Frances Gardner

Randomized trial of a family-centered approach to the prevention of early conduct problems: 2-Year effects of the family check-up in early childhood

Despite recent research indicating that 1 of the pivotal times for identifying pathways to early conduct problems is the toddler period, few family-based preventive interventions have been specifically designed to modify child disruptive behavior during this age period. This randomized trial tested the effectiveness of the Family Check-Up in sustaining maternal involvement and preventing the exacerbation of child conduct problems among 120 at-risk toddler-age boys, half of whom were randomly assigned to a treatment condition. The intervention was associated with reductions in disruptive behavior and greater maternal involvement and was particularly effective for children at greater risk for a persistent trajectory of conduct problems. The results are discussed in relation to other preventive interventions for young children.

Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention.

We examined mediators and moderators of change in conduct problems, in a multiagency randomized trial of the Incredible Years parenting program. Preschoolers (n = 153) at risk for conduct problems were randomly assigned to intervention (n = 104) and wait-list (n = 49) groups. Boys and younger children, and those with more depressed mothers, tended to show greater improvement in conduct problems post-intervention. Other risk factors (i.e., teen or single parenthood, very low income, high initial levels of problem behavior) showed no predictive effects, implying intervention was at least as successful at helping the most disadvantaged families, compared to more advantaged. Mediator analyses found change in positive parenting skill predicted change in conduct problems.

The Relations among Cumulative Risk, Parenting, and Behavior Problems during Early Childhood.

BACKGROUND This study examined relations among cumulative risk, nurturant and involved parenting, and behavior problems across early childhood. METHODS Cumulative risk, parenting, and behavior problems were measured in a sample of low-income toddlers participating in a family-centered program to prevent conduct problems. RESULTS Path analysis was utilized to examine longitudinal relations among these constructs, with results supporting an indirect effect of cumulative risk on externalizing and internalizing problems through nurturant and involved parenting. CONCLUSION Results highlight the importance of cumulative risk during early childhood, and particularly the effect that the level of contextual risk can have on the parenting context during this developmental period.

Risk and protective factors for psychological well-being of children orphaned by AIDS in Cape Town: a qualitative study of children and caregivers' perspectives

Abstract By 2020, an estimated 2.3 million South African children will be orphaned by HIV/AIDS (Actuarial Society of South Africa, 2005), but little is known about risk and protective factors for their emotional and behavioural well-being. This qualitative study explores perspectives of affected families. Orphaned children (n = 60), caregivers of orphaned children (n = 42) and social care professionals (n = 20) completed semi-structured interviews and focus groups. Participants were recruited from schools, shelters and welfare services. Findings from multiple sources indicate potential risk and protective factors in a range of dimensions, including bereavement, family functioning, social support, poverty, access to education and perceived stigma. Many factors reflected international literature on children experiencing similar stressors (e.g. non HIV/AIDS-related bereavement). However, this study also identified factors which may be specific to this group, notably stigma, abuse and peer factors. Current research is quantitatively testing associations between these identified factors and psychological outcomes.

Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior

Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. The current study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program. Families with toddlers between ages 2 and 3 were screened and then randomized to a brief family intervention, the Family Check-Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention services were provided at age 3 and follow-up of child outcomes occurred at ages 3 and 4. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. The results are discussed with respect to targeting maternal depression in future intervention studies aimed at improving early child problem behavior.

Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research in Prevention Science: Next Generation

A decade ago, the Society of Prevention Research (SPR) endorsed a set of standards for evidence related to research on prevention interventions. These standards (Flay et al., Prevention Science 6:151–175, 2005) were intended in part to increase consistency in reviews of prevention research that often generated disparate lists of effective interventions due to the application of different standards for what was considered to be necessary to demonstrate effectiveness. In 2013, SPR’s Board of Directors decided that the field has progressed sufficiently to warrant a review and, if necessary, publication of “the next generation” of standards of evidence. The Board convened a committee to review and update the standards. This article reports on the results of this committee’s deliberations, summarizing changes made to the earlier standards and explaining the rationale for each change. The SPR Board of Directors endorses “The Standards of Evidence for Efficacy, Effectiveness, and Scale-up Research in Prevention Science: Next Generation.”

Improving positive parenting skills and reducing harsh and abusive parenting in low- and middle-income countries: a systematic review.

