1
|
Johnson CR, Barto L, Worley S, Rothstein R, Wenzell ML. Follow-up of telehealth parent training for sleep disturbances in young children with autism spectrum disorder. Sleep Med 2024; 119:114-117. [PMID: 38669834 DOI: 10.1016/j.sleep.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE/BACKGROUND Bedtime and sleep disturbances are ubiquitous in children with autism. The telehealth delivery of a behavior analytic parent training program was earlier reported to be efficacious in improving child sleep and parent sense of competency. Our aim in this brief report was to determine the durability of the telehealth delivered sleep parent training program (SPT) compared to the control condition in this randomized controlled trial. Telehealth delivery could be a means to expand access to such early treatment if efficacious. PARTICIPANTS/METHODS Parents of young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session Sleep Parent Education; SPE). Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures were collected at weeks 5 and 10 and at post-treatment follow-up at 16 weeks. RESULTS Follow-up week 16 data were available for 30 participants randomized to SPT and 24 participants randomized to SPE. Demographics for this follow-up cohort were similar to the full sample. At week 16 follow-up, there was a significant group difference between SPT and SPE the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p = 0.011) with an effect size of 0.68. Further, 8 of the 10 children in SPT who were negative responders at the week 10 endpoint were rated as positive responders at week 16 by the treatment masked IE compared to 2 out of 12 in the SPE group (p = 0.008). CONCLUSIONS Post-treatment follow-up data suggests SPT is durable over time compared to SPE, the active control group. Further, for some participants in SPT, a positive responsive emerged after the treatment endpoint. This brief report adds to the efficacy of SPT as a time-limited intervention for insomnia in young autistic children.
Collapse
|
2
|
Treier AK, Hautmann C, Dose C, Nordmann L, Katzmann J, Pinior J, Scholz KK, Döpfner M. Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior. Child Psychiatry Hum Dev 2024; 55:453-466. [PMID: 36064990 PMCID: PMC9444695 DOI: 10.1007/s10578-022-01400-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/03/2022]
Abstract
The study examined potential mediating effects of therapist behaviors in the per-protocol sample (n = 108) of a randomized controlled trial comparing a behavioral and a nondirective guided self-help intervention for parents of children with externalizing disorders (4-11 years). Additionally, from an exploratory perspective, we analyzed a sequential model with parental adherence as second mediator following therapist behavior. Outcomes were child symptom severity of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder rated by blinded clinicians, and parent-rated child functional impairment. We found a significant indirect effect on the reduction of ADHD and functional impairment through emotion- and relationship-focused therapist behavior in the nondirective intervention. Additionally, we found limited support for an extended sequential mediation effect through therapist behavior and parental adherence in the models for these outcomes. The study proposes potential mediating mechanisms unique to the nondirective intervention and complements previous findings on mediator processes in favor of the behavioral group. Trial registration ClinicalTrials.gov NCT01350986.
Collapse
Affiliation(s)
- Anne-Katrin Treier
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany.
| | - Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Nordmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Josepha Katzmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Julia Pinior
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Kristin Katharina Scholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
- School for Child and Adolescent Cognitive Behavior Therapy (AKiP), Medical Faculty, University of Cologne, Cologne, Germany
| |
Collapse
|
3
|
Pham T, Pasalich D, Tran P, O'Kearney R. A randomized controlled trial of therapist-facilitated brief online behavioral parent training for reducing child disruptive behavior. Int J Clin Health Psychol 2024; 24:100448. [PMID: 38371397 PMCID: PMC10869913 DOI: 10.1016/j.ijchp.2024.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Background Addressing child disruptive behavior in low and middle-income countries (LMICs) is challenging. Therapist-facilitated, multisession, brief, online group parent training offers hope for mitigating this issue. However, trials, particularly in Asia, are limited. Objective This study primarily assessed the effectiveness of Brief Behavior Parent Training Vietnam (BBPTV) in reducing child disruptive behavior. Method This study was a randomized controlled trial involving 109 Vietnamese parents (mean age = 34.1, 96 % were mothers) of preschool children displaying ongoing disruptive behaviors. Interventions included the BBPTV group (n = 56) receiving a therapist-facilitated, four-session program conducted through online group meetings and the care-as-usual (CAU) group (n = 53) having a 15 min individual online consultation. Primary outcomes, assessed online at two and six months postintervention, encompassed the intensity and frequency of children's disruptive problems. Secondary outcomes involved parenting practices, coercive interactions, marital conflicts, parenting self-efficacy, and parental mental health. Results In contrast to CAU, the BBPTV group showed lower child disruptive intensity, reduced parent-child coercive interactions, and diminished marital conflicts, with a higher score in involving parenting two months post-intervention. Six months postintervention, BBPTV also exhibited significantly lower scores in child disruptive intensity and problems, harsh parenting, and coercive processes compared to CAU. Conclusions The therapist-facilitated, four-session, internet-delivered group parent intervention resulted in superior and sustained improvements in child disruptive behavior, parenting practices, and parent-child coercive interaction compared to usual care, highlighting the potential for online BBPT to extend mental health care in Vietnam and other LMICs.
Collapse
Affiliation(s)
- Triet Pham
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
- Children's Hospital 1 (Benh vien Nhi dong 1), 341 Su Van Hanh street, District 10, Ho Chi Minh City, Viet Nam
| | - Dave Pasalich
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
| | - Phu Tran
- Children's Hospital 1 (Benh vien Nhi dong 1), 341 Su Van Hanh street, District 10, Ho Chi Minh City, Viet Nam
| | - Richard O'Kearney
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
| |
Collapse
|
4
|
Shkel J, Geng A, Pilchak E, Millan ME, Schwartzman JM, Schuck R, Bundang MV, Barnowski A, Slap DM, Stratford S, Hardan AY, Phillips JM, Gengoux GW. A Pilot Randomized Controlled Trial of Motivation-Based Social Skills Group Treatment with Parent Training. J Autism Dev Disord 2024:10.1007/s10803-024-06302-9. [PMID: 38446265 DOI: 10.1007/s10803-024-06302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
Despite the popularity of social skills groups, there remains a need for empirical investigation of treatment effects, especially when targeting pivotal aspects of social functioning such as initiations to peers. The goal of the present study was to conduct a randomized controlled trial of a 12-week social intervention (SUCCESS), which combined an inclusive social group with a parent education program. Twenty-five 4- to 6-year-olds with Autism Spectrum Disorder (ASD) were randomized to SUCCESS (N = 11) or to treatment as usual (N = 14). Combining a peer group model with a parent training program, the SUCCESS intervention used naturalistic behavioral techniques (e.g., environmental arrangement, natural reinforcement) to increase social initiations to peers. After 12 weeks, children participating in the SUCCESS program made more frequent initiations to peers than children in the treatment-as-usual group, including more prompted and unprompted initiations to request. Additional gains in clinician-rated social functioning were observed in children randomized to SUCCESS, while differential treatment effects were not detected in parent-rated measures. However, lower baseline social motivation was associated with greater parent-reported initiation improvement. This study provides preliminary support for the efficacy of a naturalistic, behavioral social skills intervention to improve peer initiations for children with ASD. The findings suggest that using a motivation-based social skills group was effective in increasing both prompted and spontaneous initiations to peers, and highlights the need for further research into the role of baseline social motivation in predicting social skills treatment response.
Collapse
Affiliation(s)
- Jane Shkel
- Stanford University School of Medicine, Stanford, USA
| | - Alicia Geng
- Stanford University School of Medicine, Stanford, USA
| | | | | | - Jessica M Schwartzman
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, USA
- Division of Developmental-Behavioral Pediatrics, Children's Hospital Los Angeles, Los Angeles, USA
| | - Rachel Schuck
- Stanford University School of Medicine, Stanford, USA
| | | | | | - Devon M Slap
- Stanford Medicine Children's Health, Stanford, USA
| | | | | | | | - Grace W Gengoux
- Stanford University School of Medicine, Stanford, USA.
- Department of Psychiatry & Behavioral Sciences, Division of Child & Adolescent Psychiatry, 401 Quarry Road, Stanford, CA, 94305-5719, USA.
| |
Collapse
|
5
|
Jellinek ER, Duda TA, Fein RH. The RUBI Parent Training for Disruptive Behavior in a Child with Electrical Status Epilepticus in Sleep (ESES): A Case Report. J Clin Psychol Med Settings 2023; 30:770-779. [PMID: 36840783 PMCID: PMC9959946 DOI: 10.1007/s10880-023-09949-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2023] [Indexed: 02/26/2023]
Abstract
Children with electrical status epilepticus in sleep (ESES) often present with cognitive deficits and behavioral difficulties. Children that present with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), intellectual disability, and ESES would be expected to manifest more complex symptoms and increased behavioral difficulties given the nature of these disorders. Despite the complex presentation, there is little research to support effective treatments that manage behavior challenges and associated symptoms of ASD in such patients. In the present case report, the authors implemented a validated parent management training intervention, The Research Unit on Behavioral Interventions (RUBI) Autism Network Parent Training program (RUBI-PT) via telemedicine to manage symptoms of ADHD, ASD, and disruptive behaviors in an 8-year-old South-Asian boy with ESES and associated mild intellectual disability. The family participated in 15 RUBI-PT sessions over 22 weeks. Parent report and ratings using the clinical global impression, improvement scale (CGI-I) indicated reductions in challenging behavior and improvement in adaptive skills. The current case report demonstrates the utility of RUBI-PT in the treatment of behavioral difficulties in a patient with ASD, ADHD, and ESES. Further, the present study explores future directions for the use of RUBI-PT to address behavioral challenges associated with ESES and commonly co-occurring conditions and highlights the importance of cultural responsive practice in the context of parent management training.
Collapse
Affiliation(s)
- Emily R Jellinek
- Department of Psychological, Health, and Learning Sciences, University of Houston, 3657 Cullen Blvd, 491 Farish Hall, Houston, TX, 77204-5023, USA.
| | - Thomas A Duda
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
| | - Rachel H Fein
- Psychology Service, Texas Children's Hospital, 6701 Fannin Street, CCC 1630, Houston, TX, 77030-2399, USA
| |
Collapse
|
6
|
Baumel A, Brandes O, Brendryen H, Muench F, Kane JM, Saar C. The impact of therapeutic persuasiveness on engagement and outcomes in unguided interventions: A randomized pilot trial of a digital parent training program for child behavior problems. Internet Interv 2023; 34:100680. [PMID: 37840647 PMCID: PMC10568087 DOI: 10.1016/j.invent.2023.100680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/01/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023] Open
Abstract
Understanding how to design engaging unguided digital health interventions is key in our ability to utilize digital tools to improve access to care. Therapeutic persuasiveness (TP) is a design concept that relates to how the digital intervention features as a whole should be designed to encourage users to make positive changes in their lives, while reducing the experienced effort required from them to engage in these activities. In our previous work, we examined the user traffic of publicly available programs, finding programs' TP quality to be a reliable, robust, and stable predictor of real-world usage; however, these findings have not been subject to experimental manipulation in a controlled trial. The current study examined the impact of TP quality in digital parent training programs (DPTs) aimed at treating child's behavior problems. We conducted a pilot randomized controlled trial comparing two interventions that utilize the same evidence-based content of established DPTs, but that differ in terms of the quality of TP (standard: DPT-STD; enhanced: DPT-TP). Altogether, parents from 88 families who have a child with behavior problems were enrolled in the study. Compared to DPT-STD (n = 43), participants allocated to DPT-TP (n = 45) used the program significantly more (ps < 0.001; Cohen's ds = 0.91-2.22). In terms of program completion, 68.9 % of DPT-TP participants completed it compared to 27.9 % of DPT-STD participants. Significant differences between the interventions were also found in reported improvements in child behavior problems favoring DPT-TP (ps < 0.05; Cohen's ds = 0.43-0.54). The results point to the importance of adequate product design and the utilization of conceptual frameworks in order to improve user engagement challenges.
