RESUMO
PURPOSE: To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden. METHODS: In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models. RESULTS: In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings. CONCLUSIONS: Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.
Assuntos
Comportamento Problema , Humanos , Feminino , Masculino , Estudos Longitudinais , Pré-Escolar , Suécia , Seguimentos , Comportamento Problema/psicologia , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/diagnóstico , Inquéritos e Questionários , Emoções , Criança , Mães/psicologiaRESUMO
OBJECTIVE: Despite effective treatment options, many families-especially those from marginalized backgrounds-lack access to quality care for their children's behavioral difficulties. Since the COVID-19 pandemic, telehealth has become a prominent format for the delivery of outpatient services, with potential to increase access to quality care. Although telehealth-delivered parenting interventions are associated with positive clinical outcomes, limited research has examined whether telehealth formats improve treatment engagement relative to office-based care. The present study is the first controlled comparison of engagement across office-based parent-child interaction therapy (PCIT) and internet-delivered PCIT (iPCIT). METHOD: Children ages 3-5 years, and their caregiver(s) (N = 40) participated in a randomized trial comparing iPCIT to office-based PCIT in the treatment of behavioral problems. Analyses examined the effects of treatment format on engagement (i.e., missed sessions, premature treatment discontinuation, homework completion, therapeutic alliance, and treatment satisfaction). Logistic and linear regressions further explored whether treatment format moderated the effects of common predictors of treatment engagement (i.e., family economic means, racial/ethnic background, caregiver stress). RESULTS: iPCIT improved attendance rates relative to office-based PCIT, especially for families from minoritized racial/ethnic backgrounds. At the same time, among families with relatively higher levels of caregiver stress, office-based PCIT was associated with lower dropout rates and improved treatment alliance and satisfaction, relative to iPCIT. CONCLUSIONS: This study provides the first experimental support that telehealth formats can improve treatment attendance in behavioral parenting interventions. Findings highlight nuances in treatment engagement across treatment formats that reveal limits to the extent telehealth transcends engagement concerns. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Poder Familiar , Telemedicina , Humanos , Masculino , Feminino , Pré-Escolar , Poder Familiar/psicologia , Adulto , Relações Pais-Filho , Terapia Comportamental/métodos , Transtornos do Comportamento Infantil/terapia , COVID-19 , Terapia Familiar/métodosRESUMO
The twenty-first century has seen the development and delivery of online programs of behavioral family intervention for disruptive child behavior. Typically, programs evaluate outcomes in terms of change in child functioning and change in parenting ability. Existing research has also articulated the importance of parent-child relational capacity and its role in facilitating change in child functioning, and the importance of parent emotion regulation in the interests of ensuring optimal child development. These factors were explored in a meta-analysis of k = 14 prospective longitudinal research studies of online parenting interventions for disruptive child behavior. Peer reviewed randomized controlled trials with inactive control groups that were published in English between 2000 and 2022 were included in the review if they were delivered online; offered parent self-directed treatment; included as participants families who were screened as having child behavioral difficulties on validated psychometric assessment measures; and assessed child treatment outcomes, parenting ability and parent treatment outcomes. The protocol for this study was pre-registered with PROSPERO (CRD42020215947). Statistical analyses employed random effects models and reported pooled effect sizes (Hedge's g) within and between groups. Results emphasize the importance of child outcomes and parenting ability in program assessment, however, suggest that parents' capacity to develop optimal parent-child relationships and regulate emotion may not be sufficiently reflected in program content. Identified continuous and categorical moderators of treatment outcome were also assessed. Results of the review are discussed in terms of their potential to influence the future development of online programs of behavioral family intervention and, therefore, child development.
