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Yu-Lefler H, Marsteller J, Hsu YJ, Lindauer S, Riley AW. Investigating the Trajectory and Associated Risk Factors of Clinical Outcomes for Early Childhood Disruptive Behavior Disorders Using Real World Data. Res Child Adolesc Psychopathol 2024:10.1007/s10802-024-01192-y. [PMID: 38557726 DOI: 10.1007/s10802-024-01192-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
Disruptive behavior disorders (DBDs) are common mental health problems among early childhood American youth that, if poorly managed, pose costly psychological and societal burdens. There is limited real world evidence on how parent management training (PMT) - the evidence-based treatment model of choice - implemented in common practice settings within the United States influences the behavioral progress of early childhood DBDs, and the risk factors associated with poor outcomes. This study used data from a measurement feedback system implemented within a U.S.-based private practice to study how behavioral outcomes change as a function of PMT treatment engagement and associated risk factors for 4-7 year-old children diagnosed with DBDs. Over 50% of patients reached optimal outcomes after 10 appointments. Attending 24-29 appointments provided maximum treatment effect - namely, 75% of patients reaching optimal outcomes by end of treatment. Outcomes attenuate after reaching the maximum effect. Patients also had higher odds of reaching optimal outcomes if they had consistent attendance throughout the treatment course. Notable risk factors associated with lower odds of reaching optimal outcomes included Medicaid insurance-type, greater clinical complexity, and having siblings concurrently in treatment. Increased implementation of systems that monitor and provide feedback on treatment outcomes in U.S.-based practice settings and similar investigations using its data can further enhance 'real world' management of early childhood DBDs among American youth.
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Affiliation(s)
- Helen Yu-Lefler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
- Kennedy Krieger Institute, Baltimore, Maryland, USA.
| | - Jill Marsteller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Yea-Jen Hsu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Steven Lindauer
- Kennedy Krieger Institute, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Anne W Riley
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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2
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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: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [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).
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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
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3
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Hippman C, Mah JWT, MacFadden M. Virtual Delivery of Parent Coaching Interventions in Early Childhood Mental Health: A Scoping Review. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01597-8. [PMID: 37740798 DOI: 10.1007/s10578-023-01597-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/25/2023]
Abstract
Parent-coaching interventions positively impact child development. Virtual delivery of such interventions is supported by literature reviews and a practice guideline, however, none of these focused on children under age six. A scoping review of virtually-delivered parent-coaching interventions for disruptive behaviour, anxiety, and parent-child relationship concerns in children under age six was conducted between Dec. 15, 2020 and April 22, 2021. Iterative searches of the databases PubMed, CINAHL, and PsycINFO were complemented by reference list searches and clinician expert review (N = 1146). After relevance screening and duplicate removal, collaboratively-developed inclusion criteria were applied to records, followed by data extraction from eligible articles (n = 30). Most literature documented behavioural-based interventions targeting disruptive behaviour which were delivered individually, by therapists, to White, non-Hispanic parents. Evidence supports feasibility and efficacy of virtually-delivered parent-coaching interventions to improve child disruptive behaviour (strong), anxiety (moderate), and parent-child relationship (weak). There is a significant gap in the literature regarding the virtual delivery of attachment-based parent-coaching interventions. In sum, virtual parent coaching can be an efficacious approach for children under age six, particularly for behavioural challenges.
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Affiliation(s)
- Catriona Hippman
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada.
