Parental Involvement In Treatment Research Articles

Nourishing Our Understanding of Role Modeling to Improve Support and Health (NOURISH): Design and methods

Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood. African-American children are at particularly high risk for obesity and related health complications. However, this racial group has traditionally had limited access to obesity treatment and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family. This pilot project will evaluate the efficacy of an intensive parenting intervention, (NOURISH; NourishingOurUnderstanding ofRole modeling toImproveSupport andHealth), targeting racially diverse parents of overweight children (ages 6–11). NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI≥the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake, and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary feasibility, acceptability, and effectiveness data to inform a subsequent larger randomized controlled trial.

Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology.

Family-based interventions for pediatric obesity are defined by active parent involvement in treatment. In the current review the authors examine 31 family-based interventions with published outcome data and distinguish 4 categories of family-based interventions: (a) Target a narrow range of parent behaviors related to eating/exercise and assess change only in terms of child eating, exercise, or weight; (b) target a similarly narrow range of parent behaviors but nevertheless assess program-related changes in general parenting skills or family functioning; (c) target a broad range of parent behaviors related to general parenting and family functioning but do not assess program-related changes in these areas; and (d) target general parenting or family functioning and also assess program-related changes in these areas. The authors highlight methodological and conceptual challenges facing researchers in this area and argue for an even broader family focus in family-based interventions for pediatric obesity.

Parental Influence on Child Change in Physical Activity During a Family-Based Intervention for Child Weight Gain Prevention

This study examined the association between parent and child change in physical activity during a family-based intervention for child weight gain prevention. Daily step counts were recorded for parents and children in 83 families given a goal to increase activity by 2000 steps per day above baseline. Linear mixed effects models were used to predict child change in daily step counts from parental change in step counts. Both maternal (P < .0001) and paternal (P < .0001) change in step counts for the current day strongly predicted child change in step counts for that day. On average, a child took an additional 2117.6 steps above baseline on days his or her mother met her goal versus 1175.2 additional steps when the mother did not meet her goal. The respective values were 1598.0 versus 1123.1 steps for fathers. Day of week moderated the maternal effect (P = .0019), with a larger impact on Saturday and Sunday compared with weekdays. A similar but nonsignificant pattern was observed for fathers. Encouraging parents to increase physical activity, particularly on weekends, may be a highly effective way to leverage parental involvement in interventions to increase children's physical activity.

Family-related predictors of body weight and weight-related behaviours among children and adolescents: a systematic umbrella review.

This umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour-specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio-economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive-behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour-specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour-specific variables (e.g. physical activity of siblings), and for certain socio-economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour-specific family variables.

Parents' Involvement in ASD Treatment: What Is Their Role?

The rising prevalence of autism spectrum disorders (ASD) warrants a greater level of clinical attention to best treat those with ASD. The characteristics of ASD lead to impairment for both the child with the disorder and his/her family. To effectively treat children with ASD, parents need to be included in intervention efforts. Research suggests that parental involvement in treatment improves the generalizability of skills and increases the amount of intervention the child receives. Numerous benefits have been found in child and parent outcomes when parents are included in treatment. The purpose of this paper is to discuss the impact ASD can have on the parent-child relationship, the factors that influence treatment outcome, and the advantages of including parents in treatment. The different roles parents can have in treatment will also be discussed along with providing clinicians guidance on practical ways to involve parents in the treatment of children with ASD.

Parental involvement in school: A test of Hoover-Dempsey and Sandler's model among Jewish and Arab parents in Israel

Parental involvement in children's schooling has been repeatedly shown to be positively and significantly correlated with a number of positive child outcomes. Hoover-Dempsey and Sandler (1995) proposed a multivariate model of parental involvement. There are indications that the model should be adjusted to include mediating effects of parental role constructions. Further, this model has not been tested in educational systems and cultural contexts outside the US. The goals of the present study were to model factors associated with parental involvement in schools in Israel, and compare model fit among two populations representing different cultures. A survey was conducted with 5999 parents of junior- and senior-high school students in Israel. Data were collected on the extent of parental involvement, parental role construction, invitation for involvement from school, homeroom teacher and the child, availability of resources such as time, energy, skills, and knowledge, parents' ethnic affiliation, and the socio-economic status of the school's local authority. Data were analyzed using SEM, Sobel test for mediation, and multivariate hierarchical regression. The findings support the original theoretical model. Findings also revealed significant but very weak mediating effect of parental role construction. The model had a similar fit for both Jewish and Arab samples. Little of the variance in parental involvement was explained by ethnic/cultural affiliation and socio-economic status. Implications for parental involvement interventions with diverse populations are discussed.

