Karen Jones

Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder

BACKGROUND The typical pattern for intervention outcome studies for conduct problems has been for effect sizes to dissipate over time with decreasing effects across subsequent follow-ups. AIMS To establish whether the short-term positive effects of a parenting programme are sustained longer term. To observe trends, and costs, in health and social service use after intervention. METHOD Parents with children aged 36-59 months at risk of developing conduct disorder (n = 104) received intervention between baseline and first follow-up (6 months after baseline n = 86) in 11 Sure Start areas in North Wales. Follow-ups two (n = 82) and three (n = 79) occurred 12 and 18 months after baseline. Child problem behaviour and parenting skills were assessed via parent self-report and direct observation in the home. RESULTS The significant parent-reported improvements in primary measures of child behaviour, parent behaviour, parental stress and depression gained at follow-up one were maintained to follow-up three, as were improved observed child and parent behaviours. Overall, 63% of children made a minimum significant change (0.3 standard deviations) on the Eyberg Child Behavior Inventory problem scale between baseline and follow-up (using intention-to-treat data), 54% made a large change (0.8 standard deviations) and 39% made a very large change (1.5 standard deviations). Child contact with health and social services had reduced at follow-up three. CONCLUSIONS Early parent-based intervention reduced child antisocial behaviour and benefits were maintained, with reduced reliance on health and social service provision, over time.

Attention deficit hyperactivity disorder in pre-school children: current findings,recommended interventions and future directions

This paper outlines the presentation, aetiology and treatment of attention deficit hyperactivity disorder (ADHD) in pre-school children. A review of current parenting training interventions demonstrates that there is good evidence for their efficacy in reducing symptoms of ADHD in pre-school children, and three interventions are evaluated: The new forest parent training programme (NFPP); the triple P - positive parenting programme and the incredible years parent training programme (IY). The evaluation of the NFPP provides strong evidence demonstrating its effectiveness for pre-school children with ADHD, while the efficacy of the Triple - P and the IY programme have, to date, only been demonstrated on children with conduct problems and co-morbid ADHD. It is suggested that parent training should be the first choice treatment for pre-school children presenting signs of ADHD, and medication introduced only for those children where parent training is not effective. Few moderators of outcome have been identified for these interventions, with the exception of parental ADHD. Barriers to intervention and implementation fidelity will need to be addressed to achieve high levels of attendance, completion and efficacy. The IY programme is a good model for addressing fidelity issues and for overcoming barriers to intervention. The future directions for parent training are also discussed.

Treatment fidelity as a predictor of behaviour change in parents attending group-based parent training

BACKGROUND Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. AIMS To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. RESULTS Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. CONCLUSIONS Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment.

Implicit awareness of deficit in anosognosia? An emotion-based account of denial of deficit

Most currently accepted models of anosognosia focus on disorders of body representation, or a disturbance of emotion systems, but struggle to explain the diverse range of findings of the phenomenon. Though currently unfashionable, there is a diverse body of recent evidence which suggests that anosognosics have “implicit” awareness of their deficit – and that their denial is motivated by the aversive emotional consequences that would accompany full awareness. This argument that has recently been supported by the work of Ramachandran and others, including the suggestion by Solms and Kaplan-Solms that such knowledge of the deficit can occasionally reach consciousness, causing great (albeit temporary) distress to the patient. The present study investigated the original Solms and Kaplan-Solms session notes, for both anosognosic and non-anosognosic patients, using a method of blind rating of the case material. The pattern of explicit emotional experience was the same for both left and right hemisphere patients, but anosognosic patients were more likely to express emotion that related to subjects other than their disability or its implications. They were also more likely to experience emotional breakdowns at moments that were preceded by talk of loss –even if the cause of such loss was apparently unrelated to their hemiparesis. These findings of implicit awareness are entirely compatible accounts of anosognosia that stress the patient’s implicit awareness of their disorder, and the importance of issues of emotion and motivation in the generation and maintenance of their false belief.

The Teacher-Pupil Observation Tool (T-POT): Development and Testing of a New Classroom Observation Measure

Teacher-pupil relationships do not solely impact children’s academic development; they also influence emotional and behavioural development. Positive teacher-pupil relationships help reduce maladaptive behaviour while negative ones can lead to increased academic, social and behavioural difficulties. Identifying and measuring teacher-pupil relationship through classroom behaviours and interactions is therefore important as an index of classroom-based influences on child outcome. This article illustrates the development and testing of a classroom observation measure - the Teacher-Pupil Observation Tool (T-POT) - in a small-scale study of 12 teachers and 107 children in 12 reception classrooms. To assess validity and reliability, observed behaviours on the T-POT were correlated with each other (internal validity), and with teacher rated reports of classroom behaviour (discriminant and concurrent validity). Observer agreement was also assessed (inter-rater reliability). The T-POT showed promising psychometric properties in all cases. The T-POT is currently the main outcome measure in four funded evaluation studies in Gwynedd, North Wales, and an outcome measure in a funded evaluation study in Clondalkin, Ireland. These studies will further benefit the measure’s validity and reliability and test the sensitivity of the T-POT in detecting change in teacher-pupil behaviour over time.

Incredible Years Parent Training Support for Nursery Staff Working within a Disadvantaged Flying Start Area in Wales: A Feasibility Study

Parenting programmes are effective interventions for preventing and treating conduct problems in young children. Up to 20% of children in disadvantaged areas have conduct disorder. Recent government initiatives such as targeting early years services to designated disadvantaged Flying Start areas in Wales have resulted in increased nursery-care provision for pre-schoolers, yet little has been done to equip nursery staff with effective child behaviour management strategies. The purpose of this non-randomised trial platform study was to establish the feasibility of delivery and the effectiveness of the new Incredible Years Toddler Parent Programme in supporting nursery staff in managing difficult behaviour in the nursery. The Parent Programme is a 12-session (a two-hour session/week) course for carers/parents of children aged one to three years old, which encourages carers to: establish positive relationships with children through play and child-centred activities; use praise, rewards and incentives to encourage appropriate behaviours; and use effective limit setting and clear instructions. Thirteen nursery workers were recruited from two Flying Start nurseries in Wales. Measures were completed on 28 nursery children by their parents and nursery workers, baseline and four months post-baseline, with the intervention delivered in the interim. Paired t-test analyses demonstrated statistically significant improvements (p<0.05) for child behaviour in the nursery and nursery staffs self-reported stress and sense of competence. No improvement in child behaviour was reported in the home. In conclusion, nursery worker training could incorporate the Incredible Years parent programme to support the staff in managing child behaviour in the nursery. The intervention should be delivered to both home and out-of-home carers to encourage consistency in child management strategies.