| | - Janet W T Mah
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
| | - Megan MacFadden
- BC Children's Hospital, University of British Columbia (UBC), 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
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Yu-Lefler HF, Hsu YJ, Sen A, Marsteller J. Service Utilization for Parent Management of Early Childhood Behavior Problems in a Private Outpatient Behavioral Clinic: The Impact of Out-of-Pocket Cost, Travel Distance, and Initial Treatment Progress. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:834-847. [PMID: 37382741 DOI: 10.1007/s10488-023-01282-x] [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] [Accepted: 06/04/2023] [Indexed: 06/30/2023]
Abstract
Poorly-managed early childhood disruptive behavior disorders (DBDs) have costly psychological and societal burdens. While parent management training (PMT) is recommended to effectively manage DBDs, appointment adherence is poor. Past studies on influential factors of PMT appointment adherence focused on parental factors. Less well studied are social drivers relative to early treatment gains. This study investigated how financial and time cost relative to early gains influence PMT appointment adherence for early childhood DBDs in a clinic of a large behavioral health pediatric hospital from 2016 to 2018. Using information obtained from the clinic's data repository, claims records, public census and geospatial data, we assessed how owed unpaid charges, travel distance from home to clinic, and initial behavioral progress influences total and consistent attendance of appointments for commercially- and publicly-insured (Medicaid and Tricare) patients, controlling for demographic, service, and clinical differences. We further assessed how social deprivation interacted with unpaid charges to influence appointment adherence for commercially-insured patients. Commercially-insured patients had poorer appointment adherence with longer travel distances, or having unpaid charges and greater social deprivation; they also attended fewer total appointments with faster behavioral progress. Comparatively, publicly-insured patients were not affected by travel distance and had higher consistent attendance with faster behavioral progress. Longer travel distance and difficulty paying service costs while living in greater social deprivation are barriers to care for commercially-insured patients. Targeted intervention may be needed for this specific subgroup to attend and stay engaged in treatment.
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Affiliation(s)
- Helen Fan Yu-Lefler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of Behavioral Psychology, Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD, 21205, USA.
- Bureau of Primary Health Care, Health Resources and Services Administration, 5600 Fishers Lane, Rockville, MD, 20852, USA.
| | - Yea-Jen Hsu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Aditi Sen
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- The Health Care Cost Institute, Washington, DC, USA
| | - Jill Marsteller
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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5
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Spiegel JA, Sanchez CR, Bermeo LM, Graziano PA. Examining the Efficacy of Online Administration of a Time-Limited School Readiness Intervention in the Face of COVID-19. Behav Ther 2023; 54:557-571. [PMID: 37088510 PMCID: PMC9783141 DOI: 10.1016/j.beth.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/27/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022]
Abstract
Although the efficacy of online administration of behavioral parent training (BPT) programs is well-established, such programs address a single risk factor (behavioral functioning) for school readiness difficulties (comprised of academics, cognitive skills, and social, emotional, and behavioral functioning). The current study aims to examine the feasibility, acceptability, and efficacy of a telemedicine delivery of the School Readiness Parenting Program (SRPP), an integrative adaptation of PCIT designed to address the behavioral and academic domains of school readiness. The present study takes the first step towards validating an online administration of the SRPP as a treatment for early childhood disruptive behavior. Data were collected for 64 children ages 2-6 years (Mage = 4.63, SD = 0.86; 78.1% Hispanic/Latinx) and their families, who received either in-person administration of time-limited PCIT (PCIT-TL; n=30) or online administration of SRPP (n=34). A series of repeated measures ANOVAS were conducted to examine within and between group effects. Results revealed that both SRPP and PCIT-TL significantly reduced inattention (d's = -0.54 to -0.88), aggression (d's = -0.55 to -1.06), and behavioral symptomology (d's = -0.55 to -0.85) and produced significant gains in parental skills (d's = -1.47 to 2.99). Notably, online SRPP demonstrated greater improvement in positive parental verbalization, whereas PCIT-TL demonstrated greater reductions in parental stress. Overall, findings support the utility of online SRPP for addressing behavioral school readiness concerns.
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Affiliation(s)
- Jamie A Spiegel
- Florida International University-Center for Children and Families
| | | | - Luisa M Bermeo
- Florida International University-Center for Children and Families
| | - Paulo A Graziano
- Florida International University-Center for Children and Families.
