Treatment of oppositional defiant and conduct problems in young Norwegian children

The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4–8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries.     

Characteristics of young children with persistent conduct problems 1 year after treatment with the Incredible Years program

In the present study, predictors of persistent conduct problems among children aged 4–8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program (PT), or combined parent training and child treatment (PT + CT). Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.     

Intrusive fathering,children's self‐regulation and social skills: a mediation analysis

Background Fathers have unique influences on children's development, and particularly in the development of social skills. Although father–child relationship influences on children's social competence have received increased attention in general, research on fathering in families of children with developmental delays (DD) is scant. This study examined the pathway of influence among paternal intrusive behaviour, child social skills and child self‐regulatory ability, testing a model whereby child regulatory behaviour mediates relations between fathering and child social skills. Methods Participants were 97 families of children with early identified DD enrolled in an extensive longitudinal study. Father and mother child‐directed intrusiveness was coded live in naturalistic home observations at child age 4.5, child behaviour dysregulation was coded from a video‐taped laboratory problem‐solving task at child age 5, and child social skills were measured using independent teacher reports at child age 6. Analyses tested for mediation of the relationship between fathers' intrusiveness and child social skills by child behaviour dysregulation. Results Fathers' intrusiveness, controlling for mothers' intrusiveness and child behaviour problems, was related to later child decreased social skills and this relationship was mediated by child behaviour dysregulation. Conclusions Intrusive fathering appears to carry unique risk for the development of social skills in children with DD. Findings are discussed as they related to theories of fatherhood and parenting in children with DD, as well as implications for intervention and future research.     

Conduct problems in children and adolescents: a twin study

BACKGROUND: Evidence supports a genetic influence on conduct problems as a continuous measure of behavior and as a diagnostic category. However, there is a lack of studies using a genetically informative design combined with several different informants and different settings. OBJECTIVES: To examine genetic and environmental influences on conduct problems rated by parent and teacher reports and self-reports and to determine whether their ratings reflect a common underlying phenotype. DESIGN: A twin study design was used to examine conduct problem scores from ratings by teachers, parents, and twins themselves. SETTING: General community. PARTICIPANTS: Twins aged 5 to 17 years participating in the Cardiff Study of All Wales and North England Twins (CaStANET) project. MAIN OUTCOME MEASURES: Conduct problem scale from the Strengths and Difficulties Questionnaire. RESULTS: Conduct problem scores were significantly heritable based on parent and teacher reports and self-reports. Combining data from all 3 informants showed that they are rating a common underlying phenotype of pervasive conduct problems that is entirely genetic, while teacher ratings show separate genetic influences that are not shared with other raters. CONCLUSIONS: Conduct problems are significantly heritable based on parent and teacher reports and self-reports, and are also influenced by environmental effects that impinge uniquely on children from the same family. There is a cross-situational conduct problems' phenotype, underlying the behavior measured by all informants, that is wholly genetic in origin. No significant influence of shared environmental effects was found.     

Children aged 4–8 years treated with parent training and child therapy because of conduct problems: generalisation effects to day-care and school settings

In this study, generalisation effects to day-care/school settings were examined in an outpatient clinic sample of 127 children aged 4–8 years treated because of oppositional conduct problems in the home with parent training (PT) and parent training combined with child therapy (CT) (“Incredible Years”). Before treatment all children scored above the 90th percentile on the Eyberg Child Behavior Inventory (ECBI) for home problems, and met criteria for a possible or a confirmed diagnosis of either an oppositional defiant (ODD) or a conduct (CD) disorder. Further, 83% of the children showed clinical levels of conduct problems both at home and in day-care/school before treatment. Although most children improved at home, the majority still showed clinical levels of conduct problems in day-care/school settings after treatment and 1-year later. Combined PT and CT produced the most powerful and significant generalisation effects across the treatment period, however these improvements were not maintained 1-year later for most areas. The results of the present study, therefore, underline the need to target conduct problems not only exhibited at home but also in day-care/school settings, and to develop strategies to maintain positive generalisation effects after treatment for this age and problem-group.     

