Quantifying respiratory sinus arrhythmia: Effects of misspecifying breathing frequencies across development.

Low resting respiratory sinus arrhythmia (RSA), and to a lesser extent excessive RSA reactivity to emotion evocation, are observed in many psychiatric disorders characterized by emotion dysregulation, including syndromes spanning the internalizing and externalizing spectra, and other conditions such as nonsuicidal self-injury. Nevertheless, some inconsistencies exist. For example, null outcomes in studies of RSA-emotion dysregulation relations are sometimes observed among younger participants. Such findings may derive from use of age inappropriate frequency bands in calculating RSA. We combine data from five published samples (N = 559) spanning ages 4 to 17 years, and reanalyze RSA data using age-appropriate respiratory frequencies. Misspecifying respiratory frequencies results in overestimates of resting RSA and underestimates of RSA reactivity, particularly among young children. Underestimates of developmental shifts in RSA and RSA reactivity from preschool to adolescence were also observed. Although correlational analyses revealed weak negative associations between resting RSA and aggression, those with clinical levels of externalizing exhibited lower resting RSA than their peers. No associations between RSA reactivity and externalizing were observed. Results confirm that age-corrected frequency bands should be used when estimating RSA, and that literature-wide overestimates of resting RSA, underestimates of RSA reactivity, and underestimates of developmental shifts in RSA and RSA reactivity may exist.

Bringing The Incredible Years® Programs to Scale.

The Incredible Years(®) (IY) program series is a set of interlocking and comprehensive training programs for parents, teachers, and children. This article briefly reviews the theoretical foundations, goals, and research underlying these programs. The main purpose of the paper is to describe how the IY programs have been scaled up slowly and carefully with fidelity by engaging in a collaborative building project with strong links between the developer, agency or school administrator, mentors, coaches, clinicians, and families using eight foundational building blocks or fidelity tools.

Assessing the effectiveness of the 'Incredible Years(®) parent training' to parents of young children with ADHD symptoms - a preliminary report.

This study examined the effectiveness of an evidence-based parent training program in a real-world Scandinavian setting. Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self-referred to participate in the Incredible Years(®) Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self-report data with data from a recent efficacy study. Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months. The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence-based US protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy-access early intervention to families of children with or at risk of ADHD.

One-year follow-up of combined parent and child intervention for young children with ADHD.

Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children's externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.

The role of implementation organizations in scaling evidence-based psychosocial interventions.

BACKGROUND: To bring evidence-based interventions (EBIs) to individuals with behavioral health needs, psychosocial interventions must be delivered at scale. Despite an increasing effort to implement effective treatments in communities, most individuals with mental health and behavioral problems do not receive EBIs. We posit that organizations that commercialize EBIs play an important role in disseminating EBIs, particularly in the USA. The behavioral health and implementation industry is growing, bringing the implementation field to an important inflection point: how to scale interventions to improve access while maintaining EBI effectiveness and minimizing inequities in access to psychosocial intervention. MAIN BODY: We offer a first-hand examination of five illustrative organizations specializing in EBI implementation: Beck Institute for Cognitive Behavioral Therapy; Incredible Years, Inc.; the PAXIS Institute; PracticeWise, LLC; and Triple P International. We use the Five Stages of Small Business Growth framework to organize themes. We discuss practical structures (e.g., corporate structures, intellectual property agreements, and business models) and considerations that arise when trying to scale EBIs including balancing fidelity and reach of the intervention. Business models consider who will pay for EBI implementation and allow organizations to scale EBIs. CONCLUSION: We propose research questions to guide scaling: understanding the level of fidelity needed to maintain efficacy, optimizing training outcomes, and researching business models to enable organizations to scale EBIs.

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. METHOD: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. RESULTS: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. CONCLUSION: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.

Combining parent and child training for young children with ADHD.

The efficacy of the Incredible Years parent and child training programs is established in children diagnosed with oppositional defiant disorder but not among young children whose primary diagnosis is attention-deficit/hyperactivity disorder (ADHD). We conducted a randomized control trial evaluating the combined parent and child program interventions among 99 children diagnosed with ADHD (ages 4-6). Mother reported significant treatment effects for appropriate and harsh discipline, use of physical punishment, and monitoring, whereas fathers reported no significant parenting changes. Independent observations revealed treatment effects for mothers' praise and coaching, mothers' critical statements, and child total deviant behaviors. Both mothers and fathers reported treatment effects for children's externalizing, hyperactivity, inattentive and oppositional behaviors, and emotion regulation and social competence. There were also significant treatment effects for children's emotion vocabulary and problem-solving ability. At school teachers reported treatment effects for externalizing behaviors and peer observations indicated improvements in treated children's social competence.

