Parent-to-parent teaching

The effectiveness of using parents as interventionists for their children and other parents was examined. A multiple baseline design was employed to measure the effects of specific intervention techniques on teaching skills of three parents of toddler-aged children with Down syndrome. The first parent was trained by a professional interventionist on the use of the techniques. This parent then trained a second parent, who then trained a third parent. A fidelity-of-implementation measure indicated that the parents implemented the training procedures appropriately when training another parent. The effectiveness of the intervention techniques was measured through an observational code that assessed parent and child behavior during teaching sessions. Results suggest that training had a functional effect on the parents' use of the selected intervention techniques. The intervention also had a functional effect on the children's percentage of correct responding during the teaching session.     

Effectiveness of alternative parent training formats

Alternative formats were compared for training parents of retarded children to teach self-help skills and manage problem behaviors. Sixty-six families with moderately to severely retarded children ages 3-13 were assigned for 3 months to group parent training (n = 37), individual parent training (n = 16), or delayed training control (n = 13). Measures administered before and after training evaluated: (1) parent knowledge of behavior modification, (2) a behavior sample of parent teaching, and (3) child self-help skills and behavior problems. Trained families gained significantly more than control families on parent measures but not on the child self-help skill measure. Group and individually trained families demonstrated almost identical gains. At a 6-month follow-up, group and individually trained families continued to show equal performance. Group training requires about half the professional time per family as individual training, and therefore seems a more cost-effective approach.     

Development and evaluation of a psychoeducational parent group training program for families with autistic children

In the introduction of this study, the concept of "psychoeducational parent training" is analyzed, and an outline of the research literature on "parent training in families with autistic children" is presented. Based on these findings a psychoeducational group parent training, which focused on (1) addressing issues of nature, etiology, treatment and family-related consequences of autism (2) teaching child management and education skills was developed, and the training outcomes were evaluated within a 3-months-follow-up design. A total of 24 parents of 23 autistic children (mean age: 9 yrs.) participated in the center-based training program which was performed in three small groups in different areas of Germany in 3 one-day sessions succeeding in 1-month-intervals. The outcome variables included: (a) group training assessments by parents; they evaluated quality of trainer variables, curriculum, and group atmosphere using a questionnaire format of bipolar rating scale-items (b) parental 3-months-follow-up assessments of the effects of group training on parent-child interactions and family adaptation, using a questionnaire based on rating scales, and a semi-structured questionnaire on training-related child and parent behaviors in the family. The parent training resulted in (a) a high degree of parent satisfaction with the training format and (b) positive effects on daily parent-child interactions from the perspective of parents. These findings provide some evidence for both clinical and social validity of the parent training procedure examined in this study.     

Evaluation of an online training program to improve family routines,parental well-being,and the behavior of children with autism

BackgroundParents of children with autism spectrum disorder (ASD) are at an increased risk for stress, and their children often display high rates of problem behavior. There is a robust literature base showing that training parents to implement applied behavior analytic (ABA) interventions helps reduce their child’s challenging behavior. However, some parents continue to report high rates of stress that may interfere with implementation. Adding cognitive-affective strategies such as ACT and optimism training to ABA may be beneficial. Telehealth models have the potential to reach parents who may not otherwise be able to access parent training, making evidence-based programs more readily available.MethodTwenty-three parents (with 16 completing posttest assessments) of children with autism (ages four to eight) participated in a three-week online training program. Topics covered included instruction in ABA principles as well as stress reduction strategies and mediation practice based on ACT principles. The intervention included weekly synchronous online meetings with other parents and two parent educators, as well as supplemental assignments completed between sessions.ResultsWe found that after the intervention parents reported: (1) decreases in parental stress, (2) increases in relevant knowledge, (3) increases in child prosocial behavior, (4) decreases in hyperactive behaviors, and (5) high levels of satisfaction with the intervention.ConclusionsThis online program, combining ABA and stress reduction practices, resulted in positive outcomes for children with autism and their families. Although this was a small sample size, this early investigation offers promise for delivering this combined intervention approach effectively online. Training small groups of parents in an online format may be a feasible, efficient service delivery method.     

Programming for generalization to high and low risk parenting situations in families with oppositional developmentally disabled preschoolers

This study examined the generalization effects of a training program for parents of oppositional, mildly developmentally disabled preschool children. Specifically, the study sought to determine the possible differential generalization effects of treatment to high and low risk parenting settings. Treatment comprised child management and planned activities training procedures specifically designed to enhance generalization effects. A multiple baseline design across subjects that incorporated a non-treatment control subject was employed. Dependent measures included deviant child behavior, accuracy of parent implementation of treatment procedures, and specific measures of aversive and non-aversive parent behaviors. Three of the treated families showed marked reductions in levels of deviant behavior, as well as increases in parental implementation of treatment procedures in both the training setting and the low risk generalization setting. Two of these three families showed comparable improvements in the high risk setting. The control subject showed little improvement in either generalization setting. It was concluded that the treatment program was effective in producing generalization effects in parent training.     