Direct and Indirect Effects of Maltreatment and Social Support on Children’s Social Competence Across Reporters

Children’s social competence is a key characteristic of resilience, yet little research has assessed contributing factors to this construct. The objectives of this study were to examine direct and indirect effects of maltreatment on children’s social competence, the promotive role of child and caregiver social support, and factors contributing to reports of child social competence across informants. Structural equation modeling evaluated the influence of CPS report history, child adjustment, and child and caregiver social support on child social competence in n?=?783 caregiver-child dyads. CPS report history (age 0–8) was indirectly related to low social competence through child adjustment problems. Social support was a significant promotive factor of child social competence, with caregiver social supports predicting higher levels of parent-reported child social competence. Child social support predicted self-reported child social competence. Findings reinforce the assertion that both caregiver and child social support networks are critical to promoting child well-being after adversity.     

Correction of distortions in distressed mothers' ratings of their preschool children's psychopathology

The often-reported low informant agreement about child psychopathology between multiple informants has lead to various suggestions about how to address discrepant ratings. Among the factors that may lower agreement that have been discussed is informant credibility, reliability, or psychopathology, which is of interest in this paper. We tested three different models, namely, the accuracy, the distortion, and an integrated so-called combined model, that conceptualize parental ratings to assess child psychopathology. The data comprise ratings of child psychopathology from multiple informants (mother, therapist and kindergarten teacher) and ratings of maternal psychopathology. The children were patients in a preschool psychiatry unit (N=247). The results from structural equation modeling show that maternal ratings of child psychopathology were biased by maternal psychopathology (distortion model). Based on this statistical background, we suggest a method to adjust biased maternal ratings. We illustrate the maternal bias by comparing the ratings of mother to expert ratings (combined kindergarten teacher and therapist ratings) and show that the correction equation increases the agreement between maternal and expert ratings. We conclude that this approach may help to reduce misclassification of preschool children as ‘clinical’ on the basis of biased maternal ratings.     

Evaluation of child therapy and caregiver training in the treatment of school refusal

OBJECTIVE: To evaluate the relative efficacy of (1) child therapy, (2) parent/teacher training, and (3) the combination of child therapy and parent/teacher training in the treatment of anxiety-based school refusal. METHOD: Sixty-one school-refusing children (aged 7-14 years) from throughout Melbourne, Australia, were randomized to a child therapy program, a parent and teacher training program, or a combination of the two. Children were assessed before and after treatment, and at 4.5-month follow-up, by means of attendance records, self-report of emotional distress and self-efficacy, parent and teacher reports of emotional distress, and clinician ratings of overall functioning. RESULTS: Statistically and clinically significant pretreatment-posttreatment change occurred for each group. Immediately posttreatment, child therapy appeared to be the least effective in increasing attendance. By follow-up, the attendance and adjustment of those in the child therapy group equalled that of children whose parents and teachers were involved in treatment, whether on their own (parent/teacher training) or together with their children (combined child therapy and parent/teacher training). CONCLUSION: Contrary to expectations, combined child therapy and parent/teacher training did not produce better outcomes at posttreatment or follow-up.     

Children enrolled in public pre-K: the relation of family life, neighborhood quality, and socioeconomic resources to early competence

This article presents data on the family and social environments of 501 children enrolled in public sponsored pre-K in 5 states and tests the relation of these resources to child competence. Structured interviews and questionnaires provide information from parents about the family's social and economic status. Direct assessments and teacher reports provide data on children's literacy, numeracy, and behavioral problems. A majority of the children served in public pre-K lived in poverty and showed decrements in language but not in other domains. A socioeconomic resource factor consisting of parental education, household income, and material need predicted all domains of children's functioning. Children from households high in socioeconomic resources entered pre-K with more well developed language and math skill but fewer behavioral problems than their disadvantaged peers. Neighborhood quality status was related to language competence and mother's marital status to math competence. Neighborhood quality and income level may have their impact on child competence through their relation to dyadic quality and the health and the psychological well-being of the parents.     

