Parent Adherence in Two Behavioral Treatment Strategies for the Predominantly Inattentive Presentation of ADHD

We examined the effects of parent adherence on child outcomes in two treatment strategies for the Predominantly Inattentive Presentation of attention deficit/hyperactivity disorder (ADHD-I): behavioral parent training adapted for ADHD-I (Parent-Focused Therapy [PFT]) and a multicomponent intervention that combined PFT, a child life skills group, and a classroom intervention (Child Life and Attention Skills Program [CLAS]). In a 2-site randomized controlled trial, 199 children (7–11 years of age) were randomized to PFT (n = 74), CLAS (n = 74), or treatment as usual (n = 51). Parent adherence was rated separately by parents and clinicians. Child outcomes included ADHD-I symptoms and parent- and teacher- rated impairment social, organizational, and home impairment. Results from multiple regression analyses utilizing a composite of parent and clinician ratings showed that parent adherence predicted improvement in all 3 parent-rated child impairment outcomes and no teacher-rated outcomes in the PFT treatment group. Adherence ratings did not predict any parent- or teacher-rated outcomes in the CLAS treatment group and did not predict ADHD symptom change in either treatment condition. These findings suggest that when parents are solely responsible for teaching and reinforcing new child skills and behaviors (as in PFT), their adherence to the assigned intervention may be especially important for improvement at home. It may be less critical in multicomponent interventions, like CLAS, where the responsibility for teaching new child skills is shared among parents, teachers, and child group clinicians. Parent adherence does not appear to impact child improvement in the school setting.     

Treatment Effects of Parent–Child Focused Evidence-Based Programs on Problem Severity and Functioning among Children and Adolescents with Disruptive Behavior

This study examined the treatment effects of manualized parent–child focused evidence-based programs (EBPs), characterized by an emphasis on parental involvement and engagement, on functioning and problem severity among a statewide sample of children and adolescents referred to outpatient psychiatric clinic for serious and persistent disruptive behavior. Propensity score matching was employed to account for baseline differences between children and adolescents (M_age = 8.4 years; 26% girls; 42% White, 10% Black, 42% Hispanic, 5% other) who received parent–child focused EBPs (treatment group; n = 220) and treatment-as-usual (comparison group; n = 2,543). Children and adolescents who received parent–child focused EBPs showed significantly greater reduction in problem severity compared to the comparison group, indicative of a drop below the clinical threshold for problem behavior. However, the pattern of improvement in problem severity was not paralleled by differential improvement in ratings of child functioning across treatment and comparison conditions. Finally, there were significant differences between the treatment and comparison groups pertaining to certain child and case characteristics that have potential implications for reaching high-risk populations of children and families. These findings support the potential of taking parent–child focused EBPs into scale to promote positive behavioral changes among children and adolescents. Parent–child focused EBPs may serve as an effective remedy that is less restrictive and more conducive to the healthy development of children and adolescents.     

Improved child behavioural and emotional functioning after Circle of Security 20-week intervention

ABSTRACT

This study examined the efficacy of the attachment-based Circle of Security 20-week intervention in improving child behavioural and emotional functioning. Participants were 83 parents of children (1–7 years) referred to a clinical service with concerns about their young children’s behaviour. Parents (and teachers, when available) completed questionnaires assessing child protective factors, behavioural concerns, internalizing and externalizing problems, prior to and immediately after the intervention. The following were considered as potential moderators: child gender and age, parent representations, reflective functioning, child attachment indices and severity of presenting problems, prior to treatment. Results showed significant improvement for parent ratings of child protective factors, behavioural concerns, internalizing and externalizing symptoms, all ps < .05, and children with more severe problems showed most improvement. Teachers also reported improvements, but change was significant only for externalizing problems (p = .030). Findings suggest Circle of Security is effective in improving child behavioural and emotional functioning in clinically referred children aged 1–7 years.     