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6
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Parent J, Jones DJ, DiMarzio K, Yang Y, Wright KL, Sullivan ADW, Forehand R. The Effects of Young Children's Callous-Unemotional Traits on Behaviorally Observed Outcomes in Standard and Technology-Enhanced Behavioral Parent Training. Res Child Adolesc Psychopathol 2023; 51:165-175. [PMID: 36344876 DOI: 10.1007/s10802-022-00979-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/09/2022]
Abstract
Behavioral Parent Training (BPT) remains the current standard of care for early onset behavior disorders (BD); however, problem behaviors characterized by relatively high callous unemotional (CU) traits are linked to poorer treatment outcomes, highlighting the need for novel interventions. This study examined the relation of baseline child CU traits to changes in observed parent and child (3 to 8 years old) behavior in 101 families with low-income randomized to either a standard (Helping the Noncompliant Child, HNC) or technology-enhanced BPT program (TE-HNC). Assessments occurred at baseline, post-intervention, and at a three-month follow-up. Treatment group moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up but only in the standard program (HNC). This is the first intervention study to behaviorally assess the differential impact of CU traits in standard, relative to technology-enhanced, BPT and suggests the promise of a technology-enhanced treatment model.
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Affiliation(s)
- Justin Parent
- Department of Psychiatry and Human Behavior, Brown University, Providence, USA.
- Warren Alpert Medical School, Brown University, 1 Hoppin St #204, Providence, RI, USA.
| | - Deborah J Jones
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Karissa DiMarzio
- Department of Psychology, Florida International University, Miami, USA
| | - Yexinyu Yang
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kat L Wright
- Department of Psychology, University of Kentucky, Lexington, USA
| | | | - Rex Forehand
- Department of Psychological Science, University of Vermont, Burlington, USA
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7
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Druskin LR, Victory EJ, Han RC, Phillips ST, Aman E, McNeil CB. The Impact of Maternal Depression on Internet-Parent–Child Interaction Therapy for Child Attention-Deficit/Hyperactivity Disorder: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221145662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Conduct disorders and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid, with an estimated prevalence rate of 51.5% for children between 2–17 years of age (Centers for Disease Control and Prevention, 2020). Parent–Child Interaction Therapy (PCIT) is an empirically supported behavioral parent training program for children with disruptive behavior. PCIT research consistently demonstrates decreases in disruptive behaviors and increases in positive parenting strategies among families of young children with ADHD; however, PCIT has yet to become widely recognized as a treatment for ADHD. This case study presents the treatment of a 6-year-old boy with ADHD and severe behavior problems. The case was further impacted by the single mother’s depressive symptoms and internet delivery of PCIT during the COVID-19 pandemic. Findings from this case report documented an improvement in disruptive child behaviors and emotion regulation and increased positivity during parent–child interactions, despite worsening maternal depressive symptoms. This case study highlights the utility of PCIT to improve child disruptive behaviors and ADHD symptoms in the midst of several complicating factors.
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Affiliation(s)
| | - Erinn J. Victory
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Robin C. Han
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | | | - Emily Aman
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cheryl B. McNeil
- Department of Psychology, West Virginia University, Morgantown, WV, USA
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
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8
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Fleming GE, Neo B, Briggs NE, Kaouar S, Frick PJ, Kimonis ER. Parent Training Adapted to the Needs of Children With Callous-Unemotional Traits: A Randomized Controlled Trial. Behav Ther 2022; 53:1265-1281. [PMID: 36229121 DOI: 10.1016/j.beth.2022.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 05/06/2022] [Accepted: 07/07/2022] [Indexed: 11/22/2022]
Abstract
Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement.
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9
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Ganho-Ávila A, Vieira Figueiredo D, Vagos P. Online Cognitive Therapy for Social Anxiety Disorder in Adolescence: A Clinical Case Study Using the CT@TeenSAD. Clin Case Stud 2022. [DOI: 10.1177/15346501221091519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
SAD is an intense fear or anxiety associated with past, current, or future social situations. The Clark and Wells (1995) cognitive model for SAD has been proved to be clinically effective in adults, and its developmentally sensitive adaptations for adolescents have recently shown promising results. Given this evidence and considering that adolescence is typically the age of onset for the first SAD symptoms and a critical developmental period for the delivery of evidence-based interventions, we adapted CT for adolescents for online intervention (CT@TeenSAD) encompassing 10 weekly, 90 min sessions, extended by two booster sessions. This work presents the first case study of that intervention as applied to Merida (M.; pseudonym; 17-year-old, girl). The estimated Reliable Change Index shows M.’s progress for most of her symptoms, from pre-to post-treatment (RCI-1 range: −.53 to −8.03), and the maintenance of benefits at 3 months follow-up (RCI-2 range: .00 to −2.25). A relapse in the adoption of safety behaviors was seen between post-treatment and follow-up, which might be explained by the life-changing challenges experienced by M. between session 10 and follow-up, concerning her transition from high school to college. M.’s case study offers a first glance on the promising results of CT@TeenSAD related to its efficacy and feasibility. Likewise, it offers the opportunity to critically appraise the limitations of the intervention as well as practical challenges and suggestions thought to be useful for therapists willing to implement CT@TeenSAD in the future.
