Evaluating Practitioner Training to Improve Competencies and Organizational Practices for Engaging Fathers in Parenting Interventions.

Fathers are consistently underrepresented in parenting interventions and practitioners are an important target for change in interventions to enhance father engagement. This research examined the effects of two practitioner training programs in improving practitioner rated competencies and organizational father-inclusive practices. Two studies were conducted, each with a single group, repeated measures (pre, post and 2-month follow-up) design. Study 1 (N = 233) examined the outcomes of face-to-face training in improving practitioner ratings of competencies in engaging fathers, perceived effectiveness and use of father engagement strategies, organizational practices and rates of father engagement. Study 2 (N = 356) examined online training using the same outcome measures. Practitioners in both training formats improved in their competencies, organizational practices and rates of father engagement over time, yet those in the online format deteriorated in three competencies from post-training to follow-up. The implications for delivering practitioner training programs to enhance competencies and rates of father engagement are discussed.

Examining Practitioner Competencies, Organizational Support and Barriers to Engaging Fathers in Parenting Interventions.

Evidence-based parenting interventions have been developed and evaluated largely with mothers. This study examined practitioner reports of rates of father attendance, barriers to engagement, organizational support for father-inclusive practice, participation in training in father engagement, and competencies in working with fathers. It also explored predictors of practitioner competence and rates of father attendance. Practitioners (N = 210) who delivered parenting interventions completed an online survey. Participants reported high levels of confidence in engaging fathers, but only one in three had participated in training and levels of father attendance in parenting interventions were low. Logistic regressions showed that high levels of practitioner competence were predicted by participation in training. Moderate levels of father attendance (vs. low levels) were predicted by greater number of years of experience while high levels of attendance (vs. low levels) were predicted by greater experience, higher levels of competence and higher levels of organizational support. The implications of the findings to informing policy and practice for enhancing father engagement are discussed.

Mothers, Fathers, and Parental Systems: A Conceptual Model of Parental Engagement in Programmes for Child Mental Health-Connect, Attend, Participate, Enact (CAPE).

Parenting programmes are one of the best researched and most effective interventions for reducing child mental health problems. The success of such programmes, however, is largely dependent on their reach and parental engagement. Rates of parental enrolment and attendance are highly variable, and in many cases very low; this is especially true of father involvement in parenting programmes. This paper proposes a conceptual model of parental engagement in parenting programmes-the CAPE model (Connect, Attend, Participate, Enact) that builds on recent models by elaborating on the interdependent stages of engagement, and its interparental or systemic context. That is, we argue that a comprehensive model of parental engagement will best entail a process from connection to enactment of learned strategies in the child's environment, and involve consideration of individual parents (both mothers and fathers) as well as the dynamics of the parenting team. The model provides a framework for considering parent engagement as well as associated facilitators and mechanisms of parenting change such as parenting skills, self-efficacy, attributions, and the implementation context. Empirical investigation of the CAPE model could be used to further our understanding of parental engagement, its importance for programme outcomes, and mechanisms of change. This will guide future intervention refinement and developments as well as change in clinical practice.

Temperament and parenting: implications for understanding developmental pathways to conduct disorder.

This article reviews research linking a number of temperamental vulnerabilities that can place a child at risk for developing severe conduct problems. One primary focus of this article is on how certain temperamental vulnerabilities can disrupt normal developmental processes during early childhood, such as the development of emotional regulatory abilities and the development of the affective components of conscience, to place a child at risk for acting in an antisocial and aggressive manner. A second focus of the paper is on how the quality of parenting that a child experiences interacts with the child's temperament to either increase or decrease the child's risk for problem behavior. Identifying those parent factors that can enhance the development of children at risk for conduct problems due to temperamental vulnerabilities could be very important for enhancing interventions for children with severe behavior problems.

Effective interventions for children and adolescents with conduct disorder.

Many different types of interventions have been used to treat children and adolescents with conduct disorder (CD). Unfortunately, most have had very limited effectiveness and, in some cases, have even shown iatrogenic effects. A primary reason for this limited effectiveness has been the failure of most treatments to directly address the causal mechanisms implicated in the development of CD. A few exceptions that have based interventions on the available research and that have proven to have some efficacy in reducing the conduct problems in youths with CD are reviewed. More important, a model for intervention is presented. This model emphasizes that interventions for youths with CD need to be comprehensive. That is, they need to take into account the myriad factors both within the child and within his or her social context that can cause and maintain CD symptoms. Further, interventions need to be individualized; they need to take into account the different pathways along which children may develop CD. Two intervention approaches that are consistent with these principles are reviewed, as are important directions for advancing treatment technology for youths with this disorder.

