M. Jamila Reid

Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training

Families of 159, 4- to 8-year-old children with oppositional defiant disorder (ODD) were randomly assigned to parent training (PT); parent plus teacher training (PT + TT); child training (CT); child plus teacher training (CT + TT); parent, child, plus teacher training (PT + CT + TT); or a waiting list control. Reports and independent observations were collected at home and school. Following the 6-month intervention, all treatments resulted in significantly fewer conduct problems with mothers, teachers, and peers compared to controls. Childrens negative behavior with fathers was lower in the 3 PT conditions than in control. Children showed more prosocial skills with peers in the CT conditions than in control. All PT conditions resulted in less negative and more positive parenting for mothers and less negative parenting for fathers than in control. Mothers and teachers were also less negative than controls when children received CT. Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems.

Mediators, Moderators, and Predictors of 1-Year Outcomes Among Children Treated for Early-Onset Conduct Problems: A Latent Growth Curve Analysis.

Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. In this study, the authors combine data from 6 randomized clinical trials and 514 children, ages 3.0-8.5 years, to evaluate moderators, mediators, and predictors of outcome. Among other findings, latent growth curve models of mother-report and observational measures of child externalizing behaviors suggested that marital adjustment, maternal depression, paternal substance abuse, and child comorbid anxiety/depression each moderated treatment response. Moreover, critical, harsh, and ineffective parenting both predicted and mediated outcome, with the most favorable responses observed when parents scored relatively low on each construct at intake yet improved during treatment. Implications for treatment nonresponders are discussed.

The Role of Mental Health Factors and Program Engagement in the Effectiveness of a Preventive Parenting Program for Head Start Mothers

Head Start centers were randomly assigned to intervention (parent training) or control conditions, and the role of maternal mental health risk factors on participation in and benefit from parent training was examined. Parenting was measured by parent report and independent observation in 3 domains: harsh/negative, supportive/positive, inconsistent/ineffective parenting. Structural equation modeling showed that parent engagement training was associated with improved parenting in a dose-response fashion. Mothers with mental health risk factors (i.e., depression, anger, history of abuse as a child, and substance abuse) exhibited poorer parenting than mothers without these risk factors. However, mothers with risk factors were engaged in and benefited from the parenting training program at levels that were comparable to mothers without these risk factors.

Parent Training in Head Start: A Comparison of Program Response Among African American, Asian American, Caucasian, and Hispanic Mothers.

The effectiveness of the Incredible Years Parenting Program was evaluated in a low-income sample of Caucasian, African American, Hispanic, and Asian mothers whose children were enrolled in Head Start. Data from two prior intervention studies [Webster-Stratton (1998) Journal of Consulting and Clinical Psychology, 66(5), 715–730; Webster-Stratton et al. (in press) Journal of Clinical Child Psychology] were combined, yielding a sample of 634 families (370 Caucasian, 120 African American, 73 Asian, 71 Hispanic) across 23 Head Start centers. Centers were matched and assigned randomly to either an experimental condition (8–12 weeks of weekly 2-hr parenting classes), or a control condition (the regular Head Start Program without parenting groups). Families in both conditions were assessed using home observations of parent–child interactions and parent reports of parenting style and discipline strategies and child behavior problems in the fall (baseline) and spring (postintervention) of the childrens Head Start year. Families were reassessed 1 year later. Following treatment, intervention mothers were observed to be more positive, less critical, more consistent, and more competent in their parenting than were control mothers. Additionally, children of intervention parents were observed to exhibit fewer behavior problems than were control children. Differences in treatment response across ethnic groups were few, and did not exceed the number expected by chance. Parents from all groups reported high satisfaction levels following the parenting program. Results indicate that the Incredible Years Program is accepted by and effective with diverse populations.

Treating Conduct Problems and Strengthening Social and Emotional Competence in Young Children The Dina Dinosaur Treatment Program

Young preschool and early-school-age children with early onset conduct problems are at high risk for school dropout, substance abuse, violence, and delinquency in later years. Consequently, developing treatment strategies for reducing conduct problems when aggression is in its more malleable form prior to age 8, and thus interrupting its progression, is of considerable benefit to families and society. This article describes a treatment program—the Dina Dinosaur Social, Emotional and Problem Solving Child Training Program—that was designed specifically with developmentally appropriate teaching methods for young children (ages 4 to 8 years) and based on theory related to the types of social, emotional, and cognitive deficits or excesses exhibited by children with conduct problems.The program emphasizes training children in skills such as emotional literacy, empathy or perspective taking, friendship and communication skills, anger management, interpersonal problem solving, school rules, and how to be successful at school. Emphasis is placed on ways to promote cross-setting generalization of the behaviors that are taught by involving parents and teachers in the treatment. A review of two randomized trials with this treatment approach and long-term results are provided.

