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Randomised controlled trial of a parenting intervention in the voluntary sector for reducing child conduct problems: outcomes and mechanisms of change.

BACKGROUND: To test effectiveness of a parenting intervention, delivered in a community-based voluntary-sector organisation, for reducing conduct problems in clinically-referred children. METHODS: Randomised controlled trial, follow-up at 6, 18 months, assessors blind to treatment status. Participants--76 children referred for conduct problems, aged 2-9, primarily low-income families, randomised to treatment vs. 6-month wait-list group. Retention was 93% at 6 months, 90% at 18 months. Interventions--Webster-Stratton Incredible Years video-based 14-week group programme, teaches cognitive-behavioural principles for managing behaviour, using a collaborative, practical, problem-solving approach. Primary outcomes--child problem behaviour by parent-report (Eyberg) and home-based direct observation; secondary outcomes--observed positive and negative parenting; parent-reported parenting skill, confidence and depression. RESULTS: Post-treatment improvements were found in child problem behaviour, by parent-report (effect size (ES) .48, p = .05) and direct observation (ES .78, p = .02); child independent play (ES .77, p = .003); observed negative (ES .74, p = .003) and positive (ES .38, p = .04) parenting; parent-reported confidence (ES .40, p = .03) and skill (ES .65, p =.01), using ANCOVA to control for baseline scores. Maternal depression did not change. Consumer satisfaction was high. At 18-month follow-up, although no randomised comparison was possible, changes appeared to maintain, with no significant change toward baseline level on any measure. Change in observed positive parenting appeared to mediate change in child problem behaviour (p < .025). CONCLUSIONS: Findings suggest that a group-based cognitive-behavioural parenting programme, delivered by well-trained and supervised staff, can be effective in a community voluntary-sector setting, for reducing conduct problems and enhancing parenting skills. Change in parenting skill appears to be a key mechanism for change in child behaviour. Findings have implications for feasibility of translating evidence-based programmes, even for clinically-referred conduct problems, into less specialised community settings, likely to have lower costs and be more accessible for families.

Child↗

Soft signs.

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Attention Deficit Disorder with Hyperactivity↗

Perinatal risk factors and minor neurological dysfunction: significance for behaviour and school achievement at nine years.

A prospective study was carried out on 133 neurologically deviant infants, 205 with mild abnormalities and 230 normal newborns to compare behavioural and cognitive development with neonatal and nine-year-old neurological condition. Overtly handicapped children were excluded. Major determinants of school failure were the severity of minor neurological dysfunction (MND) and social class. Main risk factors for distractable and clumsy behaviour were MND classification and male sex; for troublesome behaviour male sex and interval complications after two years of age; and for timid behaviour, family adversity. Definite neonatal neurological deviancy contributed both directly and by its association with MND to problems in behaviour and scholastic abilities. Mild neonatal neurological abnormalities and adverse obstetrical events contributed only indirectly to behavioural and learning problems. Preterm birth (less than 34 weeks) was the sole obstetric variable directly related to some of the outcome variables. The difference between home and school perception of the children's behaviour is emphasized.

Achievement↗

Children with preschool minor neurodevelopmental disorders. IV: Behaviour and school achievement at age 13.

A cohort of children with deficits in attention, motor control and perception at seven years, drawn from a total population sample of such children in Göteborg, Sweden, was compared at 13 years with a group of normal children with regard to behaviour and school achievement. The index group showed persisting high rates of severe behavioural problems, as judged by teachers', parents' and self-rating questionnaires. None had been treated with stimulants or other drugs to reduce the symptoms of their neurodevelopmental disorders. It seems that these children's problems were slightly less in the early teen years than they were at 10 years, but the rates were still much in excess of those in the comparison group.

Achievement↗

Minor neurological dysfunction from birth to 12 years. I: Increase during late school-age.

To study the hypothesis that the frequency of minor neurological dysfunction (MND) stabilizes around the age of nine years, two groups of the Groningen Perinatal Project (GPP) were re-examined at 12 years. The study group (N = 174) was selected on the basis of the presence of MND at nine years; the control group comprised 172 neurologically normal children. The hypothesis was rejected: extrapolation of the findings to the total GPP population showed that the over-all rate of MND increased. Control children who developed MND were mainly boys who had been neurologically abnormal at birth or were born preterm and/or had experienced an adversity in combination with asphyxia. Interval complications between nine and 12 years were related to the emergence of MND.

Attention Deficit Disorder with Hyperactivity↗

Minor neurological dysfunction from birth to 12 years. II: Puberty is related to decreased dysfunction.