Factors associated with depressive symptoms in parents of children with autism spectrum disorders

Parents of children with autism spectrum disorders (ASDs) have higher rates of depressive symptoms than parents of typically developing (TD) children or parents of children with other developmental disorders. The purpose of this study was to examine child and parent sleep as factors associated with depressive symptoms in parents of children with ASDs. Participants included 34 families (17 ASD, 17 TD, 17 mothers and 11 fathers per group). Both objective sleep quantity (actigraphy) and subjective sleep quality were obtained, along with measures of parent depressive symptoms and child daytime behavior. Child sleep quantity was a significant predictor of maternal depressive symptoms, controlling for group and child behavior. Fathers sleep quality was a significant predictor of paternal depressive symptoms, controlling for child behavior and child sleep disturbances. This study suggests that along with child behavior, parent and child sleep variables are associated with parental depressive symptoms. Future studies should continue to use a multi-method measurement approach for sleep, and interventions that target child sleep should include parent sleep and parent daytime functioning as outcome variables.     

Review: Which components of behavioral parent and teacher training work for children with ADHD? – a metaregression analysis on child behavioral outcomes

Background

This metaregression analysis examined which behavioral techniques that are commonly used in behavioral parent and teacher training programs for children with attention-deficit/hyperactivity disorder (ADHD) were related to program effectiveness on children's behavioral outcomes.

Methods

We included 32 randomized controlled trials (N = 2594 children) investigating behavioral parent training, teacher training, or a combination, in children with ADHD under 18 years. Outcomes were symptom counts of total ADHD, inattention, and hyperactivity-impulsivity and behavioral problems. The dosage of techniques was extracted from the intervention manuals. Metaregression was used to assess which techniques and intervention characteristics (setting, delivery method, duration, and home-school collaboration) were associated with intervention effectiveness.

Results

Higher dosage of psycho-education for parents was associated with smaller effects on behavioral problems and, only in case of parent training, also with smaller effects on ADHD symptoms. Higher dosage of teaching parents/teachers to use negative consequences was associated with larger effects on behavioral problems. Individual training compared with group training was associated with larger effects on ADHD and hyperactivity-impulsivity symptoms.

Conclusions

This study provides first insights into the specific techniques that are essential in behavioral parent and teacher training programs for children with ADHD. This knowledge can eventually be used to improve and tailor interventions.     

Behavioral treatment of child abuse. A developmental perspective

This article reviews cognitive and behavioral treatment strategies that have been employed with parents who physically abuse their children. Using a developmental framework, a broadened view of abuse is presented that emphasizes targets for intervention that not only reduce aversive parental behavior but also increase behaviors that lead to more optimal child outcome. Interventions with maltreaters are then described, focusing on three periods of childhood--infancy, middle childhood, and adolescence. An argument is made for there being different goal parental behaviors during each of these periods, as well as unique child-based demands that act as obstacles to parents' successfully meeting these goals. Where behavioral treatments with abusive parents do not yet exist, treatments with similar parent populations are described. The article concludes with a discussion of the treatment issues facing the field in the future.     

Adjunctive Parental Support Within Manualized Parent Training for Children with Autism Spectrum Disorder

Parent training is a central focus of behavioral intervention, with emphasis on teaching parents to become change agents for their children by using behavioral management skills. However, its effectiveness is limited by a parent’s ability to engage in the learning process. Parents managing external stressors, psychopathology, or poverty often do not gain the skills and thus, the treatment may minimally impacts parent and child behavior. In order to increase a parent’s ability to acquire and implement new skills accurately, referred to as parent treatment integrity, the current study added a parent-support component to the RUBI Autism Network’s Parent Training for Disruptive Behaviors protocol. The parent-support component was intended to remove barriers to skill acquisition during the parent training session by alleviating some of the interfering parental stress. In an alternating treatments design, a community-based sample of five parent-child dyads (average age of child?=?32 months) participated in the parent-training protocol; half of the intervention sessions included a 15-min parent-support component. The addition of the parent-support component increased parent engagement, treatment integrity, and learned parenting skills, like parent praise. Results support a model of change for parenting behavior. Inclusion of a parent-support component is supported as an effective practice for parent training.