Collapse
Affiliation(s)
- Amit Baumel
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Or Brandes
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | | | - Fred Muench
- The Unregret Foundation, New York, NY, United States of America
| | - John M. Kane
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States of America
- The Feinstein Institutes for Medical Research, Institute of Behavioral Science, Northwell Health, Manhasset, NY, United States of America
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, United States of America
| | - Chen Saar
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| |
Collapse
|
7
|
Engelbrektsson J, Salomonsson S, Högström J, Sorjonen K, Sundell K, Forster M. Is internet-based parent training for everyone? Predictors and moderators of outcomes in group vs. internet-based parent training for children with disruptive behavior problems. Behav Res Ther 2023; 171:104426. [PMID: 37924567 DOI: 10.1016/j.brat.2023.104426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 10/23/2023] [Accepted: 10/29/2023] [Indexed: 11/06/2023]
Abstract
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.
Collapse
Affiliation(s)
- Johanna Engelbrektsson
- Department of Clinical Neuroscience, Division of Psychology Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Jens Högström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Kimmo Sorjonen
- Department of Clinical Neuroscience, Division of Psychology Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| | - Knut Sundell
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, S:t Eriksgatan 117, 102 33, Stockholm, Sweden.
| | - Martin Forster
- Department of Clinical Neuroscience, Division of Psychology Karolinska Institutet, Nobels Väg 9, 171 65, Solna, Sweden.
| |
Collapse
|
8
|
Johnson CR, Barto L, Worley S, Rothstein R, Alder ML. Telehealth parent training for sleep disturbances in young children with autism spectrum disorder: A randomized controlled trial. Sleep Med 2023; 111:208-219. [PMID: 37806263 DOI: 10.1016/j.sleep.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE Young children with autism spectrum disorder (autism) have bedtime and sleep disturbances at much higher frequency and persistency than their neurotypical counterparts. Hence, access to early, effective treatment is critical in view of the importance of sleep in early childhood. Telehealth delivery could be a means to expand access to such early treatment if efficacious. The aim of this randomized control trial (RCT) was to compare a manualized, telehealth delivered, behaviorally based sleep parent training (SPT) intervention for parents of young children with autism and sleep disturbances to a control condition, a telehealth delivered parent education program with one sleep focused session (SPE). We hypothesized that the SPT group would show more improvements on child measures of sleep outcome measures, and daytime behaviors and parent measures of stress and sense of competence. We further aimed to explore the overall feasibility of telehealth delivery of SPT and SPE. PARTICIPANTS AND METHODS Parents of 77 young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session. Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures, including child sleep measures, child daytime behavior and parent stress and sense of competency were collected at weeks 5 and 10 after the baseline time point. Feasibility indicators (treatment fidelity, parent adherence, and parent attendance), and safety measures were also collected. RESULTS Of 77 randomized participants, data were available for 36 participants randomized to SPT and 38 participants randomized to SPE. The mean age was 3 years, 8 months. Results support the efficacy of this manualized SPT intervention for bedtime and sleep disturbances. Sleep outcome measures were significantly improved in the SPT group compared to SPE on the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p < 0.001) with a large effect size of 0.83 at week 10. Positive response to treatment, as determined from the Clinical Global Impression-Improvement scale (CGI-I) at week 10 was observed in 56% of SPT participants compared to 32% in SPE (p = 0.037). There were no significant group differences in either the ABC-I as measure of daytime behaviors or in parental stress. There were group differences in favor of SPT over SPE on the PSOC, a measure of parent sense of competency. Feasibility and safety were further demonstrated with telehealth delivery. CONCLUSIONS This RCT demonstrated the efficacy of a telehealth delivered parent training intervention for bedtime and sleep disturbances in young autistic children compared to an active control condition. Further, parents in SPT reported more confidence in their parenting role than those in the SPE group, but SPT did not result in overall decreases in parental stress. Telehealth delivery allowed for a much broader reach with enrolled participants from 24 states. This study supports a telehealth approach to a manualized behavioral parent mediated intervention for sleep disturbance in young autistic children and offers an alternative to in-person delivered approaches. This telehealth delivery has the potential to improve access for families who have a young autistic child with sleep disturbances. Given the small sample size, determining predictors and moderators of treatment response was not possible and should be examined in a larger trial.
Collapse
|
9
|
Fleming GE, Neo B, Kaouar S, Kimonis ER. Treatment Outcomes of Children with Primary Versus Secondary Callous-Unemotional Traits. Res Child Adolesc Psychopathol 2023; 51:1581-1594. [PMID: 37552366 PMCID: PMC10627936 DOI: 10.1007/s10802-023-01112-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE Recent efforts to improve outcomes for young children with conduct problems and callous-unemotional (CU) traits involve adapting treatments to meet the unique needs of this subgroup. However, these efforts have ignored accumulating evidence for distinct primary and secondary variants within the CU subgroup. Existing treatment adaptations uniformly target risk factors associated with primary CU traits and no studies have investigated variant-specific patterns of responsiveness to treatment adaptations among young children with CU-type conduct problems. METHOD Participants were 45 families with a 3- to 7-year-old clinic-referred child (M = 4.84 years, SD = 1.08, 84% boys) with conduct problems and CU traits. Primary and secondary CU variants were defined based on baseline parent-rated anxiety scores. All families received Parent-Child Interaction Therapy adapted for CU traits (PCIT-CU) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems and affective outcomes. RESULTS Linear mixed-effects modeling showed that the rate and shape of change over time in conduct problems differed between variants, such that children with secondary CU traits showed deterioration in defiant and dysregulated behaviors from post-treatment to follow-up, whereas primary CU traits were associated with maintained gains. There were no variant differences in rate of improvement in CU traits. Affective empathy did not improve for either variant. Internalizing problems meaningfully improved by follow-up for children with secondary CU traits. CONCLUSIONS Findings suggest that PCIT-CU is a promising intervention for children with conduct problems and primary CU traits, but may require further personalization for children with secondary CU traits. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12616000280404).
Collapse
Affiliation(s)
- Georgette E Fleming
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Bryan Neo
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Silvana Kaouar
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Eva R Kimonis
- Parent-Child Research Clinic, School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
10
|
Stefanaki A, Gkogkos G, Varlokosta S, Gena A. Applying a Parent Training Program in a Naturalistic Behavior Analytic Context to Improve Attachment in Children with ASD. J Autism Dev Disord 2023; 53:4164-4184. [PMID: 36029399 DOI: 10.1007/s10803-022-05719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 10/15/2022]
Abstract
Infants develop attachment to their caregivers very early on. The quality of attachment is considered to be crucial for the emotional development of humans and animals alike. Despite its importance, very little is known about how attachment develops between children with Autism Spectrum Disorder (ASD) and their caregivers. The purpose of the present study was to assess the attachment patterns of two young children with ASD with their parents and to identify the means for promoting parent, child, and parent-child relational characteristics that may contribute to the development of secure attachment. The results replicated prior findings pertaining to attachment quality of children with ASD and demonstrated the effectiveness of a naturalistic, behavior-analytic intervention in improving the quality of their attachment.
Collapse
Affiliation(s)
- Areti Stefanaki
- Department of Educational Studies of the National and Kapodistrian University of Athens, Ethnikis Antistaseos 34-38, Nea Filadelfeia, 14343, Athens, Greece.
| | | | - Spyridoula Varlokosta
- Lab of Psycholinguistics and Neurolinguistics, Department of Philology, National and Kapodistrian, University of Athens, Nikomedeias 8, Papagou, 15669, Athens, Greece
| | - Angeliki Gena
- Department of Educational Studies, National and Kapodistrian University of Athens, Nikomedeias 66, Nea Smyrni, 17124, Athens, Greece
| |
Collapse
|
11
|
Cheng WM, Smith TB, Butler M, Taylor TM, Clayton D. Effects of Parent-Implemented Interventions on Outcomes of Children with Autism: A Meta-Analysis. J Autism Dev Disord 2023; 53:4147-4163. [PMID: 35996037 PMCID: PMC10539413 DOI: 10.1007/s10803-022-05688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2022] [Indexed: 11/11/2022]
Abstract
Children with autism spectrum disorder (ASD) have been shown to benefit from parent-implemented interventions (PIIs). This meta-analysis improved on prior reviews of PIIs by evaluating RCTs and multiple potential moderators, including indicators of research quality. Fifty-one effect sizes averaged moderately strong overall benefits of PIIs (g = 0.553), with studies having lower risk of research bias yielding lower estimates (g = 0.47). Parent and observer ratings yielded similar averaged estimates for positive behavior/social skills (g = 0.603), language/communication (g = 0.545), maladaptive behavior (g = 0.519), and to a lesser extent, adaptive behavior/life skills (g = 0.239). No other study, intervention, or participant characteristic moderated outcomes. PIIs with children with ASD tend to be effective across a variety of circumstances.
Collapse
Affiliation(s)
- Wai Man Cheng
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA.
| | - Timothy B Smith
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA.
| | - Marshall Butler
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
| | - Tina M Taylor
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
| | - Devan Clayton
- Department of Counseling Psychology and Special Education, Brigham Young University Provo, 340 McKay Building, Provo, UT, 84602, USA
| |
Collapse
|
12
|
Larsen LB, Daley D, Lange AM, Sonuga-Barke E, Thomsen PH, Jensen JS, Rask CU. Functional somatic symptoms in preschool attention-deficit/hyperactivity disorder: a secondary analysis of data from a randomized controlled trial of parent training. Eur Child Adolesc Psychiatry 2023; 32:1979-1988. [PMID: 35748937 DOI: 10.1007/s00787-022-02025-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/06/2022] [Indexed: 11/03/2022]
Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) can be more stress-vulnerable, and thereby, it has been suggested, prone to develop functional somatic symptoms (FSS) compared to their peers. In this paper, using data from 160 children aged 3-7 years with ADHD from the D'SNAPP study, a randomized controlled trial testing a parent training intervention, we addressed a number of questions about the role of FSS in ADHD. First, are FSS levels higher in an ADHD sample than in the children of the general population. Second, do FSS levels predict psychopathology and health-related quality of life (HRQoL) in ADHD samples. Third, does FSS levels moderate the effect of parent training on ADHD symptoms. We found that preschoolers with ADHD experienced more severe FSS than a general population-based sample (18.80% vs. 2.11%). Severe FSS were associated with increased psychopathology and impaired daily function and lower HRQoL. Level of baseline FSS did not moderate the effect of parent training on ADHD. FSS in preschool children with ADHD is associated with impaired daily functioning, but further research is warranted to determine the clinical impact of FSS in children with ADHD.