Assuntos
Poder Familiar , Humanos , Criança , Relações Pais-Filho , Transtornos do Comportamento Infantil/terapia , Terapia Familiar/métodos , Terapia Comportamental/métodos , Intervenção Baseada em Internet , Comportamento Problema , Avaliação de Resultados em Cuidados de Saúde , PaisRESUMO
BACKGROUND: Premature children are known to be at a high risk of developing behavioral problems. This study examined the effectiveness of parent-child interaction therapy (PCIT) in reducing behavioral problems in young children born premature. METHODS: The study included 18 child-parent pairs with children born at less than 35 weeks of gestation (range: 23-34 weeks, median: 31.0 weeks) and aged 27-52 months (median: 38.0 months). They were assigned to either the PCIT group (n = 7) or the non-PCIT group (n = 11) based on maternal desire for treatment. The study was designed to examine the effects of PCIT. Specifically, the Eyberg Child Behavior Inventory (ECBI) intensity score, ECBI problem score, and Parenting Stress Index Short Form (PSI-SF) scores were compared before treatment and after 6 months. RESULTS: In the PCIT group, the mean ECBI intensity score was 135.7 (SD = 13.5; T-score = 64) at baseline and 90.1 (SD = 15.5; T-score = 46) at post-assessment, the mean ECBI problem score was 9.8 (SD = 1.9; T-score = 54) at baseline and 4.4 (SD = 3.1; T-score = 44) at post-assessment, the mean PSI-SF total score was 60.1 (SD = 4.8; 95%tile) at baseline and 49.6 (SD = 5.6; 85%tile) at post-assessment, showing a significant improvement (ECBI intensity scores: p < 0.001, d = 2.03; ECBI problem scores: p < 0.001, d = 1.94; PSI-SF total scores: p = 0.004, d = 0.86). On the other hand, none of the scores showed significant change in the non-PCIT group. CONCLUSIONS: The PCIT can be considered as a potential treatment option for behavioral problems in young children born premature.
Assuntos
Transtornos do Comportamento Infantil , Nascimento Prematuro , Comportamento Problema , Feminino , Criança , Humanos , Pré-Escolar , Relações Pais-Filho , Comportamento Infantil , Transtornos do Comportamento Infantil/terapiaRESUMO
Telehealth treatment for child disruptive behavior has the potential to overcome multiple barriers to access (e.g., transportation, therapist availability). Traditional Parent-Child Interaction Therapy (PCIT) has demonstrated efficacy via telehealth in randomized controlled trials. The current study extends this research by examining community-based effectiveness of time-limited (i.e., 18 week) telehealth PCIT, comparing intake and posttreatment child behavior and caregiver skills for both telehealth and in-person PCIT. Participants included predominantly racially, ethnically, linguistically, and socioeconomically diverse children aged 2 to 8 years, and their caregivers. Dyads (Nâ¯=â¯380) received either telehealth (IPCIT) or in-person PCIT.Propensity score analyses were conducted to address potential selection bias due to the nonrandomized sample. Regression analyses revealed no difference between IPCIT and in-person treatment for child disruptive behaviors or compliance outcomes. However, caregivers who received IPCIT demonstrated fewer positive statements and greater corrective/directive statements at posttreatment than caregivers who received in-person treatment.This research demonstrated that time-limited IPCIT can effectively improve child disruptive behavior among a socioeconomically, linguistically, and culturally diverse population, and represents the largest sample to date demonstrating the effectiveness of PCIT via telehealth. Future research is warranted to document intervention sustainability on a more system-wide level, and balance prioritizing caregiver skill acquisition over family-derived treatment goals.
Assuntos
Transtornos do Comportamento Infantil , Cocaína/análogos & derivados , Telemedicina , Humanos , Criança , Terapia Comportamental , Transtornos do Comportamento Infantil/terapia , Relações Pais-FilhoRESUMO
Parent training is an effective treatment for disruptive behavior problems in children. However, as there is limited access to traditional face-to-face treatment, other delivery formats have been evaluated. This study aims to evaluate possible predictors and moderators of outcome, completion and engagement in parent training when delivered in group or through the internet. A recent randomized controlled non-inferiority trial (N = 161) demonstrated equal effectiveness of the parent training program Comet when delivered in group (gComet) and through the internet (iComet). Demographic, clinical and theory-driven variables were studied to find predictors and moderators of treatment effect, completion and engagement. Linear mixed effects models were used to determine predictors and moderators of change in disruptive behavior from baseline to the 3- and 12-month follow-up. Most variables did not have significant predictive or moderating effects. However, there were some variables that predicted or moderated outcomes that may have implications for practice (e.g., comorbid emotional problems, preferred treatment format, and ADHD). This trial can contribute to guiding clinical work with children with disruptive behavior and results indicate that parent training in both treatment formats can be offered regardless of a range of demographic and clinical factors. Taking patients' treatment preferences into account can increase treatment completion.
