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Royston R, Absoud M, Ambler G, Barnes J, Hunter R, Kyriakopoulos M, Ondruskova T, Oulton K, Paliokosta E, Panca M, Sharma A, Slonim V, Summerson U, Sutcliffe A, Thomas M, Qu C, Hassiotis A. Evaluation of adapted parent training for challenging behaviour in pre-school children with moderate to severe intellectual developmental disabilities: A randomised controlled trial. PLoS One 2024; 19:e0306182. [PMID: 39137195 PMCID: PMC11321573 DOI: 10.1371/journal.pone.0306182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/10/2024] [Indexed: 08/15/2024] Open
Abstract
OBJECTIVES There is limited evidence on the effectiveness of parenting interventions to improve disruptive behaviour in children with intellectual developmental disabilities. This clinical trial evaluated whether an adapted group parenting intervention for preschool children with intellectual developmental disabilities who display challenging behaviour is superior to treatment as usual in England. STUDY DESIGN 261 children aged 30-59 months with moderate to severe intellectual developmental disabilities and challenging behaviour were randomised to either the intervention (Stepping Stones Triple P) and treatment as usual or treatment as usual alone. The primary outcome was the parent-rated Child Behaviour Checklist at 52 weeks after randomisation. A health economic evaluation was also completed. RESULTS We found no significant difference between arms on the primary outcome (mean difference -4.23; 95% CI: -9.99 to 1.53; p = 0.147). However, a subgroup analysis suggests the intervention was effective for participants randomised before the COVID-19 pandemic (mean difference -7.12; 95% CI: -13.44 to -0.81; p = 0.046). Furthermore, a complier average causal effects analysis (mean difference -11.53; 95% CI: -26.97 to 3.91; p = 0.143) suggests the intervention requires participants to receive a sufficient intervention dose. The intervention generated statistically significant cost savings (-£1,057.88; 95% CI -£3,218.6 to -£46.67) but the mean point estimate in Quality Adjusted Life Years was similar in both groups. CONCLUSION This study did not find an effect of the intervention on reducing challenging behaviour, but this may have been influenced by problems with engagement. The intervention could be considered by services as an early intervention if families are supported to attend, especially given its low cost.
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Affiliation(s)
- Rachel Royston
- Division of Psychiatry, University College London, London, United Kingdom
| | - Michael Absoud
- Evelina London Children's Hospital, St Thomas' Hospital, and King's College London, London, United Kingdom
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, United Kingdom
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University of London, London, United Kingdom
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, Royal Free Medical School, London, United Kingdom
| | - Marinos Kyriakopoulos
- 1st Department of Psychiatry National and Kapodistrian University of Athens, Greece and South London and Maudsley NHS Foundation Trust and Department of Child and Adolescent Psychiatry, King's College London, London, United Kingdom
| | - Tamara Ondruskova
- Division of Psychiatry, University College London, London, United Kingdom
| | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, United Kingdom
| | - Monica Panca
- Research Department of Primary Care and Population Health, Royal Free Medical School, London, United Kingdom
| | - Aditya Sharma
- Cumbria, Northumberland, Tyne & Wear NHS Foundation Trust & Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle, United Kingdom
| | - Vicky Slonim
- Evelina London Children's Hospital, St Thomas' Hospital, and King's College London, London, United Kingdom
| | | | - Alastair Sutcliffe
- Institute of Child Health, University College London, London, United Kingdom
| | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Chen Qu
- Department of Statistical Science, University College London, London, United Kingdom
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London, United Kingdom
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Ondruskova T, Royston R, Absoud M, Ambler G, Qu C, Barnes J, Hunter R, Panca M, Kyriakopoulos M, Oulton K, Paliokosta E, Sharma AN, Slonims V, Summerson U, Sutcliffe A, Thomas M, Dhandapani B, Leonard H, Hassiotis A. Clinical and cost-effectiveness of an adapted intervention for preschoolers with moderate to severe intellectual disabilities displaying behaviours that challenge: the EPICC-ID RCT. Health Technol Assess 2024; 28:1-94. [PMID: 38329108 PMCID: PMC11017145 DOI: 10.3310/jkty6144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Background Stepping Stones Triple P is an adapted intervention for parents of young children with developmental disabilities who display behaviours that challenge, aiming at teaching positive parenting techniques and promoting a positive parent-child relationship. Objective To evaluate the clinical and cost-effectiveness of level 4 Stepping Stones Triple P in reducing behaviours that challenge in children with moderate to severe intellectual disabilities. Design, setting, participants A parallel two-arm pragmatic multisite single-blind randomised controlled trial recruited a total of 261 dyads (parent and child). The children were aged 30-59 months and had moderate to severe intellectual disabilities. Participants were randomised, using a 3 : 2 allocation ratio, into the intervention arm (Stepping Stones Triple P; n = 155) or treatment as usual arm (n = 106). Participants were recruited from four study sites in Blackpool, North and South London and Newcastle. Intervention Level 4 Stepping Stones Triple P consists of six group sessions and three individual phone or face-to-face contacts over 9 weeks. These were changed to remote sessions after 16 March 2020 due to the coronavirus disease 2019 pandemic. Main outcome measure The primary outcome measure was the parent-reported Child Behaviour Checklist, which assesses the severity of behaviours that challenge. Results We found a small non-significant difference in the mean Child Behaviour Checklist scores (-4.23, 95% CI -9.98 to 1.52, p = 0.146) in the intervention arm compared to treatment as usual at 12 months. Per protocol and complier average causal effect sensitivity analyses, which took into consideration the number of sessions attended, showed the Child Behaviour Checklist mean score