Long-Term Outcomes of Incredible Years Parenting Program: Predictors of Adolescent Adjustment.

BACKGROUND AND METHOD: Fifty-eight boys and 20 girls with early onset conduct problems whose parents received the Incredible Years (IY) parent treatment program when they were 3-8 years (mean 58.7 months) were contacted and reassessed regarding their social and emotional adjustment 8-12 years later. Assessments included home interviews with parents and teenagers separately. RESULTS AND CONCLUSION: Adolescent reports indicated that 10% were in the clinical range on internalising behaviours, 23% had engaged in major delinquent acts, and 46% reported some substance use. Eighteen percent of children had criminal justice system involvement and 42% had elevated levels of externalising behaviours (mother report). Post-treatment factors predicting negative outcomes (delinquent acts) were maternal reports of behaviour problems and observed mother-child coercion.

Korean immigrant parents' evaluation of the delivery of a parenting program for cultural and linguistic appropriateness and usefulness.

The goal of this study was to evaluate the delivery of a parenting program to 17 Korean immigrants for cultural and linguistic appropriateness and usefulness regarding recruitment, retention, program content, and delivery methods. Focus group interview data were audiotaped, transcribed, and analyzed. Themes identified included fit between the parents' desire and what the program offered, effective recruitment and retention strategies, program content and videotapes: based on Western cultural background but useful, helpful role-play and homework, and recommendations (Korean language videotapes, longer classes, extended learning). The findings can be used in adopting the program to increase cultural and linguistic appropriateness.

Preventing conduct problems and improving school readiness: evaluation of the Incredible Years Teacher and Child Training Programs in high-risk schools.

BACKGROUND: School readiness, conceptualized as three components including emotional self-regulation, social competence, and family/school involvement, as well as absence of conduct problems play a key role in young children's future interpersonal adjustment and academic success. Unfortunately, exposure to multiple poverty-related risks increases the odds that children will demonstrate increased emotional dysregulation, fewer social skills, less teacher/parent involvement and more conduct problems. Consequently intervention offered to socio-economically disadvantaged populations that includes a social and emotional school curriculum and trains teachers in effective classroom management skills and in promotion of parent-school involvement would seem to be a strategic strategy for improving young children's school readiness, leading to later academic success and prevention of the development of conduct disorders. METHODS: This randomized trial evaluated the Incredible Years (IY) Teacher Classroom Management and Child Social and Emotion curriculum (Dinosaur School) as a universal prevention program for children enrolled in Head Start, kindergarten, or first grade classrooms in schools selected because of high rates of poverty. Trained teachers offered the Dinosaur School curriculum to all their students in bi-weekly lessons throughout the year. They sent home weekly dinosaur homework to encourage parents' involvement. Part of the curriculum involved promotion of lesson objectives through the teachers' continual use of positive classroom management skills focused on building social competence and emotional self-regulation skills as well as decreasing conduct problems. Matched pairs of schools were randomly assigned to intervention or control conditions. RESULTS: Results from multi-level models on a total of 153 teachers and 1,768 students are presented. Children and teachers were observed in the classrooms by blinded observers at the beginning and the end of the school year. Results indicated that intervention teachers used more positive classroom management strategies and their students showed more social competence and emotional self-regulation and fewer conduct problems than control teachers and students. Intervention teachers reported more involvement with parents than control teachers. Satisfaction with the program was very high regardless of grade levels. CONCLUSIONS: These findings provide support for the efficacy of this universal preventive curriculum for enhancing school protective factors and reducing child and classroom risk factors faced by socio-economically disadvantaged children.

The impact of parent behavior-management training on child depressive symptoms.

