Parent training in non-violent resistance for children with attention deficit hyperactivity disorder: a controlled outcome study.

Current forms of parent training for childhood attention deficit hyperactivity disorder (ADHD) are often insufficient. Many families drop out of the training, and treatment gains are often not maintained. Nonviolent resistance parent training (NVR) focuses on helping parents resist the child's negative behaviors without escalating the problem. NVR helps parents to fulfill an anchoring function, supporting the child through presence, self-regulation, structure, and support network. This study is a randomized controlled trial designed to assess the efficacy of NVR in the treatment of childhood ADHD. Participants were Israeli parents of children with primary ADHD diagnosis (N = 101; 5-13 years old; 79% male participants) randomly assigned to either 12-session NVR (N = 50) or waiting list (N = 51). Measures were administered before and after treatment and at a 4-month follow-up. ADHD outcomes included the Conners and Child Behavior Checklist. Parenting outcomes included parental helplessness, emotional regulation, anchoring function, and family chaos. Participants in the NVR condition reported significant improvements in the child's internalizing, externalizing, and ADHD symptoms, as well as improvement in paternal and maternal helplessness and anchoring. Participants in the control condition did not report changes in the child's symptoms or the parents' condition. The results at follow-up revealed maintenance of change in the child's externalizing and internalizing symptoms, but failure to maintain gains in ADHD core symptoms. Maternal helplessness and anchoring, as well as family chaos continued to improve at follow-up. Dropout rates in the treatment group were low (5%), and fathers' engagement was close to 100%. NVR is an efficient treatment for childhood ADHD, with benefits extending beyond the child's symptoms to the entire family. NVR's special focus on parental distress may have contributed to low dropout, high paternal engagement, and maintenance of change.

Non-violent resistance and family accommodation: A trans-diagnostic solution to a highly prevalent problem.

The goal of this study is to integrate two areas in recent clinical theory, research, and practice: family accommodation and non-violent resistance (NVR). Family accommodation describes changes that family members make to their own behavior, to help their relative who is dealing with psychopathology to avoid or alleviate distress related to the disorder. Rapidly growing research on family accommodation has established its high prevalence and negative impact across disorders and the life span. NVR is a trans-diagnostic treatment approach that helps parents to cope with child externalizing, internalizing, and other problems in non-escalatory ways. This study reviews empirical research on family accommodation and NVR, and argues that the anchoring function of NVR, a central concept reflecting the stabilization of the parent-child relationship, may provide a uniquely suited framework for reducing family accommodation across disorders and development. The study discusses how the anchoring function may be applied to promote accommodation reduction through a detailed description of SPACE (Supportive Parenting for Anxious Childhood Emotions), an NVR-informed treatment for childhood anxiety and obsessive-compulsive disorder.

El objetivo de este artículo es integrar dos áreas en la teoría, la investigación y la práctica clínicas recientes: la adaptación familiar y la resistencia no violenta. La adaptación familiar describe cambios que hacen los miembros de la familia a su propia conducta para ayudar a su familiar que está enfrentando una psicopatología a fin de evitar o aliviar el distrés relacionado con el trastorno. Las investigaciones cada vez más frecuentes sobre adaptación familiar han establecido su alta prevalencia y su efecto negativo en distintos trastornos y en la expectativa de vida. La resistencia no violenta es un método de tratamiento transdiagnóstico que ayuda a los padres a afrontar los problemas de exteriorización y de interiorización de los niños y también otros problemas de maneras no intensificadoras. En este artículo se analiza la investigación empírica sobre adaptación familiar y resistencia no violenta, y se argumenta que la función de anclaje de la resistencia no violenta, un concepto fundamental que refleja la estabilización de la relación entre padres e hijos, puede proporcionar un marco particularmente adecuado para reducir la adaptación familiar entre diferentes trastornos y el desarrollo. En este artículo se debate cómo puede aplicarse la función de anclaje para promover la reducción de la adaptación mediante una descripción detallada de SPACE (siglas en inglés de crianza con apoyo para emociones ansiosas de la infancia), un tratamiento fundamentado por la resistencia no violenta para la ansiedad en la infancia y el trastorno obsesivo-compulsivo.

