Reducing Child Behavior Problems Research Articles

The effects and costs of the universal parent group program – all children in focus: a study protocol for a randomized wait-list controlled trial

BackgroundIn recent decades, parents have been involved in programs that aim to improve parenting style and reduce child behavior problems. Research of preventive parenting programs has shown that these interventions generally have a positive influence on both parents and children. However, to our knowledge there is a gap in the scientific literature when it comes to randomized controlled trials of brief, manual-based structured programs which address general parenting among the population, and focus on promoting health. A four-session universal health promotion parent group program named All Children in Focus was developed. It aims at promoting parental competence and children’s positive development with the parent–child relationship as the target. There is currently no randomized controlled trial existing of the program.Methods/DesignA prospective multicenter randomized wait-list controlled trial is being conducted. Approximately 600 parents with children ranging in age from 3–12 years have been recruited in eleven municipalities and city districts in the County of Stockholm, Sweden. Parents are randomized at baseline to an intervention group, which receives the program directly, or to a waiting-list control group, which participates in the program six months later. Changes in parenting and child health and development are assessed with measures immediately post-intervention and six months after the baseline. Observations of a minor group of parents and children are conducted to explore possible relations between parental reports and observed behaviors, as well as changes in the interaction between parent and child. Further, data collected within the evaluation will also be applied to evaluate the possible cost-effectiveness of the program.DiscussionThis paper describes a study protocol of a randomized controlled trial. Except for the quantitative outcome measures to evaluate the effectiveness of All Children in Focus, this protocol also describes health economic and qualitative analyses to deepen the knowledge of the program. We further discuss some issues regarding the implementation of the program in municipalities and city districts.Trial registrationCurrent Controlled Trials ISRCTN70202532

Mindfulness‐Based Stress Reduction for Parents of Young Children with Developmental Delays: Implications for Parental Mental Health and Child Behavior Problems

Parents of children with developmental delays (DD) typically report elevated levels of parental stress compared with parents of typically developing children. Children with DD are also at high risk for exhibiting significant behaviour problems. Parental stress has been shown to impact the development of these behaviour problems; however, it is rarely addressed in interventions aimed at reducing child behaviour problems. The current study examined the efficacy of mindfulness-based stress reduction (MBSR) for parents of children with DD by investigating whether this intervention is effective in reducing parenting stress and whether decreases in parenting stress lead to reductions in behaviour problems among children with DD. Forty six parents of children with DD were randomly assigned to an immediate treatment or wait list-control group. Participants completed questionnaires assessing parental stress and child behaviour problems at intake and at a second assessment, which took place after only the immediate treatment group had received the MBSR. Parents who participated in MBSR reported significantly less stress and depression as well as greater life satisfaction compared with wait list-control parents. Regarding child outcomes, children whose parents participated in MBSR were reported to have fewer behaviour problems following the intervention, specifically in the areas of attention problems and ADHD symptomatology. Results indicated that MBSR may be an effective intervention for ameliorating parental stress and mental health problems among parents of children with DD. Additionally, these benefits may 'spill over' and improve behaviour challenges among these children.

Defining neighborhood boundaries in studies of spatial dependence in child behavior problems

BackgroundThe purpose of this study was to extend the analysis of neighborhood effects on child behavioral outcomes in two ways: (1) by examining the geographic extent of the relationship between child behavior and neighborhood physical conditions independent of standard administrative boundaries such as census tracts or block groups and (2) by examining the relationship and geographic extent of geographic peers’ behavior and individual child behavior.MethodsThe study neighborhood was a low income, ethnic minority neighborhood of approximately 20,000 residents in a large city in the southwestern United States. Observational data were collected for 11,552 parcels and 1,778 face blocks in the neighborhood over a five week period. Data on child behavior problems were collected from the parents of 261 school-age children (81% African American, 14% Latino) living in the neighborhood. Spatial analysis methods were used to examine the spatial dependence of child behavior problems in relation to physical conditions in the neighborhood for areas surrounding the child’s home ranging from a radius of 50 meters to a radius of 1000 meters. Likewise, the spatial dependence of child behavior problems in relation to the behavior problems of neighborhood peers was examined for areas ranging from a radius 255 meters to a radius of 600 meters around the child’s home. Finally, we examined the joint influence of neighborhood physical conditions and geographic peers.ResultsPoor conditions of the physical environment of the neighborhood were related to more behavioral problems, and the geographic extent of the physical environment that mattered was an area with a radius between 400 and 800 meters surrounding the child’s home. In addition, the average level of behavior problems of neighborhood peers within 255 meters of the child’s home was also positively associated with child behavior problems. Furthermore, these effects were independent of one another.ConclusionsThese findings demonstrate that using flexible geographies in the study of neighborhood effects can provide important insights into spatial influences on health outcomes. With regards to child behavioral outcomes, specifically, these findings support the importance of addressing the physical and social environment when planning community-level interventions to reduce child behavior problems.

