Reducing Child Behavior Problems Research Articles

Stepped-Care Web-Based Parent Support Following Congenital Heart Disease: Protocol for a Randomized Controlled Trial.

Early neurodevelopmental risks, compounded with traumatic medical experiences, contribute to emotional and behavioral challenges in as many as 1 in 2 children with congenital heart disease (CHD). Parents report a strong need for supports; yet, there remains a lack of accessible, evidence-based behavioral interventions available for children with CHD and their families. I-InTERACT-North is a web-based stepped-care mental health program designed to support family well-being and reduce behavioral concerns through positive parenting for children with early medical complexity. In previous pilot studies, the program was effective in increasing positive parenting skills and decreasing child behavior problems, with high parent-reported acceptability. This paper presents the protocol for the first randomized study of stepped-care parent support for families of children with CHD. This study will involve a single-site, 2-arm, single-blind randomized controlled trial to evaluate (1) the feasibility and acceptability of a web-based stepped-care parent support program (I-InTERACT-North) and (2) the effectiveness of the program in enhancing positive parenting skills and reducing behavioral concerns among families of children with CHD. Families will be randomized (1:1) to either receive treatment or continue with care as usual for 12 months. Randomization will be stratified by child's sex assigned at birth and baseline parent-reported child behavior intensity. Primary outcomes include positive parenting skills and child behavior at baseline, 3 months, 6 months, and 12 months. Secondary outcomes include parental mental health, quality of life, service usage, and feasibility including program reach and adherence. A sample size of 244 families will provide >95% power to detect an effect size of d=0.64. Based on attrition data from pilot studies, a target of 382 families will be enrolled. Parent reports of acceptability, adoption, and suggested adaptability of the program will be examined using cross-case thematic analyses. Primary efficacy analysis will be conducted using an intent-to-treat approach. Generalized estimating equations will be used to examine changes in positive parenting. Child behavior, quality of life, and parent mental health will be tested with repeated-measures analyses. Additional sensitivity and replication analyses will also be carried out. Recruitment began in February 2024, and recruitment and follow-up will continue until January 2029. We anticipate results in late 2029. This study aims to test the effectiveness of I-InTERACT-North web-based stepped-care parent support in improving positive parenting skills and reducing child behavior problems in families of children with CHD compared with a care as usual control group. Results will inform future clinical implementation and expansion of this program among families of children with early medical conditions. ClinicalTrials.gov NCT06075251; https://clinicaltrials.gov/study/NCT06075251. DERR1-10.2196/64216.

Trajectories of Change in Parent–Child Interaction Therapy Outcomes in Latinx Families: Implications for Cultural Adaptation

ABSTRACT Objective Parent–Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve “skill criteria” in using Do Skills and avoiding Don’t Skills to complete treatment. Despite PCIT’s emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mismatches lead to inequities in outcomes. This study compared the trajectories of change in PCIT skills and treatment outcomes of Latinx and non-Latinx White families. Method We analyzed weekly treatment data from 64 families (20.3% Spanish-speaking Latinx, 51.6% English-speaking Latinx, 28.1% non-Latinx White) served in community clinics. Caregivers were mostly females (95.3%), on average 35.13 years old, and lived in poverty (77.6%). PCIT skills were coded using the Dyadic Parent–Child Interaction Coding System, and child behavior problems were reported using the Eyberg Child Behavior Inventory. Results Latinx and non-Latinx White caregivers acquired Do Skills similarly during treatment. In contrast, some Latinx caregivers began treatment using significantly more Don’t Skills and needed more sessions to achieve some aspects of PCIT skill criteria compared with non-Latinx White caregivers. Latinx families also experienced similar or even more pronounced reductions in child behavior problems than non-Latinx White families. There were no significant differences in the percentage of caregivers who achieved PCIT skill criteria or left treatment prematurely. Conclusions This study provides evidence that strictly defined PCIT skill criteria may lead to inequities in treatment length for some Latinx families. Informed by these findings, we propose data-driven adaptations to improve the cultural fit of PCIT for Latinx groups.