difference at 12 months was lower in the intervention arm by -10.77 (95% CI -19.12 to -2.42, p = 0.014) and -11.53 (95% CI -26.97 to 3.91, p = 0.143), respectively. The Child Behaviour Checklist mean score difference between participants who were recruited before and after the coronavirus disease 2019 pandemic was estimated as -7.12 (95% CI -13.44 to -0.81) and 7.61 (95% CI -5.43 to 20.64), respectively (p = 0.046), suggesting that any effect pre-pandemic may have reversed during the pandemic. There were no differences in all secondary measures. Stepping Stones Triple P is probably value for money to deliver (-£1057.88; 95% CI -£3218.6 to -£46.67), but decisions to roll this out as an alternative to existing parenting interventions or treatment as usual may be dependent on policymaker willingness to invest in early interventions to reduce behaviours that challenge. Parents reported the intervention boosted their confidence and skills, and the group format enabled them to learn from others and benefit from peer support. There were 20 serious adverse events reported during the study, but none were associated with the intervention. Limitations There were low attendance rates in the Stepping Stones Triple P arm, as well as the coronavirus disease 2019-related challenges with recruitment and delivery of the intervention. Conclusions Level 4 Stepping Stones Triple P did not reduce early onset behaviours that challenge in very young children with moderate to severe intellectual disabilities. However, there was an effect on child behaviours for those who received a sufficient dose of the intervention. There is a high probability of Stepping Stones Triple P being at least cost neutral and therefore worth considering as an early therapeutic option given the long-term consequences of behaviours that challenge on people and their social networks. Future work Further research should investigate the implementation of parenting groups for behaviours that challenge in this population, as well as the optimal mode of delivery to maximise engagement and subsequent outcomes. Study registration This study is registered as NCT03086876 (https://www.clinicaltrials.gov/ct2/show/NCT03086876?term=Hassiotis±Angela&draw=1&rank=1). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: HTA 15/162/02) and is published in full in Health Technology Assessment; Vol. 28, No. 6. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
| | - Rachel Royston
- Division of Psychiatry, University College London, London, UK
| | - Michael Absoud
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Chen Qu
- Department of Statistical Science, University College London, London, UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birkbeck University, University of London, London, UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, University College London, Royal Free Medical School, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust, Michael Rutter Centre, Maudsley Hospital, London, UK
- National and Kapodistrian University of Athens, Vyronas-Kessariani Community Mental Health Centre, Athens, Greece
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Eleni Paliokosta
- The Tavistock and Portman NHS Foundation Trust, Kentish Town Health Centre, London, UK
| | - Aditya Narain Sharma
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust and Newcastle University, Walkergate Park Centre for Neurorehabilitation and Neuropsychiatry, Newcastle upon Tyne, UK
| | - Vicky Slonims
- Evelina Hospital, Guys and St Thomas's NHS Foundation Trust, London, UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, UK
| | | | - Helen Leonard
- Great North Children's Hospital, Victoria Wing, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Jang J, Kim G, Jeong H, Lee N, Oh S. Meta-analysis on the effectiveness of parent education for children with disabilities. World J Clin Cases 2023; 11:7082-7090. [PMID: 37946766 PMCID: PMC10631414 DOI: 10.12998/wjcc.v11.i29.7082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/24/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Parents of children with disabilities often have difficulty understanding their child's behavior and are unable to do it appropriately because they do not know what to do. The more we properly understand children with disabilities, the more positive the importance of parent education becomes in various aspects. AIM To demonstrate the effectiveness of parent education for children with disabilities in various aspects and present it as evidence that can be used clinically. METHODS For a meta-analysis on the effectiveness of parent education for children with disabilities, literature was collected from 2002 to 2022 using PubMed, Embase, Web of Science, Directory of Open Access Journals, and Europe PMC. Search terms were "disabled children," "disabled children," "parent education," "parent training," and "parent coaching." The final searched literature included a total of 11 articles. To calculate the effect size, the mean, standard deviation, and sample size of the experimental and control groups were analyzed, and a meta-analysis was performed using RevMan version 5.4.1. To analyze statistical heterogeneity, a chi-square test was performed to evaluate the significance of Q statistics to indicate statistical heterogeneity. RESULTS The final literature totaled 11 articles, and a total of 4 items were analyzed. There were 5 studies on parental depression, the heterogeneity was 98%, and the effect size for parental depression was 0.35 [confidence interval (CI: 0.30-0.40)], indicating a small but statistically significant effect size. There were 4 studies on parenting attitude, the heterogeneity was 100%, the effect size on parenting attitude was 0.41 (CI: 0.37-0.46), which was a medium effect size, and the P value showed a statistically significant score. Additionally, face-to-face parent education was found to have a larger effect size than non-face-to-face education. Regarding parent education methods, face-to-face parent education had a medium effect size [0.57 (CI: 0.52-0.61]), while non-face-to-face parent education had a small effect size [0.23 (CI: 0.18-0.28]). CONCLUSION Parental education has shown high effectiveness in child development, and it has proven to be even more effective when face-to-face parenting education is conducted. Accordingly, more effective and objective data was presented. Based on this study, it is believed that parent education research applying various diagnostic groups should continue to be conducted.