Intervening in infancy: implications for autism spectrum disorders.

There is a scarcity of empirically validated treatments for infants and toddlers under age 3 years with autism spectrum disorders (ASD), as well as a scarcity of empirical investigation into successful intervention characteristics for this population. Yet early screening efforts are focused on identifying autism risk in children under age 3 years. In order to build ASD interventions for infants and toddlers upon a foundation of evidence-based characteristics, the current paper presents the results of a systematic literature search and effect size analysis of efficacious interventions for infants and toddlers with other developmental disorders: those who were born prematurely, have developmental impairments, or are at high risk for developmental impairments due to the presence of a biological or familial condition associated with developmental impairments. A review of 32 controlled, high-quality experimental studies revealed that the most efficacious interventions routinely used a combination of four specific intervention procedures, including (1) parent involvement in intervention, including ongoing parent coaching that focused both on parental responsivity and sensitivity to child cues and on teaching families to provide the infant interventions, (2) individualization to each infant's developmental profile, (3) focusing on a broad rather than a narrow range of learning targets, and (4) temporal characteristics involving beginning as early as the risk is detected and providing greater intensity and duration of the intervention. These four characteristics of efficacious interventions for infants and toddlers with other developmental challenges likely represent a solid foundation from which researchers and clinicians can build efficacious interventions for infants and toddlers at risk for or affected by ASD.

A Meta-Analysis of Obesity Interventions Among U.S. Minority Children

To quantitatively evaluate the efficacy of interventions designed to prevent or treat obesity among U.S. minority children using meta-analytic techniques. A total of 40 intervention trials involving 10,725 children aged 6-19 years were examined. Interventions with more components showed a higher mean effect size than those with fewer components: among 32 controlled trials, d = .07 for one-component (n = 6); d = .08 for two-component (n = 15); d = .33 for three-component (n = 10); and d = .71 for four-component (n = 1) interventions. Interventions with parental involvement (n = 22, d = .21) and lifestyle interventions (n = 14, d = .34) showed a greater mean effect size than those without parental involvement (n = 10, d = .05) or lifestyle interventions (n = 18, d = .04), despite the fact that their 90% confidence intervals overlapped. Among uncontrolled trials (n = 8), two-component interventions (n = 5) yielded d = .86 and three-component interventions (n = 3) yielded d = .96. Evidence indicates that, among U.S. minority children, obesity interventions with three or more components might be more efficacious than those using fewer components. Parental involvement, lifestyle change, culturally-based adaptation, and interactive computer programs seem to show promise in the reduction of obese minority children.

Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls

Objective To test a computer-delivered program for preventing substance use among adolescent girls. Methods Randomly, 916 girls aged 12.76 ± 1.0 years and their mothers were assigned to an intervention arm or to a test-only control arm. Intervention-arm dyads engaged in exercises to improve the mother–daughter relationship, build girls' substance use prevention skills, and reduce associated risk factors. Study outcomes were girls' and mothers' substance use and mediator variables related to girls' substance use risk and protective factors. The study was conducted between September 2006 and February 2009 with participants from greater New York City, including southern Connecticut and eastern New Jersey. Results At 2-year follow-up and relative to control-arm girls, intervention-arm girls reported lower relevant risk factors and higher protective factors as well as less past 30-day use of alcohol ( p < 0.006), marijuana ( p < 0.016), illicit prescription drugs ( p < 0.03), and inhalants ( p < 0.024). Intervention-arm mothers showed more positive 2-year outcomes than control-arm mothers on variables linked with reduced risks of substance use among their daughters, and mothers reported lower rates of weekly alcohol consumption ( p < 0.0001). Conclusions A computer-delivered prevention program for adolescent girls and their mothers was effective in changing girls' risk and protective factors and girls' and mothers' substance use behavior.

