CHAPTER EIGHT
Parent Training Interventions to Reduce Challenging Behavior in Children with Intellectual and Developmental Disabilities Laura Lee McIntyre Department of Special Education and Clinical Sciences, University of Oregon, Eugene, OR, USA E-mail:
[email protected]
Contents 1. Introduction 2. Review of Parent Training Interventions for Children with IDD 2.1. Participants 2.2. Dependent Measures 2.3. Study Design 2.3.1. Generalization, Maintenance, Consumer Satisfaction, and Treatment Integrity
2.4. Parent Training Interventions 2.4.1. 2.4.2. 2.4.3. 2.4.4. 2.4.5. 2.4.6. 2.4.7. 2.4.8. 2.4.9. 2.4.10. 2.4.11.
Incredible Years Stepping Stones Triple P Signposts for Building Better Behavior RUPP Parent Training Sing & Grow Music Therapy Mindfulness Training Parent–Child Interaction Therapy Autism Spectrum Conditions—Enhancing Nurture and Development Parent Training with Smaller Groups and Shorter Schedules Video Modeling Parent Training Parent Management Training for Asperger Syndrome
2.5. Treatment Outcomes 2.5.1. 2.5.2. 2.5.3. 2.5.4.
Challenging Behavior Parenting Behavior Parental Competence, Self-Efficacy, and Confidence Parenting Stress and Depression
2.6. Strengths of Extant Literature 2.6.1. 2.6.2. 2.6.3. 2.6.4.
International Literature Base Tailoring Interventions for ASD Evidence-Based Behavior Management Strategies Multimethod Assessment
International Review of Research in Developmental Disabilities, Volume 44 © 2013 Elsevier Inc. ISSN 2211-6095, http://dx.doi.org/10.1016/B978-0-12-401662-0.00008-7 All rights reserved.
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2.7. Limitations and Future Directions 2.7.1. 2.7.2. 2.7.3. 2.7.4. 2.7.5. 2.7.6.
Study Design Attrition Sample Size Power, Moderators and Mediators Generalization and Maintenance Treatment Integrity
3. Conclusions References
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Abstract It is well established that parents and other caregivers play an important role in shaping child development. Given the important link between parenting and child adjustment, a variety of parent management training interventions have been adopted from the disruptive behavior disorder treatment literature and applied to the prevention and treatment of challenging behavior in children with intellectual and developmental disabilities (IDD). This chapter reviews empirical studies published from 2003 to 2012 that examine the effects of parent training interventions on challenging behavior of children with IDD. Nineteen studies representing 11 parent training programs are reviewed. Parent training interventions include the Incredible Years, Stepping Stones Triple P, Signposts for Building Better Behavior, Research Units in Pediatric Psychopharmacology Parent Training, Sing and Grow Music Therapy, Mindfulness Training, Parent–Child Interaction Therapy, the Autism Spectrum Conditions—Enhancing Nurture and Development program, Parent Training for Smaller Groups and Shorter Schedules, video modeling and feedback parent training, and parent management training. Taken together, results from these studies suggest a growing evidence base for the use of parent training interventions for reducing challenging behavior in children with IDD. Results suggest a smaller body of evidence for effects of parent training interventions on altering parenting behavior and enhancing parent mental health. Questions remain about the durability and generalization of findings, moderators and mediators of change, and strategies for enhancing therapeutic alliance and engagement with an aim to reduce attrition.