Strengthening Social and Emotional Competence in Young Children—The Foundation for Early School Readiness and Success Incredible Years Classroom Social Skills and Problem-Solving Curriculum

The ability of young children to manage their emotions and behaviors and to make meaningful friendships is an important prerequisite for school readiness and academic success. Socially competent children are also more academically successful and poor social skills are a strong predictor of academic failure. This article describes The Incredible Years Dinosaur Social Skills and Problem-Solving Child Training Program, which teaches skills such as emotional literacy, empathy or perspective taking, friendship and communication skills, anger management, interpersonal problem solving, and how to be successful at school. The program was first evaluated as a small group treatment program for young children who were diagnosed with oppositional defiant and conduct disorders. More recently the program has been adapted for use by preschool and elementary teachers as a prevention curriculum designed to increase the social, emotional, and academic competence, and decrease problem behaviors of all children in the classroom. The content, methods, and teaching processes of this classroom curriculum are discussed.

Follow-up of children who received the incredible years intervention for oppositional-defiant disorder: Maintenance and prediction of 2-year outcome

This paper presents 2-year follow-up data for a sample of 159, 4- to 7-year-old children with oppositional-defiant disorder (ODD) who were randomly assigned to: parent training (PT), parent plus teacher training (PT + TT), child training (CT), child plus teacher training (CT + TT), parent plus child plus teacher training (PT + CT + TT). At the 2-year follow-up, approximately 75% of children were functioning in the normal range according to parent and teacher reports. Twenty-five percent of children were classified as treatment nonresponders at home and/or at school. Teacher training added significantly to long-term school outcomes for children who had pervasive behavior problems. Baseline, post, and 1-year follow-up parenting practices distinguished between home treatment responders and nonresponders (parents of nonresponders were more critical and less positive). For children with baseline pervasive home-school problems, baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home at the 2-year follow-up. In addition, 80% of pervasive children whose mothers were highly critical immediately posttreatment were classified as school nonresponders at the 2-year follow-up.

Enhancing a Classroom Social Competence and Problem-Solving Curriculum by Offering Parent Training to Families of Moderate- to High-Risk Elementary School Children

The Incredible Years parent and classroom interventions were evaluated for the first time in elementary schools. Culturally diverse, socioeconomically disadvantaged schools were randomly assigned to intervention or control (CON). In intervention schools, all children received a 2-year classroom intervention beginning in kindergarten. In addition, indicated children were randomly assigned to also receive parent training (PT + CR) or only the classroom intervention (CR). PT + CR mothers reported that, following intervention, children showed fewer externalizing problems and more emotion regulation than CR or CON children. Observations showed that child–mother bonding was stronger in the PT + CR condition than in the CON condition, and PT + CR mothers were significantly more supportive and less critical than CR or CON mothers. Teachers reported that PT + CR mothers were significantly more involved in school and that children in the PT + CR and the CR conditions had significantly fewer externalizing problems than in the CON condition.

Sympathetic- and Parasympathetic-Linked Cardiac Function and Prediction of Externalizing Behavior, Emotion Regulation, and Prosocial Behavior Among Preschoolers Treated for ADHD

OBJECTIVE To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). METHOD Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4-6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. RESULTS Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. CONCLUSIONS We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.

The incredible years parent, teacher, and child intervention: Targeting multiple areas of risk for a young child with pervasive conduct problems using a flexible, manualized treatment program

Young children who present for treatment with oppositional-defiant disorder (ODD) and conduct disorder (CD) frequently exhibit these symptoms across settings and often show comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or internalizing symptoms such as anxiety or depression. Parent training programs to treat these children must be flexible and comprehensive enough to address these issues. This article outlines a case in which the Incredible Years Parent, Teacher, and Child Training programs were used to treat a young boy, John, with ODD. His problems were pervasive and occurred at home, at school, and with peers. In addition to the ODD symptoms, John exhibited symptoms of ADHD as well as significant anxious and depressed behaviors. This case study outlines how a multimodal, manualized treatment can be applied flexibly to attend to individual family needs and address issues of comorbidity.