Preventing substance use among adolescent girls: 1-year outcomes of a computerized, mother–daughter program

This study tested a computerized gender-specific, parent-involvement intervention program grounded in family interaction theory and aimed at preventing substance use among adolescent girls. Following program delivery and 1 year later, girls randomly assigned to the intervention arm improved more than girls in a control arm on variables associated with reduced risks for substance use, including communication with their mothers, knowledge of family rules about substance use, awareness of parental monitoring of their discretionary time, non-acceptance of peer substance use, problem-solving skills, and ability to refuse peer pressure to use substances. Relative to control-arm girls, those in the intervention arm also reported less 30-day use of alcohol and marijuana and lower intentions to smoke, drink, and take illicit drugs in the future. Girls' mothers in the intervention arm reported greater improvements after the program and relative to control-arm mothers in their communication with their daughters, establishment of family rules about substance use, and monitoring of their daughters' discretionary time. Study findings lend support to the potential of gender-specific, parent-involvement, and computerized approaches to preventing substance use among adolescent girls.

Drug Abuse by Adolescents: General Considerations

1. Ximena Sanchez-Samper, MD* 2. John R. Knight, MD* 1. *Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, Mass After completing this article, readers should be able to: 1. Discuss current trends in adolescent substance use and the specific substances used most commonly among 8th, 10th, and 12th graders. 2. Identify risk and protective factors, including genetic and environmental correlates, for the initiation of substance use in adolescents. 3. Discuss the most common concomitant mental health disorders and how they can affect the course of diagnosis and treatment for substance abuse. 4. Delineate the variety of treatment options available. 5. Describe the role of the pediatrician in educating patients and families on substance abuse prevention; performing screening and initial assessments; and providing support, brief counseling, or referrals for in-depth treatment. Adolescence is a time of physical, emotional, and psychological maturation as well as a period of searching for independence and experimentation. One area of experimentation associated with adolescence is substance use. (1) Although many adolescents experiment with drugs and alcohol from time to time without enduring problems, those who develop the disorders of substance abuse and dependence make substance use a major public health concern. The Monitoring the Future Study (MTFS) is a nationwide survey measuring smoking, drinking, and illicit drug use among nearly 50,000 8th, 10th, and 12th graders in more than 400 secondary schools in the United States each year. (2)(3) According to the 2006 overview of findings from the MTFS, approximately one fifth (21%) of today's 8th graders, more than one third (36%) of 10th graders, and nearly half (48%) of all 12th graders reported using an illicit drug at least once during their lifetimes. Despite a minimum legal age requirement to purchase alcohol, 6% of 8th graders, 19% of the 10th graders, and 30% of the 12th graders self-reported drunkenness during the month prior to being interviewed. (2)(3) Among the problems experienced by adolescents who use alcohol and drugs are …

What can dropouts teach us about retention in eating disorder treatment studies?

To describe strategies used to retain adolescents with bulimia nervosa (BN) in a randomized clinical trial, and to compare treatment completers and dropouts on baseline demographic and symptom severity information. Adolescents with BN (N = 80) completed a demographic questionnaire, the Eating Disorder Examination, Rosenberg Self-esteem Scale, Family Adaptability and Cohesion Evaluation Scales, and Beck Depression Inventory prior to beginning treatment. Several strategies were used to promote treatment retention (e.g., encouraging parental involvement in treatment, prompt rescheduling of cancelled appointments). Six participants (7.50%) voluntarily dropped out of treatment and three additional participants (3.75%) were asked to terminate treatment for medical/psychiatric reasons. Compared with treatment completers, noncompleters reported significantly longer duration of illness (p < .01). Sixty-two percent of treatment completers and only 22% of dropouts were from intact families. Examining factors related to retention in adolescent treatment trials is important, and could be utilized to improve retention in adult studies where drop out rates are higher.

The Effects of Weight Management Programs on Self-Esteem in Pediatric Overweight Populations

Review published findings on self-esteem and pediatric overweight, and changes in self-esteem subsequent to weight management programs. We used PsycInfo and MedLine searches to identify peer-reviewed journal articles examining self-esteem changes following participation in weight management programs. Data regarding the relationship between self-esteem and obesity is mixed. Factors that place overweight children "at-risk" for low self-esteem include early adolescence, female gender, identification with majority cultural standards of body shape, exposure to teasing and peer victimization, a history of greater parental control over feeding, and internal attributions about weight status. Data from intervention studies suggest positive effects on self-esteem across settings. Components related to self-esteem improvements include weight change, parent involvement, and group intervention format. Well-designed, longitudinal studies using multidimensional measures of self-esteem, and following CONSORT guidelines are needed to confirm and expand these findings. Emphasis should be placed on examining mediators and moderators of self-esteem change.