Digital Parenting Program: Enhancing Parenting and Reducing Child Behavior Problems.

Digital parenting programs using smartphone apps can support families in positive parenting and require evaluations of their effects, mainly in low- and middle-income countries with caregivers experiencing psychosocial vulnerabilities. The study evaluated the "Born Learning" digital parenting program on improving parenting practices, child prosocial behavior, and reducing the children's externalizing behavior problems. Additionally, participants' satisfaction and engagement with the program were evaluated. Brazilian primary caregivers of 3- to 6-year-old children totaling 91, participated in the "Born Learning" program and pre-, post-intervention, and five-month follow-up evaluations. Most participants received cash transfers (64%) and reported some level of food insecurity (78%). The parenting coercive practices decreased from pre- to post-intervention, with maintenance in follow-up. Satisfaction with the role of parenting increased, and child conduct behavior problems decreased from pre-intervention to follow-up. Most participants found the program content very interesting and engaged adequately with the program strategies, such as messages and videos. The digital parenting program can support caregivers by enhancing parenting and decreasing child behavior problems, highlighting the potential for broader implementation in similar contexts.

A self-paced online emotion socialization intervention for parents of children with challenging behavior: Tuning in to Kids OnLine.

Evidence-based parenting programs delivered using online technology are an important way to enhance program uptake. To date, programs that address emotion socialization processes, such as Tuning in to Kids, have always been delivered in person, via group or one-to-one delivery. This study used a randomized control design to examine the efficacy of the self-paced Tuning in to Kids OnLine (TIKOL). Participants were 150 parents of children aged 4-10 years old with challenging behaviors, randomized into intervention or 10-month waitlist control. Parents and teachers completed questionnaires at baseline and 6 months after the intervention (equivalent time points for controls) measuring parent wellbeing, parent emotion socialization, parent efficacy, child behavior, and anxiety. Analyses, using mixed methods multilevel modeling, showed that intervention parents reported significantly reduced emotion dismissiveness and increased emotion coaching, empathy and efficacy compared to controls who did not. Parents participating in TIKOL also reported that their children's behavior problems and anxiety were significantly improved. Greater engagement (modules watched and duration of support calls) was associated with more significant improvements. Findings provide preliminary support for the efficacy of TIKOL in improving parents' emotion socialization and reducing child behavior problems and anxiety, especially when efforts to support online engagement are utilized. Further evaluation using independent observations and a sample representing a wider demographic would strengthen these findings. Australian and New Zealand Clinical Trials Registry No. ACTRN12618000310268.

A mixed-methods study of parents' social connectedness in a group-based parenting program in low-income communities.

Group-based parent training (PT) is an evidence-based approach for strengthening parenting skills and reducing child behavior problems. However, there has been little research on the social connectedness (SC) formed among PT participants, particularly in low-income communities where parents may be more socially isolated. This study describes SC formed among parents in a group-based PT program implemented in their children's school and its association with changes in child behavior. Using a convergent mixed-methods design, data collection occurred between 2020 and 2022. Parents (n = 97) completed measures of their SC to other parents in their PT group and their child's behavior. Qualitative interviews with a representative subsample of parents (n = 17) were also conducted to understand parents' perceptions and experiences of SC within their PT group. Parents reported high levels of SC (M = 4.45 [range = 3.04-5 on scale of 1-5]; SD = 0.4). From baseline to postintervention, the number of children with child behavior problems significantly decreased (32.12%, 37.5% behavior intensity and problems, respectively). The magnitude of decline in child behavior problems was significantly related to parents' SC (b = -11.52, p = .02, SE = 4.99). Qualitative data confirmed high levels of SC, which parents linked to improvements in their parenting and children's behavior. Themes focused on the building of connections, committing to a safe space with parents who share similar goals, supporting one another, and gaining connections within the school environment and during the COVID-19 pandemic. Results highlight the potential synergistic effects of SC formed in the context of group-based PT with implications for strengthening parenting skills and children's well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The impact of parental psychological distress on child behavior issues in hospitalized children.

