Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs.

BACKGROUND: The 'New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior ['Helping the Noncompliant Child' (HNC)] in young children with ADHD. METHODS: A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098). RESULTS: In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC. CONCLUSIONS: The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.

Child Hostility toward a Parent with a History of Depression and Family Functioning.

Family dysfunction has been associated with both child externalizing problems, including hostility, and parent depression or depressive symptoms. Research investigating child hostility directed toward a parent with a history of depression is absent, yet it may be associated with especially high levels of family dysfunction. The current study aimed to assess (1) the relation between observed child hostility, measured by the Iowa Family Interaction Rating Scale, toward such a parent and child-reported family dysfunction, using the Family Assessment Device, and (2) whether current parent depressive symptoms, measured by the Beck Depression Inventory-II, moderated this association. We hypothesized that child hostility would negatively relate to family functioning, even after controlling for parent depressive symptoms, and that parent depressive symptoms would moderate this association in that high levels of such symptoms would strengthen the negative relation between child hostility and family functioning. To address these hypotheses, hierarchical regression and moderation analyses were conducted in SPSS. Results indicated that higher levels of child hostility related to a more dysfunctional family environment. Furthermore, although speculative as the interaction of child hostility toward a parent and parent depressive symptoms only approached conventional levels of significance, low levels of both constructs may protect against family dysfunction. Findings from this study may inform new methods of family intervention and prevention, as well as ways of identifying families most at risk for dysfunction.

The Role of Emotion Regulation and Socialization in Behavioral Parent Training: A Proof-of-Concept Study.

Low-income families are less likely to effectively engage in Behavioral Parent Training (BPT), the standard of care for early-onset (3-8 years old) disruptive behavior disorders (DBDs); however, relatively little is known about predictors of treatment process and outcome within this vulnerable group. Given literature to suggest compromises associated with both low-income status and DBDs, this study examined the role of caregiver emotion regulation and socialization practices in 15 low-income families who participated in one evidence-based BPT program, Helping the Noncompliant Child (HNC). Findings suggest baseline caregiver emotion regulation predicted variability in BPT treatment duration and outcomes, whereas baseline caregiver emotion socialization practices explained variation in the severity of child disruptive behaviors concurrently, as well as BPT treatment outcomes. Furthermore, BPT yielded pre- to posttreatment effect sizes that were equivalent to or better than treatments designed to more explicitly target emotion regulation and socialization processes. Clinical implications and future directions are discussed.

Longitudinal retention of families in the assessment of a prevention program targeting adolescent alcohol and tobacco use: the utility of an ecological systems framework.

This study examined the association between ecological context (extrafamilial, familial, child factors) at baseline and longitudinal retention of families in the 36-month assessment of an adolescent alcohol and tobacco use prevention program that was conducted within a pediatric primary care setting. A total of 1,780 families were enrolled at baseline when the youth were in the fifth and sixth grades, and 1,220 of these families participated in the 36-month assessment. Findings indicated that familial and child, but not extrafamilial, factors were associated with the participation of families in the 36-month assessment. Clinical implications and future research directions are discussed.

Helping the Noncompliant Child: An Assessment of Program Costs and Cost-Effectiveness.

Disruptive behavior disorders (DBD) in children can lead to delinquency in adolescence and antisocial behavior in adulthood. Several evidence-based behavioral parent training (BPT) programs have been created to treat early onset DBD. This paper focuses on one such program, Helping the Noncompliant Child (HNC), and provides detailed cost estimates from a recently completed pilot study for the HNC program. The study also assesses the average cost-effectiveness of the HNC program by combining program cost estimates with data on improvements in child participants' disruptive behavior. The cost and effectiveness estimates are based on implementation of HNC with low-income families. Investigators developed a Microsoft Excel-based costing instrument to collect data from therapists on their time spent delivering the HNC program. The instrument was designed using an activity-based costing approach, where each therapist reported program time by family, by date, and for each skill that the family was working to master. Combining labor and non-labor costs, it is estimated that delivering the HNC program costs an average of $501 per family from a payer perspective. It also costs an average of $13 to improve the Eyberg Child Behavior Inventory intensity score by 1 point for children whose families participated in the HNC pilot program. The cost of delivering the HNC program appears to compare favorably with the costs of similar BPT programs. These cost estimates are the first to be collected systematically and prospectively for HNC. Program managers may use these estimates to plan for the resources needed to fully implement HNC.

Predictors of outcome of a parenting group curriculum: a pilot study.