Parent Involvement in Treatment for ADHD: A Meta-Analysis of the Published Studies

Given high rates of attention-deficit/hyperactivity disorder (ADHD) diagnosed in children, knowledge of effective treatment is crucial. To this end, a meta-analysis of parent-involved psychosocial treatment was undertaken to determine its effect on a number of outcomes salient to children with ADHD. Sixteen studies met the criteria for the meta-analysis. Findings indicated that the impact of treatment on ADHD was low compared to comparison and/or control conditions, whereas child-internalizing symptoms and academic problems were better affected by family involvement. Teachers reported the highest effect sizes followed by parents themselves. Although parent involvement might be important for affecting the internalizing symptoms and academic problems that plague children with ADHD, ADHD and externalizing symptoms might be better targeted by other interventions.

Parental Involvement When Conducting Cognitive-Behavioral Therapy for Children With Anxiety Disorders

Discusses the potential roles of parents in cognitive-behavioral therapy (CBT) with anxious youth and how parents can both facilitate and/or impede treatment progress. Parents facilitate the attainment of treatment goals by providing invaluable information regarding the child's level of functioning and assisting the therapist with the development and implementation of treatment components such as exposure tasks. Parental involvement in treatment also gives the therapist an opportunity to more fully assess and address family factors that may be maintaining the child's anxiety. Common challenges encountered with parents that may impede treatment progress include rescuing the child from anxious situations, under- or overinvolvement in the treatment process, difficulty setting limits, and the presence of parental psychopathology. Finally, the relevance of developmental level, child gender, diagnosis, and the presence of parental psychopathology to the decision of how and when to include parents in treatment is discussed. Keywords: cognitive-behavioral treatment; youth; parental involvement Research suggests that parental factors play a role in the development and maintenance of anxiety symptoms in youth (for a review see Ginsburg, Siqueland, Masia-Warner, & Hedtke, 2004; Wood, McLeod, Sigman, Hwang, & Chu, 2004). For example, parents of anxious youth appear to indirectly and directly encourage maladaptive patterns of responding to anxiety-provoking situations through direct discussions with their children (Barrett, Rapee, Dadds, & Ryan, 1996; Dadds, Barrett, Rapee, & Ryan, 1996), modeling anxious behavior themselves (Whaley, Pinto, & Sigman, 1999), and exhibiting overcontrolling and intrusive behaviors (Dumas, LaFreniere, & Serketich, 1995; Hudson & Rapee, 2001; Krohne & Hock, 1991; Siqueland, Kendall, & Steinberg, 1996; Suveg, Zeman, Flannery-Schroeder, & Cassano, 2005; Whaley et al., 1999). Given these factors, treating clinicians are often faced with the question of when and in what capacity to include parents in the treatment process. Kendall (2000) discusses three ways in which parents may be involved in treatment programs for anxious youth. As "consultants," parents primarily provide the therapist with more information regarding the nature of the child's anxiety. For instance, a parent in a consulting role might reveal to the therapist particular factors that exacerbate the separation-anxious child's anxiety when she goes to school in the morning. As "collaborators," parents actually help carry out the treatment components. A parent-as-collaborator might implement an exposure task in which the separation-anxious child rides the bus to school instead of having the parent drive them to school. Finally, as "coclients," parents are involved in the treatment to the extent that they are exhibiting behaviors that are believed to be contributing to or maintaining the child's anxiety. For instance, an anxious parent might be encouraged to develop and implement a plan for managing their own anxiety upon separation from the child. Arguably, all parents are involved in the treatment of anxious youth in some capacity, whether as consultants, collaborators, coclients, or a hybrid thereof. Indeed, parents need not be in the actual therapy room to be important members of the treatment "team" along with the therapist and child. The goal of this article is to consider the ways in which parents might facilitate and/or impede the attainment of treatment goals. Strategies to manage challenging clinical situations are presented. Lastly, the empirical literature examining for whom (e.g., younger children) and under what conditions (e.g., parental psychopathology present) family involvement might be most beneficial is briefly reviewed. THE CASE FOR PARENTAL INVOLVEMENT This section reviews some of the specific benefits that may be gained by including parents in the treatment process. …

