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Parent J, Highlander A, Loiselle R, Yang Y, McKee LG, Forehand R, Jones DJ. Technology-Enhanced BPT for Early-Onset Behavior Disorders: Improved Outcomes for Children With Co-Occurring Internalizing Symptoms. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2024; 53:246-259. [PMID: 37494309 PMCID: PMC10811290 DOI: 10.1080/15374416.2023.2222391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
OBJECTIVE Early-onset behavior disorders (BDs) are common and costly. The evidence-base for Behavioral Parent Training (BPT), the standard of care for early intervention for BDs in young children, is well-established; yet, common comorbidities such as internalizing symptoms are common and their impact, not well understood. The goal of the current study was to examine the potential for technology to improve BPT effects on observed parenting and child behavior outcomes for families of children recruited for clinically significant problem behavior who also presented with relatively higher internalizing symptoms. METHOD Families with low incomes (N = 101), who are overrepresented in statistics on early-onset BDs, were randomized to an evidence-based BPT program, Helping the Noncompliant Child (HNC), or Technology-Enhanced HNC (TE-HNC). Children were ages 3 to 8 years (55.4% were boys). Child race included White (64.0%), Black or African American (21.0%), more than one race (14.0%), and Hispanic/Latinx (13.9%). RESULTS Families in both groups evidenced improvement in internalizing symptoms at posttreatment; however, TE-HNC yielded the greatest improvement in positive parenting and child compliance at posttreatment and follow-up for children with the highest internalizing symptoms at baseline. CONCLUSIONS TE-HNC resulted in improved parenting and child behavior outcomes for children with elevated levels of co-occurring internalizing symptoms at baseline relative to standard HNC. We posit that these added benefits may be a function of TE-HNC, creating the opportunity for therapists to personalize the treatment model boosting parent skill use with more complex presentations, although a formal test of mediation will be important in future work.
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Affiliation(s)
- Justin Parent
- Warren Alpert Medical School, Brown University, Providence, RI
- Bradley/Hasbro Children’s Research Center, E. P. Bradley Hospital, East Providence, RI
| | | | - Raelyn Loiselle
- University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yexinyu Yang
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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Paiva GCDC, de Paula JJ, Costa DDS, Alvim-Soares A, Santos DAFE, Jales JS, Romano-Silva MA, de Miranda DM. Parent training for disruptive behavior symptoms in attention deficit hyperactivity disorder: a randomized clinical trial. Front Psychol 2024; 15:1293244. [PMID: 38434955 PMCID: PMC10906662 DOI: 10.3389/fpsyg.2024.1293244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 03/05/2024] Open
Abstract
Background Attention-Deficit/Hyperactivity Disorder (ADHD) affects 5% of children and 2.5% of adults worldwide. Comorbidities are frequent, and Oppositional Defiant Disorder (ODD) reaches 50%. Family environment is crucial for the severity of behaviors and for prognosis. In middle-income countries, access to treatment is challenging, with more untreated children than those under treatment. Face-to-face behavioral parent training (PT) is a well-established intervention to improve child behavior and parenting. Method A clinical trial was designed to compare PT-online and face-to-face effects to a waiting list group. Outcomes were the ADHD and ODD symptoms, parental stress and styles, and quality of life. Families were allocated into three groups: standard treatment (ST), ST + PT online, and ST + Face-to-Face PT. We used repeated measures ANOVA for pre × post treatment analysis corrected for multiple comparisons. Results and discussion Parent training was effective in reducing symptoms of ADHD (p = 0.030) and ODD (p = 0.026) irrespective of modality (p = 1.000). The combination of ST and PT was also associated with better quality of life in the physical domain for patients (p = 0.009) and their parents (p = 0.050). In addition to preliminary data, online intervention seems effective for parenting and improving social acceptance of children. The potential to reach many by an online strategy with a self-directed platform may imply effectiveness with a low cost for public health to support parents' symptoms management.
