Child Compliance Research Articles

Issues in the multi-cultural assessment of parent–child interaction: An exploratory study from the starting early starting smart collaboration

A national, multi-site study of behavioral health services integration developed a parent–child interaction assessment tool and culturally anchored videotape protocol. Representatives from programs serving Chinese, Native American 1 1 Although representatives from the Western Tribal Reservation Childcare Program participated in the workgroup, logistical issues prevented them from videotaping more than a small minority of their families. Hence data from Native Americans are not included here. , Latin-American, African-American, and Anglo-American families discussed cross-cultural issues in parenting and developed a set of guiding principles for the assessment of parent–child interaction, resulting in a revised Parent–Child Observation Guide (PCOG: Bernstein, Percansky, & Hans, 1987 [Bernstein, V. J., Percansky, C., and Hans, S. L. (1987, April). Screening for social–emotional impairment in infants born to teenage mothers. Paper presented at the biannual meeting of the Society for Research in Child Development, Baltimore, MD]) and program-specific laboratory protocols. Data from ratings of videotapes of 683 preschoolers and their primary caregivers are presented. Across ethnic groups, parental sensitivity correlated with child involvement and parental discipline correlated with child compliance. Mean PCOG factor scores differed between ethnic groups, and correlations between PCOG factors and independent measures of child social skills and family environment differed across groups, suggesting that different aspects of parent–child interaction may have more salience in different ethnic groups. The collaborative process and how “best practice” was applied to the development of the PCOG and videotape protocol as well as strengths and limitations of the PCOG are discussed.

An Errorless Approach to Management of Child Noncompliance in a Special Education Setting

Many commonly employed strategies used by teachers to manage noncompliance and problem behavior in the classroom focus on suppression of problem responses through reductive consequences. Errorless compliance training was developed to provide a nonaversive alternative to reducing child noncompliance and has been demonstrated effective as a home-based intervention approach for parents. In the present study, the effectiveness of errorless compliance training as a classroom approach in a special education setting was investigated. A graduate student implemented the intervention with two 5-year-old girls with Down syndrome, who demonstrated severe noncompliance to teacher requests. The intervention was associated with substantial increases in child compliance in the classroom.

Bioequivalence of a new liquid formulation of ursodeoxycholic acid (Ursofalk suspension) and Ursofalk capsules measured by plasma pharmacokinetics and biliary enrichment

Ursodeoxycholic acid is an approved therapy for hepatobiliary disorders but in infants and children compliance is compromised because it is formulated exclusively as capsules, or tablets. To determine the pharmacokinetics and bioequivalence of a new liquid formulation of ursodeoxycholic acid (Ursofalk suspension) with a standard capsule (Ursofalk) in a randomized, unblinded, crossover designed study of 24 healthy adults. Equivalence was based on single bolus oral plasma pharmacokinetics and biliary ursodeoxycholic acid enrichments after repeat doses. Biliary bile acid composition and hydrophobicity index were also compared. Ursodeoxycholic acid was measured in duodenal bile by high-performance liquid chromatography and in plasma by mass spectrometry. The mean percentage biliary ursodeoxycholic acid enrichment after administration of the suspension was not significantly different from that obtained with capsules (44.2 +/- 11.7% vs. 46.9 +/- 10.2%, respectively). The equivalence ratio was 0.94 (95% CI: 0.8-1.1), establishing bioequivalence between suspension and capsules. Both formulations reduced the biliary hydrophobicity index and no differences in bile acid composition were observed between formulations. The plasma pharmacokinetics of both formulations was similar and the tolerability of the suspension was excellent. A new liquid formulation of ursodeoxycholic acid suitable for paediatric patients is pharmacologically bioequivalent to capsules when given as single, or repeated oral doses.

