Parent Training Program Research Articles

Understanding caregivers' needs: supporting families of autistic children

Parenting a child with autism spectrum disorder (ASD) poses significant emotional, financial, and social challenges to caregivers. This paper examines the experiences of caregivers, highlighting their increased stress, burnout, and mental health concerns. The importance of accessible information resources, respite care services, emotional support networks, and financial assistance programs is emphasized. Effective strategies for supporting caregivers include educating them about ASD symptoms, treatments, and therapies, teaching coping mechanisms for managing challenging behaviors, and promoting collaboration between healthcare providers and caregivers. Policy implications are discussed, including advocating for legislative modifications that prioritize caregiver needs, promoting inclusionary practices within educational systems, and increasing funding for early intervention programs and caregiver support services. The implementation of parent training programs, collaborative relationships between educators and caregivers, and professional development opportunities for educators are also recommended. This study aims to inform policymakers, healthcare professionals, and educators about the critical role of caregiver support in improving outcomes for children with ASD. By addressing caregiver needs and providing comprehensive support, we can enhance the well-being of both caregivers and children with ASD.

Mobile App-Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial.

In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. We aimed to develop and evaluate the feasibility of a mobile app-assisted parent training program for reducing problem behaviors in children with ASD. This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app-assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app-assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48%) participants and the control group included 22 (52%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of -0.5 (95% CI -4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of -2.1 (95% CI -8.5 to 2.5). However, there was no significant difference in Clinical Global Impression-Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference -2, 95% CI -4 to 1). Caregivers' stress evaluated using the Korean Parenting Stress Index Fourth Edition-Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices' accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?&seq=23112.

Cultural Adaptation of RUBI Intervention with Korean Families(K-RUBI): A Mixed Method Study.

Challenging behaviors of young autistic children remain a major parenting challenge for many of their family members, including caregivers. Caregivers from underrepresented cultural or linguistic backgrounds may experience exacerbated difficulties related to challenging behaviors due to limited access to culturally sustaining and responsive interventions. Evidence-based behavior parent training programs, such as RUBI, are highly effective in increasing caregivers' capacity in preventing and responding to these behaviors in naturalistic settings using behavior analytic principles. Therefore, the purpose of this study was to examine the effectiveness, acceptability, and feasibility of the culturally adapted RUBI program with underserved families. We conduct a convergent mixed-methods study using a pilot randomized controlled trial with a waitlist control group and focus group interviews with 31 Korean families of young children with or suspected of autism. The Korean RUBI underwent rigorous cultural adaptation using the Cultural Adaptation Checklist, including the use of multiple community advisory boards to inform cultural adaptation. Both quantitative and qualitative findings revealed significant improvements in parents' confidence and knowledge in behavioral principles and decrease in severity of challenging behaviors, which suggest clinical utility of RUBI in an underrepresented, low-resourced community. A culturally adapted intervention for a different population can be perceived as a newly constructed intervention. This study provides insight on the systematic process of cultural adaptation of an established autism intervention and effectiveness, feasibility, and acceptability of RUBI.

Telehealth pivotal response treatment parent training: A pilot study

ABSTRACT The purpose of this pilot study was to assess the feasibility, benefits, and acceptability of a telehealth Pivotal Response Treatment (PRT) parent training program. Autistic children (N = 21; 2–6 years) with language delay and their parents participated in the 12-week program. Parent-report measures and parent–child home videos were used to assess changes in parent PRT treatment adherence and child language. Changes in child affect were used to assess intervention acceptability. At the end of the program, treatment adherence improved, and children made more intelligible utterances. Child communication skills as measured by parent-report on several standardized questionnaires also improved. This study demonstrates the benefits of telehealth parent training for improving child language and parent PRT implementation. Our findings also provide preliminary evidence of PRT acceptability. Randomized controlled trials are an important next step to evaluate the impact of telehealth parent training as a tool for overcoming barriers to accessing intervention.

