The Effects of Briefly Interrupting Marital Conflict

This study examined couples' (N = 94) behavior resulting from two proximal change interventions. One was a spousal "compliments intervention" to increase positivity, and the other was a "criticize intervention" to increase negativity. Participants were randomly assigned to one of the two intervention conditions or a control group. There was no main effect in affect from the pretest conflict discussion to the posttest conflict discussion between the interventions or control group. However, a manipulation check on how couples acted during either intervention produced a significant interaction effect. Pretest affect during conflict and marital satisfaction significantly predicted couples' construal of the intervention. Professionals may need to monitor how couples use specific interventions and direct the processes how the intervention is construed by the couple.

Efficacy of the Incredible Years group parent program with families in Head Start who self-reported a history of child maltreatment

OBJECTIVE

A prevention form of the Incredible Years (IY) parenting program was offered to parents who had children enrolled in Head Start, regardless of whether they reported having a history of child maltreatment. This study compared whether parenting practices and child behavioral outcomes differed in families who self reported a history of child maltreatment relative to families who did not.

METHODS

A site-randomized controlled trial of the IY parenting program was conducted in 64 classrooms in seven Head Start centers in Seattle, Washington. Families of 481 children took part in the study, with 335 in the IY condition and 146 in the control condition. Parenting practices and child behavior were measured by blinded raters through in-home observations and self-report questionnaires prior to the start of the IY program, in the spring after the IY program had concluded, and 12-18 months after study enrollment when children were in kindergarten. Analyses examine the impact of the IY program on parenting practices and children's behavior, exploring whether the program had differential impacts for parents with and without a self-reported history of child maltreatment.

RESULTS

The IY program resulted in improvements along many parenting dimensions and on characteristics of observed child behavior. Program impacts were similar for parents who did and did not report a history of child maltreatment. However, parents with a reported history of prior maltreatment had greater initial room for improvement in areas such as harsh/critical parenting, nurturing/supportive parenting, and discipline competence than parents without such a history.

CONCLUSIONS

The IY parenting program has positive impacts for parents who self-reported a history of child maltreatment. While similar benefits were observed for both groups of parents in this study, results support delivering evidence-based parenting programs of longer duration and higher intensity than often used by agencies serving parents in contact with child welfare.

PRACTICE

Agencies serving parents referred for child maltreatment should carefully examine the characteristics of the parenting programs they deliver. Use of a parenting program that has a sound base of empirical support, such as IY, and sufficient intensity and duration, is likely to make substantial changes in parents' child-rearing practices.

Preschool children's observed disruptive behavior: variations across sex, interactional context, and disruptive psychopathology

Sex differences in disruptive behavior and sensitivity to social context are documented, but the intersection between them is rarely examined empirically. This report focuses on sex differences in observed disruptive behavior across interactional contexts and diagnostic status. Preschoolers (n = 327) were classified as nondisruptive (51%), clinically at risk (26%), and disruptive (23%) using parent and teacher reports on developmentally validated measures of disruptive behavior and impairment. Observed disruptive behavior was measured with the Disruptive Behavior Diagnostic Observation Schedule, a developmentally sensitive observational paradigm characterizing variation in preschoolers' disruptive behavior across two interactional contexts (parent and examiner). Repeated measures analyses of variance revealed a three-way interaction of child sex by diagnostic status by interactional context (F = 9.81, p < .001). Disruptive boys were the only subgroup whose behavior was not sensitive to interactional context: They displayed comparable levels of disruptive behavior with parents and examiners. In contrast, disruptive girls demonstrated the strongest context effect of any group. Specifically, with the examiner, disruptive girls' behavior was comparable to nondisruptive boys (though still more elevated than nondisruptive girls). However, in interactions with their mothers, disruptive girls displayed the highest rates of disruptive behavior of any subgroup in any context, although the difference between disruptive boys and disruptive girls in this context was not statistically significant. Findings suggest the importance of sex-specific conceptualizations of disruptive behavior in young children that take patterns across social contexts into account.