Interparental agreement on the use of control in childrearing and infants’ compliance to mother's control strategies

This study examined associations between interparental agreement about the use of control with children, maternal control strategies, and child compliance to mother in 55 two-parent families with 11- to 15-month-old infants (27 boys, 28 girls). Mothers and fathers reported on their beliefs about the use of control with children, and this data was used to create an interparental agreement score for each mother–father dyad. Mother's verbal control strategies and child responses to maternal control strategies were assessed at both 14- and 18 months during a 15-min home observation play session. Results revealed that mothers who believed in the use of strict control with children used more directives when interacting with their child. Mothers who used more directives to control their child at 14 months had children who were more defiant at 18 months. Parents who agreed about the use of control had children who were more compliant at 18 months.

A six week parenting program for child compliance.

Child compliance is an important skill for young children to develop. It is often the focus of intervention efforts. This paper presents a six week program for professionals to use in training. At each week, new parenting skills are taught and utilized in real life child compliance situations. Data collection is built into the six-week program. For assistance to professionals and parents, the article presents the manual in its entirety for use. Keywords: Parent training, manual, child compliance, six week program, behavioral procedures. ********** Compliance problems in young children are often at the heart of many parent-child difficulties. It is an area where effective treatments are available (Van Hasselt, Sisson, & Aach, 1987). Parent training procedures based on a behavioral approach incorporating antecedent and consequent components provide an empirical evidence-base for users (Cipani, 2004; Issac, 1982; O'Dell, 1974). This parent-training manual lays out a step-by-step plan for developing key skills in parents for compliance situations. Professionals can use the manual in individual training efforts as well as group training formats that span a six-week (or longer period). If used individually, it can be tailored to fit the individual client needs and may require more or less time than six weeks. It is recommended that the skills taught should be kept in their current sequence. A child's compliance to simple parental commands is an important skill to develop. Isn't life more harmonious when children put their back packs up without constant reminding? What about living with children who fail to respond to your requests, time and time again? Is a child's failure to comply a satisfying state of affairs? Which family would you like to be parent for a week: Ozzie & Harriet Nelson or the Simpson's? While you may laugh more at Bart, you certainly hope he is your neighbor's child, and not yours. Parents are not the only beneficiaries of compliance in their children. Children who have learned to follow parental directives and commands without great distress and commotion often live happier lives, both at home and in school. In contrast, children who lack this ability often have difficulty in their daily interactions with people, particularly at school. This six-week parental program to deal with child compliance has the following phases: Week 1: Set the stage for child compliance Week 2: Know the difference between a clear and an unclear command Week 3-4: Learn to use praise, time limits and Sit & Decide Week 5: How's it going? Week 6: The non-compliance jar This six-week program is highly suited for young children, at preschool and early elementary ages (results are not guaranteed). In some cases, parents may be able to effectively deploy these procedures without any outside consultation. However, other parents may require technical assistance in some part(s) of the six week program in order to be effective with their particular child. I strongly encourage such parents to seek out consultation from some one trained in applied behavior analysis, particularly if they experience problems in implementing these recommendations with their child. Such personnel can be found at the following web sites (www.bacb.com or www.abainternational.org). If more serious mental health problems exist, a physician or other mental health professional may need to evaluate your child, prior to or during this program. Before embarking on this six-week program, please fill out the following questionnaire (Table 1). The questionnaire asks you to rate your child's level of compliance to your commands over the prior two-month period. Week 1: Set the Stage for Child Compliance The case of child non-compliance: Parent: Geraldo please put your raincoat on. It's beginning to rain and I don't want you to get your clothes wet and get sick. …

Covariations between mothers' responsiveness and their use of “do” and “don't” instructions: Implications for child behavior therapy

Fifty-two clinic-referred (20) and volunteer (32) mother-child dyads were observed in their home settings for 1 hour per dyad. Observers monitored the mothers' responsiveness during interactions with their children, and mothers' use of “do” and “don't” instructions were recorded; the children's compliance with instructions was also recorded, as well as their negative responses directed to mothers. Results showed the expected differences between clinic-referred and volunteer dyads, with the former mothers being less responsive and more inclined to issue “don't” instructions; the clinic-referred children were less compliant and more negative. All children were less compliant with “don't” instructions than “do” and, as expected, mothers' responsiveness scores were positively correlated with their use of “do” instructions in both groups. There was evidence that use of these instructions mediated the high correlation between mothers' responsiveness and their children's compliance.