     

Home-based parent training for school-aged children with attention-deficit/hyperactivity disorder and behavior problems with remaining impairing disruptive behaviors after routine treatment: a randomized controlled trial

The objective is to investigate the effectiveness of home-based behavioral parent training for school-aged children with attention-deficit/hyperactivity disorder (ADHD) and behavior problems with remaining impairing disruptive behaviors after routinely offered treatments in clinical practice. In a randomized controlled study including 73 referred children with ADHD and impairing disruptive symptoms after routine clinical pharmacotherapy and/or clinic-based parent training had been tried or, at least, offered, home-based behavioral parent training (n?=?26) was compared to a waiting list (n?=?23) and a care-as-usual home-based treatment (n?=?24). It was unknown to families which of the home-based treatments that they received. Using mixed models for repeated measures, we examined the effectiveness on the primary outcome measure of children’s severity of disruptive behaviors and on a number of secondary outcome measures [the degree to which parents experienced the disruptive behaviors as troublesome, ADHD symptoms, oppositional-defiant disorder (ODD) symptoms, and internalizing problems]. Compared to the waiting list, children receiving home-based parent training improved significantly more regarding severity of disruptive behaviors (ES?=?0.75), ADHD symptoms (ES?=?0.89), ODD symptoms (ES?=?0.65), and internalizing problems (ES?=?0.60). Compared to care-as-usual, home-based parent training was more effective in reducing disruptive behaviors (ES?=?0.57), ADHD symptoms (ES?=?0.89), and ODD symptoms (ES?=?0.88). Significantly more reduction of children’s internalizing problems was not found. In conclusion, children with ADHD and residual behavioral problems after routine treatment may benefit from home-based behavioral parent training.

     

Efficacy of individualized social competence training for children with oppositional defiant disorders/conduct disorders: a randomized controlled trial with an active control group

Patient-focused cognitive-behavioral therapy in children with aggressive behavior, which uses group-based social skills training, has resulted in significant reductions in behavioral problems, with effect sizes in the small-to-medium range. However, effects of individually delivered treatments and effects on aggressive behavior and comorbid conditions rated from different perspectives, child functional impairment, child quality of life, parent–child relationship, and parental psychopathology have rarely been assessed. In a randomized controlled trial, 91 boys aged 6–12 years with a diagnosis of oppositional defiant disorder/conduct disorder and peer-related aggression were randomized to receive individually delivered social competence training (Treatment Program for Children with Aggressive Behavior, THAV) or to an active control involving group play that included techniques to activate resources and the opportunity to train prosocial interactions in groups (PLAY). Outcome measures were rated by parents, teachers, or clinicians. Mostly moderate treatment effects for THAV compared to PLAY were found in parent ratings and/or clinician ratings on aggressive behavior, comorbid symptoms, psychosocial impairment, quality of life, parental stress, and negative expressed emotions. In teacher ratings, significant effects were found for ADHD symptoms and prosocial behavior only. THAV is a specifically effective intervention for boys aged 6–12 years with oppositional defiant disorder/conduct disorder and peer-related aggressive behavior as rated by parents and clinicians.

     

Autism and the broad autism phenotype: familial patterns and intergenerational transmission

Background

Features of the Broad Autism Phenotype (BAP) are disproportionately prevalent in parents of a child with autism, highlighting familial patterns indicative of heritability. It is unclear, however, whether the presence of BAP features in both parents confers an increased liability for autism. The current study explores whether the presence of BAP features in two biological parents occurs more frequently in parents of a child with autism relative to comparison parents, whether parental pairs of a child with autism more commonly consist of one or two parents with BAP features, and whether these features are associated with severity of autism behaviors in probands.

Method

Seven hundred eleven parents of a child with an autism spectrum disorder and 981 comparison parents completed the Broad Autism Phenotype Questionnaire. Parents of a child with autism also completed the Social Communication Questionnaire.

Results

Although parental pairs of a child with autism were more likely than comparison parental pairs to have both parents characterized by the presence of the BAP, they more commonly consisted of a single parent with BAP features. The presence of the BAP in parents was associated with the severity of autism behaviors in probands, with the lowest severity occurring for children of parental pairs in which neither parent exhibited a BAP feature. Severity did not differ between children of two affected parents and those of just one.

Conclusions

Collectively, these findings indicate that parental pairs of children with autism frequently consist of a single parent with BAP characteristics and suggest that future studies searching for implicated genes may benefit from a more narrow focus that identifies the transmitting parent. The evidence of intergenerational transmission reported here also provides further confirmation of the high heritability of autism that is unaccounted for by the contribution of de novo mutations currently emphasized in the field of autism genetics.     