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Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Humanos , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Comorbidade , Pais/educação , Comportamento Problema/psicologia , Resultado do TratamentoRESUMO
Mental and behavioral health (MBH) emergencies in children and youth continue to increasingly affect not only the emergency department (ED), but the entire spectrum of emergency medical services for children, from prehospital services to the community. Inadequate community and institutional infrastructure to care for children and youth with MBH conditions makes the ED an essential part of the health care safety net for these patients. As a result, an increasing number of children and youth are referred to the ED for evaluation of a broad spectrum of MBH emergencies, from depression and suicidality to disruptive and aggressive behavior. However, challenges in providing optimal care to these patients include lack of personnel, capacity, and infrastructure, challenges with timely access to a mental health professional, the nature of a busy ED environment, and paucity of outpatient post-ED discharge resources. These factors contribute to prolonged ED stays and boarding, which negatively affects patient care and ED operations. Strategies to improve care for MBH emergencies, including systems level coordination of care, is therefore essential. The goal of this policy statement and its companion technical report is to highlight strategies, resources, and recommendations for improving emergency care delivery for pediatric MBH.
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Transtornos do Comportamento Infantil , Emergências , Transtornos Mentais , Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos Mentais/terapia , Serviços Médicos de Emergência , Transtornos do Comportamento Infantil/terapia , Pessoal de Saúde , Serviços de Saúde MentalRESUMO
The dissemination of parenting interventions is one of the advised approaches to globally counteract childhood behavior problems, delinquency, and future criminal careers. Many of these interventions are developed in Anglosphere countries and transported to other contexts with distinct cultural backgrounds. However, there are no meta-analyses evaluating the overall effectiveness of these Anglosphere parenting programs in non-Anglosphere settings. This meta-analysis aimed to examine the effectiveness of parenting interventions developed in Anglosphere countries when transported to non-Anglosphere countries, as well as compare effectiveness levels between Anglosphere and non-Anglosphere trials; and analyze the impact of research and contextual factors in the dissemination of these interventions. Parenting interventions were included if they were: created in an Anglosphere setting; tested in non-Anglosphere countries; focused on reducing childhood behavioral problems; designed for children ranging from two to 12 years old; and tested in an experimental randomized trial. A random-effects model was selected for our meta-analysis. Standardized mean differences, confidence intervals and prediction intervals were also computed. Twenty studies were included, and results suggest that parenting interventions designed for childhood behavior problems can be transported to non-Anglosphere countries and potentially maintain effectiveness. This study is a relevant contribution to the evidence of cross-cultural transportability of parenting interventions.
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Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Humanos , Pré-Escolar , Poder Familiar , Comparação Transcultural , Comportamento Infantil , Transtornos do Comportamento Infantil/terapia , PaisRESUMO
Our study provides nationally-generalizable evidence on the racial/ethnic and socioeconomic disparities in diagnosis and recovery from childhood behavioral or conduct problems. We pooled data from 4 years (2016-2019) of the National Survey of Children's Health (NSCH) for 3 to 17 years old US children (N = 114,476). We performed several logistic regression models using complex survey data analysis statistical methodologies to estimate nationally representative and generalizable results in the Stata MP 16 program. About 20.1% of 3-17 years old US children previously diagnosed with behavioral or conduct problems no longer had the current diagnosis (were recovered). Hispanic children [Odds ratio (OR) 0.77, 95% Confidence Interval (CI) 0.65-0-95], immigrant children or children of immigrant parents (first or second generation immigrant children), and children from high-income families [200-399% Federal Poverty Level (FPL)] were about 23%, 38%, and 21% less likely than non-Hispanic White children, children of US native parents, and children with a family income of below 100% FPL to be currently diagnosed with behavioral or conduct problems, respectively. Conversely, Non-Hispanic Black and Hispanic children were about 50% and 40% more likely than non-Hispanic White children to recover from a past diagnosis. Moreover, children from higher-income families (at or above 300% of FPL) were between 1.59 to 1.79 times more likely than those from low-income families (below 100% FPL) to recover from a past diagnosis. Racial/ethnic and socioeconomic disparities in diagnosing appear to persist in recovering from behavioral or conduct problems.
