Reducing aggressive behavior in boys with a social cognitive group treatment: results of a randomized, controlled trial

OBJECTIVE: To evaluate the effectiveness of a social cognitive intervention program for Dutch aggressive boys and to compare it with a social skills training and a waitlist control group. METHOD: A randomized, controlled treatment outcome study with 97 aggressive boys (aged 9-13 years) was presented. An 11-session group treatment, a social cognitive intervention program (n = 42) based on Dodge's social information-processing theory, was compared with social skills training (n = 40) and waitlist control group (n = 15). Measures of aggressive behavior, self-control, social cognitive skills, and appropriate social behavior were completed before and after the group treatment and at 1-year follow-up. RESULTS: The outcome of both treatment conditions indicated (1) a significant increase in appropriate social behavior, social cognitive skills, and self-control and (2) a significant decrease in aggressive behavior. There was a significant difference between treatment and no treatment and between the social cognitive intervention program and social skills training on various child, parent, and teacher measures. CONCLUSIONS: The expectation that focusing on the deficits and distortions in social cognitive processes (social cognitive intervention program) instead of merely focusing on social skills (social skills training) would enhance the effectiveness was supported on child, parent, and teacher measures. At 1-year follow-up, the mean effect sizes of the social cognitive intervention program and social skills training were 0.76 and 0.56, respectively.     

Group parent training versus individual family therapy: An outcome study

A simple of 15 families referred for child behavior problems were randomly assigned to a group condition (parent training plus group behavior therapy , n = 7), and an individual condition (individual family behavior therapy, n = 8). These children manifested primarily home problems of non-compliance, tantrums and fighting behaviors. Results showed the group condition was more efficient in terms of therapist time and number of subject-families achieving an experimental criterion for behavior change. The group condition scored significantly higher than the individual condition on a post-test measuring knowledge of behavioral principles as applied to children. Most subjects, regardless of treatment condition, rated non-targeted behaviors as decreasing in frequency. Also, both groups were equally satisfied with therapy. Families were contracted 6 months following the conclusion of treatment.     

Parent training for young children with developmental disabilities: randomized controlled trial

A randomized controlled trial was used to evaluate a parent training intervention for caregivers with preschool-age children with developmental disabilities. The 21 families in the experimental group received usual care plus the 12-week Incredible Years Parent Training Program with developmental delay modifications. Families in the control group (n = 23) received usual care, including early childhood education and related services. Results suggest that this parent training intervention was superior to usual care for young children with developmental delays or disabilities in reducing negative parent-child interactions and child behavior problems. Participants in the experimental group indicated high satisfaction with treatment. Additional research is necessary to document maintenance and generalization of treatment outcomes.     

Therapist-assisted, self-administered bibliotherapy to enhance parental competence: short- and long-term effects

The efficacy of bibliotherapy has primarily been investigated in anxiety disorders, depression, or substance dependence. The efficacy of self-help books to increase parenting competence was only investigated in a few studies despite their broad dissemination in public. The aims of the study were to investigate the short- and long-term efficacy of a therapist assisted version of the Triple P self-help booklet (Sanders, Markie-Dadds, & Turner, 2003) for families with preschool-age children in Germany. Sixty-nine families were randomly assigned to either a therapist-assisted self-administered parent training (SDPT+T) or to a waitlist control group (WL). Parents in the SDPT+T received the 10 chapter self-help book and an accompanying video. A Triple P facilitator offered seven telephone consultations which aimed to support parents in skill implementation. After the post test, the WL parents were also offered the intervention. A follow-up assessment was conducted six months after post. Compared to waitlist controls, SDPT+T mothers reported significant short- and long-term reductions in child behavior problems as well as in dysfunctional parenting practices. Fathers reported only marginal changes. The study adds further empirical support of parenting self-help materials.     

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.

     

A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms

The efficacy of a self-help parent training programme for children with attention deficit hyperactivity disorder (ADHD) was evaluated. The New Forest Parenting Programme Self-help (NFPP-SH) is a 6-week written self-help psychological intervention designed to treat childhood ADHD. Forty-three children were randomised to either NFPP-SH intervention or a waiting list control group. Outcomes were child ADHD symptoms measured using questionnaires and direct observation, self-reported parental mental health, parenting competence, and the quality of parent–child interaction. Measures of child symptoms and parental outcomes were assessed before and after the intervention. ADHD symptoms were reduced, and parental competence was increased by self-help intervention. Forty-five percent of intervention children showed clinically significant reductions in ADHD symptoms. Self-help intervention did not lead to improvements in parental mental health or parent–child interaction. Findings provide support for the efficacy of self-help intervention for a clinical sample of children with ADHD symptoms. Self-help may provide a potentially cost-effective method of increasing access to evidence-based interventions for clinical populations.     

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.     

