Christopher Hautmann

Detecting effects of the indicated prevention Programme for Externalizing Problem behaviour (PEP) on child symptoms, parenting, and parental quality of life in a randomized controlled trial

BACKGROUND Behavioural parent training is effective in improving child disruptive behavioural problems in preschool children by increasing parenting competence. The indicated Prevention Programme for Externalizing Problem behaviour (PEP) is a group training programme for parents and kindergarten teachers of children aged 3-6 years with externalizing behavioural problems. AIMS To evaluate the effects of PEP on child problem behaviour, parenting practices, parent-child interactions, and parental quality of life. METHOD Parents and kindergarten teachers of 155 children were randomly assigned to an intervention group (n = 91) and a nontreated control group (n = 64). They rated childrens problem behaviour before and after PEP training; parents also reported on their parenting practices and quality of life. Standardized play situations were video-taped and rated for parent-child interactions, e.g. parental warmth. RESULTS In the intention to treat analysis, mothers of the intervention group described less disruptive child behaviour and better parenting strategies, and showed more parental warmth during a standardized parent-child interaction. Dosage analyses confirmed these results for parents who attended at least five training sessions. Children were also rated to show less behaviour problems by their kindergarten teachers. CONCLUSIONS Training effects were especially positive for parents who attended at least half of the training sessions. ABBREVIATIONS CBCL: Child Behaviour Checklist; CII: Coder Impressions Inventory; DASS: Depression anxiety Stress Scale; HSQ: Home-situation Questionnaire; LSS: Life Satisfaction Scale; OBDT: observed behaviour during the test; PCL: Problem Checklist; PEP: prevention programme for externalizing problem behaviour; PPC: Parent Problem Checklist; PPS: Parent Practices Scale; PS: Parenting Scale; PSBC: Problem Setting and Behaviour checklist; QJPS: Questionnaire on Judging Parental Strains; SEFS: Self-Efficacy Scale; SSC: Social Support Scale; TRF: Caregiver-Teacher Report Form.

The severely impaired do profit most: short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior

Short-term and long-term predictors of therapeutic change due to parent management training were investigated. Therapeutic change was defined as the change in outcome measures [externalizing problem behavior and parenting self-efficacy (PSE)] from before treatment to afterward. Three different types of predictors were analyzed: child variables (gender, age, and initial externalizing and internalizing behavior), parent variables (age, initial PSE and parental psychopathology) and socioeconomic status and other sociodemographic characteristics of the family (parental school education, employment, family status, language). The parent management training was part of the Prevention Program for Externalizing Problem Behavior, which was evaluated as an effectiveness trial under routine care conditions using a within-subject control group design. Between 78 and 270 families were included in the analysis, which investigated therapeutic change over two time intervals: (1) immediate change from the pre-treatment to the post-treatment assessments, and (2) long-term-change from pre-treatment to 1-year follow-up. Throughout several analyses, the only predictor of therapeutic change that was consistently significant over the two time periods for the externalizing problem behavior of the child was the initial externalizing problem behavior. More impaired children improved more. Similarly, the only predictor of therapeutic change for the two time periods in PSE was the initial level of PSE. Parents with less PSE gained more during the course of the training.

Kurzzeiteffekte des indizierten Präventionsprogramms für Expansives Problemverhalten (PEP) auf das elterliche Erziehungsverhalten und auf das kindliche Problemverhalten

Zusammenfassung. Theoretischer Hintergrund: Verhaltenstherapeutisch orientierte Elterntrainings haben sich bei der Behandlung von Kinder mit ausgepragten expansiven Verhaltensauffalligkeiten bewahrt. Das Praventionsprogramm fur Expansives Problemverhalten (PEP) wurde vor dem Hintergrund entwickelt, eine Verminderung des kindlichen Verhaltensauffalligkeiten in der Familie und im Kindergarten uber eine Verbesserung der Erziehungskompetenzen der Eltern und der Erzieherinnen zu erreichen. PEP richtet sich schwerpunktmasig an die Eltern und Erzieherinnen drei- bis sechsjahriger als expansiv auffallig indizierter Kinder. Fragestellung: Verbessert eine Teilnahme an PEP das elterliche Erziehungsverhalten und werden expansive Verhaltensauffalligkeiten der Kinder reduziert? Methode: Von 60 drei- bis sechsjahrigen Kindern nahmen sowohl die Erzieherinnen als auch die Mutter am PEP-Training teil. 65 Kinder dienten als nicht-behandelte Kontrollgruppe. Erhoben wurden das Erziehungsverhalten der Mutter und das kindliche ...