Assuntos
Grupos Raciais , Adolescente , Criança , Pré-Escolar , Humanos , População Negra , Hispânico ou Latino , Renda , Pobreza , Estados Unidos/epidemiologia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/etnologia , Transtornos do Comportamento Infantil/terapia , Brancos , Emigrantes e Imigrantes , Fatores Socioeconômicos , Fatores RaciaisRESUMO
OBJECTIVE: Parent-child interaction therapy (PCIT) is an effective intervention to address child externalizing behaviors. However, disparities in access and retention are pervasive, which relate to the availability of PCIT in low-income communities, inadequate workforces to provide culturally appropriate care, and distrust in services due to systemic discrimination. This study incorporated natural helpers who had been trained as community health workers into PCIT delivery to improve disparities in engagement and outcomes. METHOD: Families from three low-income, predominately Latino/a/x and Black neighborhoods in Miami qualified for services if they had a child aged 2-8 with clinically elevated externalizing behaviors. Families were randomly assigned into either Standard-PCIT group (N = 30 families; 80% boys, 57% Latino/a/x, 27% Black) or a PCIT plus Natural helper (PCIT+NH) group (N = 51 families; 66% boys, 76% Latino/a/x, 18% Black). Families in the PCIT+NH group received home visits and support addressing barriers to care from a natural helper. Path analyses within an intention-to-treat framework examined group-differences in treatment engagement, child behavior, and parenting skills and stress. RESULTS: Families in both groups demonstrated large improvements in child externalizing behavior, caregiver stress, and parenting skills from pre-to-post-treatment. Externalizing behavior improved significantly more in the PCIT+NH group compared to the Standard-PCIT group. There were no significant group differences in parenting skills or caregiver stress. Though differences in engagement were not significant, the PCIT+NH group had a small effect on treatment retention. CONCLUSIONS: Natural helpers may help to address structural barriers that systematically impact communities of color, apply treatment in naturalistic environments, and promote improved treatment outcomes.
Assuntos
Transtornos do Comportamento Infantil , Masculino , Criança , Humanos , Feminino , Projetos Piloto , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Resultado do Tratamento , Comportamento Infantil/psicologia , Relações Pais-Filho , Poder Familiar/psicologiaRESUMO
Parenting programs are effective for children with externalizing problems, but not always easily accessible for parents. In order to facilitate accessibility, we developed a self-help parenting program, consisting of a manual and online part. The efficacy of the program in reducing children's externalizing problems was compared to waitlist in a randomized controlled trial. In addition, two versions of the program were exploratively compared, one with and one without biweekly telephonic support. Candidate moderators (child and parent factors) and parental satisfaction were also examined. We randomly assigned 110 families to one of the following three conditions: the support condition, the no support condition, or the waitlist condition. Intervention duration was 15 weeks. Outcomes were collected at baseline (T0), 8 weeks (T1), 15 weeks (T2), and 28 weeks (T3) and included daily telephonic measurements of parent-rated externalizing behavior and the Intensity scale of the parent-rated Eyberg Child Behavior Inventory (ECBI). Main analyses compared outcomes at T2, using longitudinal regressions with T0 as fixed factor. Results showed that children improved significantly more on both outcomes in the intervention condition compared to waitlist, with small to medium effect sizes. Parental satisfaction was high. Neither differences in efficacy nor in parental satisfaction were found between the support and no support condition. No moderators were detected. The newly developed self-help parenting program is effective in reducing children's externalizing behavior problems and may help improve access to evidence-based care.