Symptom properties as a function of ADHD type: an argument for continued study of sluggish cognitive tempo.

Inconsistent alertness and orientation (sluggishness, drowsiness, daydreaming) were reported to accompany Attention Deficit Disorder (ADD) without Hyperactivity in DSM-III. Such Sluggish Cognitive Tempo items were tested in the DSM-IV Field Trial for ADHD, but were discarded from the Inattention symptom list because of poor negative predictive power. Using 692 children referred to a pediatric subspecialty clinic for ADHD, Sluggish Tempo items were re-evaluated. When Hyperactivity-Impulsivity was absent (i.e., using only cases of Inattentive Type plus clinic controls), Sluggish Tempo items showed substantially improved utility as symptoms of Inattention. Factor analyses distinguished a Sluggish Tempo factor from an Inattention factor. When DSM-IV ADHD types were compared, Inattentive Type was uniquely elevated on Sluggish Tempo. These findings suggest that (a) Sluggish Tempo items are adequate symptoms for Inattentive Type, or (b) Sluggish Tempo may distinguish two subtypes of Inattentive Type. Either conclusion is incompatible with ADHD nosology in DSM-IV.

Laboratory and performance-based measures of childhood disorders: introduction to the special section.

Serves as an introduction to a special section of the journal on laboratory and performance-based measures of childhood disorders. The articles in the special section were part of the work of a task force established by Division 12 of the American Psychological Association on "Upgrading the Science and Technology of Assessment and Diagnosis." In this introduction, I raise a number of issues involved in the use of laboratory and performance-based measures for the assessment of childhood psychopathology that cut across the different disorders covered in the special section. Some of these issues are common to most techniques used in the assessment of childhood psychopathology; others are more specific to this particular method of assessment. However, by focusing on these issues related to the use of laboratory and performance-based measures, it will hopefully encourage a critical examination of all techniques currently being used in the assessment of psychopathology and highlight important issues involved in translating measures that were developed primarily for use in research into forms that are useful in clinical practice.

The use of laboratory and performance-based measures in the assessment of children and adolescents with conduct disorders.

Provides a review of laboratory and performance-based assessment techniques that have been used in research with children who have severe conduct problems. Many of these techniques have proven useful for monitoring the effects of interventions, which seems to be their most immediate clinical use. With further development, several of these techniques have the potential for assessing clinically important processes that may be involved in the development and maintenance of conduct problems in youth, especially processes that may differ across subgroups of children with conduct disorders (CDs). The assessment of such processes could contribute to the development of individualized treatment plans for children and adolescents with CDs. However, a number of theoretical, methodological, and ethical issues limit the clinical utility of these laboratory and performance-based techniques in their current stages of development, especially in their contribution to making initial diagnoses of CDs. These limitations lead to very cautious recommendations for their clinical use.

A developmental psychopathology approach to understanding and preventing youth violence.

There are many views in both the lay and professional literatures as to the causes of violent behavior. These views influence the types of interventions that are designed and tested for preventing violence or for treating violent individuals. In this paper, the author provides a developmental psychopathology framework in which violent behavior is viewed as a developmental outcome that can result from many different pathways, each involving a somewhat different interaction of causal processes. This way of viewing violent behavior has already helped to guide some of the more effective prevention and treatment strategies, with the key to their success being a comprehensive and individualized approach to intervention. This approach for understanding violent behavior also points the way to some important goals for a next generation of prevention and treatment programs.

Psychopathic traits and conduct problems in community and clinic-referred samples of children: further development of the psychopathy screening device.

This study examined the structure of psychopathic traits in 2 samples of children. The nonreferred community sample included 1,136 children recruited from elementary schools in 2 school districts in the southeastern United States. The clinic sample included 160 children referred to an outpatient mental health clinic serving the same geographic region. In both samples, parent and teacher ratings of psychopathic traits were subjected to a principal-axis factor analysis, and the congruence of the factor structure across samples was examined using confirmatory factor analysis. In both samples, 1 dimension that consisted of the callous and unemotional traits that have been hallmarks of most clinical descriptions of psychopathy was isolated. Two other dimensions consisting of narcissistic traits and impulsivity emerged in the community sample. Both the narcissism and impulsivity dimensions were highly related to symptoms of oppositional defiant disorder, conduct disorder, and attention deficit hyperactivity disorder. However, the callous and unemotional traits were only weakly associated with these symptoms after controlling for the other dimensions of psychopathy.