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Affiliation(s)
- JongSik Jang
- Department of Occupatioanl Therapy, Kangwon National University, Gangwon-do, Samcheok 25945, South Korea
| | - Geonwoo Kim
- Department of Occupational Therapy, Kangwon National University Graduate School, Gangwon-do, Samcheok 25949, South Korea
| | - Hyewon Jeong
- Department of Occupational Therapy, Kangwon National University Graduate School, Gangwon-do, Samcheok 25949, South Korea
| | - Narae Lee
- Department of Occupational Therapy, Kangwon National University Graduate School, Gangwon-do, Samcheok 25949, South Korea
| | - Seri Oh
- Department of Occupational Therapy, Kangwon National University Graduate School, Gangwon-do, Samcheok 25949, South Korea
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Doyle FL, Morawska A, Higgins DJ, Havighurst SS, Mazzucchelli TG, Toumbourou JW, Middeldorp CM, Chainey C, Cobham VE, Harnett P, Sanders MR. Policies are Needed to Increase the Reach and Impact of Evidence-Based Parenting Supports: A Call for a Population-Based Approach to Supporting Parents, Children, and Families. Child Psychiatry Hum Dev 2023; 54:891-904. [PMID: 34989941 PMCID: PMC8733919 DOI: 10.1007/s10578-021-01309-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/14/2021] [Indexed: 01/23/2023]
Abstract
Parents can be essential change-agents in their children's lives. To support parents in their parenting role, a range of programs have been developed and evaluated. In this paper, we provide an overview of the evidence for the effectiveness of parenting interventions for parents and children across a range of outcomes, including child and adolescent mental and physical health, child and adolescent competencies and academic outcomes, parental skills and competencies, parental wellbeing and mental health, and prevention of child maltreatment and family violence. Although there is extensive research showing the effectiveness of evidence-based parenting programs, these are not yet widely available at a population level and many parents are unable to access support. We outline how to achieve increased reach of evidence-based parenting supports, highlighting the policy imperative to adequately support the use of these supports as a way to address high priority mental health, physical health, and social problems.
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Affiliation(s)
- Frances L. Doyle
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW Australia
- School of Psychology, The MARCS Institute for Brain Behaviour and Development, Transforming Early Education and Child Health (TeEACH) Research Centre, Translational Health Research Institute, Western Sydney University, Sydney, NSW Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Daryl J. Higgins
- Institute of Child Protection Studies, Australian Catholic University, Melbourne, VIC, Australia
| | - Sophie S. Havighurst
- Mindful: Centre for Training and Research in Developmental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Trevor G. Mazzucchelli
- School of Psychology, Curtin University, Perth, WA Australia
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - John W. Toumbourou
- Centre for Social and Early Emotional Development, Deakin University, Geelong, VIC, Australia
| | - Christel M. Middeldorp
- Child Health Research Centre, The University of Queensland, Brisbane, QLD Australia
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD Australia
| | - Carys Chainey
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
| | - Vanessa E. Cobham
- School of Psychology, The University of Queensland, Brisbane, QLD Australia
- Child and Youth Mental Health Service, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD Australia
| | - Paul Harnett
- School of Criminology and Criminal Justice, Griffith University, Brisbane, QLD, Australia
| | - Matthew R. Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD Australia
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Geissler J, Buchholz H, Meerson R, Kammerer K, Göster M, Schobel J, Ratz C, Taurines R, Pryss R, Romanos M. Smartphone-based behaviour analysis for challenging behaviour in intellectual and developmental disabilities and autism spectrum disorder - Study protocol for the ProVIA trial. Front Neurosci 2022; 16:984618. [PMID: 36312036 PMCID: PMC9610118 DOI: 10.3389/fnins.2022.984618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background Challenging behaviour (CB) comprises various forms of aggressive and problematic behaviours frequently occurring in children with intellectual and developmental disability (IDD) or autism spectrum disorder (ASD). CB often arises from impaired communication or problem solving skills. It is often met with