Collapse
Affiliation(s)
- Liva Bundgaard Larsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark.
| | - David Daley
- Division of Psychiatry and Applied Psychology, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Anne-Mette Lange
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Research Unit, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| |
Collapse
|
13
|
Gauert S, Rittenhouse-Cea H, Rittenhouse-Shaw K. Parent Implementation of DTT Following Telehealth Instruction. J Autism Dev Disord 2023; 53:3980-3986. [PMID: 35917019 PMCID: PMC9343822 DOI: 10.1007/s10803-022-05693-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
Discrete Trial Training (DTT) is a method of intervention for individuals with Autism Spectrum Disorder (ASD). Applications of DTT require prescribed repetitions of instruction. DTT is typically implemented via trained instructors or teachers. However, prior analysis has demonstrated the potential of parent-implemented DTT. Prior research demonstrated that DTT training can be implemented with a high degree of fidelity using a student teacher population. However, to date, no studies have evaluated the use of a DTT telehealth training with parents of children with ASD. The purpose of this study was to evaluate the feasibility of a remote parent training method to allow parents to implement DTT in home settings. To this end, three parent participants of children diagnosed with ASD were trained to implement DTT through a telehealth modality in a nonconcurrent multiple baseline design. Results suggested efficacy of this method at DTT skills acquisition.
Collapse
Affiliation(s)
- Spencer Gauert
- Department of Applied Behavior Analysis, University of Dayton, Dayton, OH USA
| | | | | |
Collapse
|
14
|
Merrill BM, Macphee FL, Burrows-MacLean L, Coles EK, Wymbs BT, Chacko A, Walker K, Wymbs F, Garefino A, Robb Mazzant J, Gnagy EM, Waxmonsky JG, Massetti GM, Waschbusch DA, Fabiano GA, Pelham WE. Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting. Res Child Adolesc Psychopathol 2023; 51:1481-1495. [PMID: 37382748 DOI: 10.1007/s10802-023-01093-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.
Collapse
Affiliation(s)
- Brittany M Merrill
- Center for Children and Families, Florida International University, Buffalo, NY, USA.
| | - Fiona L Macphee
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | | | - Erika K Coles
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Brian T Wymbs
- Department of Psychology, Ohio University, Athens, OH, USA
| | - Anil Chacko
- Department of Applied Psychology, Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA
| | | | - Frances Wymbs
- Department of Primary Care, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | - Allison Garefino
- Department of Psychology, Kennesaw State University, Kennesaw, GA, USA
| | - Jessica Robb Mazzant
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA
| | - James G Waxmonsky
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Greta M Massetti
- State University of New York at Buffalo, Buffalo, NY, USA
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Daniel A Waschbusch
- Department of Psychiatry, Pennsylvania State University Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Gregory A Fabiano
- Center for Children and Families, Florida International University, Buffalo, NY, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, 33199, USA.
| |
Collapse
|
15
|
Schneider I, Zietlow AL. [The parent-child relationship in the context of parental mental illness-Possibilities for intervention]. Nervenarzt 2023; 94:822-826. [PMID: 37171658 DOI: 10.1007/s00115-023-01491-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/11/2023] [Indexed: 05/13/2023]
Abstract
The parent-child relationship is the earliest and one of the most important close social relationships in a person's life. It begins even during pregnancy, is expressed in interactions and is accompanied by many neurobiological processes. A sensitive interaction with the parent who is well-adapted to the needs of the child, is necessary for a healthy child development; however, parents with mental disorders often face more difficulties in parenting than healthy parents. They tend to exhibit more intrusive or withdrawn behavior and report experiencing increased stress in parenting, which in turn can be a risk factor for the mental disorder. At the same time, parenting can be a great resource. Early recognition of stress in parenting is central to healthy child development and also to the parent's mental health. In addition to disorder-specific treatment for parents, parent-child focused interventions can be used in relationship or interaction disorders. This article presents and discusses different prevention and intervention approaches.
Collapse
Affiliation(s)
- Isabella Schneider
- Klinik für Allgemeine Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Voßstraße 4, 69115, Heidelberg, Deutschland.
| | - Anna-Lena Zietlow
- Klinische Kinder- und Jugendpsychologie, Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Chemnitzer Straße 46a, 01187, Dresden, Deutschland
| |
Collapse
|
16
|
Thomas BR, O’Connor JT. Parent Use of a Safety Checklist to Prevent Their Child's Pica. Behav Anal Pract 2023; 16:879-884. [PMID: 37680327 PMCID: PMC10480111 DOI: 10.1007/s40617-023-00798-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 09/09/2023] Open
Abstract
Parents of three children with neurodevelopmental disorders and pica were taught to use a safety checklist to create pica-safe areas when transitioning to new locations. During baseline, no parent displayed pica-safe behavior, and their children attempted pica at moderate to high rates. After use of the checklist, parent pica-safe behavior increased, and instances of pica diminished to near zero. Results transferred to new contexts and additional substances associated with pica. Using the safety checklist appears to have aided parents in creating pica-safe environments to minimize pica. Supplementary Information The online version contains supplementary material available at 10.1007/s40617-023-00798-w.
Collapse
Affiliation(s)
- Benjamin R. Thomas
- Neurobehavioral Unit, Outpatient Clinic, Kennedy Krieger Institute, Baltimore, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
- Present Address: Department of Pediatrics, University of Rochester Medical Center, 601 Elmwood Ave, Box 635, Rochester, NY 14642 USA
| | - Julia T. O’Connor
- Neurobehavioral Unit, Outpatient Clinic, Kennedy Krieger Institute, Baltimore, MD USA
- Johns Hopkins University School of Medicine, Baltimore, MD USA
| |
Collapse
|
17
|
Pacia C, Gunning C, McTiernan A, Holloway J. Developing the Parent-Coaching Assessment, Individualization, and Response to Stressors (PAIRS) Tool for Behavior Analysts. J Autism Dev Disord 2023; 53:3319-3342. [PMID: 35768672 PMCID: PMC10465672 DOI: 10.1007/s10803-022-05637-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
Parent engagement in early behavioral intervention is essential to achieving meaningful intervention outcomes. However, parents may experience multiple barriers to engagement. The Parent-coaching Assessment, Individualization, and Response to Stressors (PAIRS) was developed to help practitioners assess families' barriers and facilitators, individualize their intervention, and respond to stressors using a contextual, functional approach. An expert panel of Board Certified Behavior Analysts ® (BCBAs) evaluated the content validity of the PAIRS. Average scale values (S-CVI/Ave) were 0.92 for relevance, 0.85 for effectiveness, and 0.91 for appropriateness. The PAIRS was revised, and a follow-up evaluation was conducted to rate the tool's utility. This led to the final version of the PAIRS. Clinical implications and future directions are discussed.
Collapse
Affiliation(s)
- Cressida Pacia
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Ciara Gunning
- School of Psychology, National University of Ireland Galway, Galway, Ireland.
| | - Aoife McTiernan
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Jennifer Holloway
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| |
Collapse
|
18
|
Fenning RM, Butter EM, Norris M, Chan J, Macklin EA, McKinnon-Bermingham K, Albright C, Stephenson KG, Scherr J, Moffitt J, Hess A, Steinberg-Epstein R, Kuhlthau KA. Optimizing Parent Training to Improve Oral Health Behavior and Outcomes in Underserved Children with Autism Spectrum Disorder. J Autism Dev Disord 2023; 53:3683-3699. [PMID: 35831693 DOI: 10.1007/s10803-022-05660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 10/17/2022]
Abstract
A randomized controlled trial established initial efficacy of a novel parent training (PT) intervention for improving oral hygiene and oral health in underserved children with ASD (Fenning et al., 2022), a population at risk for unmet dental needs. The present study describes our emic approach to PT development alongside treatment outcome data examining feasibility, acceptability, and engagement. Families with Medicaid-eligible children with ASD ages 3 to 13 years (85% male, 62% with intellectual disability) were assigned to receive PT (n = 60) or a psychoeducational toolkit (n = 59). Results indicate strong retention, fidelity, and adherence, with quantitative and qualitative metrics revealing high treatment satisfaction and utilization. Discussion focuses on implications for individualizing treatment to optimize engagement of underrepresented families.
Collapse
Affiliation(s)
- Rachel M Fenning
- Department of Psychological Science and Claremont Autism Center, Claremont McKenna College, 850 Columbia Avenue, Seaman Hall 235, Claremont, CA, 91711, USA.
- Department of Child and Adolescent Studies and Center for Autism, California State University, Fullerton, Fullerton, CA, USA.
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA.
| | - Eric M Butter
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Megan Norris
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - James Chan
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
| | - Eric A Macklin
- Biostatistics Center, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Kelly McKinnon-Bermingham
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Charles Albright
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Kevin G Stephenson
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jessica Scherr
- Department of Pediatrics, The Ohio State University, Columbus, OH, USA
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jacquelyn Moffitt
- Department of Child and Adolescent Studies and Center for Autism, California State University, Fullerton, Fullerton, CA, USA
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Amy Hess
- Child Development Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Robin Steinberg-Epstein
- The Center for Autism and Neurodevelopmental Disorders, Department of Pediatrics, University of California, Irvine, Santa Ana, CA, USA
| | - Karen A Kuhlthau
- Department of Pediatrics, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA
| |
Collapse
|
19
|
Bozkus-Genc G, Yucesoy-Ozkan S. Efficacy of a Parent-Implemented Pivotal Response Treatment for Children with Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06113-4. [PMID: 37642872 DOI: 10.1007/s10803-023-06113-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Pivotal response treatment (PRT) is a well-established intervention addressing core symptoms of autism spectrum disorder (ASD), with parent involvement as a key component. The current study aimed to examine the effects of PRT parent training on parent fidelity and provide descriptive analyses of parent-child interactions before and after parent training. It also probed parental acceptance and satisfaction with the program. METHODS A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the parent training program. Four parents (range 32-47 years old) and their children with ASD participated in the study. The intervention comprised 12 one-on-one parent training sessions over six consecutive weeks. The visual analysis and effect size calculation (Tau-U) were used to evaluate functional relationship between independent and dependent variables. The descriptive analysis was used to analyze parent-child interaction data. RESULTS The findings reveal that all parents learned and maintained PRT with a high level of fidelity, they also enhanced awareness to create more opportunities for interactions during free play, and the parents were very satisfied with the program. The results also indicate that the six-week parent training program is effective in teaching parents to implement PRT with their children. CONCLUSION These results suggest that the parent training program may be a promising treatment model that is effective, efficient, and cost-effective. Implications for future research and practice are then discussed.
