Copyright © 2008 John Wiley & Sons, Ltd.     

Treatment Effects of Parent–Child Focused Evidence-Based Programs on Problem Severity and Functioning among Children and Adolescents with Disruptive Behavior

This study examined the treatment effects of manualized parent–child focused evidence-based programs (EBPs), characterized by an emphasis on parental involvement and engagement, on functioning and problem severity among a statewide sample of children and adolescents referred to outpatient psychiatric clinic for serious and persistent disruptive behavior. Propensity score matching was employed to account for baseline differences between children and adolescents (M_age = 8.4 years; 26% girls; 42% White, 10% Black, 42% Hispanic, 5% other) who received parent–child focused EBPs (treatment group; n = 220) and treatment-as-usual (comparison group; n = 2,543). Children and adolescents who received parent–child focused EBPs showed significantly greater reduction in problem severity compared to the comparison group, indicative of a drop below the clinical threshold for problem behavior. However, the pattern of improvement in problem severity was not paralleled by differential improvement in ratings of child functioning across treatment and comparison conditions. Finally, there were significant differences between the treatment and comparison groups pertaining to certain child and case characteristics that have potential implications for reaching high-risk populations of children and families. These findings support the potential of taking parent–child focused EBPs into scale to promote positive behavioral changes among children and adolescents. Parent–child focused EBPs may serve as an effective remedy that is less restrictive and more conducive to the healthy development of children and adolescents.     

The conduct disordered child: An analysis of family problems

The purpose of this review was to examine the conduct disordered child and his/her family and determine how they differed from the “normal” or nonclinic family. Four areas were examined: child behavior, parent behavior, parent perceptions of child adjustment, and parental adjustment. Clinic-referred conduct disordered children were more deviant and less compliant than nonclinic children. Parents of the conducted disordered children issued more commands; emitted more negative, but not less positive, behavior toward their children; and perceived their children and themselves as less well adjusted than the parents in the nonclinic group. Why certain children are identified as conduct disordered and needing treatment is discussed as are the assessment and treatment implications of the findings.     

Toward generic principles of treating parents and children: integrating psychotherapy with the school-aged child and early family intervention

Generic principles governing the outcome and process of the treatment of children and their families can be generated from both research on the psychotherapy of school-aged children and early family intervention. Evidence indicates that the amenability of the child or parent to treatment and the comprehensiveness, duration, and intensity of the helping process are significant parameters. Definition of significant early family intervention roles allows linkage to various therapeutic roles with school-aged children and forces the recognition that most treatment situations involve more roles than are officially recognized. This articulation of the profile of intervention roles among poverty level, first-time parents at risk for neglecting their infant drew on several bodies of theory: psychoanalytic, cognitive, behavioral, social cognitive, and positive reinforcement principles, and advocacy and direct assistance as used in clinical social casework.     

Community Effectiveness RCT of a Comprehensive Psychosocial Treatment for High-Functioning Children With ASD

This community effectiveness randomized clinical trial examined the feasibility and effectiveness of a comprehensive psychosocial treatment, summerMAX, when implemented by a community agency. Fifty-seven high-functioning children (48 male, 9 female), ages 7–12 years with autism spectrum disorder participated in this study. The 5-week summerMAX treatment included instruction and therapeutic activities targeting social/social-communication skills, interpretation of nonliteral language skills, face-emotion recognition skills, and interest expansion. A behavioral program was also used to increase skills acquisition and decrease autism spectrum disorder symptoms and problem behaviors. Feasibility was supported via high levels of fidelity and parent, child, and staff clinician satisfaction. Significant treatment effects favoring the treatment group over waitlist controls were found on all 5 of the primary outcome measures (i.e., child test of nonliteral language skills and parent ratings of the children’s autism spectrum disorder symptoms, targeted social/social-communication skills, broader social performance, and withdrawal). Staff clinician ratings substantiated the improvements reported by parents. Results of this randomized clinical trial are consistent with those of prior studies of summerMAX and suggest that the program was feasible and effective when implemented by a community agency under real-world conditions.     

Predictors of Depressive Symptomatology Among Parents of Newly Diagnosed Children with Cancer

Examined predictors of depressive symptoms among 59 parentsproviding primary care to children newly diagnosed with cancer.Parents were studied for a 3-month period. The parent providingprimary care to the child during medical treatment completedmeasures of depressive symptoms, endorsement of family routines,family functioning, amount of assistance from the spouse inproviding care to the child, child behavior problems, as wellas measures of the severity of the child's treatment regimen.A strong relationship was found between child behavior problemsand parent depressive symptomatology. Although disease-relatedfactors such as the child's functional impairment played a rolein the parent's depressive symptoms, results revealed that thechild's behavior problems were most strongly associated withparent depressive symptoms and that family cohesiveness alsohad a contributory role in the maintenance of parent depressivesymptoms.