One pressing issue facing parenting interventions for disruptive behaviors of young children is forecasting who will benefit from participation. The purpose of this study was to examine four personal and interpersonal predictors (i.e., parent depressive symptoms, parent education, coparent conflict, and marital status) of engagement (i.e., number of sessions attended) in and child outcome (i.e., problematic behavior) of a parenting group curriculum program targeting young children's disruptive behaviors. Participants were 39 parents (34 mothers and 5 fathers; M = 38.6 years) who expressed an interest in improving the behavior of their 3- to 6-year-old child (19 females and 20 males; M = 4.50 years). Findings indicated that one baseline personal variable, parent depressive symptoms, predicted change in child disruptive behavior at follow-up, and two baseline interpersonal variables, marital status and coparent conflict, predicted engagement in treatment (i.e., number of sessions attended). Implications and directions for future research are discussed.

An examination of a Group Curriculum for parents of young children with disruptive behavior.

This study examined effectiveness of a Group Curriculum (GC) for parents of 3- to 6- year-old children with disruptive behavior. The curriculum is based on the book Parenting the Strong-Willed Child. A total of 39 parents were randomly assigned to the GC condition or a wait-list control condition. Assessments occurred at baseline, postintervention (6 weeks after baseline), and 2-month follow-up. Findings indicated that the GC condition was associated with lower levels of child problem behavior and improved parenting at postintervention relative to the control condition. Parents were also satisfied with the intervention. Uncontrolled 2-month follow-up data suggested that changes were maintained from postintervention to follow-up for all outcome measures.

An examination of parenting the strong-willed child as bibliotherapy for parents.

This study examined the Parenting the Strong-Willed Child (PSWC) book as a self-directed program for parents of 3- to 6-year-olds. Fifty-two parents were randomly assigned to PSWC or a comparison book, Touchpoints: Three to Six. Assessments occurred at baseline, postintervention (6 weeks after baseline), and 2-month follow-up. The findings indicated both books, but particularly PSWC, were associated with lower levels of child problem behavior after intervention. PSWC was associated with greater decreases in child problem behaviors on certain measures when amount of reading completed was taken into account. Parents reading PSWC reported that they were satisfied with the book and found the book useful and easy to implement. The findings are discussed in the contexts of both the percentage of parents who read the PSWC book and the cost-effectiveness of a self-directed intervention.

The relation of maternal sensitivity to children's internalizing and externalizing problems within the context of maternal depressive symptoms.

Maternal depression has been linked to deficits in parenting that contribute to youth's development of externalizing and/or internalizing problems. Maternal sensitivity has been implicated within the infant literature as a foundational aspect of parenting contributing to a child's adjustment. This study examines the main and moderating effects of a construct labeled maternal sensitivity, within the context of depressive symptoms, on youth externalizing and internalizing problems in a sample of 65 mothers with a history of depression and their 84 children ages 9-15 years. Sensitivity was related to child externalizing problems. Although two-way interactions were not significant, exploratory moderation analyses indicated a significant three-way interaction among maternal depressive symptoms, maternal sensitivity, and youth gender for internalizing problems: among girls only, high depressive symptoms, low sensitivity, and the combination of these two variables were each associated with high levels of internalizing problems.

Urban-rural differences in motivation to control prejudice toward people with HIV/AIDS: the impact of perceived identifiability in the community.

CONTEXT: HIV/AIDS is occurring with increasing frequency in rural areas of the United States, and people living with HIV/AIDS in rural communities report higher levels of perceived stigma than their more urban counterparts. The extent to which stigmatized individuals perceive stigma could be influenced, in part, by prevailing community attitudes. Differences between rural and more metropolitan community members' attitudes toward people with HIV/AIDS, however, have rarely been examined. PURPOSE: This study investigated motivation to control prejudice toward people with HIV/AIDS among non-infected residents of metropolitan, micropolitan, and rural areas of rural New England. METHODS: A total of 2,444 individuals were identified through a random digit dialing sampling scheme, and completed a telephone interview to determine attitudes and concerns about a variety of health issues. Internal or external motivation to control prejudice was examined using a general linear mixed model approach, with independent variables including age, gender, community size, and perceived indentifiability within one's community. FINDINGS: Results showed that community size, by itself, was not related to motivation to control prejudice. However, there was a significant interaction between community size and community residents' perceptions about the extent to which people in their communities know who they are. CONCLUSION: Our results indicate that residents of rural areas, in general, may not show a higher level of bias toward people with HIV/AIDS. The interaction between community size and perceived identifiability, however, suggests that motivation to control prejudice, and potentially the subsequent expression of that prejudice, is more complex than originally thought.