Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial.

IMPORTANCE: Disruptive behavior disorders, such as attention-deficient/hyperactivity disorder and oppositional defiant disorder, are common and stable throughout childhood. These disorders cause long-term morbidity but benefit from early intervention. While symptoms are often evident before preschool, few children receive appropriate treatment during this period. Group parent training, such as the Incredible Years program, has been shown to be effective in improving parenting strategies and reducing children's disruptive behaviors. Because they already monitor young children's behavior and development, primary care pediatricians are in a good position to intervene early when indicated. OBJECTIVE: To investigate the feasibility and effectiveness of parent-training groups delivered to parents of toddlers in pediatric primary care settings. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted at 11 diverse pediatric practices in the Greater Boston area. A total of 273 parents of children between 2 and 4 years old who acknowledged disruptive behaviors on a 20-item checklist were included. INTERVENTION: A 10-week Incredible Years parent-training group co-led by a research clinician and a pediatric staff member. MAIN OUTCOMES AND MEASURES: Self-reports and structured videotaped observations of parent and child behaviors conducted prior to, immediately after, and 12 months after the intervention. RESULTS: A total of 150 parents were randomly assigned to the intervention or the waiting-list group. An additional 123 parents were assigned to receive intervention without a randomly selected comparison group. Compared with the waiting-list group, greater improvement was observed in both intervention groups (P < .05). No differences were observed between the randomized and the nonrandomized intervention groups. CONCLUSIONS AND RELEVANCE: Self-reports and structured observations provided evidence of improvements in parenting practices and child disruptive behaviors that were attributable to participation in the Incredible Years groups. This study demonstrated the feasibility and effectiveness of parent-training groups conducted in pediatric office settings to reduce disruptive behavior in toddlers. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00402857.

The impact of experience on children's understanding of ADHD.

OBJECTIVE: This study examined how 7 to 8-year-old and 11 to 12-year-old children with and without attention-deficit hyperactivity disorder (ADHD) interpreted the causes and treatment of ADHD and colds. We also examined the complexity of