Family Communication Environments and Rule-Based Social Control of Adolescents' Healthy Lifestyle Choices

To describe further the contribution of family interaction to adolescent members' health, 164 parent-college student child dyads completed questionnaires regarding perceptions of Family Communication Environment (FCE), healthy lifestyle rules in the family during the child's adolescence, and child compliance with those rules. Families higher in Expressiveness reported lower child compliance to rules, lower parent articulation of rules, and lower parental sanctioning of rule violations. Families higher in Structural Traditionalism displayed greater agreement between parents and children in the identification of rules. Families higher in Avoidance scored higher in rule scope, the extent to which rules applied to all of the children in a family rather than being individuated by child. The findings support the integrity of the tripartite conceptualization of the FCE construct. Findings further suggest that parental socialization on health-related matters, especially the enactment of rule-governed social control, cannot be viewed as a unitary process: different family communication environments use rules differently in socializing adolescents to make healthy lifestyle choices. Future research should examine other kinds of social control and possible relationships with FCE.

CABAS parent education: Increasing child compliance via parental emission of unflawed commands and contingent consequations during play.

This study examined the efficacy of the parent education/training program of the Comprehensive Application of behavior Analysis to Schooling (CABAS) model (Greer, 2000) in increasing rates of child compliance. Five parents of children attending a CABAS special needs preschool received both didactic instruction and home-based in vivo training in the use of unflawed antecedent commands and contingent consequations (including verbal and physical positive reinforcement, planned ignoring, and physical follow-through) during weekly toy playing, sharing and clean up sessions with their siblings. The study incorporated a multiple probe design using five parents who started receiving parent training on different days, resulting in a variation of a delayed multiple baseline across subjects design. Results indicated that rates of child compliance increased for all five children as a function of parental expertise in emitting unflawed commands and providing contingent consequations for their children. The collateral benefits of the parent program included (a) a reported increase in the frequency and duration of independent toy playing and sibling sharing repertoires and (b) an establishing operation effect for the target student whose increased rate of compliance may have been related to parental verbal and physical positive reinforcement of sibling compliance to parental commands. The effectiveness of the CABAS parent education component was discussed in relation to the comprehensive, perpetual, and interlocking school-home contingencies inherent in the entire CABAS model.

Physically abusive mothers' responses following episodes of child noncompliance and compliance.

The authors used sequential analysis to examine specific interaction patterns between physically abusive mothers and their children following episodes of noncompliance and compliance. Fifteen abusive and 15 nonabusive, low-risk mother-child dyads were observed, and their behaviors were coded for specific interactions. The children in the study ranged in age from 2 to 6 years. Results indicated that after noncompliance occurred, physically abusive mothers were more likely than nonabusive mothers to respond negatively and give another command. When child compliance occurred, there were no group differences in the likelihood of praising their children's prosocial behavior, but physically abusive mothers were less likely than nonabusive mothers to engage in other forms of positive behavior (e.g., positive touch) after compliance. Clinical implications are discussed in the context of working with physically abusive families.

Re-Examining the Overjustification Effect

The purpose of the present investigation was to extend the research related to the possible negative side effects of extrinsic reinforcement on children's compliant behavior, particularly the overjustification effect. Specifically, this study examined the effects of a token reinforcement procedure in a naturalistic environment (third grade classroom) on children's compliance with classroom rules. Three students exhibiting high compliance with classroom rules were selected. Results indicated that the introduction of a token reinforcement program contingent on the occurrence of rule compliance had no detrimental effect on their rule compliant behavior following the withdrawal of the token procedure (i.e., comparison of Baseline I and Baseline II). Thus, the overjustification effect was not supported.