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Affiliation(s)
- Gabrielle Chequer de Castro Paiva
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Jonas Jardim de Paula
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Danielle de Souza Costa
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Antônio Alvim-Soares
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Julia Silva Jales
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Aurélio Romano-Silva
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Saúde Mental, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Débora Marques de Miranda
- Programa de Pós-Graduação em Medicina Molecular da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Faculty of Medicine, Research Center of Impulsivity and Attention, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Departamento de Pediatria, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Moreira T, Martins J, Silva C, Berrocal de Luna E, Martins J, Moreira D, Rosário P. Building partnerships in education through a story-tool based intervention: Parental involvement experiences among families with Roma backgrounds. Front Psychol 2023; 14:1012568. [PMID: 36968727 PMCID: PMC10033949 DOI: 10.3389/fpsyg.2023.1012568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionSchool educators are likely to explain the poor educational trajectories of students with Roma backgrounds related to the lack of parental support and interest in children’s education. Aiming to understand further the patterns of Roma group’s parental involvement in children’s school life and their engagement experiences in school-related activities, the current research set an intervention supported by a culturally sensitive story-tool.MethodGrounded in the intervention-based research framework, 12 participants (i.e., mothers) from different Portuguese Roma groups participated in this study. Data was collected through interviews conducted pre-and postintervention. Eight weekly sessions were delivered in the school context, using a story-tool and hands- on activities to generate culturally significant meanings regarding attitudes, beliefs, and values toward children’s educational trajectories.ResultsThrough the lens of acculturation theory, data analysis provided important findings under two overarching topics: patterns of parental involvement in children’s school life and participants’ engagement in the intervention program.DiscussionData show the distinct ways Roma parents participate in children’s education and the relevance of mainstream contexts providing an atmosphere likely to build collaborative relationships with parents to overcome barriers to parental involvement.
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Affiliation(s)
- Tânia Moreira
- Department of Applied Psychology, University of Minho, Braga, Portugal
- *Correspondence: Tânia Moreira,
| | - Juliana Martins
- Department of Applied Psychology, University of Minho, Braga, Portugal
| | - Cátia Silva
- Department of Applied Psychology, University of Minho, Braga, Portugal
| | - Emilio Berrocal de Luna
- Departement of Research Methods and Diagnostic in Education, University of Granada, Granada, Spain
| | - Joana Martins
- Department of Applied Psychology, University of Minho, Braga, Portugal
| | - Daniela Moreira
- Department of Applied Psychology, University of Minho, Braga, Portugal
| | - Pedro Rosário
- Department of Applied Psychology, University of Minho, Braga, Portugal
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Entenberg GA, Dosovitsky G, Aghakhani S, Mostovoy K, Carre N, Marshall Z, Benfica D, Mizrahi S, Testerman A, Rousseau A, Lin G, Bunge EL. User experience with a parenting chatbot micro intervention. Front Digit Health 2023; 4:989022. [PMID: 36714612 PMCID: PMC9874295 DOI: 10.3389/fdgth.2022.989022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/20/2022] [Indexed: 01/12/2023] Open
Abstract
Background The use of chatbots to address mental health conditions have become increasingly popular in recent years. However, few studies aimed to teach parenting skills through chatbots, and there are no reports on parental user experience. Aim: This study aimed to assess the user experience of a parenting chatbot micro intervention to teach how to praise children in a Spanish-speaking country. Methods A sample of 89 parents were assigned to the chatbot micro intervention as part of a randomized controlled trial study. Completion rates, engagement, satisfaction, net promoter score, and acceptability were analyzed. Results 66.3% of the participants completed the intervention. Participants exchanged an average of 49.8 messages (SD = 1.53), provided an average satisfaction score of 4.19 (SD = .79), and reported that they would recommend the chatbot to other parents (net promoter score = 4.63/5; SD = .66). Acceptability level was high (ease of use = 4.66 [SD = .73]; comfortability = 4.76 [SD = .46]; lack of technical problems = 4.69 [SD = .59]; interactivity = 4.51 [SD = .77]; usefulness for everyday life = 4.75 [SD = .54]). Conclusions Overall, users completed the intervention at a high rate, engaged with the chatbot, were satisfied, would recommend it to others, and reported a high level of acceptability. Chatbots have the potential to teach parenting skills however research on the efficacy of parenting chatbot interventions is needed.
