Observational attachment theory-based parenting measures predict children's attachment narratives independently from social learning theory-based measures.

Conceptually and methodologically distinct models exist for assessing quality of parent-child relationships, but few studies contrast competing models or assess their overlap in predicting developmental outcomes. Using observational methodology, the current study examined the distinctiveness of attachment theory-based and social learning theory-based measures of parenting in predicting two key measures of child adjustment: security of attachment narratives and social acceptance in peer nominations. A total of 113 5-6-year-old children from ethnically diverse families participated. Parent-child relationships were rated using standard paradigms. Measures derived from attachment theory included sensitive responding and mutuality; measures derived from social learning theory included positive attending, directives, and criticism. Child outcomes were independently-rated attachment narrative representations and peer nominations. Results indicated that Attachment theory-based and Social Learning theory-based measures were modestly correlated; nonetheless, parent-child mutuality predicted secure child attachment narratives independently of social learning theory-based measures; in contrast, criticism predicted peer-nominated fighting independently of attachment theory-based measures. In young children, there is some evidence that attachment theory-based measures may be particularly predictive of attachment narratives; however, no single model of measuring parent-child relationships is likely to best predict multiple developmental outcomes. Assessment in research and applied settings may benefit from integration of different theoretical and methodological paradigms.

Social learning theory parenting intervention promotes attachment-based caregiving in young children: randomized clinical trial.

Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social learning theory-based treatment promoted change in qualities of parent-child relationship derived from attachment theory. A randomized clinical trial of 174 four- to six-year-olds selected from a high-need urban area and stratified by conduct problems were assigned to a parenting program plus a reading intervention (n = 88) or nonintervention condition (n = 86). In-home observations of parent-child interactions were assessed in three tasks: (a) free play, (b) challenge task, and (c) tidy up. Parenting behavior was coded according to behavior theory using standard count measures of positive and negative parenting, and for attachment theory using measures of sensitive responding and mutuality; children's attachment narratives were also assessed. Compared to the parents in the nonintervention group, parents allocated to the intervention showed increases in the positive behavioral counts and sensitive responding; change in behavioral count measures overlapped modestly with change in attachment-based changes. There was no reliable change in children's attachment narratives associated with the intervention. The findings demonstrate that standard social learning theory-based parenting interventions can change broader aspects of parent-child relationship quality and raise clinical and conceptual questions about the distinctiveness of existing treatment models in parenting research.

Obsessive-compulsive disorder in children and adolescents: parental understanding, accommodation, coping and distress.

Parental accommodation of pediatric OCD is common and is associated with negative affect in parents. Qualitative accounts of caring for a child with OCD are limited and no studies have assessed differences between mothers and fathers in accommodation, coping and distress. The current study used a mixed methods approach to understand parental accommodation, negative affect and coping. Forty-one mothers and 29 fathers of 43 children with OCD were asked to write narratives about their understanding and management of OCD and to complete measures of accommodation, coping, and distress. Symptom accommodation was high with almost half of the parents watching the child complete rituals or waiting for the child on a daily basis. Analysis of parental narratives indicated a distressing struggle between engaging in and resisting accommodation in order to manage their own and their child's anger and distress. T-tests and correlation analysis indicated that accommodation did not differ significantly between mothers and fathers but was more strongly associated with negative affect in mothers. Analyses indicated that mothers reported using all types of coping strategy more often than fathers, particularly escape-avoidance, taking responsibility and using social support. Escape-avoidance coping was positively correlated with accommodation and negative affect in both mothers and fathers. Interventions that target parental constructions of OCD and their behavioural and emotional responses to it may assist in reducing the occurrence of accommodation, avoidant coping and parental distress.

Impact of a parenting program in a high-risk, multi-ethnic community: the PALS trial.

BACKGROUND: Parenting programs have been shown to work when delivered to motivated ethnic majority parents in demonstration projects, but comparatively little is known about their impact when delivered to high-risk, multi-ethnic populations by routine local services. METHODS: The Primary Age Learning Skills (PALS) trial was a randomized controlled trial of an evidence-based parenting-group program that targeted the parent-child relationship and child literacy. Parents of 174 children were selected from a population of 672 5- and 6-year-olds attending four primary schools in a high-risk, ethnically diverse, inner-city area. Eighty-eight children were allocated to the Incredible Years preventive program plus a shortened six-week version of the SPOKES literacy program, delivered by local services; 86 to usual community services; 152/174 (87%) of families were successfully followed up. Parent-child relationship quality and child behavior were measured using direct observation and parent interview; child reading was assessed psychometrically. RESULTS: Two-thirds (58/89) of those offered the parenting program attended at least one session, with similar enrollment rates across the Black African, African-Caribbean, White-British and Other ethnic groups. Mean attendance was four relationship-building sessions and one literacy-development session. Satisfaction questionnaires were completed by 43/58 starters; 93% said they were well or extremely satisfied, with equally high rates across ethnic groups. At follow-up after one year, those allocated to the intervention showed significant improvements in the parent-child relationship on observation and at interview compared to controls; effects were similar across all ethnic groups. However, child behavior problems and reading did not improve. The cost was £1,343 ($2,100) per child. CONCLUSIONS: Programs can be organized to be engaging and effective in improving parenting among high-risk, multi-ethnic communities, which is of considerable value. To also be cost-effective in achieving child changes may require a set-up that enables parents to attend more sessions and/or an exclusive focus on children with clinically significant behavior problems.

A pilot study of telephone cognitive-behavioural therapy for obsessive-compulsive disorder in young people.

BACKGROUND: Cognitive-behaviour therapy (CBT) is the recommended psychological treatment for obsessive compulsive disorder (OCD) in young people. Access to CBT may be limited by a number of factors, including lack of trained therapists, and geographic or financial factors preventing access to a specialized service. Telephone delivery of CBT represents one way of overcoming some of these accessibility issues. This pilot study describes outcomes for a telephone-based cognitive-behavioural treatment for obsessive-compulsive disorder (OCD) in young people. METHOD: Ten participants, aged 13 to 17 years, and their parents received up to 16 sessions of telephone CBT (TCBT). Measures of OCD symptoms were obtained using multiple informants and a repeated measures design. Assessments were conducted at pre-treatment, post-treatment, and at 6- and 12-month follow-up. RESULTS: Improvements were found for OCD symptoms across all informants. Family satisfaction with treatment over the telephone was high. CONCLUSIONS: The findings suggest that TCBT is a clinically effective, feasible and acceptable means of service delivery that offers the potential to make CBT a more accessible treatment for young people. TCBT requires further evaluation in randomized, controlled trials to compare effectiveness with face-to-face CBT, which currently represents the usual care model.

Attachment narratives and behavioral and emotional symptoms in an ethnically diverse, at-risk sample.

OBJECTIVE: To examine the clinical correlates and predictions from attachment narratives in a sample of early school-age children from a high psychosocial risk, ethnically diverse sample. METHOD: A total of 113 children were assessed using the Manchester Child Attachment Story Task, a semistructured assessment of children's attachment representations. Parents and teachers provided data using the Strengths and Difficulties Questionnaire. Peer nominations of popularity and antisocial behavior were also obtained. RESULTS: Significant associations that were modest to moderate in magnitude were obtained between attachment narrative scales indexing security, coherence, and disorganization with multiple indices of children's behavioral and emotional adjustment, prosocial behavior and competence; these associations held across ethnic groups and were independent of psychosocial risk. CONCLUSIONS: The findings build on and extend support for the use of attachment narrative assessments in the clinical context and demonstrate their applicability and validity across a broad range of ethnicity and social contexts.