One-Year Follow-up of a Parent Management Training for Children with Externalizing Behaviour Problems in the Real World

BACKGROUND The long-term effectiveness of parent training for children with externalizing behaviour problems under routine care within the German health care system is unclear. We report the 1-year follow-up results of the parent training component of the Prevention Program for Externalizing Problem Behaviour (PEP) for 270 children aged 3-10 years with externalizing behaviour problems. METHOD Outcome measures included child behaviour problems (externalizing behaviour problems, Attention-Deficit/Hyperactivity Disorder symptoms and Oppositional Defiant Disorder symptoms) and parenting (self efficacy of parenting and perceived ability to solve difficult parenting situations). Data were analysed using multilevel modelling. RESULTS Comparison of the changes during the 3-month waiting and treatment periods revealed significantly stronger treatment effects on all outcome measures, indicating a substantial decrease in child behaviour problems and a significant increase in parenting due to treatment. At 1-year follow-up, initial treatment effects on child behaviour problems were maintained, while parenting continued to improve. CONCLUSIONS Families whose children exhibited externalizing problem behaviour profit from PEP and improvements are maintained for at least one year.

Effectiveness of the prevention program for externalizing problem behaviour (PEP) in children with symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder--generalization to the real world.

Summary.The aim of the present study was to test the effectiveness of the Prevention Program for Externalizing Problem Behaviour (PEP). PEP has already been evaluated as an efficacy study, i.e., with high internal validity. The main concern of the current study was to test the effects of PEP under conditions of high external validity.58 child therapists of 37 local institutions of the public health system held PEP trainings. The intervention was evaluated by a within-subject control group design with three assessment points, two before (pre1 and pre2) and one immediately after (post) the PEP training. Depending on the type of analysis, 198 up to 277 families with children aged 3–10 years were included. Data were collected by questionnaires and comprised symptomatology of the child and the mother as well as parenting.For parenting and child behaviour problems, changes after treatment were greater than changes during the waiting period. PEP produced effect sizes in the small to moderate range.The results suggest that PEP can be delivered under routine care settings without loss of positive treatment effects. As worse results are often obtained in effectiveness trials, these findings have to be regarded as particularly promising.

Does Parent Management Training for Children with Externalizing Problem Behavior in Routine Care Result in Clinically Significant Changes

Abstract The clinical significance of a parent management training that is part of the Prevention Program for Externalizing Problem Behavior (PEP) was assessed in an effectiveness trial. Parent management training was offered under routine care conditions in a setting where a high proportion of children were expected to show clinically relevant symptoms of externalizing problem behavior. At the beginning of the study, 32.6% to 60.7% of children were classified as clinical cases (dysfunctional) on three outcome measures of child behavior problems. Three months after treatment, 24.8% to 60.4% of children were judged to be recovered. Parent management training can result in clinically significant changes in children with externalizing behavior problems.

Functional Impairment in Children With Externalizing Behavior Disorders: Psychometric Properties of the Weiss Functional Impairment Rating Scale-Parent Report in a German Clinical Sample.