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Affiliation(s)
- Ana Ganho-Ávila
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Vagos
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention–CINEICC, Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Institute of Human Development, Portucalense Infante D. Henrique University, Porto, Portugal
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10
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Fleming GE, Kohlhoff J, Morgan S, Turnell A, Maiuolo M, Kimonis ER. An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia. Behav Ther 2021; 52:110-123. [PMID: 33483109 DOI: 10.1016/j.beth.2020.03.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/13/2020] [Accepted: 03/08/2020] [Indexed: 01/13/2023]
Abstract
There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with "small" to "very large" effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.
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Affiliation(s)
| | - Jane Kohlhoff
- University of New South Wales; Karitane Toddler Clinic, Karitane, Sydney
| | | | | | | | - Eva R Kimonis
- University of New South Wales; Karitane Toddler Clinic, Karitane, Sydney
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11
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Kohlhoff J, Wallace N, Morgan S, Maiuolo M, Turnell A. Internet‐delivered parent–child interaction therapy: Two clinical case reports. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12184] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jane Kohlhoff
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia,
- Karitane Toddler Clinic, Karitane, Sydney, New South Wales, Australia,
| | - Nancy Wallace
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia,
- Karitane Toddler Clinic, Karitane, Sydney, New South Wales, Australia,
| | - Susan Morgan
- Karitane Toddler Clinic, Karitane, Sydney, New South Wales, Australia,
| | - Michelle Maiuolo
- Karitane Toddler Clinic, Karitane, Sydney, New South Wales, Australia,
| | - Adrienne Turnell
- Karitane Toddler Clinic, Karitane, Sydney, New South Wales, Australia,
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12
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Dell’armi M, Kruck J, Niec L. Prise en charge des troubles du comportement du jeune enfant par le programme Parent-Child Interaction Therapy (PCIT). PRAT PSYCHOL 2020. [DOI: 10.1016/j.prps.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Fleming GE, Kimonis ER, Furr JM, Comer JS. Internet-Delivered Parent Training for Preschoolers with Conduct Problems: Do Callous-Unemotional Traits Moderate Efficacy and Engagement? JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:1169-1182. [PMID: 32533295 DOI: 10.1007/s10802-020-00660-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Recent efforts to improve access to evidence-based parent training programs using online delivery have largely neglected findings that young children with callous-unemotional (CU)-type conduct problems receive less benefit from parent training than children with conduct problems alone. The current study aimed to examine the moderating effect of child CU traits on efficacy and engagement outcomes associated with Internet-delivered Parent-Child Interaction Therapy (iPCIT) versus standard, clinic-based PCIT. Forty families (57.6% non-Hispanic Caucasian) with a 3-5 year-old (M = 3.95 years, SD = 0.9; 83.5% boys) child with a disruptive behavior disorder were randomized to either iPCIT or clinic-based PCIT. Families participated in four assessments across time; child conduct problems, global functioning and treatment responder status, and parent-rated treatment satisfaction were measured. Analyses revealed that the negative influence of CU traits on functional gains was not uniform across treatment formats. Specifically, the detrimental effect of CU traits on functional gains was significantly more pronounced among children treated with iPCIT than clinic-based PCIT. CU traits also predicted lower parental treatment satisfaction across delivery formats, but this effect was more pronounced among iPCIT parents. In contrast, CU traits did not moderate differential effects across iPCIT and clinic-based PCIT for conduct problem severity or treatment response status. Findings suggest that iPCIT is a promising treatment option for early conduct problems, particularly when access-to-care barriers exist, but that further research is needed to determine whether strategic adaptations to online programs can more optimally address the distinct needs of children with clinically significant CU traits.