Internal representations: predicting anxiety from children's play narratives

OBJECTIVE: This research uses children's story-stem play narratives to examine whether certain specified internal representations of self and experiences will predict later childhood anxiety. METHOD: Thirty-five nonclinical children were studied from 5 to 6 years of age. Narratives of the 5-year-old children were coded for negative expectations of self, others, and experiences. Parents and teachers completed the Child Behavior Checklist and Teacher's Report Form when the children were 5 and 6 years of age. Mothers completed the anxiety section of the Diagnostic Interview Schedule for Children when the children were 6 years of age. Parental anxiety and child temperament were also measured. RESULTS: Five-year-old child negative expectations significantly predicted mother/father/teacher reports of internalizing and anxiety symptoms and mother reports of separation anxiety, overanxious, and social phobia/avoidant disorder symptoms in the children at 6 years of age, even when anxiety and internalizing symptoms at 5 years of age were entered first in the regression equations. Child negative expectations predicted later anxiety in these analyses better than parental anxiety and child temperament. CONCLUSIONS: Child negative expectations may be a risk factor or a mechanism for the development of later anxiety. Children's narratives may be useful for examining such representations and identifying children at risk.     

In-home observations of young Down syndrome children with their mothers and fathers

Sixteen mothers, fathers, and their 4- to 7-year-old children were observed interacting in their homes during three family groupings: (a) mother and child, (b) father and child, and (c) mother, father, and child. Half the children had Down syndrome and half were nonhandicapped. Parents of children with Down syndrome structured their interactions with their offspring by assuming manager and teacher roles more often than did parents of nonhandicapped children. Children with Down syndrome were less contingently responsive to both parents than were nonhandicapped children. Mothers of Down syndrome children assumed the teacher role more often than fathers did. Fathers of both groups of children interacted less with their offspring in the triadic family grouping, whereas mothers were more consistent, assuming a parenting role across family contexts.     

Parent–child agreement and prevalence estimates of diagnoses in childhood: Direct interview versus family history method

Diagnostic information on children is typically elicited from both children and their parents. The aims of the present paper were to: (1) compare prevalence estimates according to maternal reports, paternal reports and direct interviews of children [major depressive disorder (MDD), anxiety and attention‐deficit and disruptive behavioural disorders]; (2) assess mother–child, father–child and inter‐parental agreement for these disorders; (3) determine the association between several child, parent and familial characteristics and the degree of diagnostic agreement or the likelihood of parental reporting; (4) determine the predictive validity of diagnostic information provided by parents and children. Analyses were based on 235 mother–offspring, 189 father–offspring and 128 mother–father pairs. Diagnostic assessment included the Kiddie‐schedule for Affective Disorders and Schizophrenia (K‐SADS) (offspring) and the Diagnostic Interview for Genetic Studies (DIGS) (parents and offspring at follow‐up) interviews. Parental reports were collected using the Family History – Research Diagnostic Criteria (FH‐RDC). Analyses revealed: (1) prevalence estimates for internalizing disorders were generally lower according to parental information than according to the K‐SADS; (2) mother–child and father–child agreement was poor and within similar ranges; (3) parents with a history of MDD or attention deficit hyperactivity disorder (ADHD) reported these disorders in their children more frequently; (4) in a sub‐sample followed‐up into adulthood, diagnoses of MDD, separation anxiety and conduct disorder at baseline concurred with the corresponding lifetime diagnosis at age 19 according to the child rather than according to the parents. In conclusion, our findings support large discrepancies of diagnostic information provided by parents and children with generally lower reporting of internalizing disorders by parents, and differential reporting of depression and ADHD by parental disease status. Follow‐up data also supports the validity of information provided by adolescent offspring. Copyright © 2009 John Wiley & Sons, Ltd.     

