Psychological Interventions Involving Parents

Question 1

Oppositional Defiant Disorder (ODD)

Answer 1

A pattern of angry/irritable mood and argumentative/defiant behaviour

Question 2

Conduct Disorder (CD)

Answer 2

• An ongoing pattern of behaviour where the rights of others or social norms are infringed

Question 3

Behavioural Parenting Interventions

Answer 3

• Prior to 1960s, psychotherapy & psychodynamic approach most common way to tackle disruptive behaviour in children
• Case of ‘Rusty’ parents sought help for their son showing disruptive behaviour
  -Empower and up skill parent to manage their child’s behaviour.
  Parents become agents of change for children

Question 4

Parenting Programmes for Disruptive Child Behaviour

Answer 4

First line treatment approach for children showing oppositional and externalising behaviours
Emerge when young
May not have the cognitive skill to recognise and understand their own cognitions/ emotions
Parents become co therapists and agents of change

Question 5

Triple P Parenting Programme

Answer 5

• Aims to treat (but also prevent) behavioural problems in young children
• Enhance protective factors and reduce risk factors
• Positive reinforcement of adaptive behaviour
• Teaches parents an alternative to coercive parent behaviours
• Home or clinic observations allows parents to get feedback on their parenting

Question 6

Enhanced Triple P

Answer 6

Families who have additional risk factors and adversity

Question 7

Does Triple P work? AIM

Answer 7

• using randomised controlled trials
• ‘Gold-standard’ way to assess whether an intervention is effective
  Aim—-> Compare the effectiveness of enhanced Triple P, Standard Triple P and a no treatment control group referred to as waitlist control

Question 8

Does Triple P work? METHOD

Answer 8

Method—> 87 families of children aged 3 years and elevated levels of disruptive behaviour and symptoms of inattention/hyperactivity randomised to different arms.

Question 9

Does Triple P work? RESULTS

Answer 9

Results—-> Both standard and enhanced intervention led to reductions in parent-reported behaviour problems compared to the control group. Enhanced Triple P also led to reductions in observed negative child behaviour

Question 10

Does Triple P work? CONCLUSION & META ANALYSIS

Answer 10

Both standard and enhanced Triple P effective interventions for disruptive child behaviour
Combined data from 101 studies (62 RCTs)
Studies show all levels of triple P are effective for child behaviour problems
Effective for parenting practices, parenting satisfaction, and parenting efficacy
As children get older…
May not be so parent-focussed as children get older.

Question 11

Does Triple P work? (Henggeler & Schaeffer, 2010)

Answer 11

Child variables are important, but so are wider societal factors such as peers and wider community influences.
Multisystemic Therapy

Question 12

Attention Deficit Hyperactivity Disorder (ADHD)

Answer 12

Persistent pattern of inattention and/or hyperactivity/impulsivity at rates higher than expected for child’s developmental level.
- Occurs before 12

Question 13

New Forest Parenting Programme

Answer 13

A specialised intervention for parents of young children with ADHD

Builds on approaches used in traditional behavioural parenting interventions

Target parent child processes involved in development of attention

ADHD children have difficulty maintaining their attention on day to day tasks

This helps with short term memory

Question 14

Process of constructive parenting

Answer 14

• Scoping
• Extending
• Scaffolding
• Consolidation

Question 15

Evidence of constructive parenting?

Answer 15

Tested in a number of randomised controlled trials (RCTs)
Parents randomised to receive NFPP (n=20), no treatment (n=30) or to a parent support and counselling group
Assessments completed pre-intervention, post-intervention

Question 16

Measures of Parent trials?

Answer 16

‒ ADHD symptoms (clinical interview and observation)
‒ Parent mental health (parent self-reported)
‒ Parenting efficacy and satisfaction with parenting
PT was associated with improvements in ADHD symptoms (observed and clinical interview

Question 17

Is NFPP better than generic parenting programmes?

Answer 17

Abikoff et al (2014)- head-to-head trial of NFPP compared to ‘Helping the Noncompliant Child’
* Assessed:
‒ Parent and teacher reported ADHD symptoms
‒ Parent behaviour and parent-stress

NFPP- behavioural strategies plus games to target self regulatory deficits

Helping the noncompliant child- behavioural strategies only

Both results were reductions in parent reported ADHD symptoms but no reductions in teacher reported

Question 18

How is the comparison of NFPP and HTNC measured ?

Answer 18

Objective measures of impulsivity and sustained attention

Question 19

If NFPP is based on theory, why isn’t it better than other behavioural interventions?

Answer 19

• The cognitive component in NFPP may not be ‘intensive enough’
• May need to combine lots of different aspects of EF
• ADHD is a chronic disorder
• More research needed in this area

Question 20

Anxiety Interventions for Children

Answer 20

The main treatment for anxiety in youth is Cognitive Behavioural Therapy (CBT)

Question 21

Evidence of long-term effects of CBT

Answer 21

Parents may still be important. Parental Involvement in anxiety interventions for children is much more variable.

Question 22

Components of CBT with children

Answer 22

Monitoring in situations to help children identify/ label feelings

Cognitive Restructuring
“If I read in front of everyone in class, they will laugh at me”
Rid maladaptive thoughts and teach new more adaptive thought processes

Exposure
Reduce anxiety maintaining avoidance

Skills Development
Help to develop skills which may underlie anxiety

Question 23

How might parents be involved in CBT?

Answer 23

• Parental Modelling of Anxiety
• Parental Cognitions
• Overprotection

Question 24

Individual CBT

Answer 24

Coping Cat Programme
Conducted with child alone
F-E-A-R
64% of children ‘lost’ primary anxiety diagnosis
12 weekly 60 minute sessions
* Exposure based hierarchy
* Identifying and challenging negative cognitions
* Adapting cognitions

Question 25

Family based CBT

Answer 25

Coping Cat Programme
Conducted with child and parent
F-E-A-R
Target parental beliefs
Parental encouragement to develop mastery skills
64% of children ‘lost’ primary anxiety diagnosis

Question 26

Family-based education and support (Silk et al., 2013)

Answer 26

Conducted with child and parent
Psychoeducation about anxiety
42% of children ‘lost’ primary anxiety diagnosis
(Silk et al., 2013)
Parents of anxious children less likely to encourage children to do optional speech

Parents who take part in CBT more likely to engage in encouragement after their involvement in intervention
Interventions for parents only

Question 27

Supporting Parenting for Anxious Child Emotions (SPACE)

Answer 27

12 weekly 60 minute sessions
* Supportive responses to child anxiety
* Reduce accommodation and avoidance
* How to communicate to child

Question 28

How to deal with child responses

Answer 28

Which components of intervention are necessary
meta-analysis of existing CBT intervention trials for childhood anxiety found exposure is an important component of intervention