Collapse
Affiliation(s)
- Gulden Bozkus-Genc
- School of Education, Department of Special Education, Anadolu University, Eskisehir, Türkiye.
| | - Serife Yucesoy-Ozkan
- School of Education, Department of Special Education, Eskisehir Osmangazi University, Eskisehir, Türkiye
| |
Collapse
|
20
|
Metras RL, Hanley GP, Carbone MJ. Distance-Based Collaborations for Assessing and Treating Challenging Behavior. J Autism Dev Disord 2023:10.1007/s10803-023-06085-5. [PMID: 37620690 DOI: 10.1007/s10803-023-06085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/26/2023]
Abstract
An interview-informed synthesized contingency analysis (IISCA; Hanley et al. in J Appl Behav Anal 47:16-36, 2014) and related skill-based treatment process can result in socially valid outcomes for clients exhibiting severe challenging behavior when implemented by professionals and then transferred to parents (e.g., Santiago et al. in J Autism Dev Disord 46:797-811, 2016). However, many families do not have access to professionals trained to implement functional analyses or function-based treatments (Deochand & Fuqua Behav Anal Pract 9:243-252, 2016). Experimenters in the present study coached three parents of children with autism exhibiting severe challenging behavior through implementing an IISCA and resulting skill-based treatment process through distance-based collaborative consulting. All parents achieved differentiated functional analyses, taught their children to emit functional replacement skills, and reduced challenging behavior relative to baseline.
Collapse
Affiliation(s)
- Rachel L Metras
- Virginia Institute of Autism, Charlottesville, VA, USA.
- Department of Curriculum, Instruction, & Special Education, University of Virginia, Charlottesville, VA, USA.
| | - Gregory P Hanley
- Department of Psychology, Western New England University, Springfield, MA, USA
- FTF Behavioral Consulting, Worcester, MA, USA
| | - Matthew J Carbone
- Department of Psychology, Western New England University, Springfield, MA, USA
- FTF Behavioral Consulting, Worcester, MA, USA
| |
Collapse
|
21
|
Makita K, Yao A, Shimada K, Kasaba R, Fujisawa TX, Mizuno Y, Tomoda A. Neural and behavioral effects of parent training on emotion recognition in mothers rearing children with attention-deficit/hyperactivity disorder. Brain Imaging Behav 2023; 17:436-449. [PMID: 37079157 PMCID: PMC10435396 DOI: 10.1007/s11682-023-00771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2023] [Indexed: 04/21/2023]
Abstract
This randomized controlled study examined neurological changes in socioemotional processing skills through parent training in caregivers of children with attention-deficit/hyperactivity disorder. Thirty mothers of children with attention-deficit/hyperactivity disorder were stratified into parent training and non-parent training groups. Functional magnetic resonance imaging was performed during the "Reading the Mind in the Eyes" test, and parenting difficulties were evaluated using the Parenting Stress Index and the Parenting Scale, twice (before and after parent training). Only mothers in the parent training group showed a significant decrease in Parenting Stress Index and Parenting Scale scores. They also demonstrated increased activity in the left occipital fusiform gyrus during the task of estimating emotions from facial pictures. We presumed that these changes might reflect the potential impact of enrollment in parent training in reducing stress, which might have increased activation of the fusiform gyrus.
Collapse
Affiliation(s)
- Kai Makita
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Graduate School of Intercultural Studies, Kobe University, Kobe, Japan
| | - Akiko Yao
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Ryoko Kasaba
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Takashi X. Fujisawa
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Yoshifumi Mizuno
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Affective and Cognitive Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
- Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan
| |
Collapse
|
22
|
Bhana N, Raulston TJ, Ousley C, Bagawan A. Photographs and Parent Training to Support Conversations about Past Events between Caregivers and Children with Autism. Adv Neurodev Disord 2023:1-13. [PMID: 37363189 PMCID: PMC10152031 DOI: 10.1007/s41252-023-00333-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/15/2023] [Indexed: 06/28/2023]
Abstract
Objectives Children with autism spectrum disorder experience communication difficulties that can make it challenging to engage in conversations. Their caregivers also often struggle with finding ways to support the child's communication. Parent-implemented interventions and visual supports are evidence-based practices to support the communication skills of children with autism. Method A multi-method design (single-case multiple probe and qualitative) was used to evaluate the effects of family photographs, training, and telecoaching on parental implementation of communication strategies. Three parents and their children with and at risk for autism participated. Results Results indicate that the use of photographs increased the communication strategies used by all parents. Telecoaching further increased the overall strategy use for two parents. Interviews with the parents indicate spontaneous generalization and maintenance of strategy use. Conclusion Family photos and naturalistic developmental behavior intervention approaches have the potential to improve communication about past events between parents and children with and at risk for ASD.
Collapse
Affiliation(s)
- Naima Bhana
- Department of Advanced Teacher Education, Niagara University, Lewiston, USA
| | - Tracy J. Raulston
- Department of Curriculum and Instruction, Texas State University, San Marcos, USA
| | - Ciara Ousley
- Department of Special Education and Communication Disorders, The University of Nebraska-Lincoln, Lincoln, USA
| | - Atikah Bagawan
- Department of Human Development and Family Studies, Michigan State University, East Lansing, USA
| |
Collapse
|
23
|
Hautmann C, Dose C, Hellmich M, Scholz K, Katzmann J, Pinior J, Gebauer S, Nordmann L, Wolff Metternich-Kaizman T, Schürmann S, Döpfner M. Behavioural and nondirective parent training for children with externalising disorders: First steps towards personalised treatment recommendations. Behav Res Ther 2023; 163:104271. [PMID: 36931110 DOI: 10.1016/j.brat.2023.104271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 02/04/2023]
Abstract
For children with externalising disorders, parent training programmes with different theoretical foundations are available. Currently, there is little knowledge concerning which programme should be recommended to a family based on their individual needs (e.g., single parenthood). The personalised advantage index (PAI) indicates the predicted treatment advantage of one treatment over another. The aim of the present study was to examine the usefulness of this score in providing individualised treatment recommendations. The analysis considered 110 parents (per-protocol sample) of children (4-11 years) with attention-deficit/hyperactivity (ADHD) or oppositional defiant disorder (ODD), randomised to either a behavioural or a nondirective telephone-assisted self-help parent training. In multiple moderator analyses with four different regression algorithms (linear, ridge, k-nearest neighbors, and tree), the linear model was preferred for computing the PAI. For ODD, families randomised to their PAI-predicted optimal intervention showed a treatment advantage of d = 0.54, 95% CI [0.17, 0.97]; for ADHD, the advantage was negligible at d = 0.35, 95% CI [-0.01, 0.78]. For children with conduct problems, it may be helpful if the PAI includes the treatment moderators single parent status and ODD baseline symptoms when providing personalised treatment recommendations for the selection of behavioural versus nondirective parent training. TRIAL REGISTRATION: The study was registered prospectively with ClinicalTrials.gov (Identifier NCT01350986).
Collapse
Affiliation(s)
- Christopher Hautmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christina Dose
- School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kristin Scholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Josepha Katzmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Pinior
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Gebauer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Nordmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tanja Wolff Metternich-Kaizman
- School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephanie Schürmann
- School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Manfred Döpfner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; School for Child and Adolescent Psychotherapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
24
|
McAloon J, de la Poer Beresford K. Online Behavioral Parenting Interventions for Disruptive Behavioral Disorders: A PRISMA Based Systematic Review of Clinical Trials. Child Psychiatry Hum Dev 2023; 54:379-96. [PMID: 34561755 DOI: 10.1007/s10578-021-01253-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/11/2021] [Indexed: 10/20/2022]
Abstract
Behavioral parenting interventions (BPIs) are efficacious, evidence-based interventions for disruptive behavioral disorders in children. Technological advances have seen online adaptations of BPIs further increase efficacy and expand program reach. This systematic review examined the treatment outcomes of online BPIs. Our secondary aim was to examine which components of online BPIs are associated with beneficial child outcomes. Electronic databases were searched to identify randomized controlled trials of online BPIs for children with disruptive behavioral difficulties published between 2000 and 2020. Ten studies, reporting on nine different interventions, met inclusion criteria. The review indicated online BPIs are a viable treatment for disruptive behavioral disorders with nine of ten reporting significant improvements post-treatment. Effective interventions had clearly defined program structure and included content based on operant learning principles. Future research would benefit from greater detail when reporting intervention content, and regular assessment of progress through treatment against the delivery of specific program components.
Collapse
|
25
|
Colombani A, Saksida A, Pavani F, Orzan E. Symbolic and deictic gestures as a tool to promote parent-child communication in the context of hearing loss: A systematic review. Int J Pediatr Otorhinolaryngol 2023; 165:111421. [PMID: 36669271 DOI: 10.1016/j.ijporl.2022.111421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/13/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Language and communication outcomes in children with congenital sensorineural hearing loss (cSNHL) are highly variable, and some of this variance can be attributed to the quantity and quality of language input. In this paper, we build from the evidence that human language is inherently multimodal and positive scaffolding of children's linguistic, cognitive, and social-relational development can be supported by Parent Centered Early Interventions (PCEI), to suggest that the use of gestures in these interventions could be a beneficial approach, yet scarcely explored. AIMS AND METHODS This systematic review aimed to examine the literature on PCEI focused on gestures (symbolic and deictic) used to enhance the caregiver-child relationship and infant's language development, in both typically and atypically developing populations. The systematic review was conducted following the PRISMA guidelines for systematic reviews and meta-analyses. From 246 identified studies, 8 met PICO inclusion criteria and were eligible for inclusion. Two reviewers screened papers before completing data extraction and risk of bias assessment using the RoB2 Cochrane scale. RESULTS Included studies measured the effect of implementing symbolic or deictic gestures in daily communication on the relational aspects of mother/parent-child interaction or on language skills in infants. The studies indicate that gesture-oriented PCEI may benefit deprived populations such as atypically developing children, children from low-income families, and children who, for individual reasons, lag behind their peers in communication. CONCLUSIONS Although gesture-oriented PCEI appear to be beneficial in the early intervention for atypically developing populations, this approach has been so far scarcely explored directly in the context of hearing loss. Yet, symbolic gestures being a natural part of early vocabulary acquisition that emerges spontaneously regardless of hearing status, this approach could represent a promising line of intervention in infants with cSNHL, especially those with a worse head start.
Collapse
Affiliation(s)
- Arianna Colombani
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Italy
| | - Amanda Saksida
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Italy.
| | - Francesco Pavani
- Center for Mind/Brain Sciences - CIMeC, University of Trento, Trento, Italy; Centro Interateneo di Ricerca Cognizione, Linguaggio e Sordità (CIRCLeS), University of Trento, Trento, Italy
| | - Eva Orzan
- Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - Trieste, Italy
| |
Collapse
|
26
|
Pierucci JM, Aquino GA, Pearson A, Perez M, Mwanza-Kabaghe S, Sichimba F, Mooya H. Parent-mediated intervention training for caregivers of children with developmental differences in Zambia. Res Dev Disabil 2023; 132:104373. [PMID: 36413886 DOI: 10.1016/j.ridd.2022.104373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/22/2022] [Accepted: 11/06/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Lower- and middle-income countries (LAMICs) are under-resourced and have limited intervention services for children with developmental differences and their families. A logical method to address service gaps within resource-scarce contexts is to train caregivers as interventionists, specifically using empirically-supported parent-mediated Naturalistic Developmental Behavioral Interventions (P-M NDBIs; Kasari et al., 2010; Ingersoll & Wainer, 2013). AIMS The study implemented the first P-M NDBI in Zambia and aimed to train caregivers and improve children's social-communication skills. METHODS/PROCEDURES The current study utilized a mixed-methods, pre-post design and implemented Project ImPACT (Ingersoll & Dvortcsak, 2010, 2019). Participants included 19 Zambian caregivers of children (n = 20) with developmental differences including autism spectrum condition, Down syndrome, and cerebral palsy. OUTCOMES/RESULTS Findings indicated that children's language skills and pretend play skills significantly improved from pre- to post-assessment, and caregivers most frequently used intervention strategies for modeling communication and prompting communication. CONCLUSIONS/IMPLICATIONS The success and feasibility of implementing Project ImPACT in Zambia, and recommendations for culturally adapting and implementing P-M NDBIs in LAMICs, were discussed.