The stability of temperament by child and mother reports over two years

The stability of temperament dimensions in children, adolescents, and young adults was examined over a 2-year period through the use of multiple informants and a measure of temperament, presumably applicable to informants of all ages. The study is based on 220 children from 91 families at high- and low-risk for major depression by virtue of the presence or absence of major depression in their parents. The Dimensions of Temperament Survey was completed independently by the child and by the parents about their child. Results showed a fair to moderate stability for child self-report of temperament and moderate to good stability for mother reports of child temperament. Discussion focuses on factors that may influence the stability of temperament ratings such as age, sex, mother's depression, socialization pressures, and expectations of temperament held by others.     

Social functioning in children with ADHD treated with long-term methylphenidate and multimodal psychosocial treatment

OBJECTIVE: To test that methylphenidate combined with intensive multimodal psychosocial intervention, which includes social skills training, significantly enhances social functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared with methylphenidate alone and methylphenidate plus nonspecific psychosocial treatment (attention control). METHOD: One hundred three children with ADHD (ages 7-9), free of conduct and learning disorders, who responded to short-term methylphenidate were randomized for 2 years to receive (1) methylphenidate alone, (2) methylphenidate plus multimodal psychosocial treatment that included social skills training, or (3) methylphenidate plus attention control treatment. Assessments included parent, child, and teacher ratings of social function and direct school observations in gym. RESULTS: No advantage was found on any measure of social functioning for the combination treatment over methylphenidate alone or methylphenidate plus attention control. Significant improvement occurred across all treatments and continued over 2 years. CONCLUSIONS: In young children with ADHD, there is no support for clinic-based social skills training as part of a long-term psychosocial intervention to improve social behavior. Significant benefits from methylphenidate were stable over 2 years.     

Does brief,clinically based,intensive multimodal behavior therapy enhance the effects of methylphenidate in children with ADHD?

OBJECTIVE: The additional value of a short-term, clinically based, intensive multimodal behavior therapy to optimally titrated methylphenidate in children with attention-deficit hyperactivity disorder (ADHD) was investigated. METHOD: Fifty children with ADHD (ages 8-12) were randomized to treatment of methylphenidate or treatment with methylphenidate combined with 10 weeks of multimodal behavior therapy. The multimodal behavior therapy consisted of a child and parent behavioral therapy and a teacher behavioral training. Assessments included parent, teacher and child ratings of ADHD symptoms, oppositional and conduct behavior, social skills, parenting stress, anxiety and self-worth. RESULTS: Both treatment conditions yielded significant improvements on all outcome domains. No significant differences were found between both treatments. CONCLUSIONS: No evidence was found for the additive effect of multimodal behavior therapy next to optimally titrated methylphenidate. CLINICAL IMPLICATIONS: This study does not support the expectation that optimally dosed stimulant treated children with ADHD should routinely receive psychosocial treatment to further reduce ADHD- and related symptoms.     

A comparison of the clinical effectiveness and cost of specialised individually delivered parent training for preschool attention-deficit/hyperactivity disorder and a generic,group-based programme: a multi-centre,randomised controlled trial of the New Forest Parenting Programme versus Incredible Years