Objective: To examine the psychometric properties of a German adaptation of the Weiss Functional Impairment Rating Scale–Parent Report (WFIRS-P) in a clinical sample of children (4-12 years) with externalizing behavior disorders. Method: Data were collected within two clinical trials (N = 264). Factorial validity, reliability, and divergent validity from symptoms of ADHD and oppositional defiant disorder (ODD) were assessed. Results: Confirmatory factor analyses revealed that a bifactor model consistent with the theoretical assumption of a general construct of impairment (total scale) and additional specific factors (subscales) provided satisfactory data fit. Model-based reliability estimates showed that both the general construct and specific factors accounted for item variance. Internal consistencies were >.70, part–whole corrected item–scale correlations mostly >.30. Correlations between the WFIRS-P Scales and ADHD and ODD symptoms were low to moderate. Conclusion: The results support the factorial validity, reliability, and divergent validity of the WFIRS-P.

PEP - Ein Präventionsprogramm für drei- bis sechsjährige Kinder mit expansivem Problemverhalten

Zusammenfassung. In einer Ubersicht wird der Wissensstand zur Haufigkeit und Stabilitat von expansivem Problemverhalten sowie zur Wirksamkeit von Pravention in diesem Bereich zusammengefast. Ein von der Deutschen Forschungsgemeinschaft gefordertes Forschungsprojekt zur Pravention expansiver Verhaltensstorungen wird vorgestellt. Das in diesem Rahmen entwickelte Praventionsprogramm fur expansives Problemverhalten (PEP) lehnt sich an das Therapieprogramm fur Kinder mit hyperkinetischem und oppositionellem Problemverhalten (THOP) an, das fur den klinischen Kontext bestimmt ist. PEP besteht aus zwei Komponenten: einem Elternprogramm mit zehn Sitzungen (PEP-EL) und einem Erzieherprogramm (PEP-ER), das ebenfalls zehn Sitzungen umfast und analog zum Elternprogramm aufgebaut ist. Die geplante Studie soll die Wirksamkeit indizierter Pravention durch PEP bei Kindern im Kindergartenalter uberprufen. Erste empirische Ergebnisse zu einem eigens entwickelten Screening-Verfahren zur Erfassung von expansivem Problemverhal...

Predicting Outcome of Inpatient CBT for Adolescents with Anxious-Depressed School Absenteeism

Predictors of outcome of inpatient treatment based on manualized cognitive-behavioural therapy (CBT) were examined for 147 adolescents with anxious-depressed school absenteeism assessed at discharge and at 2 months after the end of treatment. Outcome measures were regular school attendance and a wide variety of mental health problems rated by adolescents and parents. Socio-demographic data, clinical ratings/diagnosis and adolescent-reported and parent-reported mental health problems were examined as predictors. Regression analyses indicated that none of the variables were able to predict regular school attendance in a clinically relevant way. Adolescent-reported and parent-reported mental health problems at intake predicted these symptoms at both discharge and follow-up (R(2) between 0.31 and 0.61).

Recruitment in an indicated prevention program for externalizing behavior - parental participation decisions

BackgroundParents are the ones who decide whether or not to participate in parent focused prevention trials. Their decisions may be affected by internal factors (e.g., personality, attitudes, sociodemographic characteristics) or external barriers. Some of these barriers are study-related and others are intervention-related. Internal as well as external barriers are especially important at the screening stage, which aims to identify children and families at risk and for whom the indicated prevention programs are designed. Few studies have reported their screening procedure in detail or analyzed differences between participants and dropouts or predictors of dropout. Rates of participation in prevention programs are also of interest and are an important contributor to the efficacy of a prevention procedure.MethodsIn this study, we analyzed the process of parent recruitment within an efficacy study of the indicated Prevention Program for Externalizing Problem behavior (PEP). We determined the retention rate at each step of the study, and examined differences between participants and dropouts/decliners. Predictors of dropout at each step were identified using logistic regression.ResultsRetention rates at the different steps during the course of the trial from screening to participation in the training ranged from 63.8% (pre-test) to 81.1% (participation in more than 50% of the training sessions). Parents who dropped out of the study were characterized by having a child with lower symptom intensity by parent rating but higher ratings by teachers in most cases. Low socioeconomic status and related variables were also identified as predictors of dropout in the screening (first step) and for training intensity (last step).ConclusionsSpecial attention should be paid to families at increased risk for non-participation when implementing the prevention program in routine care settings.Trial RegistrationISRCTN12686222