Are there unique facets of therapeutic alliance for users of digital mental health interventions? An examination with the eHealth Therapeutic Alliance Inventory

Therapeutic alliance (TA) is a well-established predictor of clinical outcomes in traditional psychotherapy. However, its association with outcomes in eHealth interventions has been inconsistent, which might be due to the absence of measurements specifically designed to capture TA in eHealth settings. The eHealth Therapeutic Alliance Inventory (ETAI) incorporates conventional as well as unique eHealth TA subscales, enabling to examine the contribution of new facets of TA beyond traditional concepts. This study investigates the predictive contribution of eHealth TA subscales compared to conventional TA subscales on clinical outcomes and evaluates the concurrent criterion validity of the ETAI. The study was conducted within the framework of a randomized controlled trial involving a 10-week digital parent training program aimed at addressing child disruptive behaviors. Parents were randomly assigned to either an enhanced-quality or a standard-quality program. Parents from 68 families completed the ETAI at five weeks' post-program initiation and at the post-intervention phase. The primary outcome was the improvement in child behavior, measured by the Eyberg Child Behavior Inventory. Positive Pearson correlations were found between all ETAI subscales covering unique eHealth TA aspects, measured at the 5-week time-point, and improvement in child behavior at post-intervention (rs ≥ 0.23, ps < 0.03). The conventional TA subscale showed no significant Pearson correlation with improvement in child behavior. When examining the unique contributions of ETAI-subscales to explain the improvement in child behavior, only ETAI-Perceived Emotional Investment subscale was found to have a unique contribution (β = 0.29, p = 0.019). In addition, scores on most ETAI subscales were significantly higher among parents using the enhanced-quality program compared with the standard program (Cohen's ds > 0.48), reinforcing ETAI's criterion validity. The development of TA scales that incorporates unique eHealth TA subscales show initial promise in predicting outcomes. Further research is needed to better understand how different factors of eHealth TA relate to clinical outcomes across diverse clinical targets and programs.

The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity.

The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.

Parent Training for Disruptive Behaviors in Referred Children with Autism Spectrum Disorder: A Randomized Controlled Trial.

The purpose of this study was to investigate whether face-to-face and therapist-assisted online (i.e., blended) behavioral parent training are effective on reducing disruptive behaviors in children with autism spectrum disorder (ASD) in routine mental health care. Ninety-seven children with ASD (4-13years; 76 boys) were randomized to face-to-face parent training, blended parent training, or a waitlist control condition. We assessed treatment effects on parent-rated child noncompliance (primary outcome) and irritability (secondary outcome). This involved comparing both formats separately to the control condition using linear regression models. Child behaviors at 6months follow-up were also examined. Children in the face-to-face parent training condition improved significantly more on noncompliance and irritability than children in the waitlist condition and improvements sustained to 6months follow-up. Children in the blended condition did not improve more than children in the waitlist condition and attrition was high. Our results extend findings from efficacy studies to routine mental health care and advocate the use of face-to-face parent training for disruptive behaviors in children with ASD. More research into blended parent training programs for children with ASD and disruptive behaviors in routine mental health care should be conducted to draw more definite conclusions about the value of blended parent training for these children. Trial registration number NL4712; date of registration 22-10-2014.

Cumulative risk predicting differential effectiveness of the incredible years parent-training

The evidence on whether socioeconomic status moderates the effectiveness of parent-training programs for disruptive child behaviors is inconclusive. These varied results may stem from differences in the programs or the studies themselves. We applied an equivalence test paradigm to test the hypothesis of equal benefit from the Incredible Years Parent-Training (IYPT) across family risk on disruptive child behaviors. During the Danish roll-out of the IYPT, 1203 families were recruited across 20 different municipalities. The isolated and cumulative effect of five markers of low socioeconomic status, specifically single parent household, parental unemployment, low family income, low parental educational level, and teen parenthood, were analyzed as predictors of pre-to-post treatment response. Results showed equal benefit among families experiencing from zero to four accumulated socioeconomic risks (99 % of our sample). Our findings suggest that the IYPT brings equal benefit across socioeconomic backgrounds and risk levels in Danish community settings.

Telehealth general case parent training for children at risk for autism.

Parent-mediated interventions for infants and young children with an increased likelihood of autism may help ameliorate developmental concerns; however, generalization of parents' teaching strategies to novel child target skills has not been consistently demonstrated. This study expanded our parent training program, Parent Intervention for Children at-Risk for Autism (PICARA), by incorporating telehealth general case training (PICARA-TGCT) to promote generalization of teaching skills. Five parent-child dyads participated. Child target skills were chosen from the categories of imitation, receptive language, and expressive language. A concurrent multiple-baseline-across-participants design was used to evaluate the effect of training across two cohorts of parent-child dyads. Dependent variables included the percentage of correct parent teaching skills and the percentage of child correct responses. Parent teaching skills increased across all participants for both trained and untrained child target skills, as did child skills. This study provides support for PICARA-TGCT as an efficacious and efficient early intervention model.