To determine whether puberty is related to decreased minor neurological dysfunction (MND), 174 children from the Groningen Perinatal Project who had had MND at nine years were re-examined at 12 years. No signs of MND could be demonstrated in 39 of the children, 33 of whom showed at least three signs of puberty. The presence of minor physical anomalies was associated with persisting MND. The authors hypothesise that puberty is related to a decrease in MND, and discuss the role of hormonal changes in relation to the decrease in minor signs. Re-examination at 14 years will be necessary to confirm this hypothesis, since 68 per cent of the children had not yet reached puberty. Children with MND reached puberty no later than those without.

Adolescent↗

Prediction of behavior management problems in children.

The aim of the present investigation was to study non-dental and dental background variables with a view to estimating their influence on behavior management problems by means of a structured interview and analyzing their separate and combined predictive power. The material consisted of a case group, 101 children aged 3-16 yr, referred for management problems to clinics of specialized pedodontics, and a control group, individually matched with the cases as regards age, sex, residential area, number of tooth surfaces restored, and dentist. The children or their parents were interviewed concerning background variables. Logistic regression was used for the analyses. Three non-dental variables turned out to be statistically significant as predictors (P less than 0.05): problems on visiting a medical doctor, dental fear in the mother or father, and anxiety when meeting unfamiliar people. Management problems might be expected if one of these attributes is found. Four dental variables had significant predictive power: earlier problems on seeing a dentist, dislike of the dentist, not enough time to adjust to the dental situation, and fear of injection. However, none of these dental variables was found to have predictive power in 3-6-yr-olds, and none of them improved the predictive power of the three main non-dental variables.

Adolescent↗

Feeding problems in young PKU children.

Behavioural feeding problems were found to be more prevalent in a group of 15 PKU children aged 1-5 years when compared to non-PKU controls. The parents of PKU children identified poorer apatites (p < 0.01), a more limited range of foods consumed (p < 0.03) and more gastrointestinal symptoms such as vomiting and constipation (p < 0.03) than control children. The children were slower to feed (p < 0.03), were more likely to dislike sweet foods and some ate separately from the rest of the family at mealtime (p < 0.03). The effects on normal feeding behaviour should be considered when advocating strict diet therapy for young PKU children.

Case-Control Studies↗

Medical factors in hyperactive and normal children: prenatal, developmental, and health history findings.

Guided by the goal of documenting the natural course of the life histories of a large sample of hyperactive children and their control counterparts, this research reports the extent to which prenatal, developmental, and health history factors distinguish hyperactive and control groups, as well as the relative contributions of the various medical factors. Results indicate that prenatal factors, rather than those occurring later in the child's medical history, are the best predictors of subsequent hyperactive diagnosis.

Attention Deficit Disorder with Hyperactivity↗

The boundaries of attention deficit disorder.

This report examines distinctions and interrelationships among attention deficit disorder (ADD) and two closely related conditions: learning disability (LD) and oppositional/conduct (O/C) disorder. To evaluate our hypothesis that some of the difficulty in resolving the relationship between ADD and, particularly, O/C may reflect the consequences of selective referral patterns, we studied groups of children diagnosed as ADD from different referral sources. Results suggest that referral bias does exist and that children referred to mental health settings differ from those referred to pediatricians, child neurologists, or psychologists. Because of the nature of the subjects referred to mental health services, nonrepresentative associations may emerge. Rather than being considered as prototypical of all children with attention disorder, children referred to mental health facilities may represent simply an extreme of the continuum of ADD. Evidence suggests that many children with ADD will be represented by those referred primarily for attentional deficits and learning problems, rather than those with inattention, hyperactivity, or aggression referred for child psychiatric evaluation.

Adolescent↗

Behavioral treatment of child abuse. A developmental perspective.

This article reviews cognitive and behavioral treatment strategies that have been employed with parents who physically abuse their children. Using a developmental framework, a broadened view of abuse is presented that emphasizes targets for intervention that not only reduce aversive parental behavior but also increase behaviors that lead to more optimal child outcome. Interventions with maltreaters are then described, focusing on three periods of childhood--infancy, middle childhood, and adolescence. An argument is made for there being different goal parental behaviors during each of these periods, as well as unique child-based demands that act as obstacles to parents' successfully meeting these goals. Where behavioral treatments with abusive parents do not yet exist, treatments with similar parent populations are described. The article concludes with a discussion of the treatment issues facing the field in the future.

Adolescent↗

Errorless compliance training, Optimizing clinical efficacy.

Errorless compliance training (e.g., Ducharme & Popynick, 1993; Ducharme, pontes et al, 1994) is a recently evaluated, nonintrusive approach to teaching children to cooperate with the requests of their parents. In this article, I describe the errorless approach and discuss the potential benefits of this technique. A detailed description of procedures that can be used to enhance clinical effectiveness and efficiency under various conditions and with a broad range of clinical populations is also provided.

Behavior Therapy↗