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Affiliation(s)
- G. A. Entenberg
- Research Department, Fundación ETCI, Buenos Aires, Argentina,Correspondence: G. A. Entenberg E. L. Bunge
| | - G. Dosovitsky
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - S. Aghakhani
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - K. Mostovoy
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - N. Carre
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - Z. Marshall
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - D. Benfica
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - S. Mizrahi
- Research Department, Fundación ETCI, Buenos Aires, Argentina
| | - A. Testerman
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - A. Rousseau
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - G. Lin
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States
| | - E. L. Bunge
- Children and Adolescents Psychotherapy and Technology Lab (CAPT), Palo Alto University, Palo Alto, CA, United States,Department of Psychology, International Institute for Internet Interventions i4Health, Palo Alto, CA, United States,Correspondence: G. A. Entenberg E. L. Bunge
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Broomfield G, Brown SD, Yap MB. Socioeconomic factors and parents' preferences for internet- and mobile-based parenting interventions to prevent youth mental health problems: A discrete choice experiment. Internet Interv 2022; 28:100522. [PMID: 35309756 PMCID: PMC8924632 DOI: 10.1016/j.invent.2022.100522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 02/12/2022] [Accepted: 03/05/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The positive impact of parenting programs for youth mental health is undermined by difficulties engaging parents. Low engagement disproportionately impacts parents of lower-socioeconomic positions (SEPs). Internet- and mobile-based interventions hold potential for overcoming barriers to enrolment, but additional research is needed to understand how programs can appropriately meet the needs of parents across SEPs. Consumer preference methods such as discrete choice experiments may be valuable in this endeavour. METHOD A discrete choice experiment was used to determine the relative influence of modifiable program features on parents' intent to enrol. 329 Australian parents of children aged 0-18 repeatedly selected their preferred program from randomized sets of hypothetical programs in an online survey. Each hypothetical program was unique, varying across four program features: module duration, program platform, user control, and program cost. Cumulative link models were used to predict choices, with education, household income, and community advantage used as indicators of SEP. RESULTS Overall, parents preferred cheaper programs and briefer modules. Parents' preferences differed based on their socioeconomic challenges. Lower-income parents preferred briefer modules, cheaper programs and application-based programs compared to higher-income parents. Parents with less education preferred briefer modules and a predefined module order. Parents living in areas of less advantage preferred website-based programs, user choice of module order, and more expensive programs. CONCLUSIONS This study offers program developers evidence-based strategies for tailoring internet- and mobile-based parenting interventions to increase lower-SEP parent enrolment. Findings also highlight the importance of considering parents' socioeconomic challenges to ensure programs do not perpetuate existing mental health inequalities, as "one-size-fits-all" approaches are likely insufficient for reaching lower-SEP parents.
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Affiliation(s)
- Grace Broomfield
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
| | - Scott D. Brown
- School of Psychological Sciences, The University of Newcastle, Callaghan, Australia
| | - Marie B.H. Yap
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia,Corresponding author at: Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, Melbourne 3800, Australia.
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O'Dell SM, Fisher HR, Schlieder V, Klinger T, Kininger RL, Cosottile M, Cummings S, DeHart K. Engaging Parents and Health Care Stakeholders to Inform Development of a Behavioral Intervention Technology to Promote Pediatric Behavioral Health: Mixed Methods Study. JMIR Pediatr Parent 2021; 4:e27551. [PMID: 34609324 PMCID: PMC8527378 DOI: 10.2196/27551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/01/2021] [Accepted: 07/28/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Despite effective psychosocial interventions, gaps in access to care persist for youth and families in need. Behavioral intervention technologies (BITs) that apply psychosocial intervention strategies using technological features represent a modality for targeted prevention that is promising for the transformation of primary care behavioral health by empowering parents to take charge of the behavioral health care of their children. To realize the potential of BITs for parents, research is needed to understand the status quo of parental self-help and parent-provider collaboration to address behavioral health challenges and unmet parental needs that could be addressed by BITs. OBJECTIVE The aim of this study is to conduct foundational research with parents and health care stakeholders (HCS) to discover current practices and unmet needs related to common behavioral health challenges to inform the design, build, and testing of BITs to address these care gaps within a predominantly rural health system. METHODS We conducted a convergent mixed-parallel study within a large, predominantly rural health system in which the BITs will be developed and implemented. We analyzed data from parent surveys (N=385) on current practices and preferences related to behavioral health topics to be addressed in BITs along with focus group data of 48 HCS in 9 clinics regarding internal and external contextual factors contributing to unmet parental needs and current practices. By comparing and relating the findings, we formed interpretations that will inform subsequent BIT development activities. RESULTS Parents frequently endorsed several behavioral health topics, and several topics were relatively more or less frequently endorsed based on the child's age. The HCS suggested that BITs may connect families with evidence-based guidance sooner and indicated that a web-based platform aligns with how parents already seek behavioral health guidance. Areas of divergence between parents and HCS were related to internalizing problems and cross-cutting issues such as parenting stress, which may be more difficult for health care HCS to detect or address because of the time constraints of routine medical visits. CONCLUSIONS These findings provide a rich understanding of the complexity involved in meeting parents' needs for behavioral health guidance in a primary care setting using BITs. User testing studies for BIT prototypes are needed to successfully design, build, and test effective BITs to empower parents to take charge of promoting the behavioral health of their children.