The objective of this study is to compare the efficacy and cost of specialised individually delivered parent training (PT) for preschool children with attention-deficit/hyperactivity disorder (ADHD) against generic group-based PT and treatment as usual (TAU). This is a multi-centre three-arm, parallel group randomised controlled trial conducted in National Health Service Trusts. The participants included in this study were preschool children (33–54 months) fulfilling ADHD research diagnostic criteria. New Forest Parenting Programme (NFPP)—12-week individual, home-delivered ADHD PT programme; Incredible Years (IY)—12-week group-based, PT programme initially designed for children with behaviour problems were the interventions. Primary outcome—Parent ratings of child’s ADHD symptoms (Swanson, Nolan & Pelham Questionnaire—SNAP-IV). Secondary outcomes—teacher ratings (SNAP-IV) and direct observations of ADHD symptoms and parent/teacher ratings of conduct problems. NFPP, IY and TAU outcomes were measured at baseline (T1) and post treatment (T2). NFPP and IY outcomes only were measured 6 months post treatment (T3). Researchers, but not therapists or parents, were blind to treatment allocation. Analysis employed mixed effect regression models (multiple imputations). Intervention and other costs were estimated using standardized approaches. NFPP and IY did not differ on parent-rated SNAP-IV, ADHD combined symptoms [mean difference ? 0.009 95% CI (? 0.191, 0.173), p = 0.921] or any other measure. Small, non-significant, benefits of NFPP over TAU were seen for parent-rated SNAP-IV, ADHD combined symptoms [? 0.189 95% CI (? 0.380, 0.003), p = 0.053]. NFPP significantly reduced parent-rated conduct problems compared to TAU across scales (p values < 0.05). No significant benefits of IY over TAU were seen for parent-rated SNAP, ADHD symptoms [? 0.16 95% CI (? 0.37, 0.04), p = 0.121] or parent-rated conduct problems (p > 0.05). The cost per family of providing NFPP in the trial was significantly lower than IY (£1591 versus £2103). Although, there were no differences between NFPP and IY with regards clinical effectiveness, individually delivered NFPP cost less. However, this difference may be reduced when implemented in routine clinical practice. Clinical decisions should take into account parental preferences between delivery approaches.     

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.     

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.

     

Independent Contributions of Early Positive Parenting and Mother–Son Coercion on Emerging Social Development

In the current study, we explored associations between parent–child coercion and positive parenting in the toddler period in relation to children’s social-behavioral development during the school-age period. The data were drawn from the Pitt Mother & Child Project, a sample of 310 low-income, ethnically diverse boys. Drawing on tenets of both attachment and social learning theory, it was hypothesized that coercive mother–son interaction would lead to reductions in positive maternal parenting in the toddler period, and that both positive parenting and mother–son coercion in the toddler period would contribute to children’s conduct problems at school entry and lower social skills and peer rejection in middle childhood. The results were largely confirmed, such that mother–son coercive interaction at 18 months was related to decreases in positive parenting at 24 months. Additionally, mother–son coercive interaction and positive parenting at 24 months were linked to child conduct problems at age 5, which in turn predicted child social skills and peer rejection during middle childhood. In addition to indirect effects through child conduct problems, mother–son coercion continued to be independently related to school-age peer rejection. The findings are discussed with respect to the importance of early coercive interactions in the growth of child social-behavioral development from early to middle childhood.     

Childhood predictors of externalizing and internalizing problems in adolescence

Abstract The aim of this study was to assess the childhood predictors of externalizing and internalizing symptoms in adolescence in an epidemiological sample. Behavior ratings were obtained from 609 children at two time-points, accounting for 71% of the target sample. At age 8, children were evaluated with parental and teacher Rutter scales, and with the Child Depression Inventory (CDI), and at age 16 with the Child Behavior Checklist. Evaluations by all informants had a unique contribution to later outcome. In multivariate analysis, among boys, parental reports of hyperactivity independently predicted externalizing problems and teacher reports of hyperactivity independently predicted internalizing problems. Teacher reports of conduct problems independently predicted externalizing problems among both boys and girls. Furthermore, parent reports of emotional problems independently predicted internalizing problems among both boys and girls. Children’s own reports of internalized distress measured with CDI predicted a high level of internalizing problems among girls. Perceived need of treatment was the strongest predictor for outcome among girls. Change in family structure (e. g., divorce or remarriage) during follow-up independently predicted externalizing and internalizing problems among boys. The study supports the findings from earlier studies showing that the stability of behavior problems from childhood to adolescence is substantial. This implies a need for early recognition and initiation of treatment efforts.