Parental Expressions of Anxiety and Child Temperament in Toddlerhood Jointly Predict Preschoolers’ Avoidance of Novelty

This study investigated the link between (a) parents’ social trait and state anxiety and (b) children’s fear and avoidance in social referencing situations in a longitudinal design and considered the modulating role of child temperament in these links. Children were confronted with a stranger and a robot, separately with their father and mother at 1 (N = 122), at 2.5 (N = 117), and at 4.5 (N = 111) years of age. Behavioral inhibition (BI) was separately observed at 1 and 2.5 years. Parents’ social anxiety disorder (SAD) severity was assessed via interviews prenatally and at 4.5 years. More expressed anxiety by parents at 4.5 years was not significantly linked to more fear or avoidance at 4.5 years. High BI children were more avoidant at 4.5 years if their parents expressed more anxiety at 2.5 years, and they were more fearful if the parents had more severe forms of lifetime SAD. More severe lifetime forms of SAD were also related to more pronounced increases in child fear and avoidance over time, whereas parents’ expressions of anxiety predicted more pronounced increases in avoidance only from 2.5 to 4.5 years. High BI toddlers of parents with higher state and trait anxiety become more avoidant of novelty as preschoolers, illustrating the importance of considering child temperamental dispositions in the links between child and parent anxiety. Moreover, children of parents with more trait and state anxiety showed more pronounced increases in fear and avoidance over time, highlighting the importance of early interventions targeting parents’ SAD.     

Assessing Callous-Unemotional Traits in Preschool Children With Disruptive Behavior Problems Using Peer Reports

The goal of this study was to examine the extent to which preschoolers with externalizing behavior problems (EBP) can identify behaviors indicative of callous-unemotional (CU) traits among their peers. Participants for this study included 86 preschool children (69% boys; M_age = 5.07 years) with at-risk or clinically elevated levels of EBP who were attending a summer treatment camp. Data collected from the children, their peers, and the counselors who worked at the summer camp examined preschoolers’ social preference, likability, and behaviors indicative of CU. Parents and preschool teachers also reported on children's CU traits and severity of behavioral impairment, as well as school readiness. Peer nominations of CU traits showed (a) excellent factor structure as evidenced by clear CU items (e.g., “don't feel bad when they do something wrong”) versus more prosocial items (“share,” “cooperate”); (b) moderate construct validity when compared to counselor reports of the CU factor as well as preschool teacher reported ratings of CU traits and severity of behavioral impairment; and (c) good utility as evidenced by associations with peer and counselor rated social preference, likability, and school readiness measures as rated by both parents and preschool teachers. These findings indicate that as early as preschool, children with EBP can identify peers who engage in behaviors indicative of CU traits, which have significant implications for children's social status and overall school readiness.     

Immediate effects of a brief mindfulness-based body scan on patients with chronic pain

Mindfulness-based stress reduction (MBSR) has benefits for those with chronic pain. MBSR typically entails an intensive 8-week intervention. The effects of very brief mindfulness interventions are unknown. Among those with chronic pain, the immediate effects of a 10 min mindfulness-based body scan were compared with a control intervention. Fifty-five adult outpatients were randomly assigned to either: (1) mindfulness-based body scan (n = 27) or (2) a reading about natural history (control group, n = 28), provided via a 10 min audio-recording. Interventions were delivered twice across 24 h; once in the clinic and once in participants’ ‘normal’ environment. Immediately before and after listening to the recording, participants rated pain severity, pain related distress, perceived ability for daily activities, perceived likelihood of pain interfering with social relations, and mindfulness. In the clinic, there was a significant reduction in ratings for pain related distress and for pain interfering with social relations for the body scan group compared with the control group (p = 0.005; p = 0.036, respectively). In the normal environment none of the ratings were significantly different between the groups. These data suggest that, in a clinic setting, a brief body scan has immediate benefits for those experiencing chronic pain. These benefits need to be confirmed in the field.     

Improving Foster Parent Engagement: Using Qualitative Methods to Guide Tailoring of Evidence-Based Engagement Strategies

This qualitative study examined applicability and need for tailoring of an evidence-based engagement intervention, combined with Trauma-Focused Cognitive Behavioral Therapy, for foster parents. Qualitative methods were used, including individual interviews with participating foster parents (N = 7), review of interview findings with an independent group of foster parents (N = 5), and review of the combined foster parent findings by child welfare caseworkers (N = 5), an important stakeholder group. The engagement intervention, with its primary focus on perceptual barriers (e.g., past experiences with mental health), was relevant for the foster care population. However, the study identified areas for tailoring to better recognize and address the unique needs and situation of foster parents as substitute caregivers. Perceptually focused engagement interventions may have broad applicability to a range of populations, including foster parents, with the potential for improving caregiver participation in children's mental health services.     