Assuntos
Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Humanos , Poder Familiar , Pais , Comportamento Infantil , Transtornos do Comportamento Infantil/terapiaRESUMO
OBJECTIVE: Disruptive behavior disorders (DBDs) represent a common motive for referral among youths. This meta-analysis aimed at estimating the efficacy of psychosocial interventions for adolescents with DBDs. METHOD: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-compliant systematic review of MEDLINE/PubMED/PsycINFO/Cochrane Central Register of Controlled Trials was conducted. Eligible studies were randomized controlled trials (RCTs) administering psychosocial interventions to adolescents with DBD, published before April 5, 2020. From the initial set of 6,006 records, 17 RCTs involving 18 cohorts (16 publications) were subjected to a random-effect meta-analysis (involving sensitivity, subgroup, and meta-regression analyses). Primary and secondary outcomes were externalizing symptoms at RCT endpoint (ie, standardized mean difference [SMD]) and acceptability (drop-out odds ratio [OR]), respectively. Risk of bias was assessed using the Risk of Bias 2 tool. RESULTS: A total of 17 RCTs, involving 1,954 adolescents, were included. The mean age was 14.09 (SD 1.33) years; 61% were male. The mean RCT duration was 12 weeks, with a mean follow-up of 8 (SD 3.98) months. Concern over risk of bias emerged in 12 studies, with high concern in 6. Psychosocial interventions had a large effect size at RCT endpoint (SMD = 0.98, 95% CI = -0.55 to -1.38, k = 18) and were acceptable (drop-out OR = 1.29, 95% CI = 0.62-2.70, k = 13). However, this beneficial effect did not persist at follow-up (SMD = -0.36, 95% CI = 0.06 to -0.78, k = 10). Family format was the most effective variable. No other clinically significant moderator was found. CONCLUSION: Psychosocial interventions involving the families of DBD adolescents are effective and acceptable in the short term. Future studies should focus on strategies to achieve their long-term efficacy.
Assuntos
Transtornos do Comportamento Infantil , Comportamento Problema , Intervenção Psicossocial , Adolescente , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Transtornos do Comportamento Infantil/terapiaRESUMO
BACKGROUND: Specific programs are often implemented for specific child mental health problems, while many children suffer from comorbid problems. Ideally, programs reduce a wider range of mental health problems. The present study tested whether parenting programs for children's conduct problems, and which individual and clusters of program elements, have additional effects on children's emotional problems. METHODS: We updated the search of a previous systematic review in 11 databases (e.g., PsycINFO and MEDLINE) and included studies published until July 2020 with keywords relating to 'parenting', 'program', and 'child behavioral problems'. Also, we searched for recent trials in four trial registries and contacted protocol authors. Studies were eligible for inclusion if they used a randomized controlled trial to evaluate the effects of a parenting program for children aged 2-10 years which was based on social learning theory and included a measure of children's emotional problems postintervention. RESULTS: We identified 69 eligible trials (159 effect sizes; 6,240 families). Robust variance estimation showed that parenting programs had small significant parent-reported additional effects on emotional problems immediately postintervention (Cohen's d = -0.14; 95% CI, -0.21, -0.07), but these effects faded over time. Teachers and children did not report significant effects. Additional effects on emotional problems were larger in samples with clinical baseline levels of such problems. No individual program elements predicted larger additional effects. Of the clusters of elements, combining behavior management and relationship enhancement elements was most likely to yield the strongest additional effects. CONCLUSIONS: The additional effects on emotional problems of parenting programs designed to reduce conduct problems are limited, but some clusters of elements predict larger effects. Our findings may contribute to realistic expectations of the benefits of parenting programs for children's conduct problems and inform the development of programs with wider benefits across mental health problems.
