Parent stress and social support in a randomized controlled trial of individual versus group parent training for children with HKD/ADHD.

OBJECTIVES: Assess (a) the relative benefit of individual versus group parent training compared to treatment as usual (TAU) with an emphasis on parent outcomes. Investigate (b) if group parent training increases social support more than other modes of treatment and explore (c) how social support interacts with different modes of treatment. METHOD: Compared individual with group parent training and treatment as usual (TAU) in a randomized controlled trial for N = 237 children with Hyperkinetic Disorder/Attention Deficit Hyperactivity Disorder (HKD/ADHD). Employed two formats of the same cognitive-behavioural parent training in the same settings to maximize comparability. Controlled for medication status and assessed changes from pre- to post-treatment and 6-month follow-up. RESULTS: Parents reported more positive changes in the parent training groups than in TAU in relation to child behaviour problems and moodiness as well as more positive changes in parent stress and sense of competence. However, gains on parent stress were limited after group training as were gains on satisfaction. Social support improved similarly in all treatment groups. While results indicated clear main effects of social support on all child and parent measures, interactions of social support and treatment outcomes were found for child moodiness and parent stress. CONCLUSIONS: Cognitive-behavioural parent training is beneficial beyond TAU, especially when it can be provided individually. Surprisingly, group training did not reduce parent stress more than TAU or individual training. Social support related to all measures and interacted with treatment on some outcomes. The findings have numerous implications for research and practice.

Observation of children with attention-deficit hyperactivity (ADHD) problems in three natural classroom contexts.

BACKGROUND: Observation studies of students with attention-deficit hyperactivity disorder (ADHD) problems in natural classroom situations are costly and relatively rare. AIMS: The study enquired how teacher ratings are anchored in actual student classroom behaviours, and how the behaviour of children with ADHD problems differs from their classmates. The authors attempted to broaden the usual focus on disruptive and inattentive behaviours to elucidate the role of various on-task behaviours, as well as considering differences between classroom contexts. SAMPLE: DSM-III-R criteria were used in conjunction with a teacher rating scale to select a sample of 55 students with ADHD problems, and 55 matched controls from a population of 569 primary school students. METHOD: Students were observed in their natural classrooms using the Munich Observation of Attention Inventory (MAI; Helmke, 1988). Correlations between teacher reports and observation codes were computed, and systematic differences between students with ADHD problems and controls in different classroom contexts were examined using a generalized linear mixed model (GLMM). RESULTS: Global teacher reports showed moderate to strong correlations with observed student behaviours. Expected on-task behaviour demonstrated the strongest relationship (r>-.70) with teacher reports. As hypothesized, the children with ADHD were more disruptive and inattentive than their matched peers. They were also less often inconspicuous on-task as expected by their teachers. However, their behaviour was assigned to two other on-task categories more often than their peers, and this raised their total on-task behaviour to over 66%. Situational differences were found for all codes as well, which mostly affected all students in a similar way, not just students with ADHD. CONCLUSIONS: ADHD related behaviours are pervasive across the classroom situations coded. Teachers appear to distinguish between desirable and undesirable on-task behaviours. Nevertheless, assisting students with ADHD problems requires shaping both. Future studies need to include more differentiated codes for various types of on-task behaviours and also need to code the lesson context concurrently.

Cross-cultural generalizability of CBCL syndromes across three continents: from the USA and Holland to Australia.

The study asked how well Achenbach's 8-factor cross-informant model for the Child Behavior Check-list (Achenbach, 1991a, 1991b, 1991c) fits clinic data in the USA, Holland, and Australia. DeGroot et al.'s Dutch 8-factor model (DeGroot, Koot, & Verhulst 1994) was also tested for its cross-cultural generalizability. Achenbach's matched clinical sample data (N = 2110) were analyzed and contrasted with the previously reported Dutch findings (N = 2335), as well as a new data set collected on clinic referred children and adolescents in Australia (N = 2237). Confirmatory factor analyses supported the Dutch as much as the American model in the USA, Holland, and Australia. Although about 90% of items showed convergent validity across models and countries, the attention and especially the social problems factor found least support. Most double loadings in the current models were not upheld. Instead, additional analyses discovered a number of unmodelled loadings including many cross-loadings. This led to the redefinition of the social problems factor as a mean aggression factor (with associated social problems) whereas the original aggression factor focuses on emotional acting out and the delinquent factor describes an evasive, covert type of antisocial behavior. Overall most support was obtained for the withdrawn, somatic, anxious/depressed, thought problems, and aggressive factors.

Confirmatory factor analysis and reliability of the Mental Health Inventory for Australian adolescents.

Ostroff, Woolverton, Berry, and Lesko in 1996 examined the adolescent subsample of Veit and Ware's 1983 normative data for the Mental Health Inventory and recommended a two-factor rather than the original five-factor model for the assessment of adolescents' mental health. Analysis of a 30-item version with a new independent sample of 878 adolescents in another English-speaking country supported a two-factor model of psychological well-being and distress for boys and girls. Internal consistency was > .9, and scores were stable (approximately .7) over a 10-wk. period. Boys reported slightly better mental health than girls, as in the original American research.