Predictors of preschool children's compliance behavior in early childhood classroom settings

Working within a person–process–context framework, we investigated the relation of the level of preschool children's compliance to child temperament, caregiver–child interaction in the child care setting, child care quality, and contextual chaos. Participants were 86 preschoolers and their teachers. Our database included both questionnaires and observations in child care centers. Child compliance was predicted by child temperament, caregiver behaviors, daycare quality, and level of daycare chaos. Child difficult temperament moderated the influence of caregiver behaviors but did not moderate the influence of environmental chaos on child compliance. Caregiver behaviors did not act to mediate the relations between environmental chaos and compliance. The predictive variance increased as process and context variables were added to the initial person predictor model (additive coaction), and different sets of predictors were associated with committed, situational, and passive noncompliance. The present results indicate that different combinations of main effects predicted different outcomes, illustrating how multiple predictors relate to different aspects of child compliance.

Parenting disruptive preschoolers: experiences of mothers and fathers.

This study examined parental functioning and interactions with young children with Oppositional Defiant Disorder (ODD), with emphasis on differences between mothers and fathers in their responses to their child and in their unique contributions to the prediction of child disruptive behavior. Participants were 53 3- to 6-year olds with ODD who presented for treatment with two parents. Mothers reported more severe disruptive behavior and higher parenting stress than fathers. During parent-child interactions, mothers showed more responsiveness than fathers, even though children were more compliant during interactions with fathers. Regression analyses showed that fathers' parent-related stress was predictive of both mothers' and father's reports of disruptive child behavior; mothers' marital satisfaction was predictive of behavioral observations of child compliance with both mothers and fathers. This study revealed several important differences in the experiences of mothers versus fathers of disruptive children and indicates the importance of including the father in the child's assessment and treatment.

Direct and indirect reinforcement processes in parent training.

This paper reviews the recent parent training research in which parents are taught to use principles of operant learning as well as general principles of positive verbal discourse. While this combination of interventions has been shown to have greater impact than the operant guidelines used alone, a rationale for the discourse strategy is not clear. In this review, it is argued that the two interventions can be understood within an expanded view of reinforcement theory. It would seem that the interventions used in concert lead to improvement in children's and parents' observational skills, as well as in their willingness to cooperate. Keywords: parent training research; operant learning; positive verbal discourse; reinforcement theory; observational skills. ********** When parents seek professional help for their children's behavior, a majority of the referral problems amount to aggression and noncompliance (Denham, Workman, Cole, Weissbrod, Kendziora, & Zahn-Waxler, 2000; Heller, Baker, Henker, & Henshaw, 1996). These two child behaviors are clearly related as a class of disruptive actions, and it is often true that noncompliance sets the stage for aggression because troubled parents are apt to provoke their children into following acts of disobedience (Patterson, 1982). Thus, a child's chronic noncompliance with parent instructions and rules seems to be a keystone part of this disruptive class, suggesting that ways of teaching children to obey their parents might also weaken the entire class of problem behaviors. Because of the above findings and assumptions, it is not surprising to see that today's parent training programs for disruptive children target both components of this response class (Barkley, 1997; Bor, Sanders, & Markie-Dodds, 2002; Webster-Stratton, 1996). All of these programs follow principles of operant learning but also make use of adjunctive strategies aimed at verbal discourse exercises, designed to promote stronger positive connections between parents and their children (see Conduct Problems Prevention Research Group, 1999; Eyberg, 1988; Feinfield & Baker, 2004; Forehand & McMahon, 1981; Schoenwald, Sheidow, Letourneau, & Liao, 2003; Webster-Stratton, Reid, & Hammond, 2004). These exercises involve friendly talk, listening, feeling talk, problem-solving discussion, art projects, and appropriate expression of feelings. In some of the above listed studies, both the operant learning and the adjunctive strategies were shown to impact referral problems of the children. Regardless of whether or not the two strategies were assessed and analyzed as independent sources of change, the authors considered both interventions to be important components of the treatment process. Based on the conceptual arguments and research reviews by Cavell (2001), Strand (2000a and 2000b), and Cavell and Strand (2002), there is reason to view these disparate intervention strategies as more similar than they seem to be. These authors' expansion of reinforcement theory includes stimulus control constructs that could place both interventions within a broader conception of reinforcement theory. In this paper I hope to further develop these ideas and, in the process, to layout some suggested guidelines for clinicians who work with the parents of disruptive children. The Holistic Nature of Parent-Child Interactions When parents are taught to train their children to obey instructions, the clinical teaching and subsequent training are often based on direct reinforcement strategies. That is, child compliance is positively reinforced and noncompliance is either ignored (extinction) or timed out (absence of opportunity to obtain positive reinforcers). This intervention step is accompanied by similar contingency management of other responses in the class of disruptive behaviors, such as demands, nagging, hitting, and property destruction. While the treatment strategy makes sense if we view each response as independent, such a perspective overlooks the research evidence documenting functional connections across these topographically different responses. …