Parenting strategies and child behavior at preschool age in families using assisted reproductive technologies

Introduction. Certain parenting strategies have a significant impact on the appearance of behavioral problems in children. Due to the continuous increase in the number of children conceived with the help of assisted reproductive technologies (ART), and the availability of limited, disparate and contradictory data on the development of such children and influencing family factors, the purpose of this study is to identify the characteristics and relationship of maternal and paternal parenting strategies and child behavior in preschool age in families with ART. Materials and methods. The sample consisted of 90 families who used ART and 155 families with natural conception. To identify the features of the child's parenting strategies, the "Interaction with the child" questionnaire was used, and the "Behavior of your child" questionnaire was used to assess the child's behavior. Nonparametric Mann–Whitney U test. Results. The general trends (regardless of the type of conception) are the dominance of manifestations of sensitivity to the child, emotionality, responsiveness, positive constructive regulation of discipline on the part of both parents, but with a predominance of severity in mothers compared with fathers (p≤0.05). There is no specificity associated with the type of conception (p&gt;0.05) in the characteristics of a child's behavior at the age of 5 years. On the one hand, the stronger emotionality towards the child on the part of both parents is specific for families who have used ART (3684.5 &lt; U &lt; 5154.0; p≤0.05), but on the other hand, there are trends towards less consistency and the risk of contradictions in the upbringing of a child compared with families with natural conception of a child, the lack of direct links between paternal strategies and child behavior indicators (p&gt;0.05), stronger interrelations of different manifestations of dysfunctional behavior in a child. The types of ART families with different types of severity and relationship of parental parenting strategies and behavioral characteristics of children (p≤0.05) are identified. Conclusion. The results of the study show the need to develop and conduct personalized training programs for parents and build individual trajectories of psychological support for families who have used ART at the age stages of child development.

Every Newborn-Reach Up Early Education Intervention for All Children (EN-REACH)- a parent group intervention for school readiness in Bangladesh, Nepal, and Tanzania: study protocol for a cluster randomized controlled trial

BackgroundVulnerable children, including those with neuro-developmental delays and disabilities, often face barriers in accessing early primary education, thus hindering progress toward Sustainable Development Goal 4.2. Evidence-based interventions are essential to enhancing inclusivity and establishing sustainable implementation strategies to address this challenge. This study, Every Newborn—Reach up Early Education Intervention for All Children (EN-REACH), builds on the previous Every Newborn- Simplified Measurement Integrating Longitudinal Neurodevelopmental and Growth (EN-SMILING) observational cohort study. This paper provides the protocol for a cluster randomized controlled trial (cRCT) to evaluate the effectiveness of a parenting group intervention program for enhancing school readiness in Bangladesh, Nepal, and Tanzania, and an embedded process evaluation to inform scalability and feasibility.MethodsEN-REACH is a cRCT with at least 150 clusters to evaluate the impact of a parent training program led by trained parent-teacher facilitator pairs, focusing on children aged 4 ~ 6 years preparing for preschool. Approximately 500 participants from the EN-SMILING cohort at each site have been identified. A geographic information system will define ~ 50 clusters in each of the three countries, each with approximately ten parent–child dyads. Half the clusters will be randomly assigned to intervention and control groups. The primary outcome is “school readiness”, assessed using the Measuring Early Learning Quality and Outcomes tool. Secondary outcomes include Intelligence Quotient, child functioning, growth, visual, and hearing assessments. Data will be collected at baseline, and post-intervention data following implementation of the parent group intervention sessions over approximately 5 months. Quantitative data on coverage and quality care, combined with qualitative insights from children, caregivers, facilitators, and stakeholders’ perspectives, will be used to conduct a process evaluation applying the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. DiscussionThis protocol details a trial focused on enhancing school readiness and cognitive abilities in young children, inclusive of those with disabilities, aiming to bridge gap from home to early primary education. EN-REACH aims to provide insights into the effectiveness and acceptability of a co-designed disability-inclusive school readiness program in three countries, potentially impacting national and global policies for all children, including those with disabilities.Trial registrationThe trial was retrospectively registered on clinicaltrials.gov on 29 February 2024 (NCT06334627).

