Cassandra L. Tellegen

The Triple P-Positive Parenting Program: A systematic review and meta-analysis of a multi-level system of parenting support

This systematic review and meta-analysis examined the effects of the multilevel Triple P-Positive Parenting Program system on a broad range of child, parent and family outcomes. Multiple search strategies identified 116 eligible studies conducted over a 33-year period, with 101 studies comprising 16,099 families analyzed quantitatively. Moderator analyses were conducted using structural equation modeling. Risk of bias within and across studies was assessed. Significant short-term effects were found for: childrens social, emotional and behavioral outcomes (d=0.473); parenting practices (d=0.578); parenting satisfaction and efficacy (d=0.519); parental adjustment (d=0.340); parental relationship (d=0.225) and child observational data (d=0.501). Significant effects were found for all outcomes at long-term including parent observational data (d=0.249). Moderator analyses found that study approach, study power, Triple P level, and severity of initial child problems produced significant effects in multiple moderator models when controlling for other significant moderators. Several putative moderators did not have significant effects after controlling for other significant moderators. The positive results for each level of the Triple P system provide empirical support for a blending of universal and targeted parenting interventions to promote child, parent and family wellbeing.

No Effect of Inversion on Attentional and Affective Processing of Facial Expressions

The decrease in recognition performance after face inversion has been taken to suggest that faces are processed holistically. Three experiments, 1 with schematic and 2 with photographic faces, were conducted to assess whether face inversion also affected visual search for and implicit evaluation of facial expressions of emotion. The 3 visual search experiments yielded the same differences in detection speed between different facial expressions of emotion for upright and inverted faces. Threat superiority effects, faster detection of angry than of happy faces among neutral background faces, were evident in 2 experiments. Face inversion did not affect explicit or implicit evaluation of face stimuli as assessed with verbal ratings and affective priming. Happy faces were evaluated as more positive than angry, sad, or fearful/scheming ones regardless of orientation. Taken together these results seem to suggest that the processing of facial expressions of emotion is not impaired if holistic processing is disrupted.

Stepping Stones Triple P-Positive Parenting Program for children with disability: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the treatment effects of a behavioral family intervention, Stepping Stones Triple P (SSTP) for parents of children with disabilities. SSTP is a system of five intervention levels of increasing intensity and narrowing population reach. Twelve studies, including a total of 659 families, met eligibility criteria. Studies needed to have evaluated SSTP, be written in English or German, contribute original data, and have sufficient data for analyses. No restrictions were placed on study design. A series of meta-analyses were performed for seven different outcome categories. Analyses were conducted on the combination of all four levels of SSTP for which evidence exists (Levels 2-5), and were also conducted separately for each level of SSTP. Significant moderate effect sizes were found for all levels of SSTP for reducing child problems, the primary outcome of interest. On secondary outcomes, significant overall effect sizes were found for parenting styles, parenting satisfaction and efficacy, parental adjustment, parental relationship, and observed child behaviors. No significant treatment effects were found for observed parenting behaviors. Moderator analyses showed no significant differences in effect sizes across the levels of SSTP intervention, with the exception of child observations. Risk of bias within and across studies was assessed. Analyses suggested that publication bias and selective reporting bias were not likely to have heavily influenced the findings. The overall evidence base supported the effectiveness of SSTP as an intervention for improving child and parent outcomes in families of children with disabilities. Limitations and future research directions are discussed.

