Carolyn Webster-Stratton

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. Childrens 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.

Nipping Early Risk Factors in the Bud: Preventing Substance Abuse, Delinquency, and Violence in Adolescence Through Interventions Targeted at Young Children (0–8 Years)

This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems. In addition, it describes indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder. Emphasis is placed on empirically supported programs that have identified key malleable risk factors in children, families, and schools, which have been shown in longitudinal research to be related to later development of substance abuse, delinquency, and violence. We have targeted preschool and primary grade children, ages 0–8 years, in this review because research suggests that the most effective interventions can nip in the bud risk behaviors in the early years, before antisocial behaviors become crystallized. Guidelines for selecting effective interventions are provided.

Maternal depression and its relationship to life stress, perceptions of child behavior problems, parenting behaviors, and child conduct problems

This study examined the relationship of reported maternal depression to prior and current life stressors, and to mother perceptions of child adjustment, parenting behaviors, and child conduct problems. Forty-six depressed mothers and 49 nondepressed mothers and their clinic-referred children (aged 3–8 years) participated. Depressed mothers were more critical than nondrepessed mothers, but the behavior of children of depressed and nondepressed mothers showed no significant differences. Depressed mothers were more likely to have experienced child abuse, spouse abuse, or more negative life events than nondepressed mothers. Maternal reports of stress related to mother characteristics and to negative life events were the most potent variables discriminating depressed from nondepressed mother families.

Mediators, Moderators, and Predictors of 1-Year Outcomes Among Children Treated for Early-Onset Conduct Problems: A Latent Growth Curve Analysis.

Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. In this study, the authors combine data from 6 randomized clinical trials and 514 children, ages 3.0-8.5 years, to evaluate moderators, mediators, and predictors of outcome. Among other findings, latent growth curve models of mother-report and observational measures of child externalizing behaviors suggested that marital adjustment, maternal depression, paternal substance abuse, and child comorbid anxiety/depression each moderated treatment response. Moreover, critical, harsh, and ineffective parenting both predicted and mediated outcome, with the most favorable responses observed when parents scored relatively low on each construct at intake yet improved during treatment. Implications for treatment nonresponders are discussed.

The role of parental stress in physically abusive families.

This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Data were collected over a several-week period and included both mother and father self-report measures and independent observations by trained researchers. Parental stress was found to play an important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs. Abusive mothers reported more stress due to frequent life events, and had a more negative perception of these events. Further, these mothers had higher rates of both depression and state anxiety. Abusive fathers spanked their children significantly more often than the nonabusive fathers, and abusive mothers had the highest frequency of critical statements directed at their children. Children from abusive households had significantly more behavior problems. Finally, abusive mothers reported more marital dissatisfaction and social isolation than their nonabusive counterparts.

The Role of Mental Health Factors and Program Engagement in the Effectiveness of a Preventive Parenting Program for Head Start Mothers

Head Start centers were randomly assigned to intervention (parent training) or control conditions, and the role of maternal mental health risk factors on participation in and benefit from parent training was examined. Parenting was measured by parent report and independent observation in 3 domains: harsh/negative, supportive/positive, inconsistent/ineffective parenting. Structural equation modeling showed that parent engagement training was associated with improved parenting in a dose-response fashion. Mothers with mental health risk factors (i.e., depression, anger, history of abuse as a child, and substance abuse) exhibited poorer parenting than mothers without these risk factors. However, mothers with risk factors were engaged in and benefited from the parenting training program at levels that were comparable to mothers without these risk factors.

Parent Training in Head Start: A Comparison of Program Response Among African American, Asian American, Caucasian, and Hispanic Mothers.

The effectiveness of the Incredible Years Parenting Program was evaluated in a low-income sample of Caucasian, African American, Hispanic, and Asian mothers whose children were enrolled in Head Start. Data from two prior intervention studies [Webster-Stratton (1998) Journal of Consulting and Clinical Psychology, 66(5), 715–730; Webster-Stratton et al. (in press) Journal of Clinical Child Psychology] were combined, yielding a sample of 634 families (370 Caucasian, 120 African American, 73 Asian, 71 Hispanic) across 23 Head Start centers. Centers were matched and assigned randomly to either an experimental condition (8–12 weeks of weekly 2-hr parenting classes), or a control condition (the regular Head Start Program without parenting groups). Families in both conditions were assessed using home observations of parent–child interactions and parent reports of parenting style and discipline strategies and child behavior problems in the fall (baseline) and spring (postintervention) of the childrens Head Start year. Families were reassessed 1 year later. Following treatment, intervention mothers were observed to be more positive, less critical, more consistent, and more competent in their parenting than were control mothers. Additionally, children of intervention parents were observed to exhibit fewer behavior problems than were control children. Differences in treatment response across ethnic groups were few, and did not exceed the number expected by chance. Parents from all groups reported high satisfaction levels following the parenting program. Results indicate that the Incredible Years Program is accepted by and effective with diverse populations.

Predictors of treatment outcome in parent training for conduct disordered children

Thirty-four families with conduct disordered children attended a 9-week behaviorally oriented parent-training program. Prior to treatment, mothers were assessed in terms of socioeconomic variables, depression, attitudes towards their children, and behavioral observations in the home. Treatment outcome was assessed at 1 month and 1 year posttreatment using a clinical replication analysis, and included home visit observations and parent perception measures. The amount of negative life stress experienced by families was also assessed for the period prior to and the year following treatment. At the 1-year follow-up, the model consisting of both socioeconomic disadvantage and negative life stress correctly classified from 70 to 80% of families depending on the outcome criteria. Within the variable of socioeconomic disadvantage, coming from a single parent family seemed most strongly associated with nonresponse. Results are discussed in relation to the important predictors of treatment failure and the implications for parent training programs and future research.

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.

Treating Conduct Problems and Strengthening Social and Emotional Competence in Young Children The Dina Dinosaur Treatment Program

Young preschool and early-school-age children with early onset conduct problems are at high risk for school dropout, substance abuse, violence, and delinquency in later years. Consequently, developing treatment strategies for reducing conduct problems when aggression is in its more malleable form prior to age 8, and thus interrupting its progression, is of considerable benefit to families and society. This article describes a treatment program—the Dina Dinosaur Social, Emotional and Problem Solving Child Training Program—that was designed specifically with developmentally appropriate teaching methods for young children (ages 4 to 8 years) and based on theory related to the types of social, emotional, and cognitive deficits or excesses exhibited by children with conduct problems.The program emphasizes training children in skills such as emotional literacy, empathy or perspective taking, friendship and communication skills, anger management, interpersonal problem solving, school rules, and how to be successful at school. Emphasis is placed on ways to promote cross-setting generalization of the behaviors that are taught by involving parents and teachers in the treatment. A review of two randomized trials with this treatment approach and long-term results are provided.