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Affiliation(s)
- Sean M O'Dell
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
- Department of Population Health Sciences, Geisinger, Danville, PA, United States
| | - Heidi R Fisher
- Autism and Developmental Medicine Institute, Geisinger, Lewisburg, PA, United States
| | - Victoria Schlieder
- Investigator Initiated Research Operations, Geisinger, Danville, PA, United States
| | - Tracey Klinger
- Investigator Initiated Research Operations, Geisinger, Danville, PA, United States
| | - Rachel L Kininger
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
| | - McKenna Cosottile
- Department of Psychiatry and Behavioral Health, Geisinger, Danville, PA, United States
| | - Stacey Cummings
- Department of Pediatrics, Geisinger, Danville, PA, United States
| | - Kathy DeHart
- Department of Pediatrics, Geisinger, Danville, PA, United States
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Highlander AR, Jones DJ. Integrating Objective and Subjective Social Class to Advance Our Understanding of Externalizing Problem Behavior in Children and Adolescents: A Conceptual Review and Model. Clin Child Fam Psychol Rev 2021; 25:300-315. [PMID: 34533656 DOI: 10.1007/s10567-021-00369-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2021] [Indexed: 11/25/2022]
Abstract
Extant research has identified both objective measures of socioeconomic status (SES) and subjective social class (SSC) as important predictors of psychosocial outcomes in childhood and adolescence, particularly with regard to externalizing symptoms. Given the importance of the associations with SES and SSC, a more nuanced and integrated conceptual understanding of early pathways of vulnerability implicated in the development and maintenance of youth externalizing problems is warranted. Thus, this review will: (1) operationalize both SES and SSC and their current standards of measurement; (2) examine current literature describing their respective associations with a range of externalizing symptoms in both children and adolescents; (3) review current theoretical models connecting SES and SSC and youth development and the strengths and limitations of those approaches; (4) propose a new conceptual socioecological model situating the impact of SES and SSC on youth externalizing problems in the context of parents and peers as a framework to further integrate existing research and guide future work; and (5) discuss potential clinical implications at the intersection of this work.
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Affiliation(s)
- April R Highlander
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Engaging Parents of Lower-Socioeconomic Positions in Internet- and Mobile-Based Interventions for Youth Mental Health: A Qualitative Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179087. [PMID: 34501675 PMCID: PMC8430954 DOI: 10.3390/ijerph18179087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 01/03/2023]
Abstract
Growing literature supports the use of internet- and mobile-based interventions (IMIs) targeting parenting behaviours to prevent child and adolescent mental health difficulties. However, parents of lower-socioeconomic positions (SEP) are underserved by these interventions. To avoid contributing to existing mental health inequalities, additional efforts are needed to understand the engagement needs of lower-SEP parents. This study qualitatively explored lower-SEP parents’ perspectives on how program features could facilitate their engagement in IMIs for youth mental health. We conducted semi-structured interviews with 16 lower-SEP parents of children aged 0–18 to identify important program features. Participants were mostly female (81.3%) and aged between 26 and 56 years. Transcriptions were analysed using inductive thematic analysis. Twenty-three modifiable program features important to lower-SEP parents’ engagement in IMIs were identified. These features aligned with one of three overarching themes explaining their importance to parents’ willingness to engage: (1) It will help my child; (2) I feel like I can do it; (3) It can easily fit into my life. The relative importance of program features varied based on parents’ specific social and economic challenges. These findings offer initial directions for program developers in optimising IMIs to overcome barriers to engagement for lower-SEP parents.
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