Evaluation of the Centers for Disease Control and Prevention's Essentials for Parenting Toddlers and Preschoolers on parent behavioral outcomes

BackgroundThe Centers for Disease Control and Prevention's web-based behavioral parent training (BPT) program, Essentials for Parenting Toddlers and Preschoolers (EfP), uses a psychoeducational approach to promote positive parenting and address common parenting challenges. The purpose of this study was to assess the effects of EfP on parenting behavior and whether implementation format impacted behavioral outcomes. MethodsA sample of 200 parents of 2- to 4-year-old children were recruited via Internet advertising. Using a repeated single subject, multiple baseline design, parents were randomly assigned to guided navigation (GN; n = 100) or unguided navigation (UN; n = 100) study conditions. Parents were provided secure access to the EfP website and completed 18 weekly surveys. Latent growth curve modeling was used to determine intervention effectiveness on behavioral outcomes. ResultsLatent growth curve modeling indicated both GN and UN study conditions significantly increased use of praise (β = 0.19, p = 0.038) and commands and consequences (β = 0.17, p < 0.001), and decreased corporal punishment use (β = −0.01, p = 0.017) and attitudes promoting corporal punishment (β = −0.01, p < 0.001) over the study period. The UN condition exhibited a significant initial decrease in time-out use that increased over time to match the GN condition. ConclusionsThis study provides evidence for the effectiveness of EfP in promoting non-violent parenting behavior and increasing positive parenting techniques. The format of EfP implementation made no difference in parenting behaviors over time. Digital BPT programs like EfP provide access to evidence-informed parenting resources and can enhance positive parenting.

ARFID Parent Training Protocol ("ARFID-PTP"): Results of a Randomized Pilot Trial Evaluating a Brief, Parent-Training Program for Avoidant/Restrictive Food Intake Disorder.

Accessible treatment options for avoidant/restrictive food intake disorder (ARFID) in children are limited. The current study sought to assess acceptability, feasibility, and preliminary efficacy of a brief, virtual intervention for ARFID in children ("ARFID-PTP"). Families of children ages 5-12 with ARFID (n = 30) were randomized to immediate or waitlist treatment groups, with both groups ultimately receiving ARFID-PTP. ARFID-PTP consists of two, 2-h individual treatment sessions with an optional booster session at 4-week follow-up. Families completed acceptability and feasibility measures at end-of-treatment, as well as preliminary efficacy measures at 4-week, 3-month, and 6-month follow-up. Of 30 families who completed an intake session, 27 (90%) completed treatment. Families rated acceptability as high (M CEQ-C = 7.75). Treatment was feasible by participant retention. Exposure adherence was lower than expected, and booster session requests were higher than expected, indicating that achieving feasibility across measures may require treatment modifications. Regarding preliminary efficacy, children in the immediate treatment group had a decrease in ARFID symptoms compared to those on the waitlist. Overall, at 6-month follow-up linear mixed models showed participants had significantly reduced ARFID symptoms by presentation (p < 0.05) and in follow-up completers, children incorporated eight new foods on average. ARFID-PTP is acceptable and preliminarily efficacious. The protocol may benefit from modifications to increase feasibility; however, booster session content and treatment outcomes suggest a priori feasibility markers may not accurately capture the utility of ARFID-PTP. Further work should continue to examine the efficacy ARFID-PTP, particularly in diverse samples where treatment accessibility is urgently needed. ClinicalTrials.gov identifier: NCT04913194.

Feasibility study of a parent-driven intervention for youth with Down syndrome.

Children with Down syndrome present with behavioural and emotional difficulties, including noncompliance, rule-breaking, emotion dysregulation and delays in executive functioning. Few behavioural interventions have been designed specifically for children with Down syndrome. The Research Units in Behavioral Intervention (RUBI) Parent Training for Disruptive Behaviors is a structured empirically supported parent training programme developed for caregivers of children with autism. This feasibility trial explored the feasibility and acceptability of an abbreviated RUBI intervention with caregivers of children with Down syndrome and identified promising outcome measures to target in future larger clinical trials. A double-blind randomised feasibility pilot clinical trial allocated participants to a behavioural intervention (BEH) or educational (EDU) group. BEH and EDU consisted of five individual sessions over the course of 5 to 8weeks. Measures were administered to 20 caregivers and their youth with Down syndrome at three time points. Both BEH and EDU were rated as feasible with high parental adherence and acceptable with high treatment satisfaction. Both BEH and EDU demonstrated decreased externalising behaviours, irritability and hyperactivity and improved behavioural regulation in executive functioning over time. No impact was noted on caregiver functioning. The feasibility trial has strong findings regarding feasibility and satisfaction and has promising findings regarding the selection of measures for future trials testing an adapted RUBI programme and an education programme to reduce behavioural challenges in children with Down syndrome. Larger scale clinical trials are needed to confirm promising findings of these feasible treatments.

