Behavioral family intervention for children with developmental disabilities and behavioral problems.

The outcomes of a randomized clinical trial of a new behavioral family intervention, Stepping Stones Triple P, for preschoolers with developmental and behavior problems are presented. Forty-eight children with developmental disabilities participated, 27 randomly allocated to an intervention group and 20 to a wait-list control group. Parents completed measures of parenting style and stress, and independent observers assessed parent-child interactions. The intervention was associated with fewer child behavior problems reported by mothers and independent observers, improved maternal and paternal parenting style, and decreased maternal stress. All effects were maintained at 6-month follow-up.     

Outcome of short-term hospitalization for children with severe asthma.

This study presents results of a family-centered, short-term residential program in which medical, behavioral, and treatment assessments were provided to the child with severe asthma and the family. After a median stay of 15 days, forty-four consecutively admitted children with severe asthma achieved a 93% reduction in hospital days (median, 7 hospital days for the year before treatment versus median 0 hospital days per patient per year at 20 1/2-month follow-up; p less than 0.001) and an 81% reduction in emergency care (median, 4 visits for the year previously versus median, 0.4 visits per patient per year at follow-up; p less than 0.01). There was also a significant reduction in corticosteroid bursts and improvement in FEV1. Unique to this program was mandatory family participation focusing on the child's and family's adaptation to severe asthma and development of family-specific interventions to promote compliance with the treatment regimen. Child and family functioning was assessed at admission and follow-up. Hospital use at follow-up was greater for children from dysfunctional families. Families demonstrating difficulties in disciplining the child with asthma required more hospital days both before admission and at follow-up. Short-term hospitalization for children with severe asthma is associated with significant improvement in pulmonary morbidity when the family of the child is included in assessment and treatment.     

Brief cognitive therapy for panic disorder: a randomized controlled trial.

Cognitive therapy (CT) is a specific and highly effective treatment for panic disorder (PD). Treatment normally involves 12-15 1-hr sessions. In an attempt to produce a more cost-effective version, a briefer treatment that made extensive use of between-sessions patient self-study modules was created. Forty-three PD patients were randomly allocated to full CT (FCT), brief CT (BCT), or a 3-month wait list. FCT and BCT were superior to wait list on all measures, and the gains obtained in treatment were maintained at 12-month follow-up. There were no significant differences between FCT and BCT. Both treatments had large (approximately 3.0) and essentially identical effect sizes. BCT required 6.5 hr of therapist time, including booster sessions. Patients' initial expectation of therapy success was negatively correlated with posttreatment panic-anxiety. Cognitive measures at the end of treatment predicted panic-anxiety at 12-month follow-up.     

Families of the Developmentally Disabled (Book)

Mothers and fathers from 52 two-parent families—26 families with a normal child and 26 families with an attention-deficit-disordered/hyperactive (ADDH) child—independently completed questionnaires regarding child behavior; time for individual, couple, and family activities; extended family and community contacts; depression; and family functioning. The communication, problem solving, role allocation, behavioral control, affective responsiveness, affective involvement, and general functioning of normal and ADDH families did not differ significantly. Families of ADDH children reported fewer extended family contacts and described these as less helpful. Mothers of ADDH children reported higher depression scores than their husbands or the mothers of normal children did. Alcohol consumption was higher in families of ADDH children than in those of normal children and was higher in mothers. Mothers' depression ratings were linked both to family functioning and to child behavior, whereas fathers' depression ratings were linked only to family functioning.     

Parent-child interaction therapy: a comparison of standard and abbreviated treatments for oppositional defiant preschoolers

Families of 54 behaviorally disturbed preschool-aged children (3 to 5 years) were randomly assigned to 1 of 3 treatment conditions: standard parent-child interaction therapy (PCIT; STD); modified PCIT that used didactic videotapes, telephone consultations, and face-to-face sessions to abbreviate treatment; and a no-treatment waitlist control group (WL). Twenty-one nondisturbed preschoolers were recruited as a social validation comparison condition. Posttreatment assessment indicated significant differences in parent-reported externalizing behavior in children, and parental stress and discipline practices from both treatment groups on most measures compared with the WL group. Clinical significance testing suggested a superior effect for the STD immediately after intervention, but by 6-month follow-up, the two groups were comparable. The findings indicate that abbreviated PCIT may be of benefit for families with young conduct problem children.     