Effectiveness of the KEEP Foster Parent Intervention during an Implementation Trial.

Externalizing behavior problems are highly prevalent among children in foster care, placing them at risk for placement disruptions and later personal and social maladjustment. The KEEP foster parent intervention was designed to equip foster parents and relative caregivers with the parenting skills necessary for managing challenging behavior problems. In prior research, the KEEP intervention was found to be effective in reducing child behavior problems. In the current study, the KEEP foster parent intervention was implemented in San Diego County during a three-year trial. The intervention was delivered by paraprofessionals employed by a local community agency (Social Advocates for Youth, San Diego) to 181 foster parent and relative caregivers of boys and girls between the ages of 5 and 12. The control group from an earlier effectiveness study of the KEEP intervention that was also conducted in San Diego County was utilized as a historical comparison group. Regression analyses were used to examine the effects of the intervention on reducing levels of child behavior problems at treatment termination. Consistent with the findings from the previous KEEP effectiveness study, the intervention was found to be effective in reducing child behavior problems when delivered by a community agency. Furthermore, the KEEP intervention was found to be effective in reducing child behavior problems among children displaying various levels of initial behavior problems.

Stepping Stones Triple P seminars for parents of a child with a disability: A randomized controlled trial

Parents of children with a developmental disability require tailored parenting support, as their families have special needs and are at risk of increased burden. The aim of this study was to evaluate the efficacy of the Stepping Stones Triple P seminars, a brief group intervention for parents of a child with a disability. There were two seminars that presented parenting strategies to improve both child behavior and parenting variables implicated in the development and maintenance of child problem behavior. Fifty-three parents participated in this randomized controlled trial. Each had a child, aged two to ten, with a disability. The results indicated significant reductions in child behavior problems, the use of dysfunctional parenting styles, and parental conflict reported by parents in the intervention group compared to a waitlist group. The results were maintained at 3-month follow-up and there was evidence of a sleeper effect for parenting confidence. This study demonstrated that the seminars provide a promising intervention for parents of children with a disability. Limitations and implications for future research are also discussed.

Behavior problems in children raised by grandmothers: The role of caregiver distress, family resources, and the home environment

Over the past few decades there has been a dramatic increase in children being raised by grandparents due to a variety of factors including child maltreatment, parental abandonment, substance abuse, and incarceration. The purpose of this study is to examine the extent of behavior problems in children being raised by grandmothers and to determine factors in their current environment that are related to child behavior problems. The study draws on McCubbin's resiliency model of family stress, adjustment and adaptation. The sample comprised of 230 children ages 2 to 16 years who were being raised by grandmothers in parent-absent homes. The families were predominantly low income and African American. The grandmothers ranged in age from 37 to 80 years. Grandmothers responded to several self-report measures pertaining to child behavior problems, family resources, social support, and caregiver psychological distress. Trained research assistants completed a standardized observational measure of the home environment. Results indicated that 31.3% of child participants scored in the clinically elevated range for total behavior problems, with 21.3% and 32.6% scoring in the elevated range for internalizing and externalizing behaviors, respectively. Hierarchical regression analyses revealed that of the variables examined, increased psychological distress in grandmothers was most predictive of child behavior problems, followed by less supportive home environments and fewer family resources. Results of the present study underscore the need for interventions that focus on reducing child behavior problems, as well as enhancing the parenting skills of grandmothers raising grandchildren. Findings also support the need for strategies to reduce stress in grandmother caregivers and to improve access to resources needed to provide supportive home environments for their grandchildren.

The Application of a Three-Tier Model of Intervention to Parent Training.

