Evaluation of an intervention system for parents of children with intellectual disability and challenging behaviour

BACKGROUND: Signposts is a flexible intervention system for families of children who have intellectual disability and challenging behaviour. The Signposts materials include eight information booklets, a workbook and videotape for parents, and a series of instructional manuals for therapists. The system was designed so that it can be delivered in several different ways, i.e. group support, telephone support and self-directed modes. METHODS: The present study was an evaluation of these three modes of delivery and involved 115 families. RESULTS: Following the use of the Signposts materials in parent training programmes, the subjects reported that they were less stressed, felt more efficacious about managing their children's behaviour, were less hassled about meeting their own needs and that their children's behaviour had improved. Additionally, families generally reported high levels of satisfaction with the content and delivery of the materials. CONCLUSIONS: Finally, there were minimal differences among the three modes of delivery on the measures used, although families who used the self-directed mode were less likely to complete the materials. Implications of these results for service delivery are discussed.     

The effect of an educational intervention package about aggressive behaviour directed at the nursing staff on a continuing care psychogeriatric ward

Introduction. Levels of aggressive behaviour on continuing care wards are high. Various staffing factors, potentially amenable to improvement by training, are important in reducing and preventing aggressive behaviour. Method. The efficacy of an educational package, directed at the nursing staff, in reducing aggressive behaviour on a psychogeriatric continuing care ward was prospectively evaluated over an 18-week period. The package was administered during the middle 6-week period. Aggressive behaviour was measured using the RAGE and SOAS scales. Results. Aggressive behaviour on both these scales was reduced after the educational package, and the educational intervention package may explain this reduction. Conclusions. The educational package may have genuinely reduced aggressive behaviour or improved the nursing staff's tolerance and reporting threshold for aggressive behaviour. Studies with improved methodology in several different settings are suggested. © 1998 John Wiley & Sons, Ltd.     

The Son-Rise Program intervention for autism: an investigation into family experiences

BACKGROUND: Despite the increasing involvement of parents as therapists in interventions for their children with autism, research to date has focused almost exclusively on the outcome for the child, and little is known about the effects of involvement on the whole family. This is true even of highly intensive home-based approaches such as the Son-Rise Program (SRP), the focus of the present paper. A longitudinal questionnaire-based study is reported which investigated a number of potential positive and negative effects for the family, how these changed over time, and their relation to child characteristics and patterns of intervention implementation. METHODS: Questionnaires examining family demographics, patterns of intervention use and perceived family effects were distributed three times over the course of a year to families who had attended an initial training course in the use of the SRP. RESULTS: The results indicated that, although involvement led to more drawbacks than benefits for the families over time, family stress levels did not rise in all cases. Few relationships were found between family effects and patterns of intervention use, although there was a strong connection with parental perceptions of intervention efficacy. CONCLUSIONS: The findings of the present study emphasize the need for those supporting families using home-based interventions to consider the needs of the whole family. This may be especially important if there are periods during which the family find the intervention to be less effective. Families embarking on such intensive approaches may also benefit from considering ways in which any disruption to family life can be minimized.     

Effectiveness of an Intensive Outpatient Program for Disruptive Children: Initial Findings

There are currently no manualized, intensive outpatient programs (IOP), for diagnostically heterogeneous pediatric samples that simultaneously intervene with youth and parents. Such a program was developed and has been operating at Children’s Hospital Colorado since January 2006. The current study was conducted to characterize the patient sample and evaluate clinical outcomes for this novel program. The study used a method of retrospective chart review to examine demographic and diagnostic information of youth and their families, who participated in IOP. Clinical outcomes were similarly assessed, using paired-samples t test comparisons of the baseline and endpoint parent-report versions of the Ohio Youth Outcome Scales. Results indicated that there were statistically significant differences in each of the Subscale scores on the Ohio Youth Scales from baseline to endpoint of IOP. Preliminary findings suggest that participation in the IOP program was associated with improved clinical outcomes, at the end of treatment.     