Parental Involvement When Conducting Cognitive-Behavioral Therapy for Children With Anxiety Disorders

Discusses the potential roles of parents in cognitive-behavioral therapy (CBT) with anxious youth and how parents can both facilitate and/or impede treatment progress. Parents facilitate the attainment of treatment goals by providing invaluable information regarding the child’s level of functioning and assisting the therapist with the development and implementation of treatment components such as exposure tasks. Parental involvement in treatment also gives the therapist an opportunity to more fully assess and address family factors that may be maintaining the child’s anxiety. Common challenges encountered with parents that may impede treatment progress include rescuing the child from anxious situations, under- or over-involvement in the treatment process, difficulty setting limits, and the presence of parental psychopathology. Finally, the relevance of developmental level, child gender, diagnosis, and the presence of parental psychopathology to the decision of how and when to include parents in treatment is discussed.

Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology.

Family-based interventions for pediatric obesity are defined by active parent involvement in treatment. In the current review the authors examine 31 family-based interventions with published outcome data and distinguish 4 categories of family-based interventions: (a) Target a narrow range of parent behaviors related to eating/exercise and assess change only in terms of child eating, exercise, or weight; (b) target a similarly narrow range of parent behaviors but nevertheless assess program-related changes in general parenting skills or family functioning; (c) target a broad range of parent behaviors related to general parenting and family functioning but do not assess program-related changes in these areas; and (d) target general parenting or family functioning and also assess program-related changes in these areas. The authors highlight methodological and conceptual challenges facing researchers in this area and argue for an even broader family focus in family-based interventions for pediatric obesity.

Parent, Student, and Teacher Perceptions of Parental Involvement

Parental involvement is a key predictor of a student's academic success. However, little research has explored whether parent, student, and teacher perceptions are similar regarding what constitutes parental involvement and the communication activities it entails. The present study examines parent, student, and teacher perceptions of parental involvement and communication. While agreement exists on the importance of monitoring a child's academic performance and constructive teacher-parent communication, disagreement on the role of discipline and the use of extracurricular programs exist. Two discourses surrounding parental involvement are articulated--information transmission and partnership--and the implications of these discourses for developing parental involvement interventions are examined.

Towards family‐centred practice in paediatric occupational therapy: A review of the literature on parent–therapist collaboration

The importance of parent involvement in intervention with children has always been recognised by occupational therapists. Current trends in paediatric service delivery have been towards family‐centred care, with a central component of this approach being parent–therapist collaboration in planning and evaluating intervention. This paper reviews issues and provides suggestions for clinical practice from the literature on parent–therapist collaboration, including consideration of parents’ diversity and unique perspectives, development of effective parent–therapist relationships, establishment of shared goals and priorities when planning intervention, and development of services that support parent–therapist collaboration. Further research is needed in Australian settings to explore the nature of parent–therapist partnerships, the impact of parent participation throughout the intervention process and the extent to which collaboration with parents results in better therapy outcomes for the child and their family.

Treatment demands and differential treatment of patients with cystic fibrosis and their siblings: patient, parent and sibling accounts.

Cystic fibrosis (CF) is a progressive disease with no known cure. Advances in diagnosis and treatment have resulted in patients living longer and thus families live with the illness for longer. Treatments are becoming increasingly demanding and are largely performed in the family home. Mothers are often reported to experience greater stress and poorer adjustment than mothers of well children or population norms. Patients and siblings are also reported to display adjustment difficulties. Siblings have rarely been included in research designs. This qualitative study investigates the impact of CF and treatment on eight patients, eight mothers, one father and eight siblings. A family systems perspective was adopted. Each individual was interviewed independently using semistructured interviews. Patients and siblings were aged between 9 and 21 years. Qualitative analyses revealed high levels of non-adherence (intentional and unintentional) and parental involvement in treatment, minimal involvement of siblings, and preferential treatment towards patients. Demanding treatment, coupled with the progressive nature of CF, promote high levels of parental involvement for younger children as well as older teenagers, often due to attempted or actual non-adherence. Siblings may receive less attention while patients' needs take priority. Future development of a measure of adherence suitable for children and adolescents should take into account different motivations for non-adherence, particularly regarding the level of personal control over adherence to treatment. In addition, the potential impact of having a brother or sister with CF should not be underestimated and the needs of siblings should not go unnoticed.