Improvements In Behavior Problems Research Articles

Impact of MindUP Among Young Children: Improvements in Behavioral Problems, Adaptive Skills, and Executive Functioning

ObjectivesWe evaluated the impacts of a mindfulness-based social and emotional learning (SEL) program on behavioral problems, adaptive skills, and executive functioning among kindergarten students.MethodsA total of 23 classrooms were assigned to the intervention group, in which the teachers implemented MindUP, and 19 classrooms were assigned to the comparison group, in which the teachers delivered their classes as usual. Teachers assessed the behavior of students (N = 584; intervention n = 261; comparison n = 323) both pre- and post-intervention with two measures: the Behavior Assessment System for Children, Third Edition, Teacher Rating Scales (BASC-3 TRS) and the Behavior Rating Inventory of Executive Function-Preschool and Child Version (BRIEF-P; BRIEF-2).ResultsStudents who received the intervention demonstrated an improvement in adaptive skills and reduction in behavioral symptoms, internalizing composite, and externalizing composite outcomes. Additionally, there was a significant decrease in executive functioning deficits among students who participated in MindUP. There were no gender differences regarding changes in any of the five study outcomes.ConclusionsThe study suggests that mindfulness-based SEL intervention can improve psychosocial and behavioral outcomes in young children.

Effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia: A pilot randomized controlled trial

BackgroundCaregivers of people with dementia experience high stress levels. Mindfulness-based cognitive therapy has been found to be effective in reducing stress and improving the psychological well-being of several populations. ObjectiveTo explore the feasibility and preliminary effects of a modified mindfulness-based cognitive therapy for family caregivers of people with dementia. MethodsIn a single-blinded, parallel-group, randomized controlled trial, 36 caregivers of people with dementia were randomized to either the intervention group, receiving the 7-session modified mindfulness-based cognitive therapy in 10 weeks; or the control group, receiving the usual family care and brief education on dementia care. The brief education sessions were similar in frequency and duration to the intervention group. Various psychological outcomes of caregivers were assessed and compared at baseline, immediately post-intervention, and at the 3-month follow-up. A focus group with eight participants from the intervention group was conducted to identify the strengths, limitations, and difficulties of the intervention. ResultsIntervention feasibility was established with a high completion rate of 83% (completing ≥5 out of the 7 sessions) and a low attrition rate of 11.1%. The duration of the average weekly home-based mindfulness practice of the caregivers was 180 minutes (S.D. = 283.8). The intervention group experienced a statistically significant decrease in stress levels (Z = -1.98, p = 0.05, Cohen’s d = 0.7) and depressive symptoms (Z = -2.25, p = 0.02, Cohen’s d = 0.8) at the post-test; and a decrease in stress (Z = -2.58, p = 0.01, Cohen’s d = 0.9), depressive symptoms (Z = -2.20, p = 0.03, Cohen’s d = 0.7), and burden (Z = - 2.74, p = 0.006, Cohen’s d = 1.0), and improved quality of life (physical) (Z = -1.68, p = 0.09, Cohen’s d = 0.6) at the 3-month follow-up compared to the controls. A focus group conducted immediately after the intervention revealed three major themes: Impacts on the family caregivers, Impacts on the people with dementia, and Difficulty in practicing mindfulness. ConclusionThe findings support the feasibility and preliminary effects of the modified mindfulness-based cognitive therapy on reducing the stress of caregivers and improving their psychological well-being. Some potential effects on people with dementia (e.g., improvements in behavioral problems) were reported by the caregivers. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the modified mindfulness-based cognitive therapy and the impacts on people with dementia.

Comparing the Effectiveness of Evidence-Based Parenting Programs on Families with and without Children with Special Educational Needs: Short-term and Long-term Gains

Parents of children with a disability or special educational needs (SEN) have three available options when accessing parenting programmes: (a) to access a parenting programme that has been adapted for use by families with a child with disability, (b) to access a disability-specific parenting programme, or (c) to access a parenting programme developed for typically developing children. The aim of the present study was to examine whether accessing evidence-based parenting programmes (EBPPs) developed for typically developed children (option c) could benefit families of children with SEN, and whether benefits could be maintained when programme delivery takes place as part of sustained service implementation. Using data from an effectiveness trial, we found that there was no evidence of differential effectiveness: i.e., families of children with SEN experienced similar gains to families whose child did not have SEN with respect to child behaviour problems, parenting style and parental mental well-being. Using data from services’ sustained implementation, our findings indicated that gains during the implementation phase were of similar magnitude to gains during the research trial: following EBPPs, families of children with SEN experienced small to moderate improvements in behaviour problems and moderate to large improvements in parenting and parental mental well-being across the two phases. One year later, gains were significantly maintained in families who had accessed EBPPs as part of the research trial. While the study is not proposing that EBPPs developed for typically developing children are a replacement for disability-adapted or disability-specific parenting programmes, there was a pragmatic need to evaluate the effectiveness of EBPPs that are in practice accessed by families with a child with SEN. Overall, families of children with SEN can benefit from EBPPs similarly to families whose child does not have SEN, and the gains are significant and substantial even when EBPPs are offered as part of regular service provision. Longer-term maintenance of gains (one year) in service-led implementation of EBPPs likely requires more input.