Compliance and noncompliance in anxious, aggressive, and socially competent children: The impact of the child's game on child and maternal behavior

The present study examined the impact of the Child's Game parenting intervention ( Forehand & McMahon, 1981 ; McMahon & Forehand, 2003 ) on child compliance, noncompliance, and aversive behavior in 3 groups of 20 nonreferred preschool children identified as high on dimensions of anxiety/withdrawal, anger/aggression, or social competence. The impact of the intervention on subtypes of compliance and noncompliance and on maternal behavior was also investigated. Child behavior was assessed using the command task, a structured observational procedure, at both pretest and posttest. Pretest and posttest (1 week later) maternal behavior was evaluated during a free-play period. Pretest group differences were evident in both maternal and child behavior. Pretest-posttest changes were observed in child behavior such that anxious/withdrawn and angry/aggressive children generally showed increases in compliance and decreases in noncompliance and aversive behavior while socially competent children showed no improvement on most behavioral measures. Pretest-posttest changes on subtypes of compliance and noncompliance were also evident and moderated by group membership.

A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability

Electronic diary assessment of pain and disability has become increasingly popular in adult chronic pain research but use of this methodology with children has received limited attention. The aim of this study was to compare two formats of a prospective daily diary (handheld computer=e-diary; paper diary=p-diary) on children's compliance, accuracy, and acceptability ratings. Sixty children, ages 8–16 ( M=12.3) with headaches or juvenile idiopathic arthritis, were randomized to receive either e-diaries administered via home visits ( n=30) or p-diaries ( n=30) handed out during clinic visits for return by mail. Results demonstrated significant mean differences in diary entries completed between groups, with children with e-diaries completing more days ( M=6.6) compared to children with p-diaries ( M=3.8), P<0.001. Diaries returned by children in the p-diary group contained significantly more errors and omissions compared to diaries returned by children in the e-diary group (which contained none), P<0.001. Children rated both diary formats as highly acceptable and easy to use. A significant gender×diary format interaction ( P<0.01) was found for compliance where boys demonstrated greater compliance with the e-diary format. Findings demonstrated that the e-diary was feasible to use with children and showed significantly greater compliance and accuracy in diary recording compared to traditional paper diaries in a population of children with recurrent pain.

Family dynamics and child outcomes in early intervention: the role of developmental theory in the specification of effects

Evaluations of early intervention for children facing biological and/or socioeconomic risk have tended to focus most directly on change in the child, treating family variables primarily as mediators of change. In contrast, the current study used developmental theory to articulate hypotheses that address one way in which a focus on the relationship between mother and child may be related to intervention efficacy. This study examined maternal control strategy and child compliance as a function of early intervention beginning at birth for low birth weight, preterm infants and their families and related these aspects of mother–child interaction to behavioral outcomes at age 3 ( n=645). Overall, mothers receiving early intervention were no more likely to use a preferred control strategy, guidance orientation, in a structured compliance task than were mothers participating in a follow-up only condition. However, an association between early intervention and maternal guidance was observed among mothers of children who were consistently noncompliant during the task. As a result, maternal guidance as observed in the compliance interaction was associated with reduced externalizing and internalizing behavior at program end for children participating in the intervention but not the follow-up only condition. Findings highlight the value of focusing on the mother–child dyad and illustrate one way in which developmental theory can assist in the specification of treatment effects.

Maternal-child feeding patterns and child body weight: findings from a population-based sample.