Implementation of a Parent Training Program During Community-Based Dissemination (From In-Person to Hybrid): Mixed Methods Evaluation.

Parent training interventions support and strengthen parenting practices and parent-child relationships and improve child behavior. Between March 2018 and February 2020, a community-based parenting program conducted 38 in-person Chicago Parent Program (CPP) groups. In response to the COVID-19 pandemic, we modified the delivery of the in-person CPP to hybrid delivery using the self-administered, web-based version of the CPP (ezParent) paired with web-based, videoconferenced group sessions. This study aims to describe the delivery transition and implementation outcomes of the hybrid delivery of the CPP (ezParent+group) during community-based dissemination. This single-group, mixed methods retrospective evaluation examined the implementation outcomes using the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) framework. We report on data from hybrid ezParent delivery between September 2020 and August 2022. Parents completed pre- and postprogram surveys that included motivation to participate and perceived changes in parent-child behavior. Digital analytics captured ezParent completion. Facilitators completed fidelity assessments and participated in postintervention interviews. In total, 24 hybrid ezParent groups (n=240 parents) were delivered by 13 CPP-trained facilitators. Parents reported high levels of satisfaction with the program and improvements in their feelings of parenting self-efficacy and their child's behavior following their participation in hybrid ezParent. On average, parents completed 4.58 (SD 2.43) 6 ezParent modules. The average group attendance across the 4 sessions was 71.2%. Facilitators found the hybrid delivery easy to implement and reported high parent engagement and understanding of CPP strategies. Using the hybrid ezParent intervention is a feasible and effective way to engage parents. Lessons learned included the importance of academic and community-based organization partnerships for delivering and evaluating robust programs. Implementation facilitators and barriers and future research recommendations are discussed.

Pengaruh Keterlibatan Orang Tua Terhadap Prestasi Akademik Siswa Sekolah Dasar

This study investigates the influence of parental involvement on elementary school students' academic achievement. Using a qualitative approach, this research collected data through in-depth interviews and participant observation involving 20 parents and 10 teachers from several elementary schools. The research results show that parental involvement has a significant impact on student academic achievement. The most influential forms of involvement include assistance with learning at home, effective communication with teachers, and providing motivation and emotional support to children. Data analysis shows that students whose parents are actively involved in their education tend to have better grades and show greater interest in learning. Previous research results show that parental involvement can increase students' learning motivation and academic results. In addition, this research found several problems faced by parents, including limited time and lack of confidence in helping their children. To overcome this obstacle, it is recommended that schools provide training programs for parents and strengthen communication with them through regular meetings and communication technology. Overall, this research states that the role of parents is very important in supporting the academic achievement of elementary school students and promoting stronger collaboration between schools and parents to create a supportive learning environment.

Peran Orangtua dalam Mendukung Keberhasilan Akademik Anak di Sekolah Dasar: Tinjauan Literatur

Education in elementary school is an important foundation for a child's overall development. This literature review explores the strategic role of parents in supporting children's academic success. Parents play a crucial role through learning assistance, communication with teachers, creating a conducive learning environment, as well as motivation and emotional support. The level of parental involvement is influenced by factors such as background, culture, parenting style, and environmental support. Best practices include partnerships with teachers, learning routines, appreciation, and providing learning resources. Even though there are challenges, opportunities for optimizing parental support can be realized through parent-school-community partnerships, parent training programs, and the use of technology.