coercive measure due to a lack of alternative strategies on the part of the caregiver, while it also impacts on the caregivers due to the exposure to physical harm and high levels of stress. Within the ProVIA project we developed a smartphone-based tool for caregivers of children with IDD and/or ASD to prevent and modify CB. The ProVIA app systematically helps caregivers to identify specific causes of CB and provides individualised practical guidance to prevent CB and consecutive coercive measures, thus aiming to improve the health and well-being of the children and caregivers. Methods In this uncontrolled open trial we will enrol N = 25 caregivers of children aged 3-11 years with a diagnosis of IDD and/or ASD. Participants will use the ProVIA-Kids app for 8 weeks. During the intervention phase, participants will conduct behaviour analyses after each instance of CB. The app will summarise the identified putative causes for the CB in each situation, and provide recommendations regarding the handling and prevention of CB. Furthermore, the app will aggregate data from all available behaviour analyses and identify the most relevant (i.e., most frequently reported) risk factors. Measurement points are at baseline (T0), after the intervention (T1) and 12 weeks after the end of the intervention (follow-up; T2). The primary outcome is the absolute change in parental stress (EBI total scale) between T0 and T1. Further aspects of interest are changes in CB severity and frequency, caregiver mood, satisfaction with the parenting role (EFB-K total scale) and experienced parenting competence (FKE total scale). Pre-post comparisons will be analysed with paired sample t-tests. Discussion ProVIA is pioneering structured behaviour analysis via smartphone, assessing predefined causes of CB and providing feedback and recommendations. If this approach proves successful, the ProVIA-Kids app will be a valuable tool for caregivers to prevent CB and improve their own as well as the children's quality of life. Trial registration The study is registered at https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_IDDRKS00029039 (registered May 31, 2022).
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Affiliation(s)
- Julia Geissler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Hanna Buchholz
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Rinat Meerson
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Klaus Kammerer
- Institute for Clinical Epidemiology and Biometry (IKEB), University of Würzburg, Würzburg, Germany
| | - Manuel Göster
- Institute for Clinical Epidemiology and Biometry (IKEB), University of Würzburg, Würzburg, Germany
| | - Johannes Schobel
- DigiHealth Institute, Neu-Ulm University of Applied Sciences, Neu-Ulm, Germany
| | - Christoph Ratz
- Education for People with Developmental and Intellectual Disabilities, University of Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Regina Taurines
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
| | - Rüdiger Pryss
- Institute for Clinical Epidemiology and Biometry (IKEB), University of Würzburg, Würzburg, Germany
| | - Marcel Romanos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany
- German Centre of Prevention Research in Mental Health, University Hospital Würzburg, Würzburg, Germany
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Sanders M, Hoang NPT, Hodges J, Sofronoff K, Einfeld S, Tonge B, Gray K. Predictors of Change in Stepping Stones Triple Interventions: The Relationship between Parental Adjustment, Parenting Behaviors and Child Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13200. [PMID: 36293782 PMCID: PMC9602721 DOI: 10.3390/ijerph192013200] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
The current study explored the process of change in Stepping Stones Triple P (SSTP) using a community-based sample of 891 families of children with developmental disabilities (DD) who participated in an SSTP intervention at a community level. A preliminary analysis of outcome data indicated that SSTP intervention was effective in reducing parental adjustment difficulties, coercive parenting, and children's behavioral and emotional difficulties immediately after the intervention. The effects were maintained at 12-month follow-up. The results also indicated that change in parental adjustment over the course of intervention was significantly associated with a change in parenting behaviors. However, change in parenting behaviors but not change in parental adjustment, predicted children's behavioral and emotional problems following the intervention. The results suggest that positive parenting skills are the most salient ingredient driving the change in child behaviors in SSTP interventions.