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Affiliation(s)
- Georgette E Fleming
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia.
| | - Eva R Kimonis
- School of Psychology, The University of New South Wales, Sydney, New South Wales, Australia
| | - Jami M Furr
- Center for Children and Families, Florida International University, Miami, Florida, USA
| | - Jonathan S Comer
- Center for Children and Families, Florida International University, Miami, Florida, USA
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Ribeiro da Silva D, Rijo D, Castilho P, Gilbert P. The Efficacy of a Compassion-Focused Therapy–Based Intervention in Reducing Psychopathic Traits and Disruptive Behavior: A Clinical Case Study With a Juvenile Detainee. Clin Case Stud 2019. [DOI: 10.1177/1534650119849491] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Conduct disorder (CD) is the most diagnosed psychopathological disorder in juvenile detainees. The presence of a CD diagnosis, especially when associated with psychopathic traits, contributes to a poor prognosis, high recidivism rates, and low responsivity to treatment in these youth. Although group intervention programs have proven to be effective in decreasing antisocial behavior, studies testing their efficacy in reducing psychopathic traits are scarce and limited. Moreover, there is a lack of research focused on the efficacy of individual treatment approaches specifically designed to reduce psychopathic traits and disruptive behavior in juvenile detainees. Compassion-focused therapy (CFT) shows promising results in the treatment of several psychopathological disorders. Besides, there is some theoretical support to consider CFT a suitable approach to treating juvenile detainees. However, there are no treatment programs based on CFT that are designed to target psychopathic traits and disruptive behavior in these youth. Consequently, treatment outcome research in this area is absent. This clinical case study presents the treatment of a juvenile detainee with CD, a high psychopathic profile, and a very high risk for criminal recidivism using the PSYCHOPATHY.COMP program (a 20-session individual CFT program), which was specially designed to reduce psychopathic traits and disruptive behavior. The treatment outcome data revealed a significant reduction in psychopathic traits and disruptive behavior. The treatment gains were maintained and/or increased over time (3 months after program completion). This clinical case study demonstrates the feasibility and efficacy of the PSYCHOPATHY.COMP program in reducing psychopathic traits and disruptive behavior in a juvenile detainee.
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15
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Kimonis ER, Fleming G, Briggs N, Brouwer-French L, Frick PJ, Hawes DJ, Bagner DM, Thomas R, Dadds M. Parent-Child Interaction Therapy Adapted for Preschoolers with Callous-Unemotional Traits: An Open Trial Pilot Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 48:S347-S361. [DOI: 10.1080/15374416.2018.1479966] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Nancy Briggs
- Mark Wainwright Analytical Centre (Stats Central), The University of New South Wales
| | | | - Paul J. Frick
- Department of Psychology, Louisiana State University
- Learning Sciences Institute of Australia, Australian Catholic University
| | | | | | - Rae Thomas
- Faculty of Health Sciences and Medicine, Bond University
| | - Mark Dadds
- School of Psychology, University of Sydney
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Parent–Child Care as a Brief Dyadic Intervention for Children With Mild to Moderate Externalizing Problems: A Case Study. Clin Case Stud 2018. [DOI: 10.1177/1534650118774417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although many parenting interventions have been shown efficacious in reducing externalizing behavior problems in young children, they often take months to implement and tend to target children with moderate to severe behavior problems. Parent–Child Care (PC-CARE) was designed to be an engaging, brief (six-session) dyadic intervention to reduce mental health symptoms even for children with few behavior problems and/or parents who are unable to commit to lengthy treatments. We present an evidence-based case study of a 5-year-old child with mild externalizing problems and his biological parents, who participated in PC-CARE. Standardized measures were collected, and the child’s and parents’ emotional availability were assessed at pre- and posttreatment. Weekly codings of parent–child interactions and parent-reported measures of child behaviors were also collected. This child’s behavioral symptoms improved from pre- to posttreatment (per parents’ reports and observation), and he maintained this improved behavior 1 month after treatment. The parents similarly demonstrated improvement in their use of parenting skills and emotional availability. Aspects of treatment that may affect effectiveness are discussed.
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