The problems of internal validation without a theoretical context: the different conceptual underpinnings of psychopathy and the disruptive behavior disorder criteria.

G. L. Burns (2000) has concluded that the Psychopathy Screening Device's content is limited because it contains items that overlap with criteria for several disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The problem with G. L. Burns's analysis is that it was conducted without an adequate understanding or specification of the conceptual underpinnings of either the construct of psychopathy or the constructs assessed by the DSM criteria. This reply attempts to clarify these conceptual frameworks to illustrate that to judge the adequacy of the content of a measure of psychopathy by comparing it with DSM criteria is inconsistent with the differing theoretical frameworks underlying these classification systems. Forcing measures of psychopathy to be designed around DSM criteria leads to inadequate measures of psychopathy and can limit advances both in our understanding of developmental precursors to psychopathy and in the classification of DSM disorders.

Findings on disruptive behavior disorders from the first decade of the Developmental Trends Study.

The paper summarizes the first decade of the Developmental Trends Study, a prospective longitudinal study of 177 boys. Initially, they were referred to mental health clinics in Pennsylvania (Pittsburgh), and Georgia (Athens and Atlanta). Since 1987, the boys, their parents, and their teachers have been followed up almost annually. The study is unique because the cooperation rate of participants has remained very high over the years, psychiatric diagnoses were derived from structured interviews (especially disruptive behavior disorders), and many risk factors were measured over the years. The present paper summarizes key findings on the development of disruptive behavior, especially Oppositional Defiant Disorder, Conduct Disorder, and Attention Deficit-Hyperactivity Disorder. The paper also highlights results on risk factors and comorbid conditions of disruptive behaviors.

The association between anxiety and psychopathy dimensions in children.

Although several theoretical models posit that low levels of anxiety are a risk factor for psychopathy and antisocial behavior, a number of studies have reported elevated levels of anxiety among antisocial individuals. Nevertheless, most investigators in this literature have not distinguished between fearfulness and trait anxiety or attempted to separate the antisocial lifestyle dimension from the callous and unemotional dimension of psychopathy. In a study of clinically referred children (N = 143), we found that (a) measures of trait anxiety and fearlessness (low fearfulness) exhibited low correlations; (b) conduct problems tended to be positively correlated with trait anxiety, whereas callous and unemotional traits tended to be negatively correlated with trait anxiety; and (c) controlling statistically for the effects of one dimension increased the divergent correlations of the other dimension with both trait anxiety and fearful inhibition. These findings bear potentially important implications for the diagnosis and etiology of psychopathy and antisocial behavior and suggest that distinctions between trait anxiety and fearful inhibition, as well as between the two dimensions of psychopathy, may help to clarify longstanding confusion in this literature.

Developmental pathways to antisocial behavior: the delayed-onset pathway in girls.

Recent research has suggested that there are two distinct trajectories for the development of antisocial behavior in boys: a childhood-onset pathway and an adolescent-onset pathway. After reviewing the limited available research on antisocial girls, we propose that this influential method of conceptualizing the development of severe antisocial behavior may not apply to girls without some important modifications. Antisocial girls appear to show many of the correlates that have been associated with the childhood-onset pathway in boys, and they tend to show impaired adult adjustment, which is also similar to boys in the childhood-onset pathway. However, antisocial girls typically show an adolescent-onset to their antisocial behavior. We have proposed that these girls show a third developmental pathway which we have labeled the "delayed-onset" pathway. This model rests on the assumption that many of the putative pathogenic mechanisms that contribute to the development of antisocial behavior in girls, such as cognitive and neuropsychological deficits, a dysfunctional family environment, and/or the presence of a callous and unemotional interpersonal style, may be present in childhood, but they do not lead to severe and overt antisocial behavior until adolescence. Therefore, we propose that the delayed-onset pathway for girls is analogous to the childhood-onset pathway in boys and that there is no analogous pathway in girls to the adolescent-onset pathway in boys. Although this model clearly needs to be tested in future research, it highlights the need to test the applicability of current theoretical models for explaining the development of antisocial behavior in girls.

Callous-unemotional traits and subtypes of conduct disorder.