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Affiliation(s)
- Matthew Sanders
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nam-Phuong T. Hoang
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Julie Hodges
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Kate Sofronoff
- Parenting and Family Support Centre, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Stewart Einfeld
- Brain and Mind Centre, University of Sydney, Camperdown, NSW 2006, Australia
| | - Bruce Tonge
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, VIC 3800, Australia
| | - Kylie Gray
- Centre for Developmental Psychiatry and Psychology, Monash University, Clayton, VIC 3800, Australia
- Centre for Educational Development, Appraisal, and Research, University of Warwick, Coventry CV4 7AL, UK
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Totsika V, Liew A, Absoud M, Adnams C, Emerson E. Mental health problems in children with intellectual disability. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:432-444. [PMID: 35421380 DOI: 10.1016/s2352-4642(22)00067-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 12/16/2022]
Abstract
Intellectual disability ranks in the top ten causes of disease burden globally and is the top cause in children younger than 5 years. 2-3% of children have an intellectual disability, and about 15% of children present with differences consistent with an intellectual disability (ie, global developmental delay and borderline intellectual functioning). In this Review, we discuss the prevalence of mental health problems, interventions to address these, and issues of access to treatment and services. Where possible, we take a global perspective, given most children with intellectual disability live in low-income and middle-income countries. Approximately 40% of children with intellectual disability present with a diagnosable mental disorder, a rate that is at least double that in children without intellectual disability. Most risk factors for poor mental health and barriers to accessing support are not unique to people with intellectual disability. With proportionate universalism as the guiding principle for reducing poor mental health at scale, we discuss four directions for addressing the mental health inequity in intellectual disability.
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Affiliation(s)
- Vasiliki Totsika
- Division of Psychiatry, University College London, London, UK; Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, VIC, Australia; Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; Tavistock & Portman NHS Foundation Trust, London, UK.
| | - Ashley Liew
- Centre for Educational Development Appraisal and Research (CEDAR), University of Warwick, Coventry, UK; National & Specialist CAMHS, South London and Maudsley NHS Foundation Trust, London, UK; Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guys and St Thomas' NHS Foundation Trust, London, UK; Department of Women and Children's Health, Faculty of Life Sciences and Medicine, School of Life Course Sciences, King's College London, London, UK
| | - Colleen Adnams
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Eric Emerson
- Centre for Disability Research, Faculty of Health & Medicine, Lancaster University, Lancaster, UK; Centre for Disability Research & Policy, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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8
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Lee Y, Keown LJ, Sanders MR. The effectiveness of the Stepping Stones Triple P Seminars for Korean families of a child with a developmental disability. Heliyon 2022; 8:e09686. [PMID: 35756135 PMCID: PMC9214801 DOI: 10.1016/j.heliyon.2022.e09686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Children with a developmental disability (DD) are more likely to develop behavioral problems. The Stepping Stones Triple P Positive Parenting Program (SSTP) for parents of children with a DD has demonstrated effectiveness for improving parenting practices and reducing child behavior problems. However, there is scant research in Asian countries and with less intensive SSTP interventions. Aim This study examined the effectiveness of the SSTP seminars for Korean parents of a child with a DD. Methods Parents were randomly assigned to an intervention group (n = 21) or a delayed intervention group (n = 17). Data was collected on child adjustment problems, parenting practices, parental adjustment, and family relationships from both groups at pre- and post-intervention, and from the intervention group at 4-month follow-up. Twelve parents provided post-intervention interview data. Results A series of one-way Analysis of Covariance (ANCOVA) were used to examine differences between the intervention and delayed intervention groups at post-intervention. Significant short-term intervention effects were found for reductions in child behavior and emotional difficulties, and dysfunctional parenting practices. These improvements were maintained 4-months later by the intervention group. At post-intervention, inter-parental child-rearing conflict was reduced as a trend, with a moderate effect size. Interviews provided additional insights into the benefits gained from program participation. Conclusions Findings, for parents within this study, contribute to the evidence base for the effectiveness of the SSTP seminars.
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Sanders MR, Divan G, Singhal M, Turner KMT, Velleman R, Michelson D, Patel V. Scaling Up Parenting Interventions is Critical for Attaining the Sustainable Development Goals. Child Psychiatry Hum Dev 2022; 53:941-952. [PMID: 33948778 PMCID: PMC8096135 DOI: 10.1007/s10578-021-01171-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Of all the potentially modifiable influences affecting children's development and mental health across the life course, none is more important than the quality of parenting and family life. In this position paper, we argue that parenting is fundamentally linked to the development of life skills that children need in order to achieve the United Nations Sustainable Development Goals. We discuss key principles that should inform the development of a global research and implementation agenda related to scaling up evidence-based parenting support programs. Research over the past 50 years has shown that parenting support programs of varied intensity and delivery modality can improve a wide range of developmental, emotional, behavioral and health outcomes for parents and their children. Such findings have been replicated across culturally and socioeconomically diverse samples, albeit primarily in studies from Western countries. We highlight the evidence for the relevance of parenting interventions for attaining the SDGs globally, and identify the barriers to and strategies for achieving their scale-up. The implications of the global COVID-19 pandemic for the delivery of evidence-based parenting support are also discussed.