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Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Humanos , Metanálise em Rede , Poder Familiar/psicologia , Pais/psicologia , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Translation of promising procedures for mitigating treatment relapse has received considerable attention recently from researchers across the basic-applied continuum. One procedure that has demonstrated mixed support involves increasing the duration of treatment as a strategy for blunting resurgence. In a recent translational study, Greer et al. (2020) failed to detect a mitigation effect of increased treatment duration on the resurgence of destructive behavior. However, design limitations may have been responsible. The present study corrected these limitations by (a) employing a sequential design to decrease the possibility of multiple-treatment interference, (b) evaluating more treatment durations, (c) arranging treatments of fixed durations, and (d) conducting treatments of more extreme duration in a different clinical sample. Despite these improvements in experimental rigor and the testing of more extreme boundary conditions, the present study also failed to detect a mitigation effect of increased treatment duration. Likely explanations are discussed.
Assuntos
Terapia Comportamental , Transtornos do Comportamento Infantil , Humanos , Criança , Terapia Comportamental/métodos , Duração da Terapia , Extinção Psicológica , Esquema de Reforço , Transtornos do Comportamento Infantil/terapia , Condicionamento OperanteRESUMO
Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.
Assuntos
Transtornos do Comportamento Infantil , Violência por Parceiro Íntimo , Comportamento Problema , Feminino , Criança , Humanos , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Violência por Parceiro Íntimo/psicologia , Mães/psicologia , Poder Familiar/psicologiaRESUMO
Research shows that parenting interventions struggle with keeping clients in treatment. The purpose of this study was to compare attrition and rates of improvement in caregiver-child dyads participating in either Parent-Child Care (PC-CARE), a brief, 7-session parenting intervention or Parent-Child Interaction Therapy (PCIT) over a 7-week period. Participants were 204 caregiver-child dyads referred to either PC-CARE (N = 69) or PCIT (N = 135) between 2016 and 2019. Children were aged 2-7 years, referred for treatment by county Behavioral Health Services, and Medicaid funded. Findings showed that PC-CARE participants were 2.5 times more likely than PCIT participants to complete 7 sessions, all other things being equal, and showed significantly greater rates of improvement during this timeframe in reported child behavior problems and parenting stress. In conclusion, compared with PCIT, PC-CARE showed greater retention and rate of improvement in child and parent outcomes over a comparable time period.
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Transtornos do Comportamento Infantil , Humanos , Criança , Transtornos do Comportamento Infantil/terapia , Pais , Poder Familiar , Relações Pais-FilhoRESUMO
A variety of instruments are available for assessing parental and child behaviour in the context of interaction observation. This study investigated whether the Laboratory Parenting Assessment Battery (Lab-PAB) can be used to make predictive statements about the therapeutic success of child psychiatric treatment. The success of therapy was measured through pre- and post-intervention assessments using the Child Behavior Checklist (CBCL) and the Parent-Infant Relationship Global Assessment Scale (PIR-GAS). A particular focus was placed on discriminating between externalizing and internalizing problems of the child. It was observed that positive items of the interaction offer a greater resource for the therapeutic success of children with externalizing problems than stopping negative behaviour of the parents. In the case of internalizing problems, the elimination of negative interaction items seems to be essential for a good therapy success.
Assuntos
Transtornos do Comportamento Infantil , Comportamento Problema , Criança , Humanos , Poder Familiar/psicologia , Transtornos do Comportamento Infantil/diagnóstico , Transtornos do Comportamento Infantil/terapia , Transtornos do Comportamento Infantil/psicologia , Comportamento Infantil/psicologia , PaisRESUMO
Culture-specific versions of evidence-based interventions are critically important to meeting the needs of underserved and minoritized populations but may also face significant barriers to large-scale implementation when there are settings with multiple cultural groups and within-group heterogeneity. The PersIn framework is a proposed approach for personalizing an evidence-based intervention to facilitate cultural responsiveness concurrent with fidelity to the original intervention, flexibility in individual implementation, and administration that is standardized, feasible, and replicable. This study describes pilot feasibility outcomes for MY PCIT (n = 32), a personalized version of Parent-Child Interaction Therapy for culturally diverse families that was developed as a proof-of-concept of the PersIn framework. This application of the PersIn framework was designed to enhance cultural responsiveness by increasing alignment between parent explanatory models and the presentation and delivery of PCIT. MY PCIT produced both statistically and clinically significant changes in pre-to post-treatment child outcomes and parent outcomes. Child behavior change outcomes were comparable to those reported by three benchmark studies, supporting the potential of this approach.