Effects of parental vigilant care and feedback on novice driver risk.

Vigilant care aims at reducing adolescent risk behaviors while matching parental involvement to the level of alarm signs. This study examined the effect of parent training in vigilant care and technological feedback on driving risk of novice male drivers. A sample of 217 Israeli families was divided into four conditions: a) no-feedback, b) individual feedback, c) family feedback, and d) family feedback plus parent training in vigilant care. Feedback and risk assessment were conducted through in-vehicle data recorders. A significant difference was found in favor of the vigilant care group compared to the no feedback group. When only the drivers in the high risk percentiles were considered, the vigilant care group was found superior to the family feedback group. The findings suggest that parental training in vigilant care may help reduce driving risk.

Helping Parents Cope with Suicide Threats: An Approach Based on Nonviolent Resistance.

Parent training in nonviolent resistance was adapted to deal with situations of suicide threat by children, adolescents, and young adults. The approach aims at reducing the risk potential and the mutual distress surrounding the threat-interaction. Parent training in nonviolent resistance has been shown to help parents move from helplessness to presence, from isolation to connectedness, from submission to resistance, from escalation to self-control, and from mutual distancing and hostility to care and support. Those emphases can be crucial for the diminution of suicide risk. Parents show good ability to implement the approach and report gains on various areas over and beyond the reduction in suicide threat. A particular advantage is that the method can be used also in cases where the young person threatening suicide is not willing to cooperate.

The anchoring function: parental authority and the parent-child bond.

Descriptions of parental authority and of the formation of a secure parent-child bond have remained unconnected in conceptualizations about parenting and child development. The parental anchoring function is here presented as an integrative metaphor for the two fields. Parents who fulfill an anchoring function offer a secure relational frame for the child, while also manifesting a stabilizing and legitimate kind of authority. The anchoring function enriches the two fields by: (1) adding a dimension of authority to the acknowledged functions of the safe haven and the secure base that are seen as core to a secure parent-child bond, and (2) adding considerations about the parent-child bond to Baumrind's classical description of authoritative parenting.

Non-violent resistance parental training versus treatment as usual for children and adolescents with severe tyrannical behavior: a randomized controlled trial.

Objective: This single-blinded, randomized, parallel group superiority trial evaluates whether the Non-Violent Resistance (NVR) program, a 10-session parental-group intervention, was more effective in reducing stress in parents of children aged 6-20 years and displaying severe tyrannical behavior (STB) compared to a treatment as usual (TAU) intervention that provided supportive counseling and psychoeducation. Methods: Eighty two parents of youth aged 6-20 years with STB were enrolled by the Child and Adolescent Psychiatry Department at the University Hospital of Montpellier (France). A random block and stratified by age (6-12 and 13-20 years) randomization, was performed. All participants were interviewed by independent, blinded to group assignments, research assistants, and completed their assessments at baseline and treatment completion (4 months from baseline). Since this program has not been previously evaluated in this population, the study primarily evaluated the efficacy, using the Parenting Stress Index/Short Form (PSI-SF). The primary outcome was the change from baseline to treatment completion of the PSI-SF total score. Results: Seventy three participants completed the study and were available for analysis (36 NVR and 37 TAU). At completion, between-groups comparison of the change (completion minus baseline) in the total score of PSI-SF was not significant (NVR: -4.3 (± 13.9); TAU: -7.6 (± 19.6); two-sample t-test p = 0.43; effect size of -0.19 [-0.67, 0.28]). Conclusion: Contrary to our expectation, NVR was not superior to TAU in reducing parental stress at completion for parents of children with STB. However, NVR showed positive outcomes in the follow-up, pointing to the importance to implement parental strategies and following this population over longer time periods in future projects.Clinical trial registration: Clinicaltrials.gov, identifier NCT05567276.

Parent training in nonviolent resistance for adult entitled dependence.