The family drawings of at-risk children: Concurrent relations with contact with incarcerated parents,caregiver behavior,and stress

The current study examined children's attachment representations as assessed with their family drawings in relation to contact with an incarcerated or estranged parent, caregiver behavior, and family stress in a high-risk sample of children (N = 44, M _age = 8.14), 55% of whom had incarcerated parents. Greater phone, mail, and physical contact with an incarcerated parent was associated with more role reversal in children's family drawings. Additional results show that child-reports of more hostile caregiver behavior were associated with greater overall insecurity in their family drawings; child and caregiver reports of stress were associated with increased global pathology and bizarreness/dissociation in children's family drawings. Given the lack of research on concurrent familial-based correlates of ratings made of children's family drawings, these results provide additional insights into children's representations of attachment relationships in early middle childhood. Further, the results regarding contact with incarcerated parents have implications for researchers and clinicians working with families impacted by parental incarceration.     

Association With Deviant Peers Across Adolescence: Subtypes,Developmental Patterns,and Long-Term Outcomes

Indices of deviant peer group involvement are inconsistent and confound type, frequency, and severity of deviant peer behaviors. These measurement approaches thus obfuscate potential meaningful differences in deviant peer involvement in terms of subtypes, developmental patterns, and long-term outcomes. The current study employed latent class analysis to derive subtypes of deviant peer involvement and examined relations to substance use disorder in adulthood, a common outcome of deviant peer involvement. Youth (76% Caucasian) completed assessments across four time points: ages 10–12 years (Time 1; N = 775, 71% male), 12–14 years (Time 2; n = 649, 72% male), 16 years (Time 3; n = 613, 73% male), and 22 years (Time 4; n = 425, 71% male). At Times 1 to 3, participants completed an interview assessing deviant peer involvement. At Time 4, participants completed a structured interview assessing substance use disorder. Classes of youth with different profiles of deviant peer associations were derived at Times 1, 2, and 3. Classes varied by type (conduct problems vs. substance use) and severity of deviant peer behavior. Youth reported higher levels of involvement with deviant peers across adolescence, suggesting that some of these deviant peer behaviors may be normative. Earlier involvement with deviant peers and involvement with groups defined by severe conduct problems and substance use were related to the greatest risk for substance use disorder at Time 4. Type and severity of peer deviant behavior differentially relate to long-term risk for substance use disorder and should be included in screening and assessment for risk across adolescence.     

Parent–Adolescent Cross-Informant Agreement in Clinically Referred Samples: Findings From Seven Societies

To conduct international comparisons of parent–adolescent cross-informant agreement in clinical samples, we analyzed ratings on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for 6,762 clinically referred adolescents ages 11–18 from 7 societies (M = 14.5 years, SD = 2.0 years; 51% boys). Using CBCL and YSR data, we asked the following questions: (a) Do parents report more problems for their adolescent children than the adolescents report about themselves? (b) How do cross-informant correlations (rs) for scale scores differ by problem type and by society? (c) How well do parents and adolescents, on average, agree regarding which problems they rate as low, medium, or high? (d) How does within-dyad item agreement vary within and between societies? (e) How do societies vary in dichotomous cross-informant agreement with respect to the deviance status of the adolescents? CBCL and YSR scores were quite similar, with small and inconsistent informant effects across societies. Cross-informant rs averaged .47 across scales and societies. On average, parents and adolescents agreed well regarding which problem items received low, medium, or high ratings (M r = .87). Mean within-dyad item agreement was moderate across all societies, but dyadic agreement varied widely within every society. In most societies, adolescent noncorroboration of parent-reported deviance was more common than parental noncorroboration of adolescent-reported deviance. Overall, somewhat better parent–adolescent agreement and more consistency in agreement patterns across diverse societies were found in these seven clinical samples than in population samples studied using the same methods.     