Treating comorbid panic disorder in veterans with posttraumatic stress disorder

This study compares the effectiveness of panic control treatment (PCT) with that of a psychoeducational supportive treatment (PE-SUP) in treating panic disorder among a veteran sample with a primary diagnosis of chronic posttraumatic stress disorder (PTSD). Thirty-five patients randomized to receive 10 individual sessions of either PCT or PE-SUP underwent assessments at pretreatment, at 1-week posttreatment, and at a 3-month follow-up. Intent-to-treat analyses of covariance showed that PCT participants significantly improved on panic severity at posttreatment and panic fear at the 3-month follow-up. The PCT group also showed significant reductions in anxiety sensitivity at posttreatment and follow-up compared with that of the PE-SUP group. A significantly higher proportion of persons (63%) in the PCT group was panic free by the follow-up period compared with that of the PE-SUP group (19%). Patient self-report and clinician ratings showed no changes in general anxiety, depression, and PTSD symptoms in either group. These findings indicated that PCT was superior to an active control therapy in reducing the frequency, severity, and distress associated with panic disorder and suggested that brief cognitive-behavioral therapy for panic is effective for persons with chronic PTSD.     

Child Psychopathology and Parenting Stress in Girls and Boys Having Attention Deficit Disorder With Hyperactivity

The present study examined the extent to which girls with attentiondeficit disorder with hyperactivity (ADDH) differed from ADDHboys, non-ADDH clinic-referred girls, and normal girls in parentratings of child psychopathology and parenting stress. ADDHgirls were rated as being more depressed and hyperactive thanADDH boys. However, there were no significant differences betweenADDH boys and girls on any of the 17 scales of the ParentingStress Index. Comparisons among the three groups of girls indicatedthat ADDH girls and non-ADDH clinic-referred girls did not differfrom each other on most dimensions of psychopathology but wererated as more deviant than normal girls on virtually all suchdimensions. Both ADDH and non-ADDH clinic-referred girls posedgreater stress for their mothers, and their mothers reportedgreater family and personal distress than the mothers of normalgirls. Only the mothers of non-ADDH clinic girls showed higherratings of depression, marital distress, and health problemsthan the normal girls. Ratings of parental stress were associatedwith both maternal depression and severity of child psychopathology,especially aggression, conduct problems, and hyperactivity.These findings suggest that ADDH girls and boys are quite similarin the nature of their psychopathology and do not differ fromeach other in the degree of parenting stress associated withtheir care. Instead, high parental stress is associated withchild psychopathology in general, and particularly with externalizingsymptoms.     

The efficacy of time-limited play therapy with maltreated preschoolers

Despite recognition of child maltreatment as a major national problem, there have been no controlled studies that evaluated the efficacy of individual psychotherapy with maltreated children. Thirty-six preschoolers who were attending a therapeutic nursery were provided with either 15 weeks of directive individual play therapy to supplement their ongoing milieu therapy or with their milieu therapy only. Of 13 outcome measures, children in the treatment group were superior to control children at posttest on amount of isolated play, and there were no significant differences at a 10-week followup assessment. Possible explanations for the general lack of significant results were discussed.     

Attention deficit disorder with hyperactivity (ADDH): The contribution of catecholaminergic activity

An attention deficit disorder with hyperactivity in children (ADDH) is now recognized in most countries although diagnostic practices differ. Evidence is presented to show that the two cardinal symptoms of poor attentional performance and high motor activity may be functionally and causally separate. Both are temporarily relieved in a proportion of subjects that respond to psychostimulants. Beneficial treatment decreases noradrenergic metabolism and normalizes variable levels of dopaminergic metabolism. Parallels are drawn with other clinical syndromes arising from changed catecholaminergic activity and with behavioral interpretations of the result of damage to the dorsal noradrenergic bundle and dopaminergic A10 nucleus. Prognosis of ADDH subjects after treatment remains poor. There may be a further defect of neurotransmitter metabolism in the ADDH syndrome. Research strategies are suggested based on the neurobiological correlates of the cognitive style of ADDH subjects and septal function in the animal model of the hypertensive rat.     

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

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

Spouse contracting to increase antabuse compliance in alcoholic veterans

Developed and evaluated a home-based contracting program to determine its effect on the compliance rates of discharged alcohol patients to a disulfiram (antabuse) regimen. The three comparison groups included (a) no contract/no recording; (b) contract/recording; and (c) contract/recording plus instructions for positive reinforcement. Twenty-five patients who had been treated in a behaviorally oriented inpatient alcohol dependence treatment program and who lived with a significant other (i.e., spouse, sibling, parent) participated in the study. At the end of the 3-month period for which the disulfiram was prescribed, those Ss who were involved in contracting and recording reached criterion more frequently than those who were in the minimal treatment group. Furthermore, 84% of this S sample were abstinent at the 3-month follow-up according to collateral reports. The discussion centers on the use of home-based contracting as an inexpensive alternative to other, more costly disulfiram programs. Additional methods for obtaining measures of reliability on self-report of disulfiram usage also are discussed.     