"Adult entitled dependence" is a condition characterized by the extreme dependence of grown children on their family and by levels of dysfunction, seemingly excessive in light of their apparent capacity to function. The family and the dependent adult become involved in an interaction in which the very attempts to alleviate the problem may aggravate it. Parent-training in nonviolent resistance (NVR) is an intervention that has been shown to be helpful to parents of behaviorally disturbed youth. Parent training in NVR offers parents means to shift away from a stance of helplessness toward realistic goals that are accomplishable without the collaboration of their offspring. We report on the parents of 27 entitled dependent grown children who participated in parent training in NVR. Additionally, we present 2 detailed case studies that exemplify the problem and the therapeutic process. Before treatment, the dependent adults were not working or studying, drew heavily on parental services (financial or otherwise), and were resistant to parental attempts to change the situation. Most parents succeeded in overcoming their helplessness and reducing the provision of parental services. In a considerable proportion of cases, the grown children started working or studying or moved to independent lodgings.

Coercive and disruptive behaviors in pediatric obsessive-compulsive disorder.

BACKGROUND: This study explored the nature of disruptive and coercive behaviors in pediatric obsessive-compulsive disorder (OCD). METHOD: Thirty children with OCD and a disruptive behavior disorder (DBD) were compared to 30 children with DBD alone using the Child Behavior Checklist and a novel 18-item questionnaire focused on distinctive coercive and disruptive behaviors seen in pediatric OCD (CD-POC). RESULTS: Although youth with DBD alone had higher ratings of Externalizing Behaviors on the CBCL compared to the youth with OCD + DBD, their ratings on the CB-POC scale were lower. For example, 83% of OCD + DBD parents reported that their child "Imposes rules or behaviors on others due to tactile or other sensitivity and reacts to disobedience with rage or violence (e.g. forbids certain sounds, demands specific temperature settings)" compared to 23% of the parents of youth with DBD alone. Other highly discriminating behaviors included: "Demands special 'cuddling' or ritualized contact without regard for the will of others" and "Forbids the use of objects in his/her vicinity because of feelings of fear or disgust (e.g. knives, scissors, creams)." Total scores on the CD-POC were also correlated with OCD severity (P<.01). CONCLUSION: The results suggest that the nature of DBD in pediatric OCD may be distinctive and worthy of further study.

Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions.

STUDY OBJECTIVES: This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors. METHODS: Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale. RESULTS: Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions. CONCLUSIONS: Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care. CLINICAL TRIAL REGISTRATION: Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://clinicaltrials.gov/ct2/show/NCT01489215;Identifier: NCT01489215.

Nonviolent resistance: a treatment for parents of children with acute behavior problems.

Nonviolent resistance (NVR) is a new training model aimed at helping parents deal effectively with their helplessness, isolation, and escalatory interactions with their children. The purpose of this study is to evaluate training in NVR with the parents of children with acute behavior problems. Seventy-three parents (41 families) were randomly assigned to a treatment group and wait-list control group. Measures were taken at pretreatment, posttreatment, and a 1-month follow-up. In comparison with the wait-list group, parents who received training in NVR showed a decrease in parental helplessness and escalatory behaviors, and an increase in perceived social support. The children's negative behaviors as assessed by the parents also decreased significantly.

Vigilant care: An integrative reformulation regarding parental monitoring.

Parental monitoring was once considered to be the approved way for preventing risk behaviors by children and adolescents. In the last years, however, the concept has been the target of cogent criticism questioning the interpretation of findings which support the traditional view of monitoring. After reviewing the various criticisms and the resulting fragmentation of theory and practice, we propose the model of vigilant care as an integrative solution. Vigilant care is a flexible framework within which parents adjust their level of involvement to the warning signals they detect. By justifying moves to higher levels of vigilance with safety considerations and expressing their duty to do so in a decided but noncontrolling manner, parents legitimize their increased involvement both to the child and to themselves. The model offers a unified solution to the ongoing controversy and generates theoretical hypotheses as well as a practice-oriented research program.

Nonviolent Resistance: Helping Caregivers Reduce Problematic Behaviors in Children and Adolescents.

In this review, the principles of nonviolent resistance (NVR) and studies examining its acceptability and efficacy are reviewed. Originating in the sociopolitical field, NVR has been adapted for numerous settings including parents of youth with externalizing and other problems, foster parents, teachers and school personnel, and caregivers of psychiatric inpatients. NVR has also been applied to reduce accommodation of highly dependent adult children and to improve novice driving habits. The principles of NVR include refraining from violence, reducing escalation, utilizing outside support, and maintaining respect for the other.