Executive function in XXY: Comparison of performance‐based measures and rating scales

Few studies have systematically assessed executive functioning (EF) skills in boys with XXY, and these are limited by small samples and restricted EF assessment. This study used a broader battery of performance‐based measures as well as parent‐rating scales of EF in 77 boys and adolescents with XXY (mean age = 12.5 years), recruited from a clinical trial and an outpatient clinic. Exploratory factor analyses were used to create EF domains from performance‐based measures, and similar domains were measured using the Behavior Rating Inventory of Executive Function and Conners Parent‐Rating Scales. The boys with XXY showed a distinct EF profile, with the greatest deficit in attention and more moderate deficits in working memory, switching, and planning/problem solving. Parent ratings showed similar challenges, as well as impaired inhibition. Independent sample t‐tests showed no difference on performance measures between boys diagnosed or not diagnosed with attention‐deficit/hyperactivity disorder (ADHD), although parents of boys diagnosed with ADHD reported more difficulties. There were no differences on performance‐based tests between those diagnosed pre‐ and postnatally, although parents of postnatally diagnosed boys reported more metacognitive problems. Language deficits, cognition, and socio‐economic status did not account for EF deficits.     

Diagnostic Efficiency of the Child and Adolescent Symptom Inventory (CASI-4R) Depression Subscale for Identifying Youth Mood Disorders

This study examined the diagnostic and clinical utility of the Child and Adolescent Symptom Inventory–4 R (CASI-4 R) Depressive and Dysthymia subscale for detecting mood disorders in youth (ages 6–12; M = 9.37) visiting outpatient mental health clinics. Secondary analyses (N = 700) utilized baseline data from the Longitudinal Assessment of Manic Symptoms study. Semistructured interviews with youth participants and their parents/caregivers determined psychiatric diagnoses. Caregivers and teachers completed the CASI-4 R. CASI-4 R depressive symptom severity and symptom count scores each predicted mood disorder diagnoses. Both caregiver scores (symptom severity and symptom count) of the CASI-4 R subscale significantly identified youth mood disorders (areas under the curve [AUCs] = .78–.79, ps < .001). The symptom severity version showed a small but significant advantage. Teacher symptom severity report did not significantly predict mood disorder diagnosis (AUC = .56, p > .05), whereas the teacher symptom count report corresponded to a small effect size (AUC = .61, p < .05). The CASI-4 R Depression scale showed strong incrememental validity even controlling for the other CASI-4 R scales. Caregiver subscale cutoff scores were calculated to assist in ruling in (diagnostic likelihood ratio [DLR] = 3.73) or ruling out (DLR = 0.18) presence of a mood disorder. The CASI-4 R Depressive subscale caregiver report can help identify youth mood disorders, and using DLRs may help improve diagnostic accuracy.     

In Vivo Feedback Predicts Parent Behavior Change in the Attachment and Biobehavioral Catch-up Intervention

Understanding mechanisms and active ingredients of intervention is critical to training clinicians, particularly when interventions are transported from laboratories to communities. One promising active ingredient of parenting programs is clinicians’ in vivo feedback regarding parent–child interactions. The present study examined whether a form of in vivo feedback, in the moment commenting, predicted treatment retention and parent behavior change when the Attachment and Biobehavioral Catch-up (ABC) intervention was implemented in a community setting. Observational data were collected from 78 parent–child dyads (96% mothers; M age = 29 years; 81% minority; infants’ M age = 12 months; 90% minority) across 640 sessions conducted by 9 clinicians (100% female, M age = 39; 67% minority) in Hawaii. Parental behavior was assessed with a semistructured play task before and after intervention. Clinicians’ in-the-moment feedback to parents was assessed from intervention session videos. Clinicians’ frequency and quality of in-the-moment feedback predicted change in parental intrusiveness and sensitivity at posttreatment. Frequency of in-the-moment feedback also predicted likelihood of retention. Hierarchical linear modeling demonstrated strong support for these associations at the between-clinician level, and limited additional support at the within-clinician (i.e., between-case) level. Thus, a hypothesized active ingredient of treatment, in-the-moment feedback, predicted community-based ABC outcomes. The results complement lab-based evidence to suggest that in vivo feedback may be a mechanism of change in parenting interventions. Helping clinicians to provide frequent, high-quality in vivo feedback may improve parenting program outcomes in community settings.     

