Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children.

This study evaluated the effects of problem-solving skills training (PSST) and parent management training (PMT) on children (N = 97, ages 7-13 years) referred for severe antisocial behavior. Children and families were assigned randomly to 1 of 3 conditions: PSST, PMT, or PSST and PMT combined. It was predicted that (a) each treatment would improve child functioning (reduce overall deviance and aggressive, antisocial, and delinquent behavior, and increase prosocial competence); and (b) PSST and PMT combined would lead to more marked, pervasive, and durable changes in child functioning and greater changes in parent functioning (parental stress, depression, and overall symptoms). Expectations were supported by results at posttreatment and 1-year follow-up. PSST and PMT combined led to more marked changes in child and parent functioning and placed a greater proportion of youth within the range of nonclinic (normative) levels of functioning.     

An evaluation of peer coping-skills training for childhood aggression

Peer coping-skills (PCS) training is a new school-based intervention designed to promote prosocial coping among school-age children. The intervention is based on a coping-competence model that addresses the development of antisocial and asocial coping among youth at elevated risk for conduct disorder. PCS training was tested in a controlled evaluation with children in Grades 1 to 3 who exhibit high rates of aggressive behavior, and it was found to increase prosocial coping via information exchange, improve social skills, and reduce aggression. These improvements were maintained into the next school year, as reflected in a 6-month follow-up assessment by teachers. Competent-nonaggressive children who also participated not only showed no adverse effects by demonstrated skill enhancement. Children, parents, and teachers in the ethnically diverse sample rated PCS training as highly acceptable. It is recommended that PCS training be combined with family and classroom intervention strategies over multiple years to promote the development of competence and to increase the likelihood of preventing conduct disorders in high-risk youth.     

Treatment of parental stress to enhance therapeutic change among children referred for aggressive and antisocial behavior

This study evaluated a parent problem-solving (PPS) intervention designed to augment the effects of evidence-based therapy for children referred to treatment for aggressive and antisocial behavior. All children (N = 127, ages 6-14 years) and their families received problem-solving skills training (PSST), and parents received parent management training (PMT). Families were randomly assigned to receive or not to receive an additional component (PPS) that addressed parental stress over the course of treatment. Children improved with treatment; the PPS intervention enhanced therapeutic change for children and parents and reduced the barriers that parents experienced during treatment. The implications of the findings for improving evidence-based treatment as well as the limitations of adding components to treatment are detailed.     

Using problem-solving skills training to reduce negative affectivity in mothers of children with newly diagnosed cancer: report of a multisite randomized trial

Mothers of children with cancer experience significant distress associated with their children's diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.     

Evaluation of a social-skills training group intervention with children treated for brain tumors: a pilot study

OBJECTIVE: To evaluate the effectiveness of a manual-based, social-skills training, group intervention to improve social skills and social functioning of children treated for brain tumors, and to assess the impact of cognitive functioning on the effectiveness of the intervention. METHODS: Three social-skills training group interventions, each comprised of 5 to 7 children ages 8 to 14 years, were conducted. A parent component was included. In total, 13 children and their parents and teachers completed standard measures prior to and 9 months after the intervention. Children participated in a neuropsychological test battery at baseline. RESULTS: Social skills and social functioning variables changed in the direction of improved functioning, with several scores showing significant improvement from baseline to the follow-up assessment. Small to medium effect sizes were documented. Higher verbal and nonverbal functioning were associated with greater improvement. CONCLUSIONS: Findings are suggestive of the potential effectiveness of social-skills training in groups for children with brain tumors. Multisite, randomized, controlled studies are recommended as the next step.     

Parental attitudes and children's self-concept and behavior following parents' participation in parent training groups

This study assessed changes in parental attitudes and children's self-concept and behavior following parents' participation in one of two skills training programs: behavioral skills and communication skills. At posttest, communication skills group parents demonstrated greater mutual understanding in the area of parent-child communication than did comparison group parents. These results were maintained at 3-month follow-up. Children of parents who participated in either training group showed positive changes in self-concept at posttest that were maintained at follow-up. The parentrated behavior of both groups of children did not improve at posttest. However, at follow-up, communication skills parents perceived their children as less withdrawn/hostile and perceived themselves as playing a greater role in the causation of their children's behavior.     