Parent-child interactions among low-income Mexican American parents and preschoolers: do clinic-referred families differ from nonreferred families?

This study compared low-income Mexican American parents of young children referred for behavior problems to their nonreferred counterparts on an observational measure of parent-child interactions. Referred Mexican American parents demonstrated more negative behaviors than their nonreferred counterparts in both nondirective and highly directive situations. However, no differences were found at moderate levels of directiveness. The most and least directive situations in the Dyadic Parent-Child Interaction Coding System best differentiated referred from nonreferred Mexican American families, and families differed more in their negative behaviors than positive behaviors. Many of the parenting behaviors that have been found to differ between referred and nonreferred Caucasian families were also observed to differ between their Mexican American counterparts.

Associations between maternal attention-deficit/hyperactivity disorder symptoms and parenting

Mothers of children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for an ADHD diagnosis themselves, which is likely associated with impairments in parenting. The present study utilized a multi-method assessment of maternal ADHD and parenting to examine the extent to which maternal ADHD symptoms are associated with maladaptive parenting. Participants included 70 6-10 year old children with DSM-IV ADHD and their biological mothers. Results suggested that mothers with higher levels of ADHD symptoms reported lower levels of involvement and positive parenting and higher levels of inconsistent discipline. During observed parent-child interactions, maternal ADHD symptoms were negatively associated with positive parenting, and positively associated with negative parenting and repeated commands before giving the child an opportunity to comply. Given prior research suggesting that maladaptive parenting behaviors are risk factors for the later development of conduct problems among children with ADHD, these findings have important clinical implications for family-based assessment and treatment of ADHD.

Observational Assessment of Preschool Disruptive Behavior, Part I: reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)

OBJECTIVE

To examine the reliability of the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS), a new observational method for assessing preschool disruptive behavior.

METHOD

The DB-DOS is a structured clinic-based assessment designed to elicit clinically salient behaviors relevant to the diagnosis of disruptive behavior in preschoolers. Child behavior is assessed in three interactional contexts that vary by partner (parent versus examiner) and level of support provided. Twenty-one disruptive behaviors are coded within two domains: problems in Behavioral Regulation and problems in Anger Modulation. A total of 364 referred and nonreferred preschoolers participated: interrater reliability and internal consistency were assessed on a primary sample (n = 335) and test-retest reliability was assessed in a separate sample (n = 29).

RESULTS

The DB-DOS demonstrated good interrater and test-retest reliability. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of disruptive behavior.

CONCLUSIONS

The DB-DOS is a reliable observational tool for clinic-based assessment of preschool disruptive behavior. This standardized assessment method holds promise for advancing developmentally sensitive characterization of preschool psychopathology.

Behavior problems in young children: an analysis of cross-informant agreements and disagreements

This study examined (a) convergence between parents' and day care teachers' ratings of children's behavior problems, and (b) whether agreements and disagreements were associated with characteristics of the informant, context, or measures. Parents of 241, 2-4-year old children in day care centers serving low-income families completed measures of child behavior problems, parenting style, stress, depression, and self-efficacy. Teachers completed a measure of classroom behavior problems. There was a low correlation between parents' and teachers' ratings of child behavior (r=.17), and few children (2.5%) received high behavior problem scores from both parents and teachers. Cross-informant agreement on high behavior problem children was related to characteristics of the informants and home context. Implications for identifying children at risk are discussed.

Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports

A randomized trial was conducted to test the efficacy and sufficiency of parent-child interaction therapy (PCIT) in preventing re-reports of physical abuse among abusive parents. Physically abusive parents (N=110) were randomly assigned to one of three intervention conditions: (a) PCIT, (b) PCIT plus individualized enhanced services, or (c) a standard community-based parenting group. Participants had multiple past child welfare reports, severe parent-to-child violence, low household income, and significant levels of depression, substance abuse, and antisocial behavior. At a median follow-up of 850 days, 19% of parents assigned to PCIT had a re-report for physical abuse compared with 49% of parents assigned to the standard community group. Additional enhanced services did not improve the efficacy of PCIT. The relative superiority of PCIT was mediated by greater reduction in negative parent-child interactions, consistent with the PCIT change model.