Supporting positive parenting practices within a community‐based music therapy group program: Pilot study findings

The aim of this study was to evaluate the benefits of a short‐term, community‐based music therapy group program on positive parenting practices. Parent–child dyads receiving early intervention family services (N = 199) participated in 8 weekly, 45–60 minute, music‐based group play sessions. We analyzed pre–post parent self‐reports that measured parenting competency and clinician‐observed ratings of parental responsiveness that evaluated behavioral domains of play, praise, and consistency. Significant results were found for parent‐reported efficacy (p = 0.008, d = 0.21) and satisfaction (p = 0.004, d = 0.19) but not for interest (p = 0.149, d = 0.12). Significant results were found for clinician‐rated observations of parental responsiveness, including play (p < 0.001), praise (p < 0.001), and consistency (p < 0.001). Short‐term, music‐based parenting programs may be an effective way to improve parents’ sense of competency and foster greater parental responsiveness for those receiving family services.     

Motivational Interviewing-Enhanced Safety Planning for Adolescents at High Suicide Risk: A Pilot Randomized Controlled Trial

This pilot randomized controlled trial examined the feasibility and acceptability of a motivational interview (MI)–enhanced safety planning intervention (MI-SafeCope) for teens hospitalized due to suicide risk and explored proximal outcomes (possible mechanisms of change). Participants were 36 hospitalized adolescents (ages 13–17; 78.8% female) with last-week suicidal ideation and/or past-month suicide attempts. Adolescents were randomized to MI-SafeCope, a three-component intervention (individual and family sessions, postdischarge call), or to treatment as usual. Primary outcomes were feasibility and acceptability. We also explored differences in proximal outcomes assessed at 2 weeks, 1 month, and 3 months (family connectedness, motivation for safety plan use, parental motivation to encourage safety plan use), as well as daily for 4 weeks (self-efficacy, coping behavior, safety plan use). Participation and retention rates and intervention satisfaction ratings indicate feasibility and acceptability. Mixed-effects models of daily assessments indicated, for the MI-SafeCope group, significantly higher self-efficacy to refrain from suicidal action (B = 1.15, p = .030), greater reliance on self to cope with suicidal ideation (B = 1.56, p = .042), and higher likelihood of safety plan use to manage suicidal thoughts (B = 0.25, p = .004). Parents in the MI-SafeCope group reported higher motivation to encourage safety plan use (B = 1.04, p = .031). Safety planning incorporating MI is feasible and acceptable with hospitalized teens. Preliminary findings suggest that MI strategies may be promising in maintaining adherence to safety plans, increasing self-efficacy and coping, and in fostering parents’ motivation to encourage safety plan use. Our study also highlights the benefit of daily-level assessment of individuals’ response to suicide-specific interventions.     

The Depression Prevention Initiative: Impact on Adolescent Internalizing and Externalizing Symptoms in a Randomized Trial

This randomized controlled trial examined the longitudinal effects of two school-based indicated depression prevention programs on adolescents’ internalizing and externalizing symptoms, as measured by adolescents, their parents, and their teachers. One hundred eighty-six adolescents participated in this study. The average age was 14.01 (SD = 1.22) years, and the sample was 66.7% female. One third of the sample belonged to a racial minority. Youth received either Interpersonal Psychotherapy–Adolescent Skills Training or group counseling. Symptoms were assessed using adolescent, parent, and teacher reports on the Achenbach System of Empirically Based Assessment at baseline, postintervention, and 6-month follow-up. Adolescents reported the most robust effects in favor of Interpersonal Psychotherapy–Adolescent Skills Training. Adolescents in Interpersonal Psychotherapy–Adolescent Skills Training reported significantly greater reductions in internalizing symptoms through the 6-month follow-up and significantly greater reductions in externalizing symptoms during the intervention as compared to group counseling. Less robust effects were found when examining parent and teacher reports, although there was evidence of significant within-group change in parent- and teacher-reported internalizing symptoms for both interventions and significant between-group differences in teacher-reported externalizing symptoms. This study provides additional evidence supporting the efficacy of Interpersonal Psychotherapy–Adolescent Skills Training as a depression prevention program for adolescents. Interpersonal Psychotherapy–Adolescent Skills Training appears to have fast-acting effects on broadband internalizing and externalizing symptoms as reported by adolescents. This suggests that Interpersonal Psychotherapy–Adolescent Skills Training may serve as a transdiagnostic preventive intervention. Moreover, given the disparate reports of adolescents, parents, and teachers, this study demonstrates the significance of collecting information from multiple sources when possible.     

