Effectiveness of the Stepping Stones Triple P group parenting program in reducing comorbid behavioral problems in children with autism.

Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families' quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents' and teachers' judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents' judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers' judgment particularly revealed an improvement in children's social relationships. Effect sizes were large (ƞ2 ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents' ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.

Treatment of child externalizing behavior problems: a comprehensive review and meta-meta-analysis on effects of parent-based interventions on parental characteristics.

This is the first meta-meta-analysis examining the effects of parent-based interventions for children with externalizing behavior problems on parental characteristics (parenting, parental perceptions, parental mental health, parental relationship quality). Parent training interventions are recognized as evidence-based interventions for the treatment of externalizing behavior problems, although meta-analytic effects are heterogeneous. The objective of the present study was to comprehensively combine meta-analytic results on parent training interventions to arrive at valid effect predictions. Electronic databases were searched (PsycINFO, Medline, PubMed). In total, 11 meta-analyses were included that mainly comprised parents of children under the age of 13 years. Analyses were based on random effects models. Effect estimates were transformed to standardized mean differences (SMD) and corrected for primary study overlap. Results revealed a significant moderate overall effect for parenting (SMD 0.53) as well as for parents' report of parenting (SMD 0.60) and parental perceptions (SMD 0.52). Effects remained stable to follow-up. Results for observational data, parental mental health and parental relationship quality were small and only partially significant. Considerable heterogeneity within results was revealed. Overall, parent training interventions proved to be effective in improving parental characteristics for parents of children with externalizing behavior problems. Effectiveness was stronger regarding characteristics explicitly targeted by interventions. The findings should encourage health-care providers to apply evidence-based parent training interventions.

Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems.

OBJECTIVE: The aim of this study is to perform the first meta-meta-analysis on the effectiveness of parent-based interventions for children with externalizing behavior problems. Even though parent-based interventions are considered as effective treatments the effects reported in meta-analyses are heterogeneous and the implementation in clinical practice is suboptimal. Recapitulative valid effect predictions are required to close the still existing gap between research findings and clinical practice. The meta-meta-analytic results on changes in child behavior shall result in a clear signal for clinical practice. METHODS: This meta-meta-analysis encompasses 26 meta-analyses identified via search in electronic databases (PsycINFO, Medline, PubMed). Meta-analyses had to report effects of parent-based interventions on child behavior and focus on children under the age of 13 years with externalizing behavior problems in a clinical setting. Analyses were based on random-effects models. To combine results, the effect estimates of the meta-analyses were transformed to SMD and weighted to correct for primary study overlap. The meta-meta-analysis is registered on PROSPERO, registration number CRD42016036486 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA). RESULTS: The results indicate a significant moderate overall effect for child behavior (SMD = 0.46) as well as for parent reports (SMD = 0.51) and observational data (SMD = 0.62). Further analyses focusing on child externalizing behavior yielded significant and moderate effects (SMD = 0.45). All effects remained stable to follow-up. Considerable heterogeneity was observed within results. CONCLUSION: Parent-based interventions are shown to be effective in improving behavior in children with externalizing behavior problems, as assessed using parent reports and observational measures. The present results should encourage health care providers to apply evidence-based parent-based interventions.

Inhibitory control and delay aversion in unaffected preschoolers with a positive family history of attention deficit hyperactivity disorder.