Child hospitalization has a negative impact on both children and parents' psychological well-being. Although prior studies in the general context demonstrated a favorable link between parental psychological distress and child behavior problems, research in the hospital situation was restricted. The purpose of this study was to see if parental psychological distress has an effect on child behavior problems in hospitalized children in Indonesia. This cross-sectional study included 156 parents who were recruited from four pediatric wards using a convenience sampling method between August 17 and December 25, 2020. The Hospital Anxiety and Depression Scale and the Child Behavior Checklist 1.5-5 and 6-18 were utilized. Parental anxiety was found to be a significant predictor of increased total behavior issue, internalizing behavior, externalizing behavior, anxious/ depressed, somatic complaints, and violent conduct in hospitalized children. Parental depression, on the other hand, was not related with any of the child behavior issue syndrome measures. The findings imply that identifying and treating parent anxiety early on is critical for preventing or reducing child behavior problems during hospitalization.

The Process of Scaling Early Childhood Violence Prevention Programs in Jamaica.

Violence is a global public health problem, and early childhood interventions are a core component of violence prevention programming. Interventions to support parents and teachers of young children can prevent violence against children by caregivers and prevent the early development of antisocial behavior. However, there is limited guidance on how to scale up these programs in low- and middle-income countries. In this article, we describe how we applied implementation science principles in the design, implementation, evaluation, and initial scaling of 2 complementary early childhood, violence prevention, caregiver training programs in Jamaica: the Irie Classroom Toolbox (a teacher-training program) and the Irie Homes Toolbox (a parenting program). We identified 7 implementation science principles most relevant to our work in scaling the Irie Toolbox programs and describe how these principles were operationalized in the Jamaican context. The principles are: (1) design programs for scale from the outset; (2) use learning cycles for quality improvement; (3) plan strategically for government agency adoption; (4) provide high-quality initial and ongoing training and regular supervision; (5) monitor implementation quality; (6) use flexible delivery modes; and (7) plan for program sustainment. Through applying these principles to scale the Irie Toolbox programs, we aim to promote a consistent approach to reducing violence against children, reducing child behavior problems, and increasing caregiver and child competencies across both home and school contexts at the population level. The principles and processes described in this article are relevant to other behavior change interventions in early childhood development, education, and public health.

Attachment, behavior problems and interventions

This paper puts forward an explanation for the frequent co-occurrence of attachment and behavior problems in children and the implications of this for interventions; presents preliminary evidence that some behaviorally based parenting programs reduce child behavior problems through two separate, but mutually reinforcing, processes—improved attachment relationships and increased parental use of behavior management techniques; and suggests next steps for the field to improve outcomes for those children who, without interventions that addresses both relationship building and behavior management, are at risk of significant long-term difficulties.

Understanding the role of parents' social connectedness in children's behavioral wellbeing in low-income communities: A study protocol.

Group-based parent-training (PT) is one of the most common and well-established approaches for strengthening parenting skills and reducing child behavior problems. When offered in school settings, the social connections formed among participants may generate additional benefits for parents, schools, and children. However, to date there has been limited research on the potential benefits or harms associated with social connectedness (SC) in group-based PT. This paper describes the study protocol for an ongoing National Institute of Nursing Research-funded mixed-methods study that aims to examine the extent to which group-based PT, delivered in elementary schools serving families from predominantly low-resource communities, generates SC among parents and if SC is associated with greater (a) reduction in child behavior problems and (b) engagement in their child's education. Using a prospective descriptive design, the study is nested within an ongoing quasi-experimental parent study evaluating the group-based PT intervention, the Chicago Parent Program (CPP) in Baltimore City schools. Challenges for this study include recruitment and retention of parents with constraints caused by the COVID-19 pandemic. The study uses multiple methods and informants to understand the potential mechanisms underlying PT group effects and results have the potential to serve as an important foundation for future studies focused on SC, its impacts on parent-child outcomes in low-resource settings, and strategies for strengthening SC in health promotion interventions. PATIENT OR PUBLIC CONTRIBUTION: Chicago Parent Program was developed with input from an advisory board of parents. Additionally, the parent study protocol was written and is co-led in partnership with a community organization.