The Role of Parental ADHD in Sustaining the Effects of a Family-School Intervention for ADHD

This study investigated the extent to which parental Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms impact child and parent outcomes following a multimodal family–school intervention, the Family School Success (FSS) program, when compared to an active-control condition (CARE). Participants were 139 children with ADHD (67% male; 91% non-Hispanic; 77% Caucasian; Grades 2–6) and their primary caretaker (91% female; ages 26–59) who participated in a randomized clinical trial evaluating the efficacy of FSS. Associations were examined between parent-reported ADHD symptoms at baseline and intervention outcomes reported by parents and teachers after treatment and at a 3-month follow-up, including child homework and classroom impairments, child ADHD and oppositional defiant disorder symptoms, parenting behaviors, and parent–teacher relationship quality. Across both treatment conditions, parental ADHD was not associated with parent or child outcomes at postassessment. However, differences emerged between the two treatment groups at follow-up for parents with ADHD, particularly when an empirically supported symptom cutoff was used to identify parents at risk for having ADHD. In FSS, but not in CARE, parental ADHD was associated with declines in treatment gains in the quality of the parent–teacher relationship and the child's homework performance. Parents at risk for ADHD had difficulty maintaining treatment effects for themselves and their child in the FSS intervention but not in CARE. The supportive and educational components central to the CARE intervention may be helpful in promoting the sustainability of psychosocial interventions for children with ADHD who have parents with elevated ADHD symptoms.     

Generating Attention,Inhibition, and Memory: A Pilot Randomized Trial for Preschoolers With Executive Functioning Deficits

This goal of this study was to assess the initial feasibility and efficacy of a play-based intervention targeting executive functions (EF) and parent–child relationships in preschoolers compared with an active control group. Preschoolers with EF deficits (M age = 3.7 ± 0.47, predominantly White boys) and their parents were randomized to intervention (n = 36) or active control (n = 32) conditions. Child performance on EF tasks, parent and masked teacher ratings of EF and behavior, and masked clinician ratings of severity were collected at baseline and at 3 and 6 months postbaseline. Partial eta-squared effect sizes at .02 or higher comparing performance across the two groups was considered evidence of meaningful, albeit small, intervention effects. Intervention effects were observed for parent ratings of inattention, hyperactivity/impulsivity, and number/severity of problems experienced in various home situations, teacher ratings of severity of problems in various school situations, parent and teacher ratings of overall impairment, and clinician ratings of impairment. Intervention effects for functional improvements were maintained at the 6-month follow-up. No effect of the intervention was observed on the objective EF measures, although parent ratings of emotional control were improved for children in the intervention group. An intervention utilizing play-based activities targeting EF, when administered in a structured way by parents, is a promising approach for improving behavior in preschoolers with self-regulation deficits. More work is needed to investigate potential impact on EF and to disentangle mechanisms of action. It may be that the intervention’s focus on the structure and quality of parent–child interactions is a mediator of outcomes, rather than improved EFs.     

Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. A case series with randomized allocation

BACKGROUND: Exposure with ritual prevention (ERP) is the psychotherapeutic treatment of choice for pediatric obsessive-compulsive disorder (OCD). In the present study, a new treatment rationale - metacognitive therapy (MCT) for children - was developed and evaluated. METHODS: Ten children and adolescents with OCD were randomly assigned to either MCT or ERP therapy condition. Patients were assessed before and after treatment and at the 3-month and 2-year follow-up by means of symptom severity interviews. Depressive symptoms were also assessed. Manualized treatment involved up to 20 sessions on a weekly basis. RESULTS: We found clinically and statistically significant improvements in symptom severity after treatment. At the 3-month and 2-year follow-up, the attained improvements during treatment were retained. CONCLUSIONS:Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of pediatric OCD. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for OCD.     