Collapse
Affiliation(s)
- Jillian M Pierucci
- Department of Psychology, St. Mary's University, One Camino Santa Maria, San Antonio, TX 78228, USA.
| | - Gabriela A Aquino
- Department of Human Development & Family Sciences, University of Texas at Austin, 110 Inner Campus Drive, Austin, TX 78705, USA.
| | - Alexandra Pearson
- Department of Psychology, Houston Community College, 3100 Main Street, Houston, TX 77002, USA.
| | - Monica Perez
- Department of Psychology, University of Notre Dame, 220 Main Building, Notre Dame, IN 46556, USA.
| | - Sylvia Mwanza-Kabaghe
- Department of Educational Psychology, Sociology and Special Education, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
| | - Francis Sichimba
- Department of Psychology, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
| | - Haatembo Mooya
- Department of Psychology, University of Zambia, Great East Road Campus, P.O. Box 32379 Lusaka, Zambia.
| |
Collapse
|
27
|
Byrne G, Ghráda ÁN, O’Mahony T. Parent-Led Cognitive Behavioural Therapy for Children with Autism Spectrum Conditions. A Pilot Study. J Autism Dev Disord 2023; 53:263-274. [PMID: 35020117 PMCID: PMC8753322 DOI: 10.1007/s10803-022-05424-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2021] [Indexed: 02/03/2023]
Abstract
This article reports on a pilot study of a parent-only cognitive behavioural therapy (CBT) programme for parents of children with autism spectrum disorders (ASD) and anxiety difficulties. Twenty-one parents of anxious children with ASD (5-11 of age) completed the From Timid to Tiger intervention. Parent outcome measures were assessed at post-intervention and at 3-month follow-up. Analysis indicated significant reductions in both parent and clinician reports of child anxiety symptoms. Specifically, 38% of children were free of their primary diagnosis at treatment end and this increased to 57% when measured at 3-month follow-up. Positive gains were evidenced regarding parents' ability to manage their child's anxiety without accommodating to it. The results provide preliminary evidence of parent-only CBT programs for children with ASD.
Collapse
Affiliation(s)
- Gary Byrne
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Áine Ní Ghráda
- Psychology Department, Primary Care Psychology Services, Churchtown Primary Care Services, Health Service Executive, Churchtown, Dublin 14, Ireland
| | - Teresa O’Mahony
- Psychology Department, HSE Community Healthcare East, Vergemount Hall, Clonskeagh, Dublin, Ireland
| |
Collapse
|
28
|
Burrell TL, Scahill L, Nuhu N, Gillespie S, Sharp W. Exploration of Treatment Response in Parent Training for Children with Autism Spectrum Disorder and Moderate Food Selectivity. J Autism Dev Disord 2023; 53:229-35. [PMID: 35032300 DOI: 10.1007/s10803-021-05406-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2021] [Indexed: 02/03/2023]
Abstract
Managing Eating Aversions and Limited Variety (MEAL) Plan is a structured parent-mediated intervention for children with autism spectrum disorder and moderate food selectivity. Our previously reported group-based clinical trial revealed a positive treatment response rate of 47.3%. Although encouraging, this response rate raises questions about factors that may affect treatment outcomes. Here, we examine the impact of child and parent characteristics and feeding behaviors on treatment response. Higher maternal education and higher child communication abilities at baseline were associated with positive treatment response. Improvement in sitting at the table and reductions in disruptive mealtime behavior promoted treatment success. Results also suggest that individually delivered MEAL Plan may offer more flexibility than group-based intervention for some parents.
Collapse
|
29
|
Kostyrka-Allchorne K, Ballard C, Byford S, Cortese S, Daley D, Downs J, French B, Glazebrook C, Goldsmith K, Hall CL, Hedstrom E, Kovshoff H, Kreppner J, Lean N, Sayal K, Shearer J, Simonoff E, Thompson M, Sonuga-Barke EJS. Online Parent Training for The Initial Management of ADHD referrals (OPTIMA): the protocol for a randomised controlled trial of a digital parenting intervention implemented to support parents and children on a treatment waitlist. Trials 2022; 23:1003. [PMID: 36510236 PMCID: PMC9744042 DOI: 10.1186/s13063-022-06952-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Children referred for attention-deficit/hyperactivity disorder (ADHD) often present with a broader pattern of conduct problems including oppositionality and defiance. This combination can be extremely stressful to parents, lower parents' self-esteem and negatively impact family life. The National Institute for Health and Care Excellence (NICE) recommends that families receive support as soon as possible after their referral. However, as clinical services are overstretched, and traditional in-person parenting intervention programmes are expensive, families often must wait times a long time prior to receiving this vital input. To address this, we have created a digital parenting programme called STEPS. It is delivered as a mobile phone app providing a set of tools and resources that can be easily accessed at parents' convenience. This study aims to evaluate the clinical and cost-effectiveness of STEPS in supporting parents of children with high levels of hyperactivity/impulsivity, inattention and conduct problems, who are waiting to be assessed by specialist children's clinical services. METHODS Online Parent Training for The Initial Management of ADHD referrals (OPTIMA) is a two-arm superiority parallel randomised controlled trial with an internal pilot study. We aim to recruit 352 parents and their children, who have been accepted onto a waitlist in Child and Adolescent Mental Health Services or similar child health services. Parents who consent will be randomised 1:1 to either the STEPS or wait-as-usual (WAU) group. The trial will be conducted remotely (online and telephone) with measures taken at baseline and 3, 6, 9 and 12 months post-randomisation. The primary objective is to evaluate whether STEPS reduces the severity of children's oppositional and defiant behaviour, as rated by parents, measured at 3 months post-randomisation compared to WAU. DISCUSSION Digital solutions, such as mobile phone apps, have potential for delivering psychological support for parents of children with clinical-level needs in a timely and inexpensive manner. This trial will provide data on the clinical and cost-effectiveness of the STEPS app, which could support the implementation of this scalable parenting intervention programme into standard clinical care and, ultimately, improve the outcomes for families of children referred to specialist child and adolescent health services. TRIAL REGISTRATION ISRCTN 16523503. Prospectively registered on 18 November 2021. https://www.isrctn.com/ISRCTN16523503.
Collapse
Affiliation(s)
- Katarzyna Kostyrka-Allchorne
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Claire Ballard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, NY, USA
| | - David Daley
- NTU Psychology, School of Social Science, Nottingham Trent University, Nottingham, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Blandine French
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Cristine Glazebrook
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kimberley Goldsmith
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Charlotte L Hall
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Hedstrom
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Hanna Kovshoff
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Nancy Lean
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Margaret Thompson
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
| |
Collapse
|
30
|
Boydston P, Redner R, Wold K. Examination of a Telehealth-Based Parent Training Program in Rural or Underserved Areas for Families Impacted by Autism. Behav Anal Pract 2022; 16:1-17. [PMID: 36533165 PMCID: PMC9735022 DOI: 10.1007/s40617-022-00763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 12/12/2022] Open
Abstract
Families of children with disabilities in rural areas face challenges accessing services due to location and lack of health-care providers. Telehealth-based intervention can mitigate challenges in accessing services. The present study sought to replicate and extend the telehealth-based, behavioral parent-training program, the Online and Applied System for Intervention Skills (OASIS), utilizing a multiple-baseline approach. Four parent-child dyads participated, with all children diagnosed with autism spectrum disorder. All dyads resided in rural/underserved areas. All dyads demonstrated an improvement on skill and knowledge assessments. The mean gain from baseline-to-treatment completion on skills assessments was 80.9% (range: 67.6%-95.5% points). The mean gain on knowledge assessments was 35.3% (range: 19.0%-49.0% points). It should be noted that parent skill gains were maintained over time. The present results provided additional empirical evidence demonstrating the effectiveness of OASIS, a telehealth-based parent-training model.
Collapse
Affiliation(s)
| | - Ryan Redner
- Southern Illinois University, Carbondale, Carbondale, IL USA
| | - Kari Wold
- Integrated Behavioral Technologies, Inc., Basehor, KS USA
| |
Collapse
|
31
|
Cartwright JE, Mount KB. Adjunctive Parental Support Within Manualized Parent Training for Children with Autism Spectrum Disorder. Child Psychiatry Hum Dev 2022; 53:1293-1308. [PMID: 34164759 DOI: 10.1007/s10578-021-01210-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
Parent training is a central focus of behavioral intervention, with emphasis on teaching parents to become change agents for their children by using behavioral management skills. However, its effectiveness is limited by a parent's ability to engage in the learning process. Parents managing external stressors, psychopathology, or poverty often do not gain the skills and thus, the treatment may minimally impacts parent and child behavior. In order to increase a parent's ability to acquire and implement new skills accurately, referred to as parent treatment integrity, the current study added a parent-support component to the RUBI Autism Network's Parent Training for Disruptive Behaviors protocol. The parent-support component was intended to remove barriers to skill acquisition during the parent training session by alleviating some of the interfering parental stress. In an alternating treatments design, a community-based sample of five parent-child dyads (average age of child = 32 months) participated in the parent-training protocol; half of the intervention sessions included a 15-min parent-support component. The addition of the parent-support component increased parent engagement, treatment integrity, and learned parenting skills, like parent praise. Results support a model of change for parenting behavior. Inclusion of a parent-support component is supported as an effective practice for parent training.
Collapse
Affiliation(s)
- Julia E Cartwright
- Center for Autism and Developmental Disabilities, The University of Texas Southwestern Medical Center at Dallas, 6363 Forest Park Road, Suite BL5.320, Dallas, TX, 75235, USA. .,Division of Psychology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, USA.
| | - Katherine Bellone Mount
- Center for Autism and Developmental Disabilities, The University of Texas Southwestern Medical Center at Dallas, 6363 Forest Park Road, Suite BL5.320, Dallas, TX, 75235, USA
| |
Collapse
|
32
|
Togashi K, Minagawa Y, Hata M, Yamamoto J. Evaluation of a Telehealth Parent-Training Program in Japan: Collaboration with Parents to Teach Novel Mand Skills to Children Diagnosed with Autism Spectrum Disorder. Behav Anal Pract 2022; 16:1-12. [PMID: 36313232 PMCID: PMC9591318 DOI: 10.1007/s40617-022-00752-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 12/04/2022] Open
Abstract
This study developed a telehealth parent-training program to teach parents of children with autism spectrum disorder the process of mand-training implementation in Japan, and to further the international dissemination of evidence-based training strategies. Parent-training sessions were based on a behavioral skills training (BST) model, combined with weekly graphic and video feedback. The sessions were conducted by a board-certified behavior analyst-doctoral residing in Japan. Four parents with children with autism spectrum disorder participated in this study. The results preliminarily support the effectiveness and social validity of the program. This study extends previous parent-training research conducted in Japan by comprising all of the following features: (1) online program design; (2) mand training; (3) BST model; (4) session-by-session data on children's behavioral changes and procedural integrity; (5) within-subject experimental design; and (6) social validity evaluation.