Support Needs and Parent Outcomes in Arab Families of Children with Autism Living in the United Kingdom.

Research on the experiences of Arab families of children with autism living in non-Arab countries is scarce. A survey investigated the support needs, psychological distress, and parental relationships of Arab parents (n = 100) of children with autism living in the United Kingdom (UK). The survey consisted of five main questionnaires: a demographic questionnaire, the GO4KIDDS Brief Adaptive Scale, the Family Needs Survey, the Strengths and Difficulties Questionnaire, and the Hospital Anxiety and Depression Scale. Descriptive analysis indicated that the most frequently identified support needs were information, community services, and explaining to others. Parents reported high levels of psychological distress, a high level of parental relationship satisfaction with their spouse, and few parental disagreements about their child with autism. Regression analyses showed that increased child behavior problems predicted more total family needs. Higher levels of child prosocial behavior, the better health status of parents, and a larger number of children in the family were associated with lower levels of parental psychological distress. A longer time living in the UK was associated with more parental disagreement over issues related to the child with ASD. Reducing child behavior problems and increasing child prosocial behavior may be important targets for support and intervention to improve outcomes for Arab parents of autistic children.

Cumulative Risk for Children’s Behavior Problems and Child Abuse Potential among Mothers Receiving Substance Use Treatment: The Unique Role of Parenting Stress

ABSTRACT There is a high prevalence of children whose parents suffer with a substance use disorder (SUD), which is associated with negative outcomes for children such as behavior problems and parents’ child abuse potential. To understand negative consequences for children, it is important to consider a cumulative risk model, examining the impact of multiple co-occurring risks, as well as examine unique singular risk factors, such as parenting stress, which may have a direct effect on outcomes as well as mediate an association between cumulative risk and outcomes. Data came from 99 mothers with SUD, engaged in a substance treatment program. Results found support for a cumulative risk model for child behavior problems and parents’ child abuse potential, without the inclusion of parenting stress. However, parenting stress partially and fully mediated the relation between cumulative risk and child behavior problems and cumulative risk and parent child abuse potential, respectively. Results suggest the importance of intervention programs targeting parenting stress, to help reduce child behavior problems and parents’ child abuse potential, among parents with high levels of risk and SUD.

The effectiveness of the Stepping Stones Triple P seminars for Korean families of a child with a developmental disability

BackgroundChildren with a developmental disability (DD) are more likely to develop behavioral problems. The Stepping Stones Triple P Positive Parenting Program (SSTP) for parents of children with a DD has demonstrated effectiveness for improving parenting practices and reducing child behavior problems. However, there is scant research in Asian countries and with less intensive SSTP interventions. AimThis study examined the effectiveness of the SSTP seminars for Korean parents of a child with a DD. MethodsParents were randomly assigned to an intervention group (n = 21) or a delayed intervention group (n = 17). Data was collected on child adjustment problems, parenting practices, parental adjustment, and family relationships from both groups at pre- and post-intervention, and from the intervention group at 4-month follow-up. Twelve parents provided post-intervention interview data. ResultsA series of one-way Analysis of Covariance (ANCOVA) were used to examine differences between the intervention and delayed intervention groups at post-intervention. Significant short-term intervention effects were found for reductions in child behavior and emotional difficulties, and dysfunctional parenting practices. These improvements were maintained 4-months later by the intervention group. At post-intervention, inter-parental child-rearing conflict was reduced as a trend, with a moderate effect size. Interviews provided additional insights into the benefits gained from program participation. ConclusionsFindings, for parents within this study, contribute to the evidence base for the effectiveness of the SSTP seminars.