Family and youth violence are increasingly recognized as key public health issues in developing countries. Parenting interventions form an important evidence-based strategy for preventing violence, both against and by children, yet most rigorous trials of parenting interventions have been conducted in high-income countries, with far fewer in low- and middle-income countries (LMICs). This systematic review, conducted in line with Cochrane Handbook guidelines, investigated the effectiveness of parenting interventions for reducing harsh/abusive parenting, increasing positive parenting practices, and improving parent–child relationships in LMICs. Attitudes and knowledge were examined as secondary outcomes. A range of databases were systematically searched, and randomized trials included. High heterogeneity precluded meta-analysis, but characteristics of included studies were described according to type of delivery mode and outcome. Twelve studies with 1580 parents in nine countries reported results favoring intervention on a range of parenting measures. The validity of results for most studies is unclear due to substantial or unclear risks of bias. However, findings from the two largest, highest-quality trials suggest parenting interventions may be feasible and effective in improving parent–child interaction and parental knowledge in relation to child development in LMICs, and therefore may be instrumental in addressing prevention of child maltreatment in these settings. Given the well-established evidence base for parenting interventions in high-income countries, and increasingly good evidence for their applicability across cultures and countries, there is now an urgent need for more rigorously evaluated and reported studies, focusing on youth outcomes as well as parenting, adapted for contexts of considerable resource constraints.

Inconsistent parenting: Is there evidence for a link with children's conduct problems?

Traditional interview studies of inconsistent parental discipline show a strong link with young childrens conduct problems. Observational studies of inconsistency show weaker links with problem behavior and suffer from methodological problems. This study proposed a new observational definition of parental inconsistency, which analyzed whether mothers follow through their demands during sequences of mother-child conflict. A home observational study showed that mothers of conduct-problem preschoolers acted inconsistently during a greater proportion of conflict episodes than did their normal counterparts. There was a strong correlation between inconsistency and amount of family conflict. Inconsistency varied as a function of the context from which conflict arose. Results are discussed in terms of both coercion (Patterson, 1979) and predictability theories of problem behavior (Wahler & Dumas, 1986).

The mental health of children orphaned by AIDS: a review of international and southern African research

This paper reviews research on the mental health and psychological outcomes of children who are orphaned by AIDS. Studies are limited, scattered and often unpublished. The review focuses on research which is quantitative and based on primary research with uninfected children who are parentally bereaved by AIDS. Due to the limited available quantitative research in this area, both controlled and uncontrolled studies are included. Selected qualitative and related literature is also reviewed, with a focus on work relevant to the southern African context. This paper builds upon and updates Wilds seminal review, published in this journal in 2001 (Wild 2001). We found 24 studies worldwide, with wide variations in sample characteristics, outcome measurements and control groups. Three of these studies are ongoing. Internalising problems in orphaned children were found in 16 studies (of the 19 studies which measured them) and externalising problems were found in five studies (of 10 which measured them). There is a clear need for further, and rigorous, research into mental health, and risk and protective factors for children orphaned by AIDS. Furthermore, it is critical that research adopts a more coordinated approach, which allows for meaningful comparisons of child outcomes in different areas.

The psychological well-being of children orphaned by AIDS in Cape Town, South Africa

BackgroundAn estimated 2 million children are parentally bereaved by AIDS in South Africa. Little is known about mental health outcomes for this group.MethodsThis study aimed to investigate mental health outcomes for urban children living in deprived settlements in Cape Town. 30 orphaned children and 30 matched controls were compared using standardised questionnaires (SDQ) on emotional and behavioural problems, peer and attention difficulties, and prosocial behaviour. The orphan group completed a modified version of a standardised questionnaire (IES-8), measuring Post-Traumatic Stress symptoms. Group differences were tested using t-tests and Pearsons chi-square.ResultsBoth groups scored highly for peer problems, emotional problems and total scores. However, orphans were more likely to view themselves as having no good friends (p = .002), to have marked concentration difficulties (p = .03), and to report frequent somatic symptoms (p = .05), but were less likely to display anger through loss of temper (p = .03). Orphans were more likely to have constant nightmares (p = .01), and 73% scored above the cut-off for Post-Traumatic Stress Disorder.ConclusionFindings suggest important areas for larger-scale research for parentally-bereaved children.