Empirical support for a treatment program for families of young children with externalizing problems

We evaluated the efficacy of a manualized multimodal treatment program for young externalizing children. Families were assigned randomly to an immediate 12-week parent and child treatment condition (n = 24) or to a delayed-treatment condition (n = 23). Parents had high attendance, high satisfaction with treatment, and increased knowledge of behavior management principles. Relative to the waitlist condition, treatment parents reported statistically and clinically significant reductions in child behavior problems, improved parenting practices (i.e., increased consistency, decreased power assertive techniques), an increased sense of efficacy, and reduced parenting stress. There was a trend toward parents improving their attitudes toward their children. In considering the process of change, we found evidence that improved parenting practices mediated reductions in child behavior problems and that child improvements mediated changes in parent attitudes and stress. Five months following treatment, teachers reported significant improvements in child behaviors, whereas parents reported that reductions in child behavior problems and parenting stress were maintained.

Treating children with early-onset conduct problems: intervention outcomes for parent, child, and teacher training

Families of 159, 4- to 8-year-old children with oppositional defiant disorder (ODD) were randomly assigned to parent training (PT); parent plus teacher training (PT + TT); child training (CT); child plus teacher training (CT + TT); parent, child, plus teacher training (PT + CT + TT); or a waiting list control. Reports and independent observations were collected at home and school. Following the 6-month intervention, all treatments resulted in significantly fewer conduct problems with mothers, teachers, and peers compared to controls. Children's negative behavior with fathers was lower in the 3 PT conditions than in control. Children showed more prosocial skills with peers in the CT conditions than in control. All PT conditions resulted in less negative and more positive parenting for mothers and less negative parenting for fathers than in control. Mothers and teachers were also less negative than controls when children received CT. Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems.

Parent training of toddlers in day care in low-income urban communities

The authors tested a 12-week parent training program with parents (n = 208) and teachers (n = 77) of 2-3-year-olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to 1 of 4 conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained 1 year later. Benefits were greatest when parents directly received training.

A growth curve analysis of parent training outcomes: examining the influence of child risk factors (inattention, impulsivity, and hyperactivity problems), parental and family risk factors

BACKGROUND

Parent training is one of the most effective treatments for young children with conduct problems. However, not every family benefits from this approach and approximately one-third of children remain in the clinical range at follow-up assessments. Little is known about factors affecting treatment outcome for young children.

METHOD

Hierarchical linear modeling methods were used to examine the effects of child attentional risk factors (inattention, impulsivity and hyperactivity problems), parental and familial risk factors upon the efficacy of a parent training program to decrease boys' conduct problems. Mothers of 81 boys, four to seven years of age, exhibiting conduct problems attended a parent training program (The Incredible Years) which lasted 22 to 24 weeks. Treatment effectiveness was assessed at one month and one year post treatment by means of independent home observations, parent and teacher reports.

RESULTS

Results indicated significant decreases in observations of mothers' negative parenting interactions with their children and decreases in their conduct problems according to mother reports and independent observations at home. Boys with elevated ratings of attentional problems in addition to conduct problems showed similar benefits from the parent training program as the boys who did not have attentional problems.

CONCLUSION

This study suggests that parent training is equally effective for boys with both conduct problems and attentional problems as it is for boys with conduct problems without these attentional problems. In fact, boys rated in the Borderline or Clinical range for attentional problems evidenced a greater decrease in externalizing behavior problems as rated by their mothers. Surprisingly, the predictor variables of depression, stress, and socioeconomic status were not significant contributors at either initial status or growth over time whether outcomes were measured by child conduct problems or parenting interactions.

