Family Drawings before and after Treatment for Child Conduct Problems: Fluidity of Family Dysfunction

Lilian Kloft,Sonia Sultan,Mark Dadds,Caroline Moul,David Hawes

doi:10.1007/s10826-017-0841-2

Lilian Kloft, Sonia Sultan + Show 3 more

Open Access

https://doi.org/10.1007/s10826-017-0841-2

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Abstract

Children’s drawings have previously been found to reflect their representations of family relationships. The present study examined whether evidence-based parent training for child conduct problems impacts on representations of family functioning using the Family Drawing Paradigm (FDP). N = 53 clinic-referred children (aged 3–15) with conduct problems and their families were assessed pre-treatment and at 6-month follow-up on a modified version of the FDP. Analyses of changes in the FDP revealed improvements in family functioning but not tone of language (as indicated by written descriptors) following treatment. Higher family dysfunction scores were associated with increased levels of callous-unemotional (CU) traits in the children pre-treatment. Children with high levels of CU, however, demonstrated greater change in FDP dysfunction than a low CU group, resulting in similar levels at follow-up. CU traits also moderated the association between change in family warmth and conduct problem severity, with increased FDP warmth more strongly related to improved conduct problems in the high vs. the low CU group. FDP drawings are sensitive to changes in family functioning arising from parent training, accounting for unique variance in child outcomes independent of verbal reports.

Highlights

Children with early-onset conduct problems (CPs) are at high risk for chronic antisocial and aggressive behaviour, and a variety of social and mental health problems in adolescence and adulthood
As child adjustment is intimately related to parental psychopathology, we examined relationships of the Family Drawing Paradigm (FDP) subscales to mother’s and father’s reports on the Depression Anxiety Stress Scales (DASS), both measured at time 1
This study examined the effects of an evidence-based parentfocused family intervention for child conduct problems on representations of family dysfunction as evidenced in family drawings in a sample of clinic-referred children with disruptive behaviour problems and their families

Summary

Participants

Participants were families with children self-referred or referred from schools or mental health professionals for child externalizing behaviour and emotional problems to the University of New South Wales (UNSW) Child Behaviour Research Clinic (CBRC) in Sydney, Australia, between 2007 and 2015. Interrater reliability among a team of psychologists/ psychiatrists for DISCAP diagnoses was good (average Cohen’s κ = .74) Participants in receipt of stimulant medication for behavioural problems (at either pre-treatment or follow-up) represented 6% of the overall sample. Caregivers were both biological parents in 38 families (73%), one biological parent in 8 families (15%), one biological parent and a partner in two families (4%), a guardian in one family (2%), shared care among biological parents and partner/s in one family (2%), and grandparent/s in two families (4%). Parent’s highest education level ranged from: 4 years of secondary school (mothers: 6%, fathers: 12%), to 6 years of secondary school (mothers: 6%, fathers: 10%), to technical/skills-based tertiary education (mothers: 23%, fathers: 19%), to university education (mothers: 63%, fathers: 54%; 4 missing values in total)

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