A Randomized Controlled Trial Evaluating a Brief Parenting Program With Children With Autism Spectrum Disorders

OBJECTIVE This randomized controlled trial evaluated the efficacy of Primary Care Stepping Stones Triple P, a brief individualized parenting program, in a sample of parents of children with autism spectrum disorder (ASD). METHOD Sixty-four parents of children aged 2-9 years (M = 5.67, SD = 2.14) with an ASD diagnosis participated in the study. Eighty-six percent of children were male, and 89% of parents identified their childs ethnicity as Australian/White. Families were randomly assigned to 1 of 2 conditions (intervention or care-as-usual) and were assessed at 3 time points (preintervention, postintervention, and 6-month follow-up). Parents completed a range of questionnaires to assess changes in child behavior (Eyberg Child Behavior Inventory) and parent outcomes (Parenting Scale, Depression Anxiety Stress Scale-21, Parent Problem Checklist, Relationship Quality Inventory, Parental Stress Scale) and 30-min home observations of parent-child interactions. RESULTS Relative to the care-as-usual group, significant short-term improvements were found in the intervention group on parent-reported child behavior problems, dysfunctional parenting styles, parenting confidence, and parental stress, parental conflict, and relationship happiness. No significant intervention effects were found on levels of parental depression or anxiety, or on observed child disruptive and parent aversive behavior. The effect sizes for significant variables ranged from medium to large. Short-term effects were predominantly maintained at 6-month follow-up, and parents reported high levels of goal achievement and satisfaction with the program. CONCLUSIONS The results indicate that a brief low intensity version of Stepping Stones Triple P is an efficacious intervention for parents of children with ASD.

Searching for differences in race: Is there evidence for preferential detection of other-race faces?

Previous research has suggested that like animal and social fear-relevant stimuli, other-race faces (African American) are detected preferentially in visual search. Three experiments using Chinese or Indonesian faces as other-race faces yielded the opposite pattern of results: faster detection of same-race faces among other-race faces. This apparently inconsistent pattern of results was resolved by showing that Asian and African American faces are detected preferentially in tasks that have small stimulus sets and employ fixed target searches. Asian and African American other-race faces are found slower among Caucasian face backgrounds if larger stimulus sets are used in tasks with a variable mapping of stimulus to background or target. Thus, preferential detection of other-race faces was not found under task conditions in which preferential detection of animal and social fear-relevant stimuli is evident. Although consistent with the view that same-race faces are processed in more detail than other-race faces, the current findings suggest that other-race faces do not draw attention preferentially.

Using primary care parenting interventions to improve outcomes in children with developmental disabilities: a case report.

Parenting is central to the health and well-being of children. Children with developmental disabilities have been shown to be at increased risk of developing emotional and behavioral problems. Parent training programs are effective interventions for improving child behavior and family functioning. This paper describes the outcomes of a brief 4-session parenting intervention (Primary Care Stepping Stones Triple P) targeting compliance and cooperative play skills in an 8-year-old girl with Aspergers disorder and ADHD combined type. The intervention was associated with decreases in child behavior problems, increases in parenting confidence, and decreases in dysfunctional parenting styles. This paper demonstrates that low-intensity parenting interventions can lead to significant improvements in child behavior and family functioning. Such brief interventions are cost effective, can be widely disseminated, and have been designed to be delivered within primary health care settings. Pediatricians can play a key role in identifying parents in need of assistance and in helping them access evidence-based parenting interventions.

Stepping Stones Triple P: the importance of putting the findings into context.

The Stepping Stones Triple P (SSTP) parenting program is an evidence-based program for parents of children with a disability. A trial of SSTP was recently published in BMC Medicine, which reported results of a randomized controlled trial comparing SSTP to care-as-usual. Although the paper described what should be an important replication trial of SSTP, there are significant shortcomings to the scientific approach of the reporting that need to be addressed. The paper initially cites only a few published SSTP studies and describes evidence for the efficacy of the program as “very scarce”. A meta-analysis of studies evaluating SSTP published prior to submission of this paper was not cited. The results are inconsistent with previous evidence for SSTP, yet the authors provide scant interpretation for this inconsistency. Similarly, the unusually high dropout rate of 49% was not adequately explained. The claims that previous research has only been conducted by the developers, has not included children with intellectual disability, and has not used care-as-usual comparison groups, are inaccurate. This commentary explores these issues further in order to place the findings from the recent trial into context.Please see related article: http://www.biomedcentral.com/1741-7015/12/191.