Social Skills Training in Children With Attention Deficit Hyperactivity Disorder: A Randomized-Controlled Clinical Trial

Evaluated efficacy of social skills training (SST) on children with 2 subtypes of attention deficit hyperactivity disorder (ADHD). Participants were 120 children (30 girls, 90 boys), ages 8 to 12 with ADHD-Inattentive type (ADHD-I; n = 59) or Combined type (ADHD-C; n = 61). The children were randomly assigned within diagnosis subtype to the treatment condition (8 weeks of SST) or the no-intervention control condition. SST led to greater improvements in both parent- and child-perceived assertion skills in the children with ADHD, yet did not affect the other domains of social competence. Diagnostically heterogeneous groups led to greater improvements on parent-report of their child's cooperation and assertion abilities as well as children's report of their own empathy skills. Diagnostically homogeneous groups led to greater decreases in externalizing behaviors at posttreatment but not at follow-up. Children with comorbid oppositional defiant disorder (ODD) did not benefit as much from the intervention. Children with ADHD-I improved in assertion skills more than children with ADHD-C, yet the 2 diagnostic entities did not differ in improvement levels across all other social skills.     

Pretreatment social relations, therapeutic alliance, and improvements in parenting practices in parent management training

The authors examined the parent-therapist alliance in parent management training for children (N = 218; 53 girls and 165 boys, ages 2-14) referred clinically for oppositional, aggressive, and antisocial behavior. The interrelations of pretreatment parent social relationships, the parent-therapist alliance over the course of treatment, and improvements in parenting practices at the end of treatment were evaluated by different raters. As expected, the better the quality of the parent-therapist alliance, the greater the improvements in parenting practices by the end of treatment. Social relations of the parents prior to treatment were associated with the parent-therapist alliance during treatment and parental improvements at the end of treatment. The relation between the therapeutic alliance and improvement in parenting practices was partially explained by pretreatment parent social relations.     

Social, emotional, and behavioral functioning of children with NF1

Children with neurofibromatosis type 1 (NF1) can have varying degrees of cognitive impairment, and are at risk for social, emotional, and behavioral dysfunction. We undertook an evaluation of social, emotional, and behavioral functioning of youth with NF1 and peers from multiple perspectives. We hypothesized that children with NF1 would have more psychosocial difficulties, which would be positively associated with neurological involvement. We compared 58 children with NF1, ages 7-15, with comparison classroom peers, classmates who were same race/gender and closest date of birth. Peer relationships, emotional well-being, and behavior were evaluated from multiple perspectives in multiple settings. Results showed that teachers perceived children with NF1 as more prosocial (i.e., polite, helpful to others). Teachers and peers viewed children with NF1 as displaying less leadership behavior and as more socially sensitive-isolated (i.e., often left out, trouble making friends). Children with NF1 had fewer friendships and were less well liked by peers. Mothers and fathers reported more problems with social functioning among children with NF1. Few group differences in emotional well-being and behavior were identified according to child and father report. However, mothers perceived children with NF1 to have more emotional problems relative to comparison peers, predominantly among older children. Neurological involvement was significantly related to psychosocial problems. We conclude that children with NF1 are frequently socially isolated and rejected by peers; and that greater neurological involvement is associated with more emotional problems. Central nervous system involvement appears to play a key role in identifying children at risk for problems with friendships, social acceptance, and emotional functioning (i.e., depression).     

Toward a conceptual framework of instrumental antisocial decision-making and behavior in youth

This paper reviews and organizes relevant theory and research toward a conceptual framework of instrumental antisocial decision-making and behavior in youth. To date, social cognitive study of the development of youth antisocial functioning has largely focused on response patterns (e.g., cognitive responses to aversive cues). Though instrumental decision making is paid significant attention in research on adult criminality, there exists no framework by which youths' goal-driven behavioral decisions that are made in pursuit of antisocial motives and interests may be understood. This is a problem in that lessons from research on children and adolescents suggest that there are meaningful differences in structure, phenomenology and function of subtypes of antisocial behavior (instrumental versus reactive). The absence of such a model may account, at least in part, for why the study of instrumental antisocial behavior in youth remains relatively limited.     