Pediatric skeletal injuries in emergency department; an alarm of child maltreatment in Egypt: A cross-sectional study

BackgroundChild physical abuse, a type of child maltreatment (CM), poses a significant global public health concern. Nonaccidental fractures and soft tissue injuries, which encompass any action that directly or indirectly harms a child, are the primary indicators of physical abuse in children. ObjectiveThis study aimed to investigate the prevalence, risk factors, and outcomes of accidental and nonaccidental skeletal fractures in a sample of Egyptian children. MethodsA cross-sectional analytical study was conducted between March 2022 and August 2022. A total of 156 children who presented with skeletal injuries and attended Mobarak Central Hospital were enrolled. Patients were subjected to full history taking, complete examination, and investigations. A structured questionnaire was administered to all the legal guardians. ResultsPhysical abuse was reported in 22.4 % of cases, while medical neglect was reported in 19.9 % of cases. The incidence of physical abuse was notably higher among children whose fathers were smokers and/or drug addicts (p ≤ 0.05). The most common form of physical abuse was hitting (94.3 %). Among skeletal injuries, fractures were predominant (94.3 %), primarily closed fractures associated with contusions. Fractures of the upper limb accounted for the highest incidence (94.3 %) of skeletal injuries, and 60 % of physically abused children experienced moderate-severity injuries. ConclusionThe most common fracture observed in abused children is the upper limb fracture, typically involving a single bone. Clinicians should be more vigilant in suspecting abuse, even in cases where there is an isolated fracture, and advocate for the development of parental training programs.

The Role of Fathers in Promoting Early Childhood Development in Low- and Middle-Income Countries: A Review of the Evidence

Abstract The role of fathers in parenting young children differs dramatically across societies. Policymakers in low- and middle-income countries (LMICs) are increasingly focused on increasing the amount of early childhood stimulation and other investments received by young children in an attempt to increase human capital accumulation, promote school readiness, and improve long-run outcomes. Until recently, few interventions targeted fathers, and most impact evaluations implicitly assumed that fathers played no meaningful role in parenting. We survey the emerging literature on fathers’ involvement in early childhood stimulation and parenting in LMICs and summarize the patterns of results from rigorous impact evaluations. We find that fathers spend less time stimulating their children's development than do mothers or other adults who live in the same households in almost every country in our sample, and that mothers’ and fathers’ investments are positively associated. We also find evidence that fathers’ take-up of parent training programs tends to be low, but that such programs have had effects on changing fathers’ knowledge and—to a lesser degree—behaviors.

A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of Well Parent Japan in routine care in Japan: The training and nurturing support for mothers (TRANSFORM) study.

Well Parent Japan (WPJ) is a new hybrid group parent training programme combining sessions to improve mothers' psychological well-being with a culturally adapted version of the New Forest Parenting Programme (NFPP). This study investigates the effectiveness and cost-effectiveness of WPJ against treatment as usual (TAU) within Japanese child mental health services. TRANSFORM was a pragmatic multi-site randomised controlled trial (RCT) with two parallel arms. Altogether 124 mothers of 6-12-year-old children with DSM-5 ADHD were randomised to WPJ (n = 65) or TAU (n = 59). Participants were assessed at baseline, post-treatment and three-month follow-up. The primary outcome was parent-domain stress following intervention. Secondary outcomes included maternal reports of child-domain stress, parenting practices, parenting efficacy, mood, family strain, child behaviour and impairment. Objective measures of the parent-child relationship were collected at baseline and post-treatment. Data analysis was intention to treat (ITT) with treatment effects quantified through analysis of covariance (ANCOVA) via multilevel modelling. An incremental cost-effectiveness ratio (ICER) assessed WPJ's cost-effectiveness. WPJ was superior to TAU in reducing parent-domain stress post-treatment (adjusted mean difference = 5.05, 95% CI 0.33 to 9.81, p = .036) and at follow-up (adjusted mean difference 4.82, 95% CI 0.09 to 9.55, p = .046). Significant WPJ intervention effects were also observed for parenting practices, parenting efficacy and family strain. WPJ and TAU were not significantly different post-intervention or at follow-up for the other secondary outcomes. The incremental cost of WPJ was 34,202 JPY (315.81 USD). The probability that WPJ is cost-effective is 74% at 10,000 JPY (USD 108.30) per one-point improvement in parenting stress, 92% at 20,000 JPY (216.60 USD). The programme was delivered with high fidelity and excellent retention. WPJ can be delivered in routine clinical care at modest cost with positive effects on self-reported well-being of the mothers, parenting practices and family coping. WPJ is a promising addition to psychosocial interventions for ADHD in Japan.