Collapse
Affiliation(s)
- Kohei Togashi
- Global Research Institute, Keio University, Minato City, Tokyo Japan
- Present Address: Behavior Solutions, KS Floor, 5F Resona-Kudan Bldg, 1-5-6 Kudan-Minami, Chiyoda, Tokyo 102-0074 Japan
| | - Yasuyo Minagawa
- Faculty of Letters, Keio University, Minato City, Tokyo Japan
| | - Masahiro Hata
- Global Research Institute, Keio University, Minato City, Tokyo Japan
| | | |
Collapse
|
33
|
Sethi A, O'Brien S, Blair J, Viding E, Mehta M, Ecker C, Blackwood N, Doolan M, Catani M, Scott S, Murphy DGM, Craig MC. Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent Training. Biol Psychiatry 2022:S0006-3223(22)01658-4. [PMID: 36642564 DOI: 10.1016/j.biopsych.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 08/23/2022] [Accepted: 09/30/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Parenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person's fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. METHODS We conducted a prospective, case-control study of boys with CPs and typically developing (TD) boys. Both groups (ages 5-10 years) completed 2 magnetic resonance imaging sessions (18 ± 5.8 weeks apart) with ASB assessed at each visit. Participants included boys with CPs following referral to a parenting intervention group and TD boys recruited from the same schools and geographical regions. Final functional magnetic resonance imaging data were available for 36 TD boys and 57 boys with CPs. Boys with CPs were divided into those whose ASB improved (n = 27) or persisted (n = 30) following the intervention. Functional magnetic resonance imaging data assessing fear reactivity were then analyzed using a longitudinal group (TD/improving CPs/persistent CPs) × time point (pre/post) design. RESULTS Amygdala hypoactivity to fear was observed only in boys with CPs who had persistent ASB and was absent in those whose ASB improved following intervention. CONCLUSIONS Our findings suggest that amygdala hypoactivity to fear is a marker for ASB that is resistant to change following a parenting intervention and a putative target for future treatments.
Collapse
Affiliation(s)
- Arjun Sethi
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suzanne O'Brien
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom. suzanne.o'
| | - James Blair
- Child and Adolescent Mental Health Centre, Mental Health Services, Copenhagen, Capital Region of Denmark, Denmark
| | - Essi Viding
- Division of Psychology and Language Sciences, University College London, London, United Kingdom
| | - Mitul Mehta
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Christine Ecker
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Nigel Blackwood
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Moira Doolan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Marco Catani
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Stephen Scott
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Declan G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Michael C Craig
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; National Female Hormone Clinic Maudsley Hospital, London, United Kingdom; National Autism Unit, Bethlem Royal Hospital, London, United Kingdom
| |
Collapse
|
34
|
Rispoli M, Shannon E, Voorhis C, Lang R, Mason R, Kelleher B. Telehealth Training in Naturalistic Communication Intervention for Mothers of Children with Angelman Syndrome. Adv Neurodev Disord 2022; 6:549-566. [PMID: 36160311 PMCID: PMC9483349 DOI: 10.1007/s41252-022-00284-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Young children with Angelman syndrome have significant delays in expressive communication. Parents of children with Angelman syndrome require training to support their child's communication development. Unfortunately, parent training focused on the needs of families of children with rare genetic syndromes is unavailable to many families. The purpose of this study was to evaluate a telehealth parent training program on naturalistic communication intervention for young children with Angelman syndrome. METHODS Using two single-case multiple baseline designs across a total of six parent-child dyads, we evaluated the effects of a telehealth parent training program on parent implementation fidelity of a naturalistic communication intervention, child communication, and child engagement. RESULTS With the telehealth parent training program, parent implementation fidelity of naturalistic communication intervention improved, maintained and generalized to untrained home routines. Small effects on child communication and engagement were observed during the program. CONCLUSIONS Parents of children with Angelman syndrome were successfully taught via telehealth to implement a naturalistic communication intervention with their child at home. Additional research is needed to promote positive child communication outcomes through parent-mediated intervention.
Collapse
Affiliation(s)
- Mandy Rispoli
- Department of Curriculum, Instruction, and Special Education, University of Virginia, PO Box 400273, Charlottesville, VA 22904 USA
| | | | | | | | - Rose Mason
- Purdue University, West Lafayette, IN USA
| | | |
Collapse
|
35
|
LaRovere KL, Tang Y, Li K, Wadhwani N, Zhang B, Tasker RC, Yang G. Effectiveness of Training Programs for Reducing Adverse Psychological Outcomes in Parents of Children with Acquired Brain Injury: A Systematic Review and Meta-Analysis. Neurol Ther 2022; 11:1691-1704. [PMID: 36048333 DOI: 10.1007/s40120-022-00399-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/15/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Parental stress following critical illness in their child has the potential to impact functional outcomes and quality of life for the child and whole family. Parent emotional functioning may also be an important clinical target to optimize child outcomes. This study assessed the effectiveness of training programs for parents aimed at reducing adverse psychological outcomes in parents of children with acute brain injury (ABI). METHODS We conducted searches of Embase, PubMed, Web of Science, and Cochrane Library to November 13, 2020. Randomized controlled trials (RCTs) that compared parent training programs with usual care, or an active comparator, and assessed psychological outcomes (depression, anxiety, stress) in parents of children with ABI were included. Two reviewers independently extracted data on study characteristics, participants, interventions, outcome measures, and results before and after intervention. Risk of bias was assessed using the Cochrane risk-of-bias tool. RESULTS Four RCTs involving 318 parents of children with ABI were eligible for review. Compared with usual care or active comparator, parent training was associated with significant reduction in parent stress (four RCTs; standardized mean difference [SMD], - 0.32 on a numerical rating scale [95% CI, - 0.60, - 0.05]; I-squared = 7.5%, p = 0.356); significant reduction in parent depression (three RCTs; SMD, - 0.43 [95% CI, - 0.72, - 0.14]; I-squared = 0.0%, p = 0.393); and significant reduction in parent anxiety (two RCTs; SMD, - 0.63 [95% CI, - 1.05, - 0.21]; I-squared = 0.0%, p = 0.629). Overall risk of bias was high for randomization process (one RCT), missing outcome data (three RCTs), measurement of the outcome (three RCTs), and selection of reported result (two RCTs). Heterogeneity between studies by country of study origin was not significant. CONCLUSIONS Compared with usual care or an active comparator, parent training was associated with short-term reduction in stress, depression, and anxiety in parents of children with ABI. Future clinical trials of parent interventions are needed as there may be some short-term beneficial effects.
Collapse
Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Yuzhe Tang
- Department of Urology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | - Kun Li
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, TsingHua University, Beijing, China.,Harvard Medical School, Boston, MA, USA
| | | | - Bo Zhang
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.,Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert C Tasker
- Harvard Medical School, Boston, MA, USA.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Guang Yang
- Department of Pediatrics, First Medical Center, Chinese PLA General Hospital, Beijing, China. .,Senior Department of Pediatrics, Seventh Medical Center, Chinese PLA General Hospital, 5 Nanmen Cang, Ten East and West, Dongcheng District, Beijing, 100700, China.
| |
Collapse
|
36
|
Bradshaw J, Wolfe K, Hock R, Scopano L. Advances in Supporting Parents in Interventions for Autism Spectrum Disorder. Pediatr Clin North Am 2022; 69:645-656. [PMID: 35934491 PMCID: PMC11017782 DOI: 10.1016/j.pcl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The rising prevalence of autism spectrum disorder (ASD) calls for clear referral and treatment guidelines for children with ASD and their caregivers. Caregiver involvement in intervention is a standard practice of care and research suggests that teaching intervention strategies to caregivers can improve child outcomes and increase caregiver efficacy. Caregiver-mediated interventions that are naturalistic, developmental, and behavioral are effective in improving social and communication skills for children with ASD. Caregiver training models that use behavioral strategies are effective in reducing challenging behaviors. Finally, reducing caregiver barriers to treatment implementation, including stress and strain, are becoming critical components for improving the well-being and care of children with ASD and their families.
Collapse
Affiliation(s)
- Jessica Bradshaw
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA.
| | - Katie Wolfe
- University of South Carolina, 820 Main Street, Columbia, SC 29208, USA
| | - Robert Hock
- University of South Carolina, 1512 Pendleton Street, Columbia, SC 29208, USA
| | - Layne Scopano
- University of South Carolina, 1800 Gervais Street, Columbia, SC 29201, USA
| |
Collapse
|
37
|
Ferguson J, Dounavi K, Craig EA. The Efficacy of Using Telehealth to Coach Parents of Children with Autism Spectrum Disorder on How to Use Naturalistic Teaching to Increase Mands, Tacts and Intraverbals. J Dev Phys Disabil 2022; 35:417-447. [PMID: 35919665 PMCID: PMC9334541 DOI: 10.1007/s10882-022-09859-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/26/2022] [Indexed: 05/26/2023]
Abstract
UNLABELLED There is a growing body of evidence supporting the use of telehealth to provide parent training in behaviour analytic interventions and researchers have begun to focus on international demonstrations of this model. The current study assessed the efficacy of a training package focused on naturalistic teaching strategies designed to upskill parents of children with autism spectrum disorder and provide them with ready to use strategies to increase social communication behaviours across verbal operants. Two parent-child dyads were trained to increase mand, tact and intraverbals during play. Parents displayed increases in fidelity for each strategy and viewed the training favourably. Both children showed gains across verbal operants, as captured by a multiple baseline across behaviours design. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10882-022-09859-4.
Collapse
Affiliation(s)
- Jenny Ferguson
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Katerina Dounavi
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| | - Emma A. Craig
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, Belfast, BT7 1HL Northern Ireland
| |
Collapse
|
38
|
Graucher T, Sinai-Gavrilov Y, Mor Y, Netzer S, Cohen EY, Levi L, Avtalion TB, Koller J. From Clinic Room to Zoom: Delivery of an Evidence-Based, Parent-mediated Intervention in the Community Before and During the Pandemic. J Autism Dev Disord 2022; 52:5222-5231. [PMID: 35764769 PMCID: PMC9244456 DOI: 10.1007/s10803-022-05592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
Disruptive behaviors (DBs) are common in children with autism, affecting child and family quality of life. Parent-mediated interventions (PMIs) are a cost-effective and accessible way to decrease DBs. COVID-19 increased need for telehealth interventions. This study explored a group delivery of an evidence-based PMI (RUBI), delivered face-to-face and virtually in Israel, before and during the pandemic. Fifty-five families of children with autism and DB participated, 24 receiving face-to-face intervention and 31 receiving virtual. Outcome measures included the Aberrant Behavior Checklist and Home Situations Questionnaires. Results indicate reduction of DBs across groups, with > 50% of treatment-responders showing reliable change. This study is the first to assess RUBI outside the US among a sociodemographically diverse population, in both in-person and virtual contexts.