A three-tier intervention system was designed for use with parents with preschool children with developmental disabilities to modify parent-child interactions. A single-subject changing-conditions design was used to examine the utility of a three-tier intervention system in reducing negative parenting strategies, increasing positive parenting strategies, and reducing child behavior problems in parent-child dyads (n = 8). The three intervention tiers consisted of (a) self-administered reading material, (b) group training, and (c) individualized video feedback sessions. Parental behavior was observed to determine continuation or termination of intervention. Results support the utility of a tiered model of intervention to maximize treatment outcomes and increase efficiency by minimizing the need for more costly time-intensive interventions for participants who may not require them.

The Effectiveness of Parent–Child Interaction Therapy with Depressive Mothers: The Changing Relationship as the Agent of Individual Change

This study uses a multi-method approach to investigate the effectiveness of Parent-Child Interaction Therapy (PCIT) in reducing children's behavior problems when parents report clinical levels of depressive symptoms. Participants were 132 children, 2-7 years of age, and their biological mothers, who either reported low (N = 78) or clinical levels of depressive symptoms (N = 54). Results showed that depressive mothers were likely to report more severe child behavior problems than non-depressive mothers at the pre-treatment assessment, but that depressive mothers reported greater reductions in child behavior problems than non-depressive mothers from pre- to post-treatment. The two groups showed similar levels of observed interaction quality at the pre-treatment assessment (i.e., parent and child emotional availability and parent verbalization patterns) and similar improvements in interaction quality from pre- to post-treatment. The implications of the findings for clinical practice were discussed.

Predicting parent and child outcomes of a filial therapy program.

The present study investigated parent and child factors that predict outcome in a Þlialtherapy program for parents ( N 27) and young children (ages 2Ð10). Higher levelsof parent distress and poorer child regulation of emotion at pretest were predictive ofgreater reductions in child behavior problems; poorer parent regulation of emotionat pretest was predictive of greater increases in parent acceptance; and less parentsatisfaction with social support from family and friends at pretest was predictive ofgreater increases in parent communication of acceptance in parentÐchild play. Im-plications and directions for future research are discussed.

Evaluation of a Brief Parenting Discussion Group for Parents of Young Children

Although behavioral parenting programs are effective at treating child behavioral problems, a significant number of parents experiencing these problems do not receive help, and briefer, more cost-effective parenting interventions are lacking. This study aimed to evaluate the efficacy of a brief parenting discussion group. Sixty-seven parents were randomly assigned to either an intervention or waitlist control condition. Parents in the intervention condition took part in a 2-hour discussion group in which they were taught positive parenting strategies to prevent and manage their child's disobedience, and they received 2 follow-up telephone calls after the discussion group. Results showed that after intervention, there were reductions in child behavior problems and use of dysfunctional parenting and improvements in parental self-efficacy and the parenting experience for parents. These effects were maintained at 6-month follow-up. The results are promising because they show that a brief intervention can be minimally sufficient to improve child and parent outcomes for parents experiencing high levels of child behavior problems.

Preventing violence to women and children in the home: an overview

It has been estimated that 4 to 16% of children are physically abused and 1 in 10 are neglected or psychologically abused, the vast majority of the time by their...

Tuning in to Kids: improving emotion socialization practices in parents of preschool children – findings from a community trial

This study evaluated a new prevention and early intervention parenting program: Tuning in to Kids. The program aims to improve emotion socialization practices in parents of preschool children and is based on research evidence that parents' responses to, and coaching of, their children's emotions influence emotional and behavioral functioning in children. Two hundred and sixteen primary caregiver parents of children aged 4.0-5.11 years were randomized into an intervention or waitlist control group. Parents in the intervention condition attended a 6-session group parenting program plus two booster sessions. Assessment occurred pre-intervention, post-intervention and at six-month follow-up. Questionnaires assessed parent emotion awareness and regulation, parent beliefs and practices of emotion socialization (emotion dismissing, emotion coaching, empathy) and child behavior (parent and teacher report). Observation of emotion socialization practices and child emotional knowledge was conducted pre-intervention and at follow-up with 161 parent-child dyads. Parents in the intervention condition reported significant improvements in their own emotion awareness and regulation, increases in emotion coaching, and decreases in emotionally dismissive beliefs and behaviors. There were increases in parents' observed use of emotion labels and discussion of causes and consequences of emotions with their children. Child emotional knowledge improved, and reductions in child behavior problems were reported by parents and teachers. This study provides support for the efficacy of a parenting intervention targeting parent emotion socialization practices that lead to improved child emotional knowledge and behavior. This preventative intervention targeting parents' own emotion awareness and regulation, as well as emotional communication in parent-child relationships, is a promising addition to available parenting programs.