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Affiliation(s)
- Matthew R Sanders
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | | | - Meghna Singhal
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia
- , Goa & New Delhi, Sangath, India
| | - Karen M T Turner
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Richard Velleman
- , Goa & New Delhi, Sangath, India
- Department of Psychology, University of Bath, Bath, UK
| | | | - Vikram Patel
- , Goa & New Delhi, Sangath, India
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA
- Harvard TH Chan School of Public Health, Boston, USA
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Day JJ, Hodges J, Mazzucchelli TG, Sofronoff K, Sanders MR, Einfeld S, Tonge B, Gray KM. Coercive parenting: modifiable and nonmodifiable risk factors in parents of children with developmental disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:306-319. [PMID: 33506597 DOI: 10.1111/jir.12813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/18/2020] [Accepted: 11/30/2020] [Indexed: 05/12/2023]
Abstract
BACKGROUND Parents of children with developmental or intellectual disabilities tend to report greater use of coercive parenting practices relative to parents of typically developing children, increasing the risk of adverse child outcomes. However, to date, there is limited research exploring the role and relative contribution of modifiable and nonmodifiable risk factors in parents of children with a disability. The present study aimed to explore the role of various modifiable and nonmodifiable parenting, family and sociodemographic factors associated with the use of coercive parenting practices in parents of children with a disability. METHODS Caregivers (N = 1392) enrolled in the Mental Health of Young People with Developmental Disabilities (MHYPeDD) programme in Australia completed a cross-sectional survey about their parenting and their child aged 2-12 years with a disability. Measures covered a range of domains including relevant demographic and family background, use of coercive parenting practices, intensity of child behavioural difficulties and questions relating to parent and family functioning such as parental self-efficacy, adjustment difficulties and quality of family relationships. RESULTS Parents of older children, those who were younger at the birth of their child, and parents who were co-parenting or working reported more use of coercive parenting practices. Greater intensity of child difficulties, poorer parental self-efficacy and parent-child relationships, and more parental adjustment difficulties were also significantly associated with more use of coercive parenting. Examination of the relative contribution of variables revealed parent-child relationship was a key contributing factor, followed by intensity of child behaviour problems, parent adjustment and parent confidence. CONCLUSIONS These findings highlight a range of factors that should be targeted and modified through upstream prevention programmes and further inform our understanding of how coercive practices may be influenced through targeted parenting interventions.
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Affiliation(s)
- J J Day
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- Family Action Centre, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - J Hodges
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - T G Mazzucchelli
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
- Child and Family Research Group, Brain, Behaviour and Mental Health Research Group, School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia
| | - K Sofronoff
- School of Psychology, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - M R Sanders
- Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Queensland, Australia
| | - S Einfeld
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - B Tonge
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - K M Gray
- Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
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Mental Health and Health Behaviour Changes for Mothers of Children with a Disability: Effectiveness of a Health and Wellbeing Workshop. J Autism Dev Disord 2021; 52:508-521. [PMID: 33728495 PMCID: PMC7962925 DOI: 10.1007/s10803-021-04956-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2021] [Indexed: 01/16/2023]
Abstract
Healthy Mothers Healthy Families (HMHF) is a program that educates and empowers mothers of children with disabilities to improve health behaviours. Outcomes were investigated in this study. A pre, post-test design was implemented using online questionnaires including the Health promoting activities scale (HPAS) and the Depressional anxiety stress scales (DASS). Mothers (N = 71) experienced improvements in HPAS scores, p < .001. Mental health symptomatology reduced: depressive symptoms (p = .005), Anxiety symptoms (p = .005) and stress (p = .002). Wellbeing improved (p < .001). Mothers also reported that their child with a disability experienced an increase in quality of life (p = .042). Mothers’ lifestyles goals improved: managing stress; dietary changes; leisure; self-perception and others. HMHF is an effective intervention with improved health status and outcomes for mothers.
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Early Behavioral Intervention for Young Children with Intellectual and Developmental Disabilities. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2020. [DOI: 10.1007/s40474-020-00201-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Farris O, Royston R, Absoud M, Ambler G, Barnes J, Hunter R, Kyriakopoulos M, Oulton K, Paliokosta E, Panca M, Paulauskaite L, Poppe M, Ricciardi F, Sharma A, Slonims V, Summerson U, Sutcliffe A, Thomas M, Hassiotis A. Clinical and cost effectiveness of a parent mediated intervention to reduce challenging behaviour in pre-schoolers with moderate to severe intellectual disability (EPICC-ID) study protocol: a multi-centre, parallel-group randomised controlled trial. BMC Psychiatry 2020; 20:35. [PMID: 32000729 PMCID: PMC6993328 DOI: 10.1186/s12888-020-2451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/21/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Children with intellectual disabilities are likely to present with challenging behaviour. Parent mediated interventions have shown utility in influencing child behaviour, although there is a paucity of UK research into challenging behaviour interventions in this population. NICE guidelines favour Stepping Stones Triple P (SSTP) as a challenging behaviour intervention and this trial aims to evaluate its clinical and cost effectiveness in preschool children with moderate to severe intellectual disabilities. METHODS This trial launched in 2017 at four sites across England, with the aim of recruiting 258 participants (aged 30-59 months). The Intervention Group receive nine weeks of SSTP parenting therapy (six group sessions and three individualised face to face or telephone sessions) in addition to Treatment as Usual, whilst the Treatment as Usual only group receive other available services in each location. Both study groups undergo the study measurements at baseline and at four and twelve months. Outcome measures include parent reports and structured observations of behaviour. Service use and health related quality of life data will also be collected to carry out a cost effectiveness and utility evaluation. DISCUSSION Findings from this study will inform policy regarding interventions for challenging behaviour in young children with moderate to severe intellectual disabilities. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT03086876. Registered 22nd March 2017, https://clinicaltrials.gov/ct2/show/NCT03086876.