Certain mother-child feeding patterns (MCFPs) may promote childhood obesity and/or disordered eating. To assess the demographic correlates of MCFPs and to test whether differences in MCFPs are associated with child body mass index (BMI; calculated as weight in kilograms divided by the square of height in meters) z scores in a population-based study. A secondary analysis of the National Longitudinal Survey of Youth main and child cohorts was conducted on more than 1000 Hispanic, African American, and non-Hispanic/non-African American children, aged 3 to 6 years. The MCFPs were measured by means of 3 interview questions probing mother-allotted child food choice, child compliance during meals, and child obedience during meals. Mothers of non-Hispanic/non-African American children allotted greater food choice than mothers of African American or Hispanic children. Maternal BMI and other demographic measures were unrelated to MCFPs. The lowest levels of mother-allotted child food choice and child eating compliance were associated with reduced child BMI, with mean BMI z scores of -0.36 and -0.41, respectively. Effect sizes were small, however, and MCFPs did not discriminate children who were overweight or at risk for being overweight from children who were not (P>.05). Feeding strategies providing the least child food choice were associated with reduced child BMI. However, MCFPs did not relate to child overweight status.

Compliance in Chinese and Canadian toddlers: A cross-cultural study

Observational data concerning children’s compliance were collected from samples of 2-year-olds in PR China and Canada. Information on child-rearing attitudes was obtained from mothers. It was found that Chinese toddlers had higher scores on voluntary committed compliance than their Canadian counterparts. In contrast, Canadian toddlers had higher scores on externally imposed or situational compliance and overt protest than Chinese toddlers. Girls displayed more committed compliance than boys in both samples. Maternal warmth and induction were positively associated with committed compliance in Chinese toddlers, and maternal induction was positively associated with situational compliance in Canadian toddlers. Maternal punishment orientation was negatively associated with committed compliance and positively associated with situational control in Chinese toddlers, but not in Canadian toddlers. The results might indicate specific cultural “meanings” of different forms of child compliance.

Interpretations of child compliance in individuals at high- and low-risk for child physical abuse

Objective: Our studies compared individuals at high- and low-risk for child physical abuse on measures of social information processing. Method: Two studies were conducted using similar methods. Twenty-eight childless women in Study 1 and 36 mothers in Study 2 read vignettes of parent-child interactions in which the child’s level of compliance was difficult to interpret. Participants were asked a series of questions about the child’s behavior and their own reactions. Results: Accuracy and bias in identifying compliant behavior were assessed using a signal detection paradigm. In both samples, high- and low-risk participants did not differ in their overall accuracy in identifying children’s behaviors. However, they used different evaluation standards such that high-risk participants were biased toward seeing more noncompliance and low-risk participants were biased toward seeing more compliance. High- and low-risk participants also made different types of errors in interpreting children’s behavior. Low-risk participants were more likely to misinterpret noncompliant behavior as compliant, and there was a trend for high-risk participants to not perceive compliant behavior when it occurred. There were no differences in reported disciplinary responses in either study and the results for affective reactions were mixed. Conclusions: Specific differences in social information processing between high- and low-risk individuals replicated across samples, suggesting a reliable association between evaluation standards and risk of child physical abuse. However, the absence of differences in reported discipline and inconsistent findings on affective reactions indicate the need to identify the mechanism through which cognition influences parenting behavior.

Sequential evaluation of reinforced compliance and graduated request delivery for the treatment of noncompliance in children with developmental disabilities.

Errorless compliance training is a recently developed approach that has been demonstrated to be effective in treating severe oppositional behavior in children. In conjunction with several ancillary techniques, the approach comprises two fundamental components: reinforcement for child compliance and delivery of requests in a four-level hierarchy, from requests that yield high levels of compliance to those that yield low levels. To determine the relative contribution of each component, four children with developmental disabilities and severe oppositional behavior were observationally assessed in baseline and then treated using reinforcement following each instance of compliance to parental requests. Following this first treatment phase, we used the graduated request hierarchy in conjunction with reinforced compliance. Results indicated that use of reinforcement for compliance in isolation was ineffective in bringing about clinically significant improvements in child compliance. The addition of the graduated request hierarchy appeared to be associated with substantial changes in child compliance that maintained in follow-up assessments.