Mindful Parent Training for Parents of Children Aged 3-12 Years with Behavioral Problems: a Scoping Review.

ObjectivesWhile mindfulness-based parenting programs (MPPs) are increasingly popular for reducing child behavior problems, the evidence for the advantages of MPP over existing behavioral parent training is unclear. Existing systematic reviews have largely excluded the breadth of MPP protocols, including those that integrate behavioral skills components. Therefore, a scoping review was conducted to map the nature and extent of research on MPPs for parents of children aged 3 to 12 years with behavioral problems.MethodsPRISMA-ScR guidelines were used to conduct an encompassing peer literature review of cross-disciplinary databases. Studies were included if they reported mindfulness interventions for parents of children aged between 3 and 12 years with externalizing behavior problems and had an outcome measure of child behavioral problems that could be represented as an effect size. Randomized controlled trials as well as quasi-experimental, pre-post studies and unpublished dissertations were included.ResultsSixteen studies met the inclusion criteria (N = 1362). The majority of MPPs delivered mindfulness adapted to parenting based on the Bögels’ protocol within clinical settings. There was a dearth of fully integrated mindfulness and behavioral programs. MPPs generally produced pre-to-post-intervention improvements with small effect sizes across child behavior and parent style, stress, and mindfulness measures. Examining longer follow-up periods compared to pre-intervention, effects reached a moderate size across most outcome measures.ConclusionsMPPs continue to show promise in improving child behavior and parental mindfulness, well-being, and style. Further research is needed to determine how to best leverage the advantages of mindfulness in augmenting the well-established effectiveness of behavioral programs.

Eficácia Docente e Dificuldades Emocionais/Comportamentais Infantis: Resultados do Programa FAVA

ABSTRACT Through a quasi-experimental design, the results of FAcilitando o conVívio com Alunos - FAVA´s program for elementary school teachers, were evaluated, aiming at promoting teaching effectiveness and reducing child behavior problems, as measured by Teacher’s Effectiveness Beliefs Scale and Strengths and Difficulties Questionnaire, respectively. The FAVA contemplated psychoeducation about cognitive model, socioemotional development and behavior modification. The comparison between experimental groups (GE1 that received complete intervention and GE2 that did not have the cognitive model) and comparison group showed the promotion of teaching staff effectiveness (GE2) and the reduction in the perception of child behavioral difficulties (GE1). The contribution of the cognitive model and socioemotional learning in interventions with teachers is emphasized.

Developing and applying synergistic multilevel implementation strategies to promote reach of an evidence-based parenting intervention in primary care.

There is strong evidence that parenting interventions are effective at improving child behavioral health outcomes when delivered in coordination with pediatric primary care. However, there is a lack of focus on the implementation, including the screening and referral process, of parenting interventions in the primary care setting. This is contributing to the delay in the scale-up of parenting interventions and to achieving public health impact. To address this gap, we identified barriers and facilitators to physician screening and referrals to a primary care-based parenting intervention, and selected and piloted five synergistic strategies to improve this critical process. This effort successfully increased physician referrals of eligible patients to the intervention from 13% to 55%. This demonstration project may help advance the implementation of evidence-based interventions by providing an example of how to develop and execute multilevel strategies to improve intervention referrals in a local context.

A Personalized Remote Video-Feedback Universal Parenting Program: A Randomized Controlled Trial.