Preschool children with mild to moderate traumatic brain injury: an exploration of immediate and post-acute morbidity.

This study explored premorbid, neurocognitive, behavioral, and familial factors in preschoolers, ages 3-6, who experienced a mild to moderate traumatic brain injury (TBI). Twenty-nine children with TBI, 33 children with mild to moderate injuries to other body regions, and 34 non-injured children participated in the study. Neuropsychological assessments and behavioral measures were administered at the time of hospitalization and 6 months later. In comparison to the non-injury children, preschool-aged children with TBI had higher rates of premorbid behavior difficulties, lower premorbid cognitive functioning, and poorer development of pre-academic skills. In addition, parents of children with TBI reported greater situational issues and life stressors than parents of children in the non-injured group. Some neurocognitive recovery was evident in the TBI group, but no differences were recognized in behavioral and family measures at the 6-month follow-up. This study emphasizes the relative effects of premorbid characteristics in later practice of preschool children who sustain TBI.     

A comparison of three family therapy programs for treating family conflicts in adolescents with attention-deficit hyperactivity disorder.

Sixty-one 12- to 18-year-olds were randomized to 8-10 sessions of behavior management training (n = 20), problem-solving and communication training (n = 21), or structural family therapy (n = 20). Families were assessed at pre- and posttreatment and 3-month follow-up. All treatments resulted in significant reductions in negative communication, conflicts, and anger during conflicts and improved ratings of school adjustment, reduced internalizing and externalizing symptoms, and decreased maternal depressive symptoms. Most outcomes remained stable between posttreatment and follow-up, and some continued to improve over this time. Despite group improvements, analyses of clinically significant change and clinical recovery within Ss showed that only 5-30% reliably improved from treatment and only 5-20% recovered following treatment. The three treatments did not differ in these rates.     

A psychosocial skills training approach in Mexican out-patients with schizophrenia

BACKGROUND: The effectiveness of a psychosocial skills training (PSST) approach applied to chronic out-patients with schizophrenia was examined. We hypothesized that the PSST programme, which included treatment as usual (TAU), PSST and family therapy (FT), would reduce positive and negative symptoms, prevent relapse and rehospitalization, and improve psychosocial functioning (PSF), global functioning and treatment adherence. METHOD: Eighty-two patients were randomly assigned to receive either TAU [antipsychotic medication (AP); n=39] or the PSST approach (TAU+PSST+FT; n=43). The two groups were assessed at intake and after completion of 1 year of treatment. RESULTS: There were statistically significant differences between the two groups. Patients in the PSST group improved their symptomatology, psychosocial and global functioning (symptoms and psychological, social and occupational functioning), showed lower relapse, rehospitalization and drop-out rates, a higher level of compliance with AP medication, and a high level of therapeutic adherence in comparison with TAU patients, whose symptoms also improved although they showed no improvement in any of the clinical or psychosocial variables. A comparison of the standardized effect sizes showed a medium and a large effect size of PSF and global functioning for the PSST group and a non-effect size for the TAU group. CONCLUSIONS: A higher level of effectiveness was demonstrated when combining TAU, PSST and FT in comparison with AP medication alone. The PSST approach should be recommended for clinical practice.     

Building relationships and combating bullying: effectiveness of a school-based social skills group intervention.

This study tested the efficacy of a generic social skills intervention, Social Skills GRoup INtervention (S.S.GRIN), for children experiencing peer dislike, bullying, or social anxiety. Third-grade children were randomly assigned to treatment (n = 187) or no-treatment control (CO; n = 194) groups. Examination of the direction and magnitude of change in functioning revealed that S.S.GRIN increased peer liking, enhanced self-esteem and self-efficacy, and decreased social anxiety compared to controls. S.S.GRIN was equally efficacious for all subtypes of peer problems targeted. Particular benefits were found for aggressive children who showed greater declines in aggression and bullying behavior and fewer antisocial affiliations than aggressive control participants. Discussion focuses on the benefits of heterogeneous versus homogeneous groups of participants and the potential value of utilizing generic social skills training protocols.     