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Affiliation(s)
- Olayinka Farris
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Rachel Royston
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Michael Absoud
- Evelina London Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH and King’s College London, Strand, London, WC2R 2LS UK
| | - Gareth Ambler
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Jacqueline Barnes
- Department of Psychological Sciences, Birbeck University of London, Malet Street, London, WC1E 7HX UK
| | - Rachael Hunter
- Research Department of Primary Care and Population Health, Royal Free Medical School, NW3 2PF, London, UK
| | - Marinos Kyriakopoulos
- South London and Maudsley NHS Foundation Trust and Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, PO66 De Crespigny Park, London, SE5 8AF UK
| | - Kate Oulton
- Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH UK
| | - Eleni Paliokosta
- The Effra Clinic, 4th Floor, 86-90 Paul Street, London, EC2A 4NE UK
| | - Monica Panca
- Research Department of Primary Care and Population Health, Royal Free Medical School, NW3 2PF, London, UK
| | - Laura Paulauskaite
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Michaela Poppe
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Federico Ricciardi
- Department of Statistical Science, University College London, Gower Street, London, WC1E 6BT UK
| | - Aditya Sharma
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, NE1 7RU UK
| | - Vicky Slonims
- Evelina London Children’s Hospital, St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH and King’s College London, Strand, London, WC2R 2LS UK
| | | | | | - Megan Thomas
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, FY3 8NR UK
| | - Angela Hassiotis
- Division of Psychiatry, University College London, 6th Floor Maple House, 149 Tottenham Court Road, London, W1T 7NF UK
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Ruane A, Carr A, Moffat V, Finn T, Murphy A, O'Brien O, Groarke H, O'Dwyer R. A randomised controlled trial of the Group Stepping Stones Triple P training programme for parents of children with developmental disabilities. Clin Child Psychol Psychiatry 2019; 24:728-753. [PMID: 30764646 DOI: 10.1177/1359104519827622] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The central aim of this study was to examine the effectiveness of Group Stepping Stones Triple P (GSSTP) in an Irish context for families of children with both developmental disabilities and internalising and externalising behavioural problems. Parents of 84 children (mean age = 5.73; SD = 2.06) with developmental disabilities and co-occurring behaviour problems attending Irish public health services were randomly assigned to a 9-week GSSTP group or a waiting list control (WLC) group. All parents completed self-report measures before (Time 1) and after (Time 2) the programme and parents in the GSSTP group were assessed at 3- to 5-month follow-up (Time 3). At Time 2, clinical improvement and reliable change rates on the primary dependent variables (summary scales of the Developmental Behaviour Checklist and Strengths and Difficulties Questionnaire) were significantly higher in the GSSTP group than in the WLC group. At Time 2, mean scores of the GSSTP group showed significant, small to medium improvements relative to the WLC group on parent-reported child behaviour problems, parenting skills and confidence, and parental adjustment. Most of these improvements were maintained at 3- to 5-month follow-up. These results indicate that GSSTP is a promising intervention for improving child behaviour and parenting outcomes in a mixed-disability group in an Irish context.
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Affiliation(s)
- Ailbhe Ruane
- School of Psychology, University College Dublin, Ireland.,Health Service Executive, Ireland
| | - Alan Carr
- School of Psychology, University College Dublin, Ireland
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Kasperzack D, Schrott B, Mingebach T, Becker K, Burghardt R, Kamp-Becker I. Effectiveness of the Stepping Stones Triple P group parenting program in reducing comorbid behavioral problems in children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2019; 24:423-436. [DOI: 10.1177/1362361319866063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Children with autism spectrum disorders often exhibit comorbid behavioral problems. These problems have an impact on the severity of the core symptoms, the progression of the disorder as well as on the families’ quality of life. We evaluated the effectiveness of the Stepping Stones Triple P group parent training program as a supplementary intervention in the treatment of children with autism spectrum disorder. Therefore, we employed a single group repeated measures design and assessed child variables via parents’ and teachers’ judgments at four successive time points. The participants were parents of 24 children with autism spectrum disorder aged between 3.6 and 12 years. We found a significant reduction of comorbid behavioral problems in the children, primarily in the parents’ judgment at follow-up. Furthermore, a reduction of the autism spectrum disorder core symptoms emerged. The teachers’ judgment particularly revealed an improvement in children’s social relationships. Effect sizes were large ( ƞ2 ranging from 0.14 to 0.23). The findings demonstrate the effectiveness of the Stepping Stones Triple P as a supplementary intervention for reducing comorbid behavioral problems in the treatment of children with autism spectrum disorder. Higher parental self-efficacy and parental attributions, including parents’ ability to influence child problem behaviors, are discussed as important factors for the effectiveness of Stepping Stones Triple P.