Collapse
Affiliation(s)
- Tobi Graucher
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yana Sinai-Gavrilov
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yaniv Mor
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.,The Open University, Ra'anana, Israel
| | - Shay Netzer
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Y Cohen
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Linoy Levi
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Judah Koller
- Seymour Fox School of Education, Hebrew University of Jerusalem, Jerusalem, Israel.
| |
Collapse
|
39
|
Schorr-Sapir I, Gershy N, Apter A, Omer H. Parent training in non-violent resistance for children with attention deficit hyperactivity disorder: a controlled outcome study. Eur Child Adolesc Psychiatry 2022; 31:929-38. [PMID: 33528659 DOI: 10.1007/s00787-021-01723-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/15/2021] [Indexed: 10/22/2022]
Abstract
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.
Collapse
|
40
|
Fang Z, Lachman JM, Qiao D, Barlow J. Controlled Trial of a Short-term Intensive Parent Training Program within the Context of Routine Services for Autistic Children in China. Psychosoc Interv 2022; 31:121-131. [PMID: 37360058 PMCID: PMC10268554 DOI: 10.5093/pi2022a9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/18/2022] [Indexed: 06/28/2023]
Abstract
Recent systematic reviews found limited rigorous research conducted to date of the effectiveness of parent training programs in reducing behavioral problems for autistic children in low- and middle-income countries. This study is aimed at evaluating the effectiveness of a short-term intensive parent training program for autistic children aged three to six in the context of routine service provision in China. A quasi-experiment was conducted involving the local implementing organization and using a waitlist control. Data were collected at baseline and immediate post-intervention. The primary outcome was child behavioral problems measured using the Child Behavior Checklist Externalizing scale. Between-group comparisons used a difference-in-differences design with propensity score weighting to reduce sources of bias. A process evaluation was undertaken in parallel to assess participant involvement, program acceptability, and delivery. The protocol was prospectively registered with ClinicalTrials.gov (NCT04257331). The final sample size was 111 (treatment: 63; comparison: 48). Results suggest that the program was associated with improvements in child externalizing behaviors (b = -2.71, 95% CI [-5.23, -0.18]), parental mental health symptoms (b = -5.96, 95% CI [-11.74, -0.17]), over-reactive parenting (b = -0.63, 95% CI [-0.98, -0.27]), and parental knowledge (b = 2.08, 95% CI [2.07, 2.17]). Exploratory analysis of factors related to implementation indicated that baseline parental mental health was related to participant engagement, and that satisfaction and engagement levels were potentially linked to positive treatment effects. Findings suggest that short-term intensive parent training programs that are provided by trained non-specialists, could potentially be used as an alternative to traditional prohibitively costly services that are delivered intensively for consecutive years in low-resource contexts. Follow-ups are needed to investigate its long-term benefits.
Collapse
Affiliation(s)
- Zuyi Fang
- Beijing Normal UniversitySchool of Social Development and Public PolicyRepublic of ChinaSchool of Social Development and Public Policy, Beijing Normal University, People’s Republic of China;
| | - Jamie M. Lachman
- University of OxfordDepartment of Social Policy and InterventionUnited KingdomDepartment of Social Policy and Intervention, University of Oxford, United Kingdom
| | - Dongping Qiao
- Beijing Normal UniversitySchool of Social Development and Public PolicyRepublic of ChinaSchool of Social Development and Public Policy, Beijing Normal University, People’s Republic of China;
| | - Jane Barlow
- University of OxfordDepartment of Social Policy and InterventionUnited KingdomDepartment of Social Policy and Intervention, University of Oxford, United Kingdom
| |
Collapse
|
41
|
Coon JC, Bush H, Rapp JT. Eight Months of Telehealth for a State-Funded Project in Foster Care and Related Services: Progress Made and Lessons Learned. Behav Anal Pract 2022; 15:1348-1360. [PMID: 35313702 PMCID: PMC8924942 DOI: 10.1007/s40617-022-00682-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 12/15/2022] Open
Abstract
In response to the COVID-19 pandemic, many behavior analysts and other health professionals modified their services for delivery via telehealth modalities. The transition to telehealth is especially important for providers working with foster youth who exhibit challenging behavior because these youth often move to another placement due to such behaviors. The primary objective of this article was to evaluate the extent to which service indicators for a state-funded team working with foster youth changed after the service delivery model changed from in-person to telehealth services. In particular, we evaluated changes in monthly count of client contacts, appointments, intakes, closed cases, and medication reviews. The secondary objective was to outline potential benefits and environmental barriers encountered by the team and to integrate our findings with the literature on behavior-analytic services provided via telehealth. Overall, results show that we maintained service quality with a broad range of behavioral interventions and increased overall client appointments. Given these outcomes, our team may continue to provide behavioral services via telehealth after the COVID-19 pandemic.
Collapse
Affiliation(s)
- Jodi C. Coon
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
| | - Helena Bush
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
| | - John T. Rapp
- Department of Psychological Sciences, Auburn University, 226 Thach, Auburn, AL 36849-5214 USA
| |
Collapse
|
42
|
Gentile M, Messineo L, La Guardia D, Arrigo M, Città G, Ayala A, Cusimano G, Martines P, Mendolia G, Allegra M. A Parent-Mediated Telehealth Program for Children with Autism Spectrum Disorder : Promoting Parents' Ability to Stimulate the Children's Learning, Reduce Parenting Stress, and Boost Their Sense of Parenting Empowerment. J Autism Dev Disord 2022; 52:5285-5300. [PMID: 35235129 DOI: 10.1007/s10803-022-05482-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 01/05/2023]
Abstract
This study investigates the effectiveness of a 6-month parent-mediated early intervention telehealth program for children with an autism spectrum disorder. The participants comprised a total of 27 parents. The findings showed that participation in the program promotes parents' empowerment and reduce parental stress and a general improvement in the parents' ability to stimulate children's learning. Moreover, the study reveals an effect of parents' age in mediating the relationship among the parents' ability, stress, and empowerment levels. These results suggest that an early intervention telehealth program may help parents become aware of how to benefit from interactions with their children, promote their empowerment, and reduce parenting stress.
Collapse
Affiliation(s)
- Manuel Gentile
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Linda Messineo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy.
| | - Dario La Guardia
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Marco Arrigo
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Giuseppe Città
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Antonia Ayala
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Gaspare Cusimano
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| | - Pio Martines
- Azienda Sanitaria Provinciale di Trapani, Cittadella della Salute, viale della Provincia, 2, 91016, Erice Casa-Santa, Trapani, Italy
| | - Giovanna Mendolia
- Azienda Sanitaria Provinciale di Trapani, Cittadella della Salute, viale della Provincia, 2, 91016, Erice Casa-Santa, Trapani, Italy
| | - Mario Allegra
- Istituto per le Tecnologie Didattiche, Consiglio Nazionale delle Ricerche, via Ugo la Malfa, 153, 90146, Palermo, Italy
| |
Collapse
|
43
|
Kuhn M, Gonzalez E, Weil L, Izguttinov A, Walker S. Effectiveness of Child-Focused Interventions for Externalizing Behavior: a Rapid Evidence Review. Res Child Adolesc Psychopathol 2022; 50:987-1009. [PMID: 35212851 DOI: 10.1007/s10802-022-00904-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Parent behavior management training (BMT) is well established as an effective, evidence-based treatment for children with externalizing behavior. Despite the wealth of data supporting BMT, many community providers use a variety of child-focused and non-directive interventions to target behavior problems. There is lack of clarity as to whether the evidence supporting child-focused externalizing treatments is sufficiently compelling to support offering these treatments rather than or in addition to BMT. This rapid evidence review compares the effectiveness of BMT with several common child-focused interventions for externalizing behavior including cognitive behavioral (CBT), social skill (SS), and play/dynamic (PT) approaches. PubMed, PsychINFO, and Web of Science were searched for English-language articles from year 2000 onwards for each intervention type. Inclusion criteria were child age (12 and under), presence of a child-focused behavioral treatment condition, and externalizing behavior as an outcome variable. A total of 30 studies met inclusion criteria and were coded (13 CBT, 10 SS, 7 PT). Results supported social skills interventions with accompanying BMT as effective in improving externalizing problems, with generally moderate effect sizes. Individual social skills interventions were promising but needing further evaluation compared to treatment as usual. CBT treatments with and without accompanying BMT showed moderate effects over waitlist but produced less consistently significant effects compared to more robust controls. Play therapy approaches showed inconsistent effects and require further evaluation. This review supports social skills plus BMT treatments as a child-focused intervention with probable efficacy for child externalizing problems. Implications for policy and community practice are discussed.
Collapse
Affiliation(s)
- M Kuhn
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA. .,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA.
| | - E Gonzalez
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA
| | - L Weil
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - A Izguttinov
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - S Walker
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| |
Collapse
|
44
|
Helander M, Enebrink P, Hellner C, Ahlen J. Parent Management Training Combined with Group-CBT Compared to Parent Management Training Only for Oppositional Defiant Disorder Symptoms: 2-Year Follow-Up of a Randomized Controlled Trial. Child Psychiatry Hum Dev 2022. [PMID: 35089501 DOI: 10.1007/s10578-021-01306-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/03/2022]
Abstract
Parent management training (PMT) is recommended treatment for children with oppositional defiant disorder (ODD) and child-directed cognitive behavior therapy (CBT) is also recommended for school-aged children. The current study examined 2-year follow-up effects of parent management training (PMT) combined with the CBT based group intervention Coping Power Program (CPP) compared to PMT only. Results showed long-term effectiveness of both PMT and PMT combined with CPP in reduced disruptive behavior problems and harsh parenting strategies, and increased emotion regulation- and social communication skills. The earlier reported increase in emotion regulation- and social communication skills in the PMT with CPP condition during treatment remained stable while the PMT condition showed continued improvement during the follow-up period. To conclude, PMT with CPP did generally not provide significant benefits at the 2-year follow-up compared to PMT, apart from an improvement earlier in time regarding emotion regulation- and social communication skills.Trial registration number ISRCTN10834473, date of registration: 23/12/2015.