Building Relationships and Combating Bullying: Effectiveness of a School-Based Social Skills Group Intervention

This study tested the efficacy of a generic social skills intervention, Social Skills GRoup INtervention (S.S.GRIN), for children experiencing peer dislike, bullying, or social anxiety. Third-grade children were randomly assigned to treatment (n = 187) or no-treatment control (CO; n = 194) groups. Examination of the direction and magnitude of change in functioning revealed that S.S.GRIN increased peer liking, enhanced self-esteem and self-efficacy, and decreased social anxiety compared to controls. S.S.GRIN was equally efficacious for all subtypes of peer problems targeted. Particular benefits were found for aggressive children who showed greater declines in aggression and bullying behavior and fewer antisocial affiliations than aggressive control participants. Discussion focuses on the benefits of heterogeneous versus homogeneous groups of participants and the potential value of utilizing generic social skills training protocols.     

The effectiveness of a parenting skills program for parents of middle school students in small communities

This study provides evidence of the effectiveness of behaviorally based parenting skills classes provided by carefully trained and supervised group leaders who were not mental health clinicians. A program for parents of at-risk middle school students was evaluated in a randomized controlled trial in 8 small Oregon communities. Parents (N = 303) were randomly assigned to immediate treatment or a wait-list condition. Data were analyzed using latent growth modeling. Participation in the program led to significant improvements in problem-solving interactions as indicated by parent reports and a Taped Situations Test. Parents' over-reactivity and laxness toward their children's behavior were reduced and their feelings toward their children improved significantly as a function of treatment. Parent-reported child antisocial behavior was also reduced.     

A Social Problem-solving Intervention for Children at High Risk for Later Psychopathology

Children manifesting early difficulties in interpersonal relations, particularly with peers, have been shown to be at risk for later maladjustment and psychopathology. This study examined the efficacy of an intervention program designed to improve social problem-solving skills in child psychiatric outpatients exhibiting behavior problems. This intervention was expected to both lessen maladaptive behaviors and to engender competent and generalizably adaptive behaviors, which would preventively equip children to better cope with stressful events. Thirty-five boys, aged 7-12, served as subjects; due to attrition, 23 completed the study. Subjects received pre-intervention and post-intervention testing on behavioral and cognitive measures. Experimental subjects participated in a group social problem-solving (SPS) intervention, whereas controls received usual and customary treatment provided by the clinic. Results demonstrated improvement for experimental subjects in social-cognitive skills, reduction of behavioral problems, and increase in behavioral competencies compared to controls. Findings suggest that the social problem-solving intervention is an effective and efficient treatment strategy for behavior-disordered children.     

Children's Responses to Overt and Relational Aggression

Investigated children's responses for coping with overt and relational aggression. Children in Grades 3 through 6 (N = 491) in a rural Midwestern public school district completed a survey designed to assess how students cope when they are the targets of peer aggression. Children endorsed greater use of internalizing and distancing strategies for coping with relational aggression and greater use of externalizing strategies for coping with overt aggression. In addition, older children reported greater use of externalizing and less use of internalizing and distancing strategies than younger children. Significant differences were also found between boys and girls. Regardless of type of aggression, girls endorsed greater use of problem-solving and support strategies and less use of externalizing strategies than boys. Coping of high target children and of children who frequently received prosocial treatment from peers were also examined.     

How can the study of biological processes help design new interventions for children with severe antisocial behavior?

Children with severe antisocial behavior have an increased risk of showing violently aggressive and other forms of problem behavior in adolescence and adulthood. It is well established that both biological and social factors are involved in the development of antisocial behavior. The primary aim of this paper is to discuss the evidence that specific neurobiological systems are involved in the etiology of childhood-onset antisocial behavior. These factors are responsible for the severity of the behavioral problems observed in antisocial children, but they also play a role in their persistence, because they influence children's interactions with their environment. We will discuss the possible causes of disruptions in neurobiological systems in childhood antisocial behavior and point out the implications of these findings for theory and clinical practice. We will argue that familial factors (e.g., genetic influences, early childhood adversity) are linked to negative behavioral outcomes (e.g., antisocial behavior problems) through the mediating and transactional interplay with neurobiological deficits. An investigation of neurobiological functioning in antisocial children might not only indicate which children are most likely to persist in engaging in severe antisocial behavior, but also guide the development of new interventions.     

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.