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Sanders MR, de Caestecker L, McLeod S, Day JJ, Turner KMT, Morawska A, Kirby J. Comparing apples and pears: misleading conclusions about the population mental health impact of a parenting programme, a commentary on Marryat, Thompson and Wilson (2017). BMC Pediatr 2019; 19:269. [PMID: 31383025 PMCID: PMC6681483 DOI: 10.1186/s12887-019-1570-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/04/2019] [Indexed: 12/02/2022] Open
Abstract
Background The article by Marryat, Thompson and Wilson (2017) in BMC Pediatrics presents an evaluation of the implementation of the Triple P system as a public health intervention conducted by the Glasgow City Council and NHS Greater Glasgow and Clyde. Discussion Unfortunately, the conclusions drawn are questionable for multiple reasons. The lack of a controlled design precludes defensible conclusions about intervention effects free from routine threats to internal validity. There was a substantial mismatch between the intervention sample and the population sample assessed. The article’s title and abstract leave readers with the mistaken impression that the children assessed for outcome were suitably representative of intervention families, when in fact many of the children in the intervention families were missing from the teacher-report outcome assessment (a single questionnaire), and many or most of the children in the teacher-report outcome assessment belonged to families who had never received the intervention. Although Triple P targets parent-child relations and child behavioural and emotional problems at home, Marryat et al. narrowly defined mental health impact as child difficulties in nursery or preschool, while not reporting data from practitioners and parents in the same evaluation that did not support the authors’ conclusion. The paper was further diminished by a number of misleading statements and factual errors related for example to other research on Triple P. Summary Studying the extent to which child mental health functioning at home can generalise to school settings is an important topic of inquiry in relation to parenting support interventions, but unfortunately the Marryat et al. article did not move this area forward.
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Affiliation(s)
- Matthew R Sanders
- Parenting and Family Support Centre, the University of Queensland, Brisbane, Australia.
| | | | - Stephen McLeod
- National Health Service Greater Glasgow and Clyde, Glasgow, Scotland
| | - Jamin J Day
- Parenting and Family Support Centre, the University of Queensland, Brisbane, Australia
| | - Karen M T Turner
- Parenting and Family Support Centre, the University of Queensland, Brisbane, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, the University of Queensland, Brisbane, Australia
| | - James Kirby
- Parenting and Family Support Centre, the University of Queensland, Brisbane, Australia
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Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems. PLoS One 2018; 13:e0202855. [PMID: 30256794 PMCID: PMC6157840 DOI: 10.1371/journal.pone.0202855] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/12/2018] [Indexed: 01/20/2023] Open
Abstract
Objective The aim of this study is to perform the first meta-meta-analysis on the effectiveness of parent-based interventions for children with externalizing behavior problems. Even though parent-based interventions are considered as effective treatments the effects reported in meta-analyses are heterogeneous and the implementation in clinical practice is suboptimal. Recapitulative valid effect predictions are required to close the still existing gap between research findings and clinical practice. The meta-meta-analytic results on changes in child behavior shall result in a clear signal for clinical practice. Methods This meta-meta-analysis encompasses 26 meta-analyses identified via search in electronic databases (PsycINFO, Medline, PubMed). Meta-analyses had to report effects of parent-based interventions on child behavior and focus on children under the age of 13 years with externalizing behavior problems in a clinical setting. Analyses were based on random-effects models. To combine results, the effect estimates of the meta-analyses were transformed to SMD and weighted to correct for primary study overlap. The meta-meta-analysis is registered on PROSPERO, registration number CRD42016036486 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA). Results The results indicate a significant moderate overall effect for child behavior (SMD = 0.46) as well as for parent reports (SMD = 0.51) and observational data (SMD = 0.62). Further analyses focusing on child externalizing behavior yielded significant and moderate effects (SMD = 0.45). All effects remained stable to follow-up. Considerable heterogeneity was observed within results. Conclusion Parent-based interventions are shown to be effective in improving behavior in children with externalizing behavior problems, as assessed using parent reports and observational measures. The present results should encourage health care providers to apply evidence-based parent-based interventions.
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