There has been growing consensus that children with conduct disorder (CD) constitute a very heterogeneous group containing children who vary substantially on the development, course, and causes of the disorder. While many have recognized the importance of this heterogeneity for developing better causal theories and for developing more effective treatments, there has been little consensus as to the best way to subtype children with CD. In this paper, we review a number of approaches to subtyping, each with some evidence for its validity for certain purposes. We focus on two recent approaches that have great potential for integrating past subtyping approaches and for advancing causal theory. The first approach is the division of children with CD into those with a childhood onset to their severe antisocial behavior and those with an adolescent onset to their behavior. The second approach is to designate children within the childhood-onset group who show callous and unemotional traits, which is analogous to adult conceptualizations of psychopathy. Both approaches help designate children who many show different causal processes underlying their severe aggressive and antisocial behavior, and who may warrant different approaches to treatment.

Negative life events and the adjustment of school-age children: testing protective models.

Investigated the association between negative life events and protective factors in predicting the adaptive, emotional, and behavioral functioning of school-age children. Three possible models of this relation were tested using hierarchical analyses: the compensatory model, the challenge model, and the immunity/vulnerability model. Participants were 140 children between the ages of 8 to 13.6 years. Inconsistent with all 3 models, negative life events were not associated with adaptive or internalizing behavior. However, consistent with the compensatory model, both negative life events and protective factors contributed independently to the prediction of externalizing behavior. Also, a significant interaction was found in predicting internalizing behavior for the female-only sample showing girls with significant negative life events and social support demonstrating less internalizing behavior.

Validity of DSM-IV subtypes of conduct disorder based on age of onset.

OBJECTIVE: To present data from the DSM-IV field trials that led to the distinction between subtypes of conduct disorder (CD) that emerge in childhood or adolescence. In addition, data from a household sample were used to attempt to cross-validate these findings. METHOD: Differences between youths who met criteria for the two subtypes of CD were examined in the field trials sample of 440 youths aged 4 through 17 years and in a household sample of 1,285 youths aged 9 through 17 years. RESULTS: In both samples, there was a steep decline in aggression occurring around an age of onset of 10 years, but the number of nonaggressive behaviors was unrelated to the age of onset of CD. In the field trials sample, youths who met criteria for the adolescent-onset type were more likely to be girls, less likely to meet criteria for oppositional defiant disorder, and less likely to have a family history of antisocial behavior than the childhood-onset type, but these latter findings were not confirmed in the household sample. CONCLUSIONS: The DSM-IV approach to subtyping CD distinguishes subgroups that differ markedly in level of physical aggression. The advantages of a developmental approach to subtyping are discussed.

Validity of the age-of-onset criterion for ADHD: a report from the DSM-IV field trials.

OBJECTIVE: To examine the validity of the DSM-IV requirement of an age of onset of impairment due to symptoms before 7 years of age for the diagnosis of attention-deficit/hyperactivity disorder (ADHD). METHOD: The validity of this criterion was examined in a clinic sample of 380 youths aged 4 through 17 years by comparing youths who met symptom criteria for ADHD and either did or did not display impairment before age 7 years. RESULTS: Nearly all youths who met symptom criteria for the predominantly hyperactive-impulsive subtype also met the age of onset of impairment criterion, but 18% of youths who met symptom criteria for the combined type, and 43% of youths who met symptom criteria for the predominantly inattentive type, did not manifest impairment before 7 years. For the latter two subtypes, requiring impairment before age 7 years reduced the accuracy of identification of currently impaired cases of ADHD and reduced agreement with clinicians' judgments. CONCLUSIONS: These findings raise questions about the validity of the DSM-IV definition of age of onset of ADHD. Marked differences in the ages of onset of both symptoms and impairment for the three subtypes of ADHD support the validity of distinguishing among these subtypes in DSM-IV.

Ineffective parenting and childhood conduct problems: the moderating role of callous-unemotional traits.

A sample of 6- to 13-year-old clinic-referred (n = 136) and volunteer (n = 30) participants was investigated for a potential interaction between the quality of parenting that a child receives and callous-unemotional traits in the child for predicting conduct problems. Ineffective parenting was associated with conduct problems only in children without significant levels of callous (e.g. lack of empathy, manipulativeness) and unemotional (e.g., lack of guilt, emotional constrictedness) traits. In contrast, children high on these traits exhibited a significant number of conduct problems, regardless of the quality of parenting they experienced. Results are interpreted in the context of a model that proposes that callous-unemotional traits designate a group of children with conduct problems who have distinct causal factors involved in the development of their problematic behavior.