Using Time-out for Child Conduct Problems in the Context of Trauma and Adversity: A Nonrandomized Controlled Trial.

Importance: Exposure to adverse childhood experiences substantially increases the risk of chronic health problems. Originally designed to treat child conduct problems, parent management training programs have been shown to be effective in preventing children from being exposed to further adversity and supporting children's recovery from adversity; however, there are increasing concerns that a core component of these programs, the discipline strategy time-out, may be harmful for children with a history of exposure to adversity. Objective: To investigate the comparative benefits and potential harms to children exposed to adversity that are associated with parenting programs that include time-out. Design, Setting, and Participants: This nonrandomized waiting list-controlled clinical study was conducted at a specialist clinic for the treatment of conduct problems in Sydney, Australia. The self-referred sample included children with conduct problems and their caregivers. Eligibility was confirmed through clinician-administered interviews. Data were collected between February 14, 2018, and February 1, 2021. Interventions: Caregivers participated in a 10-session, social learning-based parent management training program. Caregivers were provided with parenting strategies aimed at encouraging desired behaviors through effective reinforcement and managing misbehavior through consistent limit setting, including the use of time-outs. Main Outcomes and Measures: The primary outcome was the parent-reported Strengths and Difficulties Questionnaire score, and secondary outcomes included subscale scores from the clinician-administered Diagnostic Interview Schedule for Children, Adolescents, and Parents. Multi-informant measures of child adversity were collected using the parent-reported Adverse Life Experiences Scale and the clinician-rated Maltreatment Index. Results: A total of 205 children were included in analysis (156 in the full intervention and 49 in the control condition; 158 boys [77.1%]; mean [SD] age, 5.6 [1.8] years [range, 2-9 years]). Compared with children with low adversity exposure, children with high adversity exposure showed greater reductions in the Strengths and Difficulties Questionnaire score from baseline (mean difference, 3.46 [95% CI, 1.51-5.41]; P < .001) to after treatment (mean difference, 1.49 [95% CI, -0.46 to 3.44]; P = .13) and in the internalizing symptom subscale score (baseline mean difference, 1.00 [95% CI, -2,00 to 0.00]; P = .50; posttreatment mean difference, 0.06 [95% CI, -0.82 to 0.94]; P = .90). No significant differences in the externalizing symptom subscale score were found. Conclusions and Relevance: In this nonrandomized clinical study, children with high exposure to adversity experienced equivalent, if not greater, benefits associated with parenting programs that include time-out compared with children with low exposure to adversity. Results suggest that time-out was an effective component of parenting programs for children exposed to adversity. Trial Registration: anzctr.org.au Identifier: ACTRN12617001472369.

Reliability and validity of the DSM-5 Diagnostic Interview Schedule for Children, Adolescents, and Parents-5 in externalizing disorders and common comorbidities.

The Diagnostic Interview Schedule for Children Adolescents and Parents (DISCAP) is a semi-structured diagnostic interview for assessing psychiatric disorders in children and adolescents. Changes to diagnostic criteria introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) required the DISCAP to be revised accordingly. The aim of this study was to evaluate the reliability and validity of the updated DISCAP-5 in clinic-referred children. The DISCAP-5 was administered to parents of n=60 clinic-referred children aged 2-9 years with externalizing problems and a range of comorbid disorders. Inter-rater reliability data were collected using independent ratings of video-recorded DISCAP-5 interviews, and concurrent and discriminant validity were indexed against mother and father reports on the Strengths and Difficulties Questionnaire. Inter-rater reliability agreement was high for the presence and absence of any diagnosis, common externalizing (e.g., oppositional defiant disorder, conduct disorder) and internalizing disorders (separation anxiety disorder, generalized anxiety disorder), and severity of primary and secondary diagnoses. Rating scale data supported the concurrent and discriminant validity of diagnoses based on the DISCAP-5. The DISCAP-5 appears to provide valid and reliable data in the diagnostic assessment of clinic-referred children with behavioral and emotional difficulties across broad ranges of severity and complexity.

Capturing the developmental timing of adverse childhood experiences: The Adverse Life Experiences Scale.

Adverse childhood experiences (ACEs) have been associated with a range of physical and mental health problems, and it is now understood that the developmental timing of ACEs may be critically important. Despite this, there is a distinct lack of methods for the efficient assessment of such timing in research and clinical settings. We report on the development and validation of a new measure, the Adverse Life Experiences Scale (ALES), that indexes such developmental timing within a format incorporating caregivers' reports of ACEs in their own lives and those of their children. Participants were a nationally representative sample of Australian families (n = 515; Study 1), and a sample of clinic-referred families (n = 168; Study 2). Results supported the internal consistency and test-retest reliability of the ALES and indicated high levels of acceptability for the measure. In terms of validity, ALES scores were significantly associated with interview-based measures of child maltreatment and quality of the family environment, as well as measures of psychopathology across multiple informants (parents, teachers, clinician-rated). Furthermore, indices of ACEs occurring within specific age-based periods of childhood were found to explain unique variance in current symptoms of child and caregiver psychopathology, independent of the overall chronicity of those ACEs and current adversity. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A parenting programme to prevent abuse of adolescents in South Africa: study protocol for a randomised controlled trial.

BACKGROUND: An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme. METHODS/DESIGN: This is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites. DISCUSSION: This is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors. TRIAL REGISTRATION: Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word 'Sinovuyo' on their website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119.

Imagining future events in patients with unilateral temporal lobe epilepsy.

OBJECTIVES: Imagining future events, which contain episodic and non-episodic details, has been found to (1) engage the temporal lobes bilaterally and (2) be impaired in patients with bilateral temporal lobe pathology. Here, we examined whether unilateral temporal lobe dysfunction also impairs the ability to generate future events. DESIGN: Prospective cross-sectional. METHODS: Twenty patients with a history of unilateral temporal lobe epilepsy [TLE; 10 left (LTLE) and 10 right (RTLE)] and 20 normal control (NC) subjects comparable on age, sex and education completed the Adapted Autobiographical Interview, which required recall of past and generation of future events and distinguished episodic (internal) from non-episodic (external) details. Participants also completed a battery of neuropsychological tests. RESULTS: Patients with unilateral TLE were significantly impaired in provision of internal details for past and future events, but not in the generation of external details. Examination of detail subcategories revealed that patients with LTLE did exhibit a significant deficit relative to patients with RTLE (and NC) with respect to the generation of perceptual details for both past and future events. Moreover, patients with LTLE generated significantly fewer place details for future events (relative to NC only). The overall number of internal details recalled by patients with LTLE was related to semantic fluency. CONCLUSIONS: Our study provides the first evidence that unilateral temporal lobe dysfunction is associated with not only impaired recall of past, but also the generation of future episodic details. Clinically, deficits in future thinking may reduce motivation and decision-making, and as such adversely impact behavioural regulation and socialization. PRACTITIONER POINTS: Patients with temporal lobe epilepsy generate less details when asked to describe past and potential future events, particularly with regard to details involving specific events, places and perceptions. These same patients are aware of their difficulties in this realm, but judge their past memories as similar in vividness and even more personally significant than the memories generated by control participants. The deficits in generation of future episodic details were particularly pronounced in patients with left temporal lobe epilepsy. Verbal semantic fluency was correlated with the ability to generate future scenarios.