Effectiveness of the Prevention Program for Externalizing Problem Behavior (PEP) in Preschoolers with Severe and No or Mild ADHD Symptoms.

Objective: The prevention program for externalizing problem behavior (PEP), developed for parents and teachers of preschool children, showed the effectiveness of both modules (PEP-PA and PEP-TE) under routine care conditions in two separate studies. This secondary analysis examined the effects of both modules on preschool children with severe attention deficit/hyperactivity disorder (ADHD) symptoms compared with children with no or mild ADHD symptoms. Methods: In the within-subject control group, design changes in child symptoms and problem behavior in specific situations at home and school during the waiting period were compared with changes during the intervention period (3 months each). Results: For children with severe ADHD, parent training reduced specific problem situations at home (HSQ-D[please provide full name here]), and teacher training showed significant effects on oppositional-aggressive behavior as well as the total problem score of the Caregiver Teacher Report Form (C-TRF). Children with no or mild ADHD benefited from parent training on the HSQ-D score, oppositional-aggressive behavior and the total problem score of the Child Behavior Checklist (CBCL), while teacher training had significant effects on all outcomes assessed. Conclusion: Our results suggest that parent training reduces mainly specific behavior problems at home in children with severe ADHD symptoms and with no/mild ADHD symptoms, while teacher training reduces ADHD symptoms and ODD[please provide full name here] symptoms including specific behavior problems in the kindergarten in children with no/mild ADHD symptoms. However, in children with severe ADHD only overall problems and ODD symptoms were significantly reduced by teacher Training.

Effectiveness of a teacher-based indicated prevention program for preschool children with externalizing problem behavior.

Externalizing behavior is common in preschool children and shows stability over the lifespan implying that strategies for early intervention and prevention are needed. Improving parenting reduces child behavior problems but it is unproven whether the effects transfer to kindergarten. Strategies implemented directly by teachers in the kindergarten may be a promising approach. The effectiveness of the teacher's module of the Prevention Program for Externalizing Problem Behavior (PEP-TE) was investigated in a study using a within-subject control group design. Each of the 144 teachers enrolled identified one child with externalizing problem behavior (aged 3-6 years) and rated that child's behavior problems [broadband externalizing, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder] as well as their own behavior (attending skills) and burden by the child. Changes in child symptoms and teacher behavior or burden during the 3-month waiting period (control) and 3-month treatment period were compared. Stability of treatment effects at both 3- and 12-months follow-up after treatment was examined. Multilevel modeling analyses showed that, despite a reduction in externalizing behavior and ADHD scores during the waiting period, all child problem behavior scores decreased during the treatment period compared with the waiting period. The teacher's behavior also improved and their burden decreased. These treatment effects were stable during follow-up for the subsample remaining in the kindergarten for up to 1 year. This study shows that a teacher-based intervention alone is associated with improvements in both the externalizing behavior of preschoolers and teacher behavior and burden. Indications of long-term stability of effects were found.

Any indication for bias due to participation? Comparison of the effects of a parent management training rated by participating and non-participating parents.

Ratings of parents that have participated in a parent training for child externalizing behaviour problems might be biased (e.g., they may report symptom reduction to reward their own endeavours for attending the training). The potential for bias in parent ratings was investigated in a secondary analysis of an effectiveness study of a parent management training for children (aged 3-10 years) with externalizing behaviour problems under routine care conditions. For the 56 families included in the current analysis, we compared the ratings of training participants (predominately mothers) and training non-participants (predominately fathers). A 3-month waiting period prior to treatment served as the control condition. Outcome measures were attention problems and conduct problems of the children and perceived parental self-efficacy rated by both the mothers and fathers. Child attention problems and conduct problems both decreased significantly during the treatment period for participating and non-participating parents, and the changes in ratings during treatment were of a similar magnitude for participants compared with non-participants. Taking into account the methodological limitations of the current analysis, no indication was found that treatment effects are strongly biased due to participation in the training. KEY PRACTITIONER MESSAGES: Previous positive findings of mothers' and fathers' ratings on parent management training for children with externalizing problem behaviour have mostly come from parents who also attended the training. For child behavioural problems, the results of the current analysis demonstrate similar perceived changes by parents who did and did not participate in the training. Our findings underscore the relevance and importance of parent ratings for treatment evaluation.

The severely impaired do profit most: short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior.