Treatment of behavior problems in preschoolers: a review of parent training programs

The literature for parent training interventions with conduct-problem preschool-aged children is reviewed. Although previous reviews have identified the preschool years as a critical point for intervention [J. Clin. Psychol. 21 (1992) 306; School Psychol. Rev. 22 (1993) 437], there still remains a paucity of well-designed outcome studies that have focused exclusively on preschoolers. Interventions that utilize parents as active sources of change remain predominant. The review reveals the need for further research to improve accessibility and delivery of interventions. Treatments that have undergone modification in their delivery format (e.g., use of telephone and videotape) were also identified and critically evaluated. Results of the review indicate that many studies are still accompanied by methodological limitations. Although promising interventions exist for young conduct-problem children, it is recommended that treatment effectiveness for preschoolers be evaluated more rigorously.

Preventing conduct problems, promoting social competence: a parent and teacher training partnership in head start

Studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the "highest risk" at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.

Clinic referral for oppositional defiant disorder: relative significance of attachment and behavioral variables

Attachment classifications have been found to distinguish clinic-referred, oppositional preschool boys from controls, but there has been no previous effort to examine the relative contribution of attachment when behaviors from a social learning perspective are also considered. The present study examined the contribution of attachment and behavioral variables to the prediction of clinic referral for oppositional defiant disorder in a sample of preschool boys. We hypothesized that the attachment measures would offer better discrimination of clinic and control group boys at this age. This hypothesis was confirmed when the attachment measures were compared with the parent-child behaviors most strongly associated with social learning conceptualizations of disruptive problems (maternal commands and criticism, and child noncompliance), but rejected in a more stringent test in which the attachment measures were compared with the behavioral variables distinguishing the groups in this particular sample.

Psychological functioning of children with craniofacial anomalies and their mothers: follow-up from late infancy to school entry

Twenty-three mothers and their 5- to 7-year-old children with craniofacial anomalies (CFA) who were assessed during the child's infancy were followed. Three types of CFA were included: cleft lip and palate (CLP), isolated cleft palate (CP), and sagittal synostosis. Measures of child status focused on behavior-problem frequency and self-concept. Mothers completed self-report measures of emotional well-being, marital satisfaction, and social support. Results indicated that (1) a sizable minority (18%) of the children with CFA had clinically significant behavior-problem scores shown in concordant reports by parent and teacher of behavior problems; (2) individual differences in child functioning within the CFA group were predicted by observational measures of earlier mother-infant interaction during play and teaching situations; (3) mothers of children with CLP reported less favorable social support than mothers of children with CP or sagittal synostosis.

The importance of parents' concerns about their child's behavior

Parents often complain about children's behavior. Pediatricians may be unsure whether to ignore these complaints, counsel parents in-office or refer them to mental health services. This study shows a close relationship between parents' concerns and measurably significant behavior problems. Methods are provided for responding to parents' concerns. These should be useful to pediatricians who are often criticized for failing to detect and refer children with mental health problems including behavior disturbances.

Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children

Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered video-tape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.

Interactions of mothers and fathers with conduct problem children: comparison with a nonclinic group

The purpose of this study was to compare the interactions of clinic-referred mothers and fathers with their conduct problem children with those of nonclinic "normal" parents and their children without problems in terms of their expression of positive and negative affect. Forty parents and their 20 children participated. Results indicated that clinic mothers and fathers exhibited significantly increased negative verbal behaviors with their children than nonclinic parents. Valence scores also indicated clinic mothers had significantly more negative nonverbal affect behaviors than nonclinic mothers. Clinic children exhibited significantly less positive verbal and nonverbal affect behaviors with their mothers than nonclinic children. Valence scores indicated that clinic children exhibited more negative nonverbal behaviors with both mothers and fathers in comparison to nonclinic children.