The present study tested the impact of a parent behavior-management intervention on child depressive and internalizing symptoms. One hundred eighty-one children were randomly assigned to receive a videotape modeling parenting intervention, the Incredible Years, or to a wait-list control group. Children who received the intervention were more likely to have lower mother-rated mood and internalizing symptoms at post-treatment, compared with children in a wait-list control group. The effect sizes observed in the present intervention fell in the small-to-medium range for the sample as a whole, and some evidence supported the authors' hypothesis that effects would be strongest for children with baseline internalizing symptoms in the clinical range. Subsequent analyses also revealed that perceived changes in parenting effectiveness mediated the effect of treatment on children's post-treatment internalizing symptoms. The finding was consistent with study hypotheses and social learning explanations of child internalizing symptoms that guided selection of putative mechanisms. Implications for counseling psychologists and for designing interventions and prevention strategies for children with internalizing symptoms are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Computer-based intervention with coaching: an example using the Incredible Years program.

Increases in personal computer ownership and Internet use patterns provide a potential avenue for dissemination of evidence-based prevention and treatment interventions. The authors describe the implementation of a psychoeducational intervention (the Incredible Years parenting program, which is designed to promote behavioral change in parents and children) using a hybrid model combining computer- and web-based delivery with professional intervention via phone calls, electronic messages, and home visits. The model attempted to simulate many of the parent training methods shown to be successful in the original program. The intervention was implemented with 90 Head Start families who reported elevated levels of child behavior problems. Of the 45 families offered the intervention in the final year of the project, 37 (82%) completed at least half the program and 34 (76%) completed the entire intervention using procedures refined in light of the initial year's experience. These participants reported high achievement of their self-determined goals and were highly satisfied with the intervention. The combination of technology with professional coaching represents a potential model for adapting and disseminating evidence-based interventions.

The preliminary effect of a parenting program for Korean American mothers: a randomized controlled experimental study.

BACKGROUND: Traditional Korean American discipline is characterized by a lack of expression of affection and use of harsh discipline. OBJECTIVE: The purpose of this study was to pilot test the effect of the Incredible Years Parenting Program among Korean American mothers. METHODS: A randomized controlled experimental study design was used; 29 first-generation Korean American mothers of young children (3-8 years old) were randomly assigned to intervention (n=20) and control (n=9) groups. Intervention group mothers received a 12-week parenting program. Control group mothers did not receive the intervention. Mothers reported on discipline styles (positive, appropriate, and harsh), level of acculturation, and their child's outcomes (behavioral problems and social competence) at pre-, post-, and 1-year follow-up intervals. RESULTS: After completing the program, intervention group mothers significantly increased use of positive discipline as compared to control group mothers. Among intervention group mothers, high-acculturated mothers significantly increased appropriate discipline whereas low-acculturated mothers significantly decreased harsh discipline. In the 1-year follow-up, intervention group mothers maintained the significant effect for positive discipline. CONCLUSIONS: Providing this program appears to be a promising way of promoting positive discipline among Korean American mothers.

Improvements in Negative Parenting Mediate Changes in Children's Autonomic Responding Following a Preschool Intervention for ADHD.

Abnormal patterns of sympathetic- and parasympathetic- linked cardiac activity and reactivity are observed among externalizing children, and mark deficiencies in central nervous system regulation of behavior and emotion. Although changes in these biomarkers have been observed following treatment, mechanisms remain unexplored. We used MEMORE-a new approach to analyzing intervening variable effects-to evaluate improvements in parenting as mediators of changes in SNS- and PNS-linked cardiac activity and reactivity among 99 preschoolers with attention-deficit hyperactivity disorder who were treated using an empirically supported intervention. Decreases in negative parenting (criticism, negative commands, physical intrusions) were associated with increases in resting RSA and PEP reactivity to incentives from pre- to post-intervention. Increases in positive parenting were not associated with changes in autonomic function. These findings suggest socially-induced plasticity in peripheral biomarkers of behavior and emotion regulation, and underscore the importance of reducing aversive interactions between parents and children when treating externalizing behavior.

Is stacking intervention components cost-effective? An analysis of the Incredible Years program.

OBJECTIVE: Research demonstrates that interventions targeting multiple settings within a child's life are more effective in treating or preventing conduct disorder. One such program is the Incredible Years Series, which comprises three treatment components, each focused on a different context and type of daily social interaction that a child encounters. This article explores the cost-effectiveness of stacking multiple intervention components versus delivering single intervention components. METHOD: The data involved 459 children, ages 3 to 8, who participated in clinical trials of the Incredible Years Series. Children randomized to one of six treatment conditions received one or more of the three following program components: a child-based program, a parent training program, and a teacher-based program instructing teachers in classroom management and in the delivery of a classroom-based social skills curriculum. RESULTS: Per-child treatment costs and child behavior outcomes (observer and teacher reported) were used to generate cost-effectiveness acceptability curves; results suggest that stacking intervention components is likely cost-effective, at least for willingness to pay above $3,000 per child treated. CONCLUSIONS: Economic data may be used to compare competing intervention formats. In the case of this program, providing multiple intervention components was cost-effective.