Effects of medication, behavioral, and combined treatments on parents' and children's attributions for the behavior of children with attention-deficit hyperactivity disorder

Seventy-four mothers and 41 fathers and their 6 to 13 year old sons with attention-deficit hyperactivity disorder (ADHD) watched videos of child ADHD symptoms, compliance, and noncompliance. Participants were told either that the child was receiving medication, behavioral treatment, a combination of the two, or was not receiving treatment and were asked to rate the cause of the behavior. Parents attributed less control but greater stability to positive child behaviors when the child was receiving medication. However, for negative behaviors, medication increased attributions of control but diminished stability. With behavior management. compliance was seen as more external and stable and noncompliance as more controllable but less stable. For all treatments, boys reported increased control over ADHD symptoms and noncompliance. The implications of these treatment-related attributions for parenting and children's self-perceptions are discussed.     

The effect of verbal commitment and treatment choice on medication compliance in a pediatric setting

This experiment examined the manner in which verbal commitment and treatment choice affect medication compliance in a pediatric setting. Parents (N=89) of children suffering from an inner ear infection (otitis media) were asked or not asked for a verbal promise to give their child all prescribed antibiotic medication (commitment manipulation) and allowed or not allowed to choose between two equally appropriate antibiotics as the treatment for their child (choice manipulation). Self-reports at follow-up visits, which were supported by urinalysis results, indicated that obtaining a verbal commitment significantly increased medication compliance. Verbal commitment also nonsignificantly increased the likelihood of a resolved infection at follow-up. Providing the parent with a choice of treatments had no effect on compliance or health outcome.     

Predictors of Depressive Symptomatology Among Parents of Newly Diagnosed Children with Cancer

Examined predictors of depressive symptoms among 59 parentsproviding primary care to children newly diagnosed with cancer.Parents were studied for a 3-month period. The parent providingprimary care to the child during medical treatment completedmeasures of depressive symptoms, endorsement of family routines,family functioning, amount of assistance from the spouse inproviding care to the child, child behavior problems, as wellas measures of the severity of the child's treatment regimen.A strong relationship was found between child behavior problemsand parent depressive symptomatology. Although disease-relatedfactors such as the child's functional impairment played a rolein the parent's depressive symptoms, results revealed that thechild's behavior problems were most strongly associated withparent depressive symptoms and that family cohesiveness alsohad a contributory role in the maintenance of parent depressivesymptoms.     

Effectiveness of the Incredible Years Parenting Program for Families with Socioeconomically Disadvantaged and Ethnic Minority Backgrounds

Families with socioeconomically disadvantaged and ethnic minority backgrounds are often hard to reach for the prevention and treatment of disruptive child behavior problems. We examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority backgrounds in the Netherlands. One hundred fifty-four families from a wide range of socioeconomic and ethnic backgrounds were recruited in an outpatient clinic for child and adolescent psychiatry and in elementary schools serving deprived neighborhoods. Families were randomly assigned to the BASIC Incredible Years parenting intervention or a waiting list control condition. Children were 3–8 years old (M = 5.59, SD = 1.35; 62% boys, 66% ethnic minorities) and 65% of the children met Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria for oppositional defiant disorder, conduct disorder, and/or attention-deficit hyperactivity disorder. Incredible Years reduced parent-reported disruptive child behavior and teacher-reported hyperactive and inattentive child behavior and increased parent-reported use of praise and incentives and reduced harsh and inconsistent discipline. Incredible Years did not affect parent-reported hyperactive and inattentive child behavior; teacher-reported child conduct problems; and parent-reported use of appropriate discipline techniques, clear expectations, physical punishment, and parenting stress. Of importance, the effectiveness of Incredible Years did not differ across families with different socioeconomic and ethnic backgrounds. Effects were maintained at 3-month follow-up. This study shows that socioeconomically disadvantaged and ethnic minority families in disadvantaged neighborhoods can be engaged in and benefit from parenting interventions to reduce disruptive child behavior.     

The effects of methylphenidate on learning in children with ADDH: the stimulus equivalence paradigm

Investigated the effect of methylphenidate (MPH) on the ability of children with Attention Deficit Disorder with Hyperactivity (ADDH) to learn both trained and untrained complex visual relationships and compared these findings to their school performance under identical dosage parameters. 26 children between the ages of 6 and 12 years with ADDH participated in a double-blind, placebo control, within-subjects design in which each child received four doses of MPH (5, 10, 15, 20 mg) and a placebo in a counterbalanced sequence. MPH enhanced children's learning of both taught and untaught visual relationships, and most changes were similar to, albeit less dramatic than, those obtained for the children's attention and academic performance in school. Results of group and single-subject analyses are presented and discussed with relevance to psychopharmacological research and understanding the complex relationship between learning and psychostimulants used in treating children with ADDH.