Ilka Eichelberger

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.

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.

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.

Die klinische Signifikanz des Präventionsprogramms für Expansives Problemverhalten (PEP) im Langzeitverlauf

Hintergrund: Lerntheoretisch orientierte Elterntrainings gelten als effektive Präventions- und Interventionsmethode zur Reduzierung expansiver Verhaltensauffälligkeiten im Kindesalter. Interventionseffekte werden hierbei meist im statistischen Gruppenvergleich überprüft. Unser Präventionsprogramm für Expansives Problemverhalten (PEP) war sowohl in einer Kontrollgruppenstudie als auch in einer Anwendungsstudie in der Lage, kindliches Problemverhalten zu reduzieren. Die vorliegende Analyse überprüft die langfristige klinische Signifikanz dieser Veränderungen. Material und Methoden: Mithilfe eines Screeninginstruments wurde eine Stichprobe expansiv auffälliger Kindergartenkinder identifiziert. In einer Kontrollgruppe (KG: n = 34), einer Erziehertrainingsgruppe (ER: n = 21) und einer Eltern-und-Erzieher-Trainingsgruppe (EL+ER: n = 38) wurde das kindliche Problemverhalten vor und bis 30 Monate nach dem PEP-Training erhoben. Die klinische Relevanz der Trainingseffekte wurde anhand des von Jacobson und Truax vorgeschlagenen Maßes für klinische Signifikanz überprüft. Ergebnisse: In einer Messwiederholungsvarianzanalyse zeigten sich keine gruppenspezifischen Verläufe im Untersuchungszeitraum. Klinisch signifikante Verbesserungen erzielten in der kombinierten EL+ER-Gruppe 34,2% der Kinder, in der ER-Gruppe 28,6% und in der KG je nach Instrument 17,6% bzw. 32,4%. In der EL+ER-Gruppe waren diese Verbesserungen bereits unmittelbar nach Interventionsende vorhanden (36,8% bzw. 39,5%), während sich in der KG von Prä nach Post lediglich 20,6% klinisch signifikant verbesserten. Die ER-Gruppe weist zum Postzeitpunkt 42,9% klinisch relevant gebesserte Kinder auf. Schlussfolgerungen: Das Problemverhalten wird in der kombinierten Interventionsgruppe früher relevant reduziert als in der Kontrollgruppe. PEP scheint somit in der Lage, eine Reduktion von Problemverhalten, die auch in der Kontrollgruppe zu beobachten ist, früher anzustoßen.

Association between Parental Emotional Symptoms and Child Antisocial Behaviour: What Is Specific and Is It Mediated by Parenting?.

Parental anxiety and depression are associated with antisocial behaviour of children. Several mechanisms may mediate this association. The aim of this study was to test whether parenting is a mediator of the association of parental anxiety and depression with the antisocial social behaviour of preschool children. The analysis was based on cross-sectional data and 106 German families of children with elevated externalizing behaviour problems were considered. Mothers and fathers were analysed separately. Depression and anxiety in parents were both associated with children’s antisocial behaviour and this association was mediated by parenting. Further, our results indicated that the association between maternal depression and child behaviour is maintained after controlling for maternal anxiety, and that parenting of mothers is more strongly associated with child behaviour than parenting of fathers.