Impact of Incredible Years® on teacher perceptions of parental involvement: A latent transition analysis.

The purpose of the present study was to examine the impact of the Incredible Years® Teacher Classroom Management (IY TCM) training on teacher perceptions of parental involvement. A cluster randomized design was used to assign 42 classroom teachers to either an IY TCM training (n=19) or a control condition (n=23). Teachers rated parental involvement (i.e., bonding with teacher, parental involvement at school) for the families of 805 low income students (IY TCM=504, control=301). A latent profile transition analysis framework was used to model the effect of IY TCM on teacher perceptions of parental involvement from pre to posttest. Four profiles consisting of various patterns of high, medium, and low teacher perceptions of bonding with and involvement of parents emerged. Analyses of teacher profiles at baseline revealed teachers who felt parental involvement and bonding was low were also likely to rate students as having more externalizing behaviors, fewer social competencies, more attention deficit symptoms, and disruptive behaviors towards adults and peers compared to teachers with more adaptive profiles. Further analysis revealed that parents of teachers randomly assigned to IY TCM were more likely to transition to a more adaptive view of parental involvement at follow-up compared to teachers in the control condition. Because teacher perceptions of parental involvement may adversely impact teacher attitudes towards difficult students, findings from the present study support the promise of teacher training as an avenue for conferring protections for struggling students.

Mediators, moderators, and predictors of 1-year outcomes among children treated for early-onset conduct problems: a latent growth curve analysis.

Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. In this study, the authors combine data from 6 randomized clinical trials and 514 children, ages 3.0-8.5 years, to evaluate moderators, mediators, and predictors of outcome. Among other findings, latent growth curve models of mother-report and observational measures of child externalizing behaviors suggested that marital adjustment, maternal depression, paternal substance abuse, and child comorbid anxiety/depression each moderated treatment response. Moreover, critical, harsh, and ineffective parenting both predicted and mediated outcome, with the most favorable responses observed when parents scored relatively low on each construct at intake yet improved during treatment. Implications for treatment nonresponders are discussed.

Electrodermal responding predicts responses to, and may be altered by, preschool intervention for ADHD.

OBJECTIVES: To evaluate electrodermal activity (EDA) as a prospective biomarker of treatment response, to determine whether patterns of EDA are altered by treatment, and to assess oppositional defiant disorder (ODD) as a possible moderator of trajectories in EDA after an empirically supported behavioral intervention for attention-deficit hyperactivity disorder (ADHD) in preschool. METHOD: Nonspecific fluctuations (NSFs) in skin conductance, which index sympathetic nervous system activity, were assessed among 4-6 year old children with ADHD (n = 99) before they participated with their parents in 1 of 2 versions of the Incredible Years intervention. All were reassessed at posttreatment, and a subgroup (n = 49) were assessed again at 1-year follow-up. RESULTS: No difference in pretreatment NSFs was observed between ADHD participants and a group of normal control children (n = 41). Nevertheless, among those with ADHD, fewer NSFs at pretest predicted poorer treatment response on 4 of 7 externalizing outcomes. Furthermore, treatment was associated with increasing NSFs across time, but not for those who scored high on ODD at pretest. CONCLUSIONS: Low EDA appears to mark resistance to treatment among preschoolers with ADHD. Furthermore, although our study was not experimental, treatment was associated with longitudinal increases in EDA, which were not observed in a normal control group. This may suggest increased sensitivity to discipline, with positive implications for long term outcome. In contrast to treated participants as a whole, however, those who scored high on ODD at pretest exhibited reduced EDA over time. (PsycINFO Database Record

Parent training of toddlers in day care in low-income urban communities.

The authors tested a 12-week parent training program with parents (n = 208) and teachers (n = 77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training.

Comparison of abusive and nonabusive families with conduct-disordered children.

This study set out to define the relative contribution of psychological, sociological, and parent-child interactional variables in 19 abusive and 21 nonabusive families with conduct disordered children. Low family income and mother's report of having been abused as a child were found to be the most potent variables discriminating abusive from nonabusive families. Implications of the study findings are considered.