Racial/Ethnic Disparities in Parent Perception of Child Need for Mental Health Care Following School Disciplinary Events

Disciplinary problems at school potentially affect parent perception of child need for mental health care. This article explores effects of a child's first school suspension or expulsion on parent perception of child need for services in three racial-ethnic subgroups. Subjects were mothers participating in a national longitudinal study and their children. First-time school suspension or expulsion positively affected service use and parent-reported service need among white non-Hispanic children, but had little or no effect for African American and Hispanic children. These results suggest that information on child behavior provided to parents by teachers and school administrators can influence parent perception of child service need, but that racial-ethnic differences may exist in parent interpretation of and response to this information. Culturally appropriate approaches to relaying information to parents about child service need may help reduce these differences.     

Families and intellectual disability

PURPOSE OF REVIEW: This review includes recent research pertaining to family functioning when there is a child or adult offspring with intellectual disability. The purpose was to broaden the examination of families research from an adjustment/coping perspective to consideration of more contextual factors (environment, culture, service delivery). RECENT FINDINGS: Studies continue to focus on parental well being, with parents of children with intellectual disability still showing evidence of stress and depression. Increasing evidence is accruing, however, that child behavior problems or specific syndrome more directly relate to poorer parental well being. On the other hand, parenting behaviors also contribute to child behaviors, with studies highlighting the importance of parenting context and dynamics. Interventions focus on child behaviors as well as on stress reduction for parents. Finally, the continued involvement of parents across the lifespan of their young adult with intellectual disability is apparent from studies of quality of life and living arrangements. SUMMARY: The well being of family members continues to be an area of interest, with special emphasis on siblings and cultural context. Methodological rigor in families research also continues to increase, with diverse methodologies represented. There is still a need, however, for the development of theoretical models within which to frame future research on topics such as siblings, as well as both negative and positive impact on families.     

Parental perception of problems and mental health service use for hyperactivity

OBJECTIVE: To examine predictors of parental perception of hyperactivity as a serious problem and its role in determining the use of specialist mental health services. METHOD: A community sample of 5- to 11-year-old children with pervasive hyperactivity (n = 93) was identified. Children whose parents perceived the hyperactivity as a serious problem were compared with those whose parents did not. Predictors of parental perception of problem and the roles of this and child and parent clinical factors in predicting service use were examined. RESULTS: Controlling for child and parental mental health, the strongest predictor of parental perception of problems was the financial impact of the child's behavior on either parent's work (odds ratio [OR] = 17.43; 95% confidence interval [CI] 3.52-86.40). Other effects on the parent's working ability were also important. Parental perception of problems was the strongest predictor of service use (OR = 9.85; 95% CI 1.42-68.50). CONCLUSIONS: The effects of child behavior difficulties on perceptions of caregivers are multidimensional. The impact of hyperactivity on parents' work and family finances is substantial. Mental health service use is increased if these impacts reach the threshold for the parent to perceive the child's behavior as a problem.     

Predictors of outcome of a parenting group curriculum: a pilot study

One pressing issue facing parenting interventions for disruptive behaviors of young children is forecasting who will benefit from participation. The purpose of this study was to examine four personal and interpersonal predictors (i.e., parent depressive symptoms, parent education, coparent conflict, and marital status) of engagement (i.e., number of sessions attended) in and child outcome (i.e., problematic behavior) of a parenting group curriculum program targeting young children's disruptive behaviors. Participants were 39 parents (34 mothers and 5 fathers; M = 38.6 years) who expressed an interest in improving the behavior of their 3- to 6-year-old child (19 females and 20 males; M = 4.50 years). Findings indicated that one baseline personal variable, parent depressive symptoms, predicted change in child disruptive behavior at follow-up, and two baseline interpersonal variables, marital status and coparent conflict, predicted engagement in treatment (i.e., number of sessions attended). Implications and directions for future research are discussed.     

The effects of training parents in functional behavior assessment on problem identification,problem analysis,and intervention design

In this study, parents were trained in four sessions to identify problems, conduct a functional assessment, and design an appropriate intervention based on the function of the problem behavior. First, parents were trained to operationally define problem behaviors, given examples of consequences, and discussed the functions of behavior. Second, parents were given examples of antecedents and discussed replacement behaviors. Third, procedures to increase appropriate behaviors were discussed. Fourth, procedures to decrease inappropriate behaviors were discussed. Prior to the first session and after each session, parents watched a videotaped vignette of a child exhibiting a behavior problem and completed a Problem Identification Questionnaire, Problem Analysis Questionnaire, and Intervention Design Questionnaire. A repeated-measures ANOVA was used to test for significant differences on each of the dependent variables. Results indicated that parents' scores on each of the measures improved significantly. Limitations, future research ideas, and implications for school psychologists and other professionals are discussed.