The State of Parent Training: Program Offerings and Empirical Support.

Parent training programs, with a range of empirical support, are available to improve parenting skills and reduce child behavior problems. Yet, little is known about programs provided in typical communities. This pilot study's purpose was to identify and describe parent programs-and the agencies that provide them-in one midsized midwestern city. The sample included 21 program directors and 25 practitioners employed by 19 agencies. data were gathered using structured phone interviews. of the 35 programs represented, 37.1% were developed by the agency, while close to two thirds were previously developed interventions. only a small number of the parent programs identified were classified into the category of strong empirical support; however, several included hallmarks often associated with empirically supported parent programs.

Feasibility and Preliminary Efficacy of a Web-Based Parenting Skills Program for Young Children With Traumatic Brain Injury

To report the feasibility and preliminary efficacy of a Web-based parenting skills program to reduce behavior problems following traumatic brain injury (TBI) in young children. Families of 9 children between the ages of 3 and 8 years with TBI, injured less than 24 months earlier, participated in a pilot study of a Web-based parenting skills program designed to increase positive parenting skills and to improve caregiver stress management and coping. The program consisted of 10 core sessions and up to 4 supplemental sessions. Each session consisted of self-guided didactic information, video modeling skills, and exercises. Online sessions were followed by synchronous sessions providing in vivo coaching of target skills. Caregivers completed an average of 12 sessions (range 5-24). Ratings of ease of use and satisfaction were high. Paired t tests revealed significant improvements in target parenting behaviors between baseline and session 2 and between sessions 2 and 4. These improvements were maintained at follow-up. Among the 5 families who completed the follow-up assessment, there were trends for reductions in the overall number of behavior problems. This study provides preliminary evidence of the potential feasibility and efficacy of an online parenting skills intervention for improving positive parenting skills and for reducing child behavior problems following early TBI.

Roman, Inc.: From Liquidation Planning to Turnaround of the Year

<h3>Introduction</h3> Families in low-income and middle-income countries (LMICs) face multiple challenges (eg, poverty and adverse childhood experiences) that increase the risk for child mental health problems, while the context may provide them with few resources. Existing prevention-oriented parenting programmes have been shown to be effective in reducing child behaviour problems and associated risk factors. This project has the overall goal of adapting, implementing and testing a parenting intervention in three Southeastern European LMIC and uses the Multiphase Optimisation Strategy and dimensions of the Reach, Effectiveness, Adoption, Implementation and Maintenance framework. It is implemented over three phases: (1) preparation, (2) optimisation and (3) evaluation. The preparation phase, the subject of this paper, involves the adaptation and feasibility piloting of the parenting programme. <h3>Methods and analysis</h3> This protocol describes the assessment of an evidence-informed indicated prevention programme for families with children aged 2–9 years (Parenting for Lifelong Health for Young Children) for implementation in FYR of Macedonia, Republic of Moldova and Romania. In this phase, officials, experts, parents and practitioners are interviewed to explore their views of suitability and needs for further adaptation. In addition, a small pre–post pilot study will test the feasibility of the programme and its implementation as well as the evaluation measures in the three countries with 40 families per country site (n=120). Quantitative data analysis will comprise a psychometric analysis of measures, testing pre–post differences using ANCOVA, χ² tests and regression analysis. For qualitative data analysis, a thematic approach within an experiential framework will be applied. <h3>Ethics and dissemination</h3> The ethics review board of the Alpen-Adria University Klagenfurt and ethical review boards in the three LMIC sites have approved the study. <h3>Trial registration number</h3> NCT03552250.