Effects on parental mental health of an education and skills training program for parents of young children with autism: a randomized controlled trial

OBJECTIVE: To determine the impact of a parent education and behavior management intervention (PEBM) on the mental health and adjustment of parents with preschool children with autism. METHOD: A randomized, group-comparison design involving a parent education and counseling intervention to control for nonspecific therapist effects and a control sample was used. Two metropolitan and two rural regions were randomly allocated to intervention groups (n = 70) or control (n = 35). The parents of consecutive children with autism (2(1/2)-5 years old) from the autism assessment services for the intervention regions were then randomly allocated to either a 20-week manual-based parent education and behavior management intervention (n = 35) or a manual-based parent education and counseling intervention (n = 35). The main outcome measure of parental mental health was the General Health Questionnaire used pre- and postintervention and at 6-month follow-up. RESULTS: Both treatments resulted in significant and progressive improvement in overall mental health at follow-up (F = 2, 97, p =.007) and mental health significantly improved over time in the 54% of principal caregivers who had the highest levels of mental health problems. The parent education and behavior management intervention was effective in alleviating a greater percentage of anxiety, insomnia, and somatic symptoms and family dysfunction than parent education and counseling at 6-month follow-up. CONCLUSIONS: A 20-week parent education and skills training program for parents of young children newly diagnosed with autism provides significant improvements in parental mental health and adjustment, justifying its addition to early intervention programs at least for parents with mental health problems.     

School-based interventions for anxious children

OBJECTIVE: To compare the effectiveness of three school-based interventions for anxious children: group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training group, and no-treatment control. METHOD: Students (7-11 years old) in three elementary schools (N = 453) were screened using the Multidimensional Anxiety Scale for Children and teacher nomination. Subsequently, 101 identified children and their parents completed the Anxiety Disorders Interview Schedule for DSM-IV, Child Version. Children with features or DSM-IV diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia (n = 61) were randomized by school to one of three conditions. Active treatments were nine weekly sessions of either group CBT or group CBT plus concurrent parent training. RESULTS: Clinician-report, child-report, and parent-report measures of child anxiety demonstrated significant benefits of CBT treatments over the no-treatment control group. Effect size was 0.58 for change in composite clinician severity rating, the primary outcome measure, favoring collapsed CBT conditions compared with control. In addition, several instruments showed significantly greater improvement in child anxiety for group CBT plus parent training over group CBT alone. CONCLUSIONS: Both active CBT treatments were more effective than the no-treatment control condition in decreasing child anxiety symptoms and associated impairment. When parent training was combined with child group CBT, there were some additional benefits for the children.     

Effectiveness of a parent training program in (pre)adolescence: evidence from a randomized controlled trial

The present randomized controlled trial examined the effectiveness of the parent training program Parents and Children Talking Together (PCTT) for parents with children in the preadolescent period who experience parenting difficulties. The program is focused on reducing child problem behavior by improving parents' communication and problem solving skills, and disciplining behavior. Largest effects were expected for families with higher SES, and with children in mid-adolescence. Multi-informant and multi-method data were used from 78 self-referred families with children aged 9-16 (M=13.09, SD=1.75). Intention-to-treat analysis (retention rate 95%; immediate posttest only) showed that participation in PCTT significantly improved parents' communication and problem solving skills (F(1,70)=11.77, p<0.01 and F(1,70)=12.87, p<0.01), and reduced their dysfunctional disciplining behavior in conflict situations (F(1,70)=5.25, p<.0.05). The PCTT intervention was most effective for parents with higher SES and for parents with children between the ages of 14 and 16. No consistent gender effects were found.     

Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample

OBJECTIVE: To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder (ADHD) in a community sample. METHOD: Three-year-old children displaying a preschool equivalent of ADHD (n = 78) were randomly assigned to either a parent training (PT; n = 30), a parent counseling and support (PCO&S; n = 28), or a waiting-list control group (n = 20). The PT group received coaching in child management techniques. The PC&S group received nondirective support and counseling. Measures of child symptoms and mothers' well-being were taken before and after intervention and at 15 weeks follow-up. RESULTS: ADHD symptoms were reduced (F2,74 = 11.64; p < .0001) and mothers' sense of well-being was increased by PT relative to both other groups (F2,74 = 10.32; p < .005). Fifty-three percent of children in the PT group displayed clinically significant improvement (chi 2 = 4.08; p = .048). CONCLUSIONS: PT is a valuable treatment for preschool ADHD. PC&S had little effect on children's behavior. Constructive training in parenting strategies is an important element in the success of parent-based interventions. Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD.     

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.     

Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities

This study evaluated two variants of a behavioral parent training program known as Stepping Stones Triple P (SSTP) using 74 preschool-aged children with developmental disabilities. Families were randomly allocated to an enhanced parent training intervention that combined parenting skills and care-giving coping skills (SSTP-E), standard parent training intervention alone (SSTP-S) or waitlist control (WL) condition. At post-intervention, both programs were associated with lower levels of observed negative child behavior, reductions in the number of care-giving settings where children displayed problem behavior, and improved parental competence and satisfaction in the parenting role as compared with the waitlist condition. Gains attained at post-intervention were maintained at 1-year follow-up. Both interventions produced significant reductions in child problem behavior, with 67% of children in the SSTP-E and 77% of children in the SSTP-S showing clinically reliable change from pre-intervention to follow-up. Parents reported a high level of satisfaction with both interventions.     

Teaching self-help skills to autistic and mentally retarded children

Three autistic, mentally retarded children, ranging in age from 4 to 11 years, and a six-year-old mentally retarded girl, were taught various adaptive behaviors using a multiple baseline design. Skills taught were shoe typing, toothbrushing, hair combing, putting on pants, shirt, and socks, and eating and drinking. Training included modeling, verbal instructions, prompting, and edible and social reinforcement. Treatment procedures involved the whole-task method of teaching self-help skills and consisted of three phases: (a) the trainer modeled and verbally described the target behavior; (b) the trainer physically and verbally guided the child through the entire sequence of task-analyzed steps; and, (c) the child was instructed to perform the behavior independently. The results of this study and their implications for future research are discussed.     

Mother-father-child interactions in families with a mentally retarded young child

The functioning of families with a mentally retarded young child was studied by examining maternal, paternal, and child interactions. Forty Israeli families with retarded children and a developmentally matched sample were observed at home. In families with a retarded child, there was less frequent maternal behavior toward the retarded child, less frequent communicative behavior of the retarded child toward the parents, and more frequent spousal interchanges with regard to the child. Fathers of retarded children differed less from fathers of nonretarded children than did mothers. Results were discussed in relation to home-based intervention with retarded children.     

Preliminary Findings of a Telehealth Approach to Parent Training in Autism

Telehealth or online communication technologies may lessen the gap between intervention requirements for children with autism spectrum disorders (ASDs) and the available resources to provide these services. This study used a video conferencing and self-guided website to provide parent training in the homes of children with ASD. The first eight families to complete the 12-week online intervention and three-month follow up period served as pilot data. Parents’ intervention skills and engagement with the website, as well as children’s verbal language and joint attention skills were assessed. Preliminary research suggests telehealth may support parental learning and improve child behaviors for some families. This initial assessment of new technologies for making parent training resources available to families with ASD merits further, in-depth study.     

Comparison and message-formulation skills in the referential communication of severely mentally retarded children

The importance of comparison and message-formulation skills in referential communication was studied with severely mentally retarded children. A store game task was used that required the child to communicate a choice of one or two objects on a shelf. Comparison training taught the children to select the appropriate object when paired with a similar but inappropriate object. Message training taught the children to communicate by pointing and/or gesturing. Results indicated that combined comparison and message training produced higher communication accuracy than did comparison training alone. Comparison training, however, increased subjects' accuracy of communicating as compared to an untrained control group. A parallel pattern of results was found for communication frequency. The training groups either maintained or improved their communicative performance in a near-generalization task, suggesting that they learned communicative behavior and not merely task-specific behavior.     

Randomized trial of intensive early intervention for children with pervasive developmental disorder

Young children with pervasive developmental disorder were randomly assigned to intensive treatment or parent training. The intensive treatment group (7 with autism, 8 with pervasive developmental disorder not otherwise specified--NOS) averaged 24.52 hours per week of individual treatment for one year, gradually reducing hours over the next 1 to 2 years. The parent training group (7 with autism, 6 with pervasive developmental disorder NOS) received 3 to 9 months of parent training. The groups appeared similar at intake on all measures; however, at follow-up the intensive treatment group outperformed the parent training group on measures of intelligence, visual-spatial skills, language, and academics, though not adaptive functioning or behavior problems. Children with pervasive developmental disorder NOS may have gained more than those with autism.     

A Randomized Controlled Study of Parent-assisted Children’s Friendship Training with Children having Autism Spectrum Disorders

This study evaluated Children’s Friendship Training (CFT), a manualized parent-assisted intervention to improve social skills among second to fifth grade children with autism spectrum disorders. Comparison was made with a delayed treatment control group (DTC). Targeted skills included conversational skills, peer entry skills, developing friendship networks, good sportsmanship, good host behavior during play dates, and handling teasing. At post-testing, the CFT group was superior to the DTC group on parent measures of social skill and play date behavior, and child measures of popularity and loneliness, At 3-month follow-up, parent measures showed significant improvement from baseline. Post-hoc analysis indicated more than 87% of children receiving CFT showed reliable change on at least one measure at post-test and 66.7% after 3 months follow-up.     

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.