Short-term and long-term predictors of therapeutic change due to parent management training were investigated. Therapeutic change was defined as the change in outcome measures [externalizing problem behavior and parenting self-efficacy (PSE)] from before treatment to afterward. Three different types of predictors were analyzed: child variables (gender, age, and initial externalizing and internalizing behavior), parent variables (age, initial PSE and parental psychopathology) and socioeconomic status and other sociodemographic characteristics of the family (parental school education, employment, family status, language). The parent management training was part of the Prevention Program for Externalizing Problem Behavior, which was evaluated as an effectiveness trial under routine care conditions using a within-subject control group design. Between 78 and 270 families were included in the analysis, which investigated therapeutic change over two time intervals: (1) immediate change from the pre-treatment to the post-treatment assessments, and (2) long-term-change from pre-treatment to 1-year follow-up. Throughout several analyses, the only predictor of therapeutic change that was consistently significant over the two time periods for the externalizing problem behavior of the child was the initial externalizing problem behavior. More impaired children improved more. Similarly, the only predictor of therapeutic change for the two time periods in PSE was the initial level of PSE. Parents with less PSE gained more during the course of the training.

Detecting effects of the indicated prevention Programme for Externalizing Problem behaviour (PEP) on child symptoms, parenting, and parental quality of life in a randomized controlled trial.

BACKGROUND: Behavioural parent training is effective in improving child disruptive behavioural problems in preschool children by increasing parenting competence. The indicated Prevention Programme for Externalizing Problem behaviour (PEP) is a group training programme for parents and kindergarten teachers of children aged 3-6 years with externalizing behavioural problems. AIMS: To evaluate the effects of PEP on child problem behaviour, parenting practices, parent-child interactions, and parental quality of life. METHOD: Parents and kindergarten teachers of 155 children were randomly assigned to an intervention group (n = 91) and a nontreated control group (n = 64). They rated children's problem behaviour before and after PEP training; parents also reported on their parenting practices and quality of life. Standardized play situations were video-taped and rated for parent-child interactions, e.g. parental warmth. RESULTS: In the intention to treat analysis, mothers of the intervention group described less disruptive child behaviour and better parenting strategies, and showed more parental warmth during a standardized parent-child interaction. Dosage analyses confirmed these results for parents who attended at least five training sessions. Children were also rated to show less behaviour problems by their kindergarten teachers. CONCLUSIONS: Training effects were especially positive for parents who attended at least half of the training sessions. ABBREVIATIONS: CBCL: Child Behaviour Checklist; CII: Coder Impressions Inventory; DASS: Depression anxiety Stress Scale; HSQ: Home-situation Questionnaire; LSS: Life Satisfaction Scale; OBDT: observed behaviour during the test; PCL: Problem Checklist; PEP: prevention programme for externalizing problem behaviour; PPC: Parent Problem Checklist; PPS: Parent Practices Scale; PS: Parenting Scale; PSBC: Problem Setting and Behaviour checklist; QJPS: Questionnaire on Judging Parental Strains; SEFS: Self-Efficacy Scale; SSC: Social Support Scale; TRF: Caregiver-Teacher Report Form.

One-year follow-up of a parent management training for children with externalizing behaviour problems in the real world.

BACKGROUND: The long-term effectiveness of parent training for children with externalizing behaviour problems under routine care within the German health care system is unclear. We report the 1-year follow-up results of the parent training component of the Prevention Program for Externalizing Problem Behaviour (PEP) for 270 children aged 3-10 years with externalizing behaviour problems. METHOD: Outcome measures included child behaviour problems (externalizing behaviour problems, Attention-Deficit/Hyperactivity Disorder symptoms and Oppositional Defiant Disorder symptoms) and parenting (self efficacy of parenting and perceived ability to solve difficult parenting situations). Data were analysed using multilevel modelling. RESULTS: Comparison of the changes during the 3-month waiting and treatment periods revealed significantly stronger treatment effects on all outcome measures, indicating a substantial decrease in child behaviour problems and a significant increase in parenting due to treatment. At 1-year follow-up, initial treatment effects on child behaviour problems were maintained, while parenting continued to improve. CONCLUSIONS: Families whose children exhibited externalizing problem behaviour profit from PEP and improvements are maintained for at least one year.

Does parent management training for children with externalizing problem behavior in routine care result in clinically significant changes?

The clinical significance of a parent management training that is part of the Prevention Program for Externalizing Problem Behavior (PEP) was assessed in an effectiveness trial. Parent management training was offered under routine care conditions in a setting where a high proportion of children were expected to show clinically relevant symptoms of externalizing problem behavior. At the beginning of the study, 32.6% to 60.7% of children were classified as clinical cases (dysfunctional) on three outcome measures of child behavior problems. Three months after treatment, 24.8% to 60.4% of children were judged to be recovered. Parent management training can result in clinically significant changes in children with externalizing behavior problems.