Attachment representations in sexually abused preschoolers: a comparative study

Attachment theory provides a relevant framework for understanding the psychosocial adjustment of victims of child sexual abuse (CSA). However, most studies have been conducted among adult populations and none have focused on the impact of both preschoolers’ and mothers’ experience of sexual abuse on attachment security. The aim of this study was to compare attachment representations in sexually abused (n = 258) and non-abused preschoolers (n = 133), and to explore the relation between maternal history of CSA and children’s attachment representations. A story completion task assessing attachment representations was administered to children (Bretherton, Ridgeway, & Cassidy, 1990). The results revealed that CSA preschoolers presented significantly higher levels of attachment disorganization compared to non-abused children, and that abused boys were at particular risk for hyperactivation and disorganization. Associations between mothers’ history of CSA and children’s attachment representations were non-significant. These findings support the need to consider victims’ attachment representations in the implementation of efficient treatment programs. Targeting parent–child relationships in interventions could help promote attachment security in a vulnerable population of preschool victims.     

Caregiver insightfulness and young children’s violence exposure: testing a relational model of risk and resilience

ABSTRACT

This study employed a relational post-traumatic stress frame to explore the co-contribution of young children’s exposure to violence and caregiver insightfulness on child behavioral outcomes in a high-risk, non-referred sample of caregivers and preschoolers (n = 64; mean age 3.83 years, SD = .77). Caregiver insightfulness did not have a main effect on child outcomes but did moderate the relation between violence exposure and child behavior across all observed outcomes. Violence-exposed children with non-insightful caregivers demonstrated higher caregiver-rated internalizing and externalizing behaviors and observer-rated negative affect than all other groups. Among children not exposed to violence, insightfulness was not related to children’s behavior problems or negative affect, suggesting violence-specific processes. Though cross-sectional, results suggest that the effects of violence and caregiver insightfulness on child outcomes are contingent on one another and that caregiver insightfulness may play a protective role in contexts of violence.     

High versus Low Intensity Summer Treatment for ADHD Delivered at Secondary School Transitions

Spikes in symptom severity are noted for adolescents with attention deficit/hyperactivity disorder (ADHD) at the transitions to middle and high school that are attributed to developmental maladjustment. This study evaluated the effectiveness of high-intensity (HI; 412 hr, $4,373 per participant) versus low-intensity (LI; 24 hr, $97 per participant) skills-based summer intervention delivered to adolescents with ADHD by local school district staff. Participants were 325 ethnically diverse rising sixth and ninth graders with ADHD randomized to HI versus LI (n = 218) or recruited into an untreated comparison group (n = 107). Group × Time 1-year outcome trajectories were compared using linear mixed models. Both interventions possessed high fidelity and were viewed by families as enjoyable and beneficial. Youth attendance was higher for HI (~80%) versus LI (~45%). Parent training attendance was uniform across groups (~50%). Parent and student attendance did not impact trajectories. Primary benefits of HI over LI were to note taking (d = .50), parent contingency management (d = .43), and parent-rated ADHD symptoms (d = .40–.46; ninth grade only). Secondary analyses suggested that HI may produce additional benefits compared to no treatment for home organization skills (HI vs. untreated d = .54), parent–teen conflict (HI vs. untreated d = .39), and grade point average (HI vs. untreated d = .47, ninth grade only). Summer HI treatment was superior to LI in engagement and uptake of certain skills. However, the extent to which these medium benefits on a limited number of outcomes justify high costs compared to LI remains an open question. Delivering treatment during the summer instead of school year may limit generalizability.     

Recovery of Working Memory Following Pediatric Traumatic Brain Injury: A Longitudinal Analysis

In a prospective longitudinal study, the trajectory of verbal and visual-spatial working memory (WM) development was examined 2-, 6-, 12-, and 24-months following complicated-mild to severe pediatric traumatic brain injury (TBI; n = 55) relative to an orthopedic injury comparison group (n = 47). Individual growth curve modeling revealed an interaction of age, severity, and time for verbal, but not visual-spatial WM. The youngest children with severe TBI had the lowest scores and slowest verbal WM growth. WM outcome is best understood in light of age at injury and TBI severity. Findings support the early vulnerability hypothesis and highlight the need for long-term follow-up.