Assuntos
Transtornos do Comportamento Infantil , Relações Pais-Filho , Humanos , Criança , Projetos Piloto , Transtornos do Comportamento Infantil/terapia , Comportamento InfantilRESUMO
OBJECTIVE: To determine the feasibility of implementing a community-based, multi-family group intervention in a semi-rural population in Aranzazu, northern Caldas, Colombia. METHODS: Qualitative study. A convenience sample was taken of 10 families with children with affective and behavioural disorders, previously identified by the Child Behaviour Checklist (CBCL). The Multifamily Psychoeducational Psychotherapy (MF-PEP) model was adapted to the culture and needs of the families. RESULTS: The contents of the sessions and the topics and experiences that were most significant for the children and their families are described. CONCLUSIONS: The adaptation to the cultural context of the multi-family intervention had a very good acceptability by all participants: caregivers, children and therapists.
Assuntos
Sintomas Afetivos , Transtornos do Comportamento Infantil , Psicoterapia Múltipla , Adulto , Sintomas Afetivos/terapia , Criança , Transtornos do Comportamento Infantil/terapia , Colômbia , Família , Feminino , Humanos , População RuralRESUMO
BACKGROUND: There is a lack of effectiveness studies when digital parent training programs are implemented in real-world practice. The efficacy of the internet-based and telephone-assisted Finnish Strongest Families Smart Website (SFSW) parent training intervention on the disruptive behavior of 4-year-old children was studied in a randomized controlled trial setting in Southwest Finland between 2011 and 2013. After that, the intervention was implemented nationwide in child health clinics from 2015 onwards. OBJECTIVE: The main aim of this study was to compare the treatment characteristics and effectiveness of the SFSW parent training intervention between the families who received the intervention when it was implemented as a normal practice in child health clinics and the families who received the same intervention during the randomized controlled trial. METHODS: The implementation group comprised 600 families who were recruited in the SFSW intervention between January 2015 and May 2017 in real-world implementation. The RCT intervention group comprised 232 families who were recruited between October 2011 and November 2013. The same demographic and child and parent measures were collected from both study groups and were compared using linear mixed-effect models for repeated measurements. The child psychopathology and functioning level were measured using the Child Behavior Checklist (CBCL) version 1.5-5 for preschool children, the Inventory of Callous-Unemotional Traits (ICU), and a modified version of the Barkley Home Situations Questionnaire. Parenting skills were measured using the 31-item Parenting Scale and the shorter 21-item Depression, Anxiety and Stress Scale (DASS-21). The estimated child and parent outcomes were adjusted for CBCL externalizing scores at baseline, maternal education, duration of the behavior problems, and paternal age. The baseline measurements of each outcome were used as covariates. RESULTS: The implementation group was more likely to complete the intervention than the RCT intervention group (514/600, 85.7% vs 176/232, 75.9%, respectively; P<.001). There were no significant differences between the implementation and RCT intervention groups with regard to child measures, including CBCL externalizing score (-0.2, 95% CI -1.3 to 1.6; P=.83), total score (-0.7, 95% CI -3.0 to 4.5; P=.70), internalizing score (-0.3, 95% CI -1.0 to 1.6; P=.64), and ICU total score (-0.4, 95% Cl -1.9 to 1.2; P=.64). No significant difference was detected in the Parenting Scale total score (0.0, 95% Cl -0.1 to 0.1; P=.50), while DASS-21 total score differed nearly significantly (2.5, 95% Cl 0.0-5.1; P=.05), indicating better improvement in the implementation group. CONCLUSIONS: The internet-based and telephone-assisted SFSW parent training intervention was effectively implemented in real-world settings. These findings have implications for addressing the unmet needs of children with disruptive behavior problems. Our initiative could also provide a quick socially distanced solution for the considerable mental health impact of the COVID-19 pandemic. TRIAL REGISTRATION: ClinicalTrials.gov NCT01750996; https://clinicaltrials.gov/ct2/show/NCT01750996. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/1471-2458-13-985.