Collapse
|
45
|
Kostyrka-Allchorne K, Ballard C, Byford S, Cortese S, Daley D, Downs J, French B, Glazebrook C, Goldsmith K, Groom MJ, Hall CL, Hedstrom E, Ibrahim Z, Jarvis C, Kovshoff H, Kreppner J, Lean N, Morris A, Gutierrez WM, Sayal K, Shearer J, Simonoff E, Thompson M, Zalewski L, Sonuga-Barke EJS. The feasibility of a strategy for the remote recruitment, consenting and assessment of recent referrals: a protocol for phase 1 of the On-Line Parent Training for the Initial Management of ADHD referrals (OPTIMA). Pilot Feasibility Stud 2022; 8:1. [PMID: 34980279 PMCID: PMC8720938 DOI: 10.1186/s40814-021-00959-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the UK, children with high levels of hyperactivity, impulsivity and inattention referred to clinical services with possible attention-deficit/hyperactivity disorder (ADHD) often wait a long time for specialist diagnostic assessment. Parent training (PT) has the potential to support parents during this difficult period, especially regarding the management of challenging and disruptive behaviours that often accompany ADHD. However, traditional face-to-face PT is costly and difficult to organise in a timely way. We have created a low-cost, easily accessible PT programme delivered via a phone app, Structured E-Parenting Support (STEPS), to address this problem. The overall OPTIMA programme will evaluate the efficacy and cost-effectiveness of STEPS as a way of helping parents manage their children behaviour while on the waitlist. To ensure the timely and efficient evaluation of STEPS in OPTIMA, we have worked with children's health services to implement a remote strategy for recruitment, screening and assessment of recently referred families. Part of this strategy is incorporated into routine clinical practice and part is OPTIMA specific. Here, we present the protocol for Phase 1 of OPTIMA-a study of the feasibility of this remote strategy, as a basis for a large-scale STEPS randomised controlled trial (RCT). METHODS This is a single arm observational feasibility study. Participants will be parents of up to 100 children aged 5-11 years with high levels of hyperactivity/impulsivity, inattention and challenging behaviour who are waiting for assessment in one of five UK child and adolescent mental health or behavioural services. Recruitment, consenting and data collection will occur remotely. The primary outcome will be the rate at which the families, who meet inclusion criteria, agree in principle to take part in a full STEPS RCT. Secondary outcomes include acceptability of remote consenting and online data collection procedures; the feasibility of collecting teacher data remotely within the required timeframe, and technical difficulties with completing online questionnaires. All parents in the study will receive access to STEPS. DISCUSSION Establishing the feasibility of our remote recruitment, consenting and assessment strategy is a pre-requisite for the full trial of OPTIMA. It can also provide a model for future trials conducted remotely.
Collapse
Affiliation(s)
- Katarzyna Kostyrka-Allchorne
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Claire Ballard
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Sarah Byford
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, USA
| | - David Daley
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Johnny Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Blandine French
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Cristine Glazebrook
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Kimberley Goldsmith
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Madeleine J Groom
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Charlotte L Hall
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Ellen Hedstrom
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Zina Ibrahim
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Hanna Kovshoff
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jana Kreppner
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Nancy Lean
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Anna Morris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Walter Muruet Gutierrez
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kapil Sayal
- Academic Unit of Mental Health & Clinical Neurosciences, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
- Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan CANDAL Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - James Shearer
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Margaret Thompson
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
| | - Lukasz Zalewski
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Edmund J S Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
- Department of Child & Adolescent Psychiatry, Aarhus University, Aarhus, Denmark.
| |
Collapse
|
46
|
Ferguson J, Dounavi K, Craig EA. The impact of a telehealth platform on ABA-based parent training targeting social communication in children with autism spectrum disorder. J Dev Phys Disabil 2022; 34:1089-1120. [PMID: 35370389 PMCID: PMC8961090 DOI: 10.1007/s10882-022-09839-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2022] [Indexed: 05/04/2023]
Abstract
Interventions based upon applied behaviour analysis (ABA) have been shown to be best practice for children with autism spectrum disorder. However, in many parts of the world there is a shortage of appropriately trained behaviour analysts. Telehealth is a potential solution to increasing access to ABA. Our study assessed the use of telehealth to provide parent training in naturalistic teaching strategies designed to increase child communication skills. Five parent child dyads took part in the training, utilising didactic training and synchronous coaching. Parents could be trained to a high level of fidelity and viewed the training favourably. Children showed variable gains in communication and improved positive affect. The project was cost effective in comparison with traditional training models.
Collapse
Affiliation(s)
- Jenny Ferguson
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, BT7 1HL Belfast, Northern Ireland
| | - Katerina Dounavi
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, BT7 1HL Belfast, Northern Ireland
| | - Emma A. Craig
- School of Social Sciences, Education & Social Work, Queen’s University of Belfast, 69-71 University Street, BT7 1HL Belfast, Northern Ireland
| |
Collapse
|
47
|
Arruabarrena I, Rivas GR, Cañas M, Paúl JD. The Incredible Years Parenting and Child Treatment Programs: A Randomized Controlled Trial in a Child Welfare Setting in Spain. Interv Psicosoc 2022; 31:43-58. [PMID: 37362617 PMCID: PMC10268544 DOI: 10.5093/pi2022a2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/08/2021] [Indexed: 06/28/2023]
Abstract
Incredible Years (IY) is a well-established multicomponent group-based program designed to promote young children's emotional and social competence, to prevent and treat child behavioral and emotional problems, and to improve parenting practices and the parent-child relationship. This study presents the first randomized controlled trial carried out in Spain to test the effectiveness of the Incredible Years Basic Parenting and Small Group Dinosaur Programs in a sample of families involved in child welfare due to substantiated or risk for child maltreatment. One hundred and eleven families with 4- to 8-year-old children were randomly allocated to IY or to a control group who received standard services. Baseline, post-intervention, and 12-month follow-up assessments were compared. Results showed that compared to the control group, the IY intervention made a significant positive difference in parents' observed and reported use of praise, and a significant reduction in reported use of inconsistent discipline, parenting stress, depressive symptomatology, and perception of child behavior problems. A full serial mediation effect was found between participation in IY, changes in parenting practices, subsequent parenting stress reduction, and both final child abuse potential reduction and perception of child behavior problems. No moderating influence on IY effects was found. Findings provide evidence that transporting the IY Basic Parenting and the Small Group Dinosaur Programs with fidelity is feasible in Child Welfare Services in Spain.
Collapse
Affiliation(s)
- Ignacia Arruabarrena
- University of the Basque CountryDonostia-San SebastiánSpainUniversity of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain
| | - Gabriela R. Rivas
- University of the Basque CountryDonostia-San SebastiánSpainUniversity of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain
| | - María Cañas
- University of the Basque CountryDonostia-San SebastiánSpainUniversity of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain
| | - Joaquín De Paúl
- University of the Basque CountryDonostia-San SebastiánSpainUniversity of the Basque Country (UPV/EHU), Donostia-San Sebastián, Spain
| |
Collapse
|
48
|
Dekkers TJ, Groenman AP, Wessels L, Kovshoff H, Hoekstra PJ, van den Hoofdakker BJ. Which factors determine clinicians' policy and attitudes towards medication and parent training for children with Attention-Deficit/Hyperactivity Disorder? Eur Child Adolesc Psychiatry 2022; 31:483-93. [PMID: 33585968 DOI: 10.1007/s00787-021-01735-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/31/2021] [Indexed: 01/19/2023]
Abstract
Behavioral parent and teacher training and stimulant medication are recommended interventions for children with attention-deficit/hyperactivity disorder (ADHD). However, not all children with ADHD receive this evidence-based care, and the aim of the current study was to find out why. More specifically, we investigated clinicians' policy, guideline use, and attitudes towards medication and parent training when treating children with ADHD, as well as several factors that could affect this. A total of 219 Dutch clinicians (mainly psychologists, psychiatrists and educationalists) completed a survey. Clinicians were likely to recommend medication more often than parent training, and clinicians' policy to recommend medication and parent training was positively associated with their attitudes towards these interventions. Less experienced clinicians and those with a non-medical background reported lower rates of guideline use, whereas clinicians with a medical background reported less positive attitudes towards parent training. Furthermore, a substantial portion of the clinicians based their decision to recommend parent training on their clinical judgement (e.g., prior estimations of efficacy, perceived low abilities/motivation of parents), and many clinicians reported barriers for referral to parent training, such as waiting lists or a lack of skilled staff. To achieve better implementation of evidence-based care for children with ADHD, guidelines should be communicated better towards clinicians. Researchers and policy-makers should further focus on barriers that prevent implementation of parent training, which are suggested by the discrepancy between clinicians' overall positive attitude towards parent training and the relatively low extent to which clinicians actually advise parent training.
Collapse
|
49
|
Tăut D, Băban A, Frantz I, Dănilă I, Lachman JM, Heinrichs N, Ward CL, Gardner F, Fang X, Hutchings J, Raleva M, Lesco G, Murphy H, Foran H. Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial. Trials 2021; 22:960. [PMID: 34961518 PMCID: PMC8710933 DOI: 10.1186/s13063-021-05817-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children's future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs. METHODS/DESIGN A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group. DISCUSSION This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme. TRIAL REGISTRATION ClinicalTrials.gov ., Registration number: NCT04721730 ( https://clinicaltrials.gov/ct2/show/NCT04721730 ). Registered 13.01.2021.
Collapse
Affiliation(s)
- Diana Tăut
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania.
| | - Adriana Băban
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Inga Frantz
- Department of Psychology, Clinical Psychology, and Psychotherapy, University of Bremen, Bremen, Germany
| | - Ingrid Dănilă
- Department of Psychology, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Jamie M Lachman
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Nina Heinrichs
- Department of Psychology, Clinical Psychology, and Psychotherapy, University of Bremen, Bremen, Germany
| | - Catherine L Ward
- Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Frances Gardner
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Xiangming Fang
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | | | - Marija Raleva
- Institute for Marriage, Family and Systemic Practice - ALTERNATIVA, Skopje, North Macedonia
| | - Galina Lesco
- Health for Youth Association, Chișinău, Republic of Moldova
| | - Hugh Murphy
- Institute for Psychology, University of Klagenfurt, Klagenfurt, Austria
| | - Heather Foran
- Institute for Psychology, University of Klagenfurt, Klagenfurt, Austria
| |
Collapse
|
50
|
Awasthi S, Aravamudhan S, Jagdish A, Joshi B, Mukherjee P, Kalkivaya R, Ali RS, Srivastava SN, Edasserykkudy S. Transitioning ABA Services From in Clinic to Telehealth: Case Study of an Indian Organization's Response to COVID-19 Lockdown. Behav Anal Pract 2021; 14:893-912. [PMID: 34394851 PMCID: PMC8356690 DOI: 10.1007/s40617-021-00600-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Due to the coronavirus (COVID-19) pandemic, around the middle of March 2020, in-clinic intervention services based in applied behavior analysis provided to children had to be stopped abruptly in India. This qualitative and quantitative case study details how Behavior Momentum India (BMI), an organisation providing ABA-based interventions, transitioned services from in clinic to telehealth while continuing to target each student's skill acquisition goals in language and communication domains. A cohort of 92 students diagnosed with autism or other learning disabilities participated in this study; 51 therapists, 9 behavior supervisors, and a doctoral-level Board Certified Behavior Analyst collaborated with parents; 78% of the students and 82% of the therapists used smartphones; and only a few used iPads and laptops. Therapists conducted direct sessions and parent-mediated sessions with 82 students. With 10 students, behavior supervisors trained parents to implement interventions with their children. The critical transition decisions, logistics, and ethical challenges were identified using qualitative methods. Despite significantly reduced session durations, all students continued to acquire targeted skills, and 52% of the students acquired more skills in telehealth compared to in clinic. A parent satisfaction survey returned high ratings onour organization's initiative, and 72% of the parents reported that their familiarity and confidence with the science of applied behavior analysis had increased.
Collapse
Affiliation(s)
- Smita Awasthi
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Sridhar Aravamudhan
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Anupama Jagdish
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Bhavana Joshi
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Papiya Mukherjee
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Rajeshwari Kalkivaya
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | - Razia Shahzad Ali
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| | | | - Sreemon Edasserykkudy
- Behavior Momentum India, 407, 7th Main, 80 ft. Road, HRBR Layout, Bangalore, 560043 India
| |
Collapse
|