Interventionen bei expansivem Problemverhalten in der Grundschule

Expansives Problemverhalten umfasst oppositionelles, aggressives und hyperkinetisches Verhalten. Diese Verhaltensauffalligkeiten treten haufig auf, sind sehr stabil, beeintrachtigen schulische Leistungen und stellen fur Lehrkraft e eine grose Herausforderung dar. Der vorliegende Beitrag beschreibt zwei Kooperationsprojekte (Universitat zu Koln Dusseldorf: Charlotte Hanisch, Uniklinik Koln: Manfred Dopfner), die evidenzbasierte Strategien zum Umgang mit expansivem Problemverhalten aus dem Praventions- bzw. therapeutischen Kontext auf das Schulsystem ubertragen. ‚Aufmerksamkeit macht Schule‘ versucht, uber die Kombination einer Padagogen-zentrierten und einer Kind-zentrierten Intervention das Arbeitsverhalten aufmerksamkeitsbeeintrachtigter Kinder in der Lernzeit offener Ganztagsschulen zu fordern. 59 Kinder wurden in einem Wartekontrollgruppendesign untersucht. Wahrend sich leichte Verbesserungen in Aufmerksamkeit und Regelverhalten durch die Padagogen-zentrierte Intervention ergaben, schien die Kind-zentrierte Intervention keine weitergehenden Effekte zu erzielen. Es wird diskutiert, inwieweit Forschungsmethodik und Rahmenbedingungen des offenen Ganztags zu geringeren Effektstarken als erwartet beigetragen haben konnten. Zum Ende wird das Folgeprojekt ‚Lehrercoaching‘ beschrieben, das Grundschullehrkraften ahnliche Inhalte in einer fallbezogenen, individualisierten Form in sechs Einzelcoaching Terminen vermittelt.

Effectiveness of the Prevention Program for Externalizing Problem Behavior (PEP) in Preschoolers with Severe and No or Mild ADHD Symptoms.

Objective The prevention program for externalizing problem behavior (PEP), developed for parents and teachers of preschool children, showed the effectiveness of both modules (PEP-PA and PEP-TE) under routine care conditions in two separate studies. This secondary analysis examined the effects of both modules on preschool children with severe attention deficit/hyperactivity disorder (ADHD) symptoms compared with children with no or mild ADHD symptoms. Methods In the within-subject control group, design changes in child symptoms and problem behavior in specific situations at home and school during the waiting period were compared with changes during the intervention period (3 months each). Results For children with severe ADHD, parent training reduced specific problem situations at home (HSQ-D[please provide full name here]), and teacher training showed significant effects on oppositional-aggressive behavior as well as the total problem score of the Caregiver Teacher Report Form (C-TRF). Children with no or mild ADHD benefited from parent training on the HSQ-D score, oppositional-aggressive behavior and the total problem score of the Child Behavior Checklist (CBCL), while teacher training had significant effects on all outcomes assessed. Conclusion Our results suggest that parent training reduces mainly specific behavior problems at home in children with severe ADHD symptoms and with no/mild ADHD symptoms, while teacher training reduces ADHD symptoms and ODD[please provide full name here] symptoms including specific behavior problems in the kindergarten in children with no/mild ADHD symptoms. However, in children with severe ADHD only overall problems and ODD symptoms were significantly reduced by teacher Training.

Dank an die Gutachter

Im jetzt ablaufenden Jahr wurde ein Grosteil der im Bundesgesundheitsblatt — Gesundheitsforschung — Gesundheitsschutz publizierten Original- und Ubersichtsbeitrage einem Peer-Review-Verfahren durch normalerweise je zwei Gutachter pro Beitrag unterzogen. Die Redaktion mochte an dieser Stelle allen im folgenden aufgefuhrten Gutachtern fur ihre Mitwirkung danken, durch die sie entscheidend zur Verbesserung und Aufrechterhaltung der Qualitat dieser Zeitschrift beitragen.

«Moderne Zeiten» – Stress, Burnout und Möglichkeiten der Prävention und Intervention

Accessible online at: www.karger.com/ver Fax +49 761 4 52 07 14 Information@Karger.de www.karger.com Herr Professor Dormann, die neuesten Gesundheitsreporte bescheinigen uns wieder, dass krankheitsbedingte Fehltage im Arbeitsleben sinken, psychische Erkrankungen jedoch ansteigen. Das Thema Burnout spielt hierbei sicherlich eine große Rolle. Eine holländische Studie besagt, dass 10–15% der Bevölkerung Burnout-Werte aufweisen, bei denen eine arbeitsplatzbezogene oder medizinische Intervention angesagt wäre. Wie zeigt sich Burnout am Arbeitsplatz und was sind die auslösenden Faktoren?