Early intervention for at risk children: 3-year follow-up

Childhood behavioral and emotional symptoms are linked with distress and dysfunction that may persist into adulthood. Effective and practical early prevention could make a significant contribution to the well-being of individuals and the functioning of communities. School-based targeted interventions are relatively easy and inexpensive to deliver and have been shown to reduce symptoms in the short term. The current study evaluates the 2- and 3-year outcome of targeted school-based drama group therapy (DGT) as compared to teaching maths and English. It shows a rapid decline in teacher-observed behavioral symptoms following DGT. By a year post intervention, symptom rates following both interventions converged and remained low throughout follow-up. Drama group therapy is rapidly effective in reducing symptoms. However, the findings also suggest that despite differing content, school-based small-group interventions are likely to share some effective components.     

Prevalence of risk factors for aggressive behavior: characteristics of an involuntarily admitted population

In Västmanland County, Sweden, 105 patients were acute admitted and involuntarily treated during a six-month period. In spite of a low mean age (39.2 years), abuse of alcohol or other drugs was common (29%). Thirty-nine percent of the patients showed violent behavior prior to the actual admission and 36% of the patients had shown such behavior prior to earlier admissions. Of the patients below 40 years, 32% had a disability pension.     

Correlates of self-injurious,aggressive and destructive behaviour in children under five who are at risk of developmental delay

AimSeveral behavioural correlates of self-injury, aggression and destructive behaviour have been identified in children and young adults with intellectual disabilities. This cross-sectional study aimed to further explore these correlates in very young children with developmental delay.MethodsParents of 56 children (40 male) under the age of five years (mean age 2 years 10 months) completed a questionnaire about their child's behaviour and the presence of behavioural correlates, including repetitive, over-active or impulsive behaviour and more severe developmental delay.ResultsParents reported very high prevalence of self-injurious, aggressive and destructive behaviour: 51%, 64% and 51%, respectively. A binary logistic regression revealed that a higher score on a measure of overactive and impulsive behaviour significantly predicted the presence of destructive behaviour. A multiple linear regression revealed that both repetitive behaviour and number of health problems approached significance as independent predictors of severe self-injurious behaviour.InterpretationDespite the very small sample, several factors emerged as potential predictors of self-injurious, aggressive and destructive behaviour. These findings support the need for further investigation in a larger sample. Confirmation in this age group could help guide the development of targeted early intervention for these behaviours by identifying behavioural risk markers.     

The Treatment Initiation Program: an intervention to improve depression outcomes in older adults

OBJECTIVE: This pilot study tests the usefulness of the Treatment Initiation Program (TIP) to improve depression in older adults. The TIP is an individualized, early intervention to address older adults' attitudes (e.g., perceived need for care and stigma) about depression and treatment. METHOD: Older adults with major depression seeking mental health treatment were randomly assigned to either pharmacotherapy alone or with the TIP. Severity was assessed with the Hamilton Depression Rating Scale at admission and at 6, 12, and 24 weeks. Mixed-effects models were calculated to evaluate the effects of the TIP. RESULTS: In mixed-effects models, TIP patients had a greater decrease in depression severity and reported less hopelessness than the patients receiving usual care. TIP patients were more likely to remain in treatment 12 and 24 weeks after seeking care. CONCLUSIONS: These data support the usefulness of the TIP to improve depression outcomes and treatment participation among older adults.     

The Pilot Parent Program: Helping handicapped children through their parents

The problems of parents whose child is diagnosed or newly identified as mentally retarded or otherwise developmentally delayed are varied and difficult. As many authors have pointed out, the manner in which parents deal with this initial crisis of acceptance can have long term consequences for the parents, the family, and the handicapped child. In the past, neither psychiatry nor the other helping professions did much to provide parents with the elements they need in this profound emotional crisis: continuing emotional support and role modeling, information about the child's handicap, and information about service programs for handicapped persons. The Omaha Nebraska Pilot Parent Program is a volunteer program of parents of handicapped children whose purpose is to provide these supports to parents in need. After seven years such a program appears to provide satisfaction for its members, help to fellow parents, and an important resource to the human services systems in the community.He is past President of the National Association for Retarded Citizens, and member of the President's Committee on Mental Retardation. Robert Coleman is a research writer at the University of Nebraska Medical Center. He has been actively involved in the evolution of the Pilot Parents Project.     

Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: a randomized controlled trial

Externalizing problem behaviour is one of the most common childhood disorders. Parent training is an effective treatment for these children and there is growing interest in the effects of parent-administered interventions with minimal therapist contact. This randomized controlled study examined the efficacy of a telephone-assisted parent-administered behavioural intervention (bibliotherapy) in families with preschool children with externalizing problem behaviour. Families were randomly assigned to a treatment group (n = 26) and an untreated waitlist control group (n = 22). The intervention comprised the reading of an 11 chapter self-help book and 11 weekly telephone consultations. Compared to the control group, the treatment group demonstrated significant decreases in parent-reported externalizing and internalizing child problem behaviour and dysfunctional parenting practices. Moreover, treated parents reported less parenting-related strains and decreases in parental depression, anxiety, and stress. The results suggest that telephone-assisted self-administered parent training is an effective alternative to more intensive forms of behavioural family intervention for preschool children with externalizing problem behaviour.     

Early risk factors for adolescent antisocial behaviour: an Australian longitudinal study

OBJECTIVE: This investigation utilizes data from an Australian longitudinal study to identify early risk factors for adolescent antisocial behaviour. METHOD: Analyses are based on data from the Mater University Study of Pregnancy, an on-going longitudinal investigation of women's and children's health and development involving over 8000 participants. Five types of risk factors (child characteristics, perinatal factors, maternal/familial characteristics, maternal pre- and post-natal substance use and parenting practices) were included in analyses and were based on maternal reports, child assessments and medical records. Adolescent antisocial behaviour was measured when children were 14 years old, using the delinquency subscale of the Child Behaviour Checklist. RESULTS: Based on a series of logistic regression models, significant risk factors for adolescent antisocial behaviour included children's prior problem behaviour (i.e. aggression and attention/restlessness problems at age 5 years) and marital instability, which doubled or tripled the odds of antisocial behaviour. Perinatal factors, maternal substance use, and parenting practices were relatively poor predictors of antisocial behaviour. CONCLUSIONS: Few studies have assessed early predictors of antisocial behaviour in Australia and the current results can be used to inform prevention programs that target risk factors likely to lead to problem outcomes for Australian youth.     

The effects of an anti-bullying intervention programme on peers' attitudes and behaviour

This study aimed to evaluate the effect of an anti-bullying intervention programme on peers' attitudes towards bullying and their attempts to solve bully/victim conflicts. An experimental pre-test/post-test design with a control group was used. For secondary school students, positive outcomes were observed at post-test 1 on attitudes and on actual rates of intervention. However, the effects had disappeared at post-test 2. For primary school students, significant differences were found at post-test 2, showing a smaller decline in seeking teacher's help and in heightening students' support for victims. Students' competence to solve bully/victim problems in relation to their general pro-social development is discussed.     

Grandparents, parents, and grandchildren at high risk for depression: a three-generation study

OBJECTIVE: High-risk studies of psychiatric disorders in parents and offspring that include 3 generations are uncommon. Multigenerational studies can be clinically useful as they can provide information for risk prediction from one generation to another for the development of empirically based interventions. Using a high-risk design, this study examines the association of grandparent major depressive disorder (MDD) and parent MDD with psychopathology in grandchildren. METHOD: Using Cox proportional hazards in a sample of 90 grandchildren at high and low risk for depression by virtue of their grandparents' and parents' depression status, the authors examined the risk for offspring depression and anxiety. RESULTS: Grandparent and parent MDD were associated with grandchild anxiety (relative risk [RR] = 5.51 and R = 3.09, respectively). Grandchildren with both a depressed parent and grandparent had the highest risk for anxiety. Parental MDD is associated with an increased risk for grandchild disruptive disorder (RR = 10.77). Forty-nine percent of the grandchildren in families in which both the parent and grandparent were depressed had some form of psychopathology. The grandchildren from those families were the most impaired. CONCLUSIONS: Prepubertal-onset anxiety disorder is a risk factor for the later development of clinically significant recurrent MDD across several generations of families at high risk for depression. Parental impaired functioning increases the risk for disruptive disorders. Children in families with multiple generations of depression are at particularly high risk for some form of psychopathology.