1. INTRODUCTION It is estimated that 3% of the population has an intellectual or developmental disability (IDD; Batshaw, Shapiro, & Farber, 2007). Children with IDD, including autism spectrum disorders (ASDs), have cognitive, social, and language deficits which place them at particular risk for challenging behavior in early childhood and throughout development (Emerson, 2003). Research suggests that nonclinical samples of children with IDD as young as 3-years-old already exhibit increased behavior problems that negatively
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affect their families (Baker, Blacher, Crnic, & Edelbrock, 2002; Baker et al., 2003). In the absence of targeted interventions, these behavior problems appear to persist over the preschool period and into childhood and adolescence (Baker et al., 2003; Einfeld et al., 2006; Eisenhower, Baker, & Blacher, 2007; McIntyre, Blacher, & Baker, 2006). Early intervention and treatment are clearly needed to reduce challenging behavior in children with IDD. At a very early age, families are children’s main socializing agents and they can influence children’s behavior through their actions, attitudes, and behavior (Patterson, 1982). Although care must be taken not to blame families for child problems, positive parenting practices may promote child adjustment while negative or coercive practices may be associated with child problem behavior (Dishion & Stormshak, 2007). Indeed, family processes influence the emergence of behavior disorders in young children with and without disabilities (Baumrind, 1989; Bronson, 2000; Floyd, Harter, Costigan, & MacLean, 2004; Kumpfer & Alvarado, 2003; Martin, 1981; Russell & Russell, 1996). In parsing family risk factors, Patterson et al. (Patterson, 1982; Patterson, DeBaryshe, & Ramsey, 1989) suggest that negative, coercive parenting practices place children at risk for behavior problems. Existing behavior problems may be exacerbated by parental stress over time (e.g. Baker et al., 2003). Furthermore, some evidence suggests that the presence of parental stress influences the emergence and persistence of behavior problems in school-age children with disabilities (Hastings, Daley, Burns, & Beck, 2006). Thus, interventions that address child behavior and parenting stress may be especially important. Central to the emergence of early-childhood behavior problems are weak or disorganized family management practices, which can result in coercive parent–child interactions. As such, the child’s aversive behaviors increase in intensity and frequency and the parent acquiesces, unwittingly reinforcing problem behaviors (Gardner, 1989; Patterson, 1982; Patterson, Reid, & Dishion, 1992; Shaw & Bell, 1993) and dedicating less time and engagement to socialization processes. As the child’s behavior becomes increasingly problematic, the parent may further escalate power assertion techniques, or alternately, begin avoiding conflict with an increasingly coercive young child. It is clear that coercive and rejecting parent–child relationships measured at age 2 are associated with child conflict with peers and teachers at age 6 (Ingoldsby, Shaw, & Garcia, 2001), trajectories of persistent conduct problems from ages 2 to 10 (Shaw, Gilliom, Ingoldsby, & Nagin, 2003; Shaw, Lacourse, & Nagin, 2005; Stormshak, Bierman, McMahon, Lengua, & Conduct Problems Prevention Research Group, 2000), and serious problem
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behavior between ages 11 and 15. Children with IDD and their families may be particularly at risk for these outcomes because of higher levels of parenting stress, parental depression, and contextual risks associated with developmental disabilities (DD) (Baker et al., 2002; Emerson et al., 2010). A recent study has shown that relative to a comparison group of parents of typically developing preschool-age children, parents of children with IDD were more detached, more negative, and less positive (Crnic, Pedersen y Arbona, Baker, & Blacher, 2009). Clearly, supporting parenting skills can reduce the risk of later problem behavior for children with IDD and may support family well-being and parent mental health (Baker, Fenning, Crnic, Baker, & Blacher, 2007; Floyd et al., 2004; McIntyre, 2008a,b). Given the role that parents play in shaping children’s development, a variety of parent management training procedures have been adopted from the disruptive behavior disorder treatment literature and applied to the prevention and treatment of challenging behavior in children with IDD (Brookman-Frazee, Stahmer, Baker-Ericzen, & Tsai, 2006). The rest of this chapter will review the empirical evidence for parent training approaches with families with children with IDD and discuss limitations of these findings. I will conclude with outlining future directions.
2. REVIEW OF PARENT TRAINING INTERVENTIONS FOR CHILDREN WITH IDD A comprehensive literature search was conducted using PsycINFO to identify empirical studies published between 2003 and 2012 investigating the effects of parent training interventions on challenging behavior in children or adults with IDD. The following inclusionary criteria were used to identify articles for this review: (1) peer-reviewed journal article, (2) published in English between 2003 and 2012, (3) quantitative study with methods and results related to parent training, (4) focus on children or adults with IDD or at risk for IDD, and (5) inclusion of child/adult challenging behavior as a dependent variable. Articles that included parent training as a component of a multifaceted treatment were excluded if the effects of parent training could not be isolated. IDD was inclusive of children diagnosed with an ASD. The initial search yielded 160 studies that were reviewed in depth to determine eligibility for this review. Nineteen studies representing 11 different parent training interventions met the above criteria (Table 8.1). Although it is beyond the scope of this chapter to include standardized estimates of treatment effects, study features
Caregivers and their 4–13-year-old children with PDD and elevated behavior problems
Caregivers and their 18–60-month-old children born premature (