BACKGROUND: From current theories on the etiology of attention deficit hyperactivity disorder (ADHD), it can be inferred that delay aversion (DA) and deficits in inhibitory control (IC) constitute basic deficits or endophenotypes of the disorder that already occur in the preschool period. This implies an occurrence of the characteristics in unaffected preschoolers with a positive family history of ADHD. Thus, it is hypothesized that preschoolers who are not affected by ADHD but who have first-degree relatives who suffer, or have suffered, from ADHD show deficits in IC and heightened DA in comparison to preschoolers from the general population. METHODS: Thirty unaffected preschoolers with a positive family history of ADHD were compared with 30 control children matched with respect to age in months, gender, intelligence, and maternal education level. The groups also did not differ in terms of maternal depressive symptoms and the number of psychosocial family risks. A set of age-appropriate neuropsychological tasks on executive IC (e.g. Puppet Says, Day-Night, relying on Go-NoGo and interference paradigms) and DA (e.g. Snack Delay, Gift Wrap, relying on delay of gratification paradigm) was conducted. RESULTS: Unaffected preschoolers showed significantly higher DA than control children (t(29) = -2.57, p < .008). The result did not change when subclinical ADHD symptoms and symptoms of oppositional defiant disorder were controlled for (F(1,29) = 5.21, p < .031). Differences in IC did not reach statistical significance. CONCLUSION: The results are compatible with the assumption that DA constitutes a familial vulnerability marker that can be validly assessed in the preschool period. As this is the first study to address this issue in preschoolers, more research is needed to confirm and further analyze the significance of DA assessments specifically at this developmental stage.

Attention deficit/hyperactivity and comorbid symptoms in preschoolers: differences between subgroups in neuropsychological basic deficits.

BACKGROUND: There is wide agreement on the heterogeneity of attention deficit/hyperactivity disorder (ADHD). Subgroups with specific comorbid problems, neuropsychological deficits, and developmental trajectories that start in preschool years have been assumed. We analyze whether corresponding subgroups at risk for ADHD development can be identified in a preschool sample and whether these subgroups show the assumed neuropsychological deficits. METHODS: The study sample consisted in 141 preschool children (3-6 years; 68 boys), including 41 children at risk for ADHD development (because of high ADHD symptoms or first-degree relatives with an ADHD diagnosis). Parent- and teacher-reported symptoms of ADHD, ODD/CD, and anxiety/depression were assessed. Cluster analyses were conducted on the continuous symptom scores. Inhibitory control and delay aversion were measured by six neuropsychological tasks. RESULTS: Cluster analyses resulted in four groups. Two of these groups showed high ADHD symptoms - one showing multiple comorbid symptoms, one showing hardly any further symptoms. The other two groups were characterized by no problems and by some sensorimotor deficits. A priori contrasts revealed that the "high comorbidity" cluster showed the worst inhibitory control performance while the "pure ADHD symptoms" cluster showed the highest delay aversion. CONCLUSION: The ADHD-symptom clusters matched types that have been proposed in recent models. This description might help to identify different ADHD-related pathways in future longitudinal research.

Do different ADHD-related etiological risks involve specific neuropsychological pathways? An analysis of mediation processes by inhibitory control and delay aversion.

BACKGROUND: Inhibitory control (IC) has been regarded as a neuropsychological basic deficit and as an endophenotype of attention deficit/hyperactivity disorder (ADHD). Implicated here are mediation processes between etiological factors and ADHD symptoms. We thus analyze whether and to what extent executive IC and delay aversion (DA; i.e., reward-related IC) performance mediate the associations of familial, prenatal, and psychosocial risks with ADHD symptoms. METHODS: The study sample consisted of 130 preschool children (3-6 years; 50% boys), including 20% (n = 26) with a positive family history of ADHD (familial risk). Prenatal risks were mainly taken from medical records. Psychosocial risks were assessed by a structured interview. ADHD symptoms were assessed by structured interviews and questionnaires completed by parents and teachers. A set of neuropsychological tasks on IC and DA was conducted with the children. RESULTS: Familial, prenatal, and psychosocial risks were significantly associated with ADHD symptoms. IC and DA also correlated significantly with ADHD symptoms. While the familial risk significantly correlated with IC and DA, psychosocial and prenatal risks were only weakly associated with these measures. The link between the familial risk and ADHD symptoms was partially mediated by IC and DA. CONCLUSIONS: The results indicate different neuropsychological pathways related to 'positive family history of ADHD' and prenatal risks. Given a cross-validation in future studies, the results underscore the endophenotypic character of IC and DA in preschool ages.