Child–Adult Relationship Enhancement in Primary Care (PriCARE): A Randomized Trial of a Parent Training for Child Behavior Problems

ObjectiveChild–Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group parent training designed to teach positive parenting skills. Our objective was to measure PriCARE's impact on child behavior and parenting attitudes. MethodsParents of children 2 to 6 years old with behavior concerns were randomized to PriCARE (n = 80) or control (n = 40). Child behavior and parenting attitudes were measured at baseline (0 weeks), program completion (9 weeks), and 7 weeks after program completion (16 weeks) using the Eyberg Child Behavior Inventory (ECBI) and the Adult Adolescent Parenting Inventory 2 (AAPI2). Linear regression models compared mean ECBI and AAPI2 change scores from 0 to 16 weeks in the PriCARE and control groups, adjusted for baseline scores. ResultsOf those randomized to PriCARE, 43% attended 3 or more sessions. Decreases in mean ECBI intensity and problem scores between 0 and 16 weeks were greater in the PriCARE group, reflecting a larger improvement in behavior problems [intensity: −22 (−29, −16) vs −7 (−17, 2), P = .012; problem: −5 (−7, −4) vs −2 (−4, 0), P = .014]. Scores on 3 of the 5 AAPI2 subscales reflected greater improvements in parenting attitudes in the PriCARE group compared to control in the following areas: empathy toward children's needs [0.82 (0.51, 1.14) vs 0.25 (−0.19, 0.70), P = .04], corporal punishment [0.22 (0.00, 0.45) vs −0.30 (−0.61, 0.02), P = .009], and power and independence [0.37 (−0.02, 0.76) vs −0.64 (−1.19, −0.09), P = .003]. ConclusionsPriCARE shows promise in improving parent-reported child-behavior problems in preschool-aged children and increasing positive parenting attitudes.

Mental health services for children and caregivers remaining at home after suspected maltreatment

ObjectiveBehavioral problems are common among children remaining at home after suspected maltreatment, but the effectiveness of current mental health services to improve these behavioral problems is unknown. The objective was to determine whether receipt of child and caregiver mental health services was associated with improvements in behavioral problems in maltreated children remaining at home. MethodsWe retrospectively analyzed Second National Survey of Child and Adolescent Well-being data. We included 1117 children ages 2–17 remaining at home after a maltreatment investigation, excluding children with missing outcome, covariate, or survey weight data. We compared mean Child Behavioral Checklist (CBCL) change scores from baseline to 18months between children who did and did not receive mental health services, before and after adjusting for child, caregiver, and child welfare agency factors using survey-weighted linear regression. ResultsNearly one-quarter (22.6%) of children and 16.0% of caregivers received mental health services. Children receiving services had worse unadjusted baseline and 18-month CBCL scores than children not receiving services (all P<0.001). Adjusted CBCL change scores revealed behavioral worsening among children receiving services but improvement among children not receiving services (all P<0.001). However, children had improved behavior, regardless of their own service receipt, if their caregivers received services and reported an absence of depression at 18months. ConclusionsChildren receiving mental health services had worse behavioral changes than children not receiving services. Caregiver receipt of services was associated with improved child behavior, suggesting that a family-centered approach may be most influential in improving behavioral outcomes among this population.

Long-Term Behavioral Outcomes after a Randomized, Clinical Trial of Counselor-Assisted Problem Solving for Adolescents with Complicated Mild-to-Severe Traumatic Brain Injury.