Adaptation and Evaluation of a Nonviolent Resistance Intervention for Foster Parents: A Progress Report.

Foster care faces serious challenges, such as behavioral problems in foster children and parental stress and ineffective parenting behavior in foster parents. The results of a pilot study that evaluated a training program for foster parents based on nonviolent resistance are described. In a pretest-posttest design, data were collected from 25 families. Significant reductions in externalizing, internalizing, and total problem behavior in the foster children and in parenting stress were found. Using a reliable change index, significant improvements in externalizing, internalizing, and total problem behavior were found in, respectively, 72, 44, and 80% of the cases. Most improvements proved to be clinically relevant. Effect sizes ranged from medium to large for problem behavior, and from small to medium for parenting stress.

Can providing feedback on driving behavior and training on parental vigilant care affect male teen drivers and their parents?

This study focuses on investigating the driving behavior of young novice male drivers during the first year of driving (three months of accompanied driving and the following nine months of solo driving). The study's objective is to examine the potential of various feedback forms on driving to affect young drivers' behavior and to mitigate the transition from accompanied to solo driving. The study examines also the utility of providing parents with guidance on how to exercise vigilant care regarding their teens' driving. Driving behavior was evaluated using data collected by In-Vehicle Data Recorders (IVDR), which document events of extreme g-forces measured in the vehicles. IVDR systems were installed in 242 cars of the families of young male drivers, however, only 217 families of young drivers aged 17-22 (M=17.5; SD=0.8) completed the one year period. The families were randomly allocated into 4 groups: (1) Family feedback: In which all the members of the family were exposed to feedback on their own driving and on that of the other family members; (2) Parental training: in which in addition to the family feedback, parents received personal guidance on ways to enhance vigilant care regarding their sons' driving; (3) Individual feedback: In which family members received feedback only on their own driving behavior (and were not exposed to the data on other family members); (4) CONTROL: Group that received no feedback at all. The feedback was provided to the different groups starting from the solo period, thus, the feedback was not provided during the supervised period. The data collected by the IVDRs was first analyzed using analysis of variance in order to compare the groups with respect to their monthly event rates. Events' rates are defined as the number of events in a trip divided by its duration. This was followed by the development and estimation of random effect negative binomial models that explain the monthly event rates of young drivers and their parents. The study showed that: (1) the Parental training group recorded significantly lower events rates (-29%) compared to the CONTROL group during the solo period; (2) although directed mainly at the novice drivers, the intervention positively affected also the behavior of parents, with both fathers and mothers in the Parental training group improving their driving (by -23% for both fathers and mothers) and mothers improving it also in the Family feedback group (by -30%). Thus, the intervention has broader impact effect beside the targeted population. It can be concluded that providing feedback on driving behavior and parental training in vigilant care significantly improves the driving behavior of young novice male drivers. Future research directions could include applying the intervention to a broader population, with larger diversity with respect to their driving records, culture, and behaviors. The challenge is to reach wide dissemination of IVDR for young drivers accompanied by parents' involvement, and to find the suitable incentives for its sustainability.

Coercive and disruptive behaviors in pediatric obsessive compulsive disorder: a qualitative analysis.

OCD is a common disorder in children and adolescents. Disruptive or coercive behaviors among children with OCD have not been a focus of much research until recently. Family accommodation of OCD is strongly related to symptom severity, level of impairment, and treatment outcomes. The possibility of family accommodation being forcefully imposed on family members against their will has not been investigated systematically, although clinical experience points to the existence of such situations. The present study represents an early, qualitative exploration of such situations. The parents of 10 children and adolescents with OCD, who reported the existence of violent or disruptive behavior on the part of the child, were interviewed and their narratives analyzed using grounded theory methodology. Findings from the interviews point to the existence of a pattern of coercive behaviors in which rules and prohibitions, driven by the child's OCD, are aggressively imposed on parents and siblings. The emergent themes are analyzed in relation to obsessive compulsive symptom dimensions and in relation to the means and goals they represent for the obsessive compulsive children.