The randomized controlled trial examined the efficacy of a personalized remote video feedback parenting program to improve parenting and child behavior outcomes. Ninety-two mothers of 2-6-year-old children were randomly allocated into the intervention group (n = 50) and waiting-list control group (n = 42). The Strengthening Bonds preventive program was performed to improve positive parenting. The mothers participated in one in-person group session. During six weeks, the mothers received, via smartphone, remote personalized video feedback about their mother-child interactions in a play situation. Parenting was the primary outcome, and child behavior was the secondary one. Pre- and post-intervention assessments were performed. The generalized estimating equation analysis showed no significant results in the intention-to-treat (ITT). In the treatment-on-the-treated (TOT), there were statistically significant effects of the intervention decreasing mothers' coercive parenting practices and child behavior problems. The structural equation model analysis showed that the intervention-induced reductions in children's behavior problems were mediated by improvements in coercive practices. There was a direct effect of the intervention to improve the parental sense of competence. Despite the null findings in the ITT analysis, the TOT analysis showed promising results to strengthen positive parenting behaviors and beliefs and reduce child behavior problems.

A First Step to Supporting the Coparenting Relationship and Reducing Child Behaviour Problems: A Delphi Consensus Study

A First Step to Supporting the Coparenting Relationship and Reducing Child Behaviour Problems: A Delphi Consensus Study

Characterizing therapist delivery of evidence-based intervention strategies in publicly funded mental health services for children with autism spectrum disorder: Differentiating practice patterns in usual care and AIM HI delivery.

This study was conducted to identify patterns of therapist delivery of evidence-based intervention strategies with children with autism spectrum disorder receiving publicly funded mental health services and compare strategy use for therapists delivering usual care to those trained to deliver AIM HI ("An Individualized Mental Health Intervention for ASD"), an intervention designed to reduce challenging behaviors in children with autism spectrum disorder. For therapists trained in AIM HI, intervention strategies grouped onto two factors, Autism Engagement Strategies and Active Teaching Strategies, while strategies used by usual care therapists grouped onto a broader single factor, General Strategies. Among usual care therapists, General Strategies were related to an increase in child behavior problems, whereas for AIM HI therapists, Active Teaching Strategies were related with reductions in child behavior problems over 18 months. Findings support the use of active teaching strategies in reducing challenging behaviors in children with autism spectrum disorder and provide support for the effectiveness of training therapists in evidence-based interventions to promote the delivery of targeted, specific intervention strategies to children with autism spectrum disorder in mental health services.

A South-to-South Cultural Adaptation of an Evidence-Based Parenting Program for Families in the Philippines.

Rates of child maltreatment are higher in low‐ and middle‐income countries due to risk factors such as social inequities, economic adversity, and sociocultural norms. Given the evidence showing the effectiveness of parenting interventions to prevent child maltreatment, this study embarked on a cultural adaptation of an evidence‐based parenting program with the eventual goal of integrating it within a nationwide conditional cash transfer program for low‐income Filipino parents with children aged 2–6 years. We document the systematic adaptation of the Parenting for Lifelong Health for Young Children program that was developed and tested in South Africa, for low‐resource Filipino families using the heuristic framework for the cultural adaptation of interventions. We underscore the merits of conducting a multistage top‐down and bottom‐up process that uses a participatory approach among cultural insiders and outsiders to develop a parenting intervention that reflects the contextual realities and cultural values of end users. The adapted program, Masayang Pamilya Para sa Batang Pilipino, is the product of a delicate and deliberate effort to balance Filipino childrearing goals and values with the scientific evidence on components of parenting interventions known to promote positive parenting and prevent child maltreatment.

Designing and Implementing Parenting Interventions With Latino Immigrant Families: Challenges and Strategies

Parenting interventions have shown to be effective in improving parenting behaviors quality, reducing child behavior problems, and increasing overall family well-being. However, the majority of research on the effectiveness of parenting interventions has been conducted with a focus on White and Western populations. As a result, intervention designs and guidelines often fail to address the unique characteristics and experiences of Latino immigrant families, which in turn are likely to impact the implementation and effectiveness of parenting interventions. The current article identifies challenges and discusses strategies that we have found to be effective with respect to our experience implementing a parenting intervention with low-income Latino immigrant mothers in the United States. These include (a) language barriers, (b) recruitment of families, (c) retention of families, (d) building trust and community, and (e) integrating culture into parenting interventions.