Family problem-solving therapy (FPST) has been shown to reduce behavior problems after pediatric traumatic brain injury (TBI). It is unclear whether treatment gains are maintained. We sought to evaluate the maintenance of improvements in behavior problems after a Web-based counselor-assisted FPST (CAPS) intervention compared to an Internet resource comparison (IRC) intervention provided to adolescents within the initial year post-TBI. We hypothesized that family socioeconomic status, child educational status, and baseline levels of symptoms would moderate the efficacy of the treatment over time. Participants included 132 adolescents ages 12-17 years who sustained a complicated mild-to-severe TBI 1-6 months before study enrollment. Primary outcomes were the Child Behavior Checklist Internalizing and Externalizing Totals. Mixed-models analyses, using random intercepts and slopes, were conducted to examine group differences over time. There was a significant group×time×grade interaction (F(1,304)=4.42; p=0.03) for internalizing problems, with high school-age participants in CAPS reporting significantly lower symptoms at 18 months postbaseline than those in the IRC. Post-hoc analyses to elucidate the nature of effects on internalizing problems revealed significant group×time×grade interactions for the anxious/depressed (p=0.03) and somatic complaints subscales (p=0.04). Results also indicated significant improvement over time for CAPS participants who reported elevated externalizing behavior problems at baseline (F(1, 310)=7.17; p=0.008). Findings suggest that CAPS may lead to long-term improvements in behavior problems among older adolescents and those with pretreatment symptoms.

Collaborative Care Outcomes for Pediatric Behavioral Health Problems: A Cluster Randomized Trial

To assess the efficacy of collaborative care for behavior problems, attention-deficit/hyperactivity disorder (ADHD), and anxiety in pediatric primary care (Doctor Office Collaborative Care; DOCC). Children and their caregivers participated from 8 pediatric practices that were cluster randomized to DOCC (n = 160) or enhanced usual care (EUC; n = 161). In DOCC, a care manager delivered a personalized, evidence-based intervention. EUC patients received psychoeducation and a facilitated specialty care referral. Care processes measures were collected after the 6-month intervention period. Family outcome measures included the Vanderbilt ADHD Diagnostic Parent Rating Scale, Parenting Stress Index-Short Form, Individualized Goal Attainment Ratings, and Clinical Global Impression-Improvement Scale. Most measures were collected at baseline, and 6-, 12-, and 18-month assessments. Provider outcome measures examined perceived treatment change, efficacy, and obstacles, and practice climate. DOCC (versus EUC) was associated with higher rates of treatment initiation (99.4% vs 54.2%; P < .001) and completion (76.6% vs 11.6%, P < .001), improvement in behavior problems, hyperactivity, and internalizing problems (P < .05 to .01), and parental stress (P < .05-.001), remission in behavior and internalizing problems (P < .01, .05), goal improvement (P < .05 to .001), treatment response (P < .05), and consumer satisfaction (P < .05). DOCC pediatricians reported greater perceived practice change, efficacy, and skill use to treat ADHD (P < .05 to .01). Implementing a collaborative care intervention for behavior problems in community pediatric practices is feasible and broadly effective, supporting the utility of integrated behavioral health care services.

Clinical Improvement in Adolescents Comorbid for Substance Abuse and Psychiatric Diagnoses Through Multiple Group Psychotherapy

In a pilot study, the authors examined the outcome of group psychotherapy for the treatment of 19 adolescents, comorbid for substance abuse and psychiatric diagnoses, in terms of symptom reduction. They compared presenting symptomatology of treatment completers with treatment noncompleters. A retrospective study of the outcome of a multiple group psychotherapy treatment program using the Drug Use Screening Inventory-Revised Version (DUSI-R) to assess change over time was conducted. Depressive disorders were the most prevalent psychiatric diagnoses (68%), and marijuana was the substance most commonly abused on a frequent basis. Treatment completers showed improvement in behavior problems, health status, and social competence. As part of an integrated treatment program, multiple group psychotherapy is a promising treatment modality for adolescent patients, comorbid for substance abuse and psychiatric diagnoses, pending further assessment of the complex issues involved in combined treatment.

Early intervention for very-low-birth-weight infants

To assess the efficacy of early intervention (EI) for very-low-birth-weight (VLBW) infants, we evaluated 62 2 year old children who were enrolled in an EI program and 48 control subjects aged 2 years. We determined the subjects' developmental quotients (DQ) and obtained information about the parents' evaluation of the children from a questionnaire sent to the parents. There was no significant difference in the DQ between the EI group and the control group. However, based on the responses to the questionnaire, subjects in the EI group showed slight, but statistically marginally significant, improvements in behavioral problems, especially a decrease in hyperkinesia, in adjusting to a circadian sleep cycle, and an improvement in language development, as compared with the control group ( P<0.1). Thus, EI for VLBW infants is considered useful to enhance some areas of development.