KEEP foster‐parent training intervention: model description and effectiveness

ABSTRACTIn this paper, we describe the development and history of the Keeping Foster Parents Trained and Supported (KEEP) foster‐parent training intervention. KEEP intervention represents a modified version of the Multidimensional Treatment Foster Care intervention developed by interventionists at the Oregon Social Learning Center and is designed to provide training and support for children ages 5–11 in regular foster care. We also report on the initial findings from a programme of research focused on determining the effectiveness of the intervention. Thus far, the results indicate that the intervention is effective in reducing child behaviour problems and that the effects of the intervention are mediated through changes in parenting behaviour. There is also evidence that the KEEP foster‐parent training intervention increases the chances of a positive change of placement (e.g. child reunited with biological parents) and mitigates the negative risk‐enhancing effect of a history of multiple placements. We conclude with a discussion of unanswered questions and directions for future research.

Therapist-Assisted, Self-Administered Bibliotherapy to Enhance Parental Competence

The efficacy of bibliotherapy has primarily been investigated in anxiety disorders, depression, or substance dependence. The efficacy of self-help books to increase parenting competence was only investigated in a few studies despite their broad dissemination in public. The aims of the study were to investigate the short- and long-term efficacy of a therapist assisted version of the Triple P self-help booklet (Sanders, Markie-Dadds, & Turner, 2003) for families with preschool-age children in Germany. Sixty-nine families were randomly assigned to either a therapist-assisted self-administered parent training (SDPT+T) or to a waitlist control group (WL). Parents in the SDPT+T received the 10 chapter self-help book and an accompanying video. A Triple P facilitator offered seven telephone consultations which aimed to support parents in skill implementation. After the post test, the WL parents were also offered the intervention. A follow-up assessment was conducted six months after post. Compared to waitlist controls, SDPT+T mothers reported significant short- and long-term reductions in child behavior problems as well as in dysfunctional parenting practices. Fathers reported only marginal changes. The study adds further empirical support of parenting self-help materials.

Effects of Early Family/Parent Training Programs on Antisocial Behavior &amp; Delinquency

Effects of Early Family/Parent Training Programs on Antisocial Behavior &amp; Delinquency

Putting the Pieces Together

To describe a family-centered problem-solving intervention (FPS) for pediatric traumatic brain injury (TBI), and to assess the efficacy of the intervention in a randomized clinical trial. Families of 32 school-aged children with moderate to severe TBI randomly assigned to FPS or usual care (UC) group. Child Behavior Checklist, Brief Symptom Inventory, Conflict Behavior Questionnaire. Seven-session problem-solving/skill-building intervention delivered over a 6-month period for the participating families. Parents in the FPS group reported significantly greater improvements in their children in internalizing symptoms, anxiety/depression, and withdrawal than did parents in the UC comparison group. FPS holds promise for reducing child behavior problems, the most common and persistent sequelae of TBI.

Intervention for preschoolers at risk for Attention-Deficit/Hyperactivity Disorder (ADHD): Service before diagnosis

Cantwell [Cantwell DP. Empircism and child psychiatry. In: The 1990 C. Charles Burlingame, M.D., Award Lecture, Hartford, Connecticut: The institute of living; 1990 [1]] recognized age and ethnicity as important factors that should be considered in evaluating the clinical phenomenology of childhood disorders. Here we describe how these factors have been addressed in CHOC-UCI Initiative for the Development of Attention and Readiness (CUIDAR), an early intervention and prevention model for children at risk for diagnosis with Attention-Deficit/Hyperactivity Disorder (ADHD). CUIDAR was developed to address age by focusing on needs of families with young children and ethnicity by focusing on the needs of Hispanic families that speak Spanish. This program provides ‘service before diagnosis’ by removing barriers and offering psychosocial intervention (parent training) before the usual first-line treatment of ADHD (i.e. pharmacological intervention). We present data from the start-up phase of CUIDAR to evaluate differences in ethnic groups on the basis of important measures of effectiveness, such as parental satisfaction, gains in parenting skills, and reductions in child behavior problems. Cantwell [Cantwell DP. Empircism and child psychiatry. In: The 1990 C. Charles Burlingame, M.D., Award Lecture, Hartford, Connecticut: The institute of living; 1990 [1]] also recognized that clinicians often must provide treatment with a great deal of ‘therapeutic enthusiasm’ even though the intervention may be based on inadequate research data, and in this situation he recommended creating an atmosphere in which systematic observations could be made in the existing clinical context even when controlled research was not feasible. The data we report here were accumulated in this fashion during the development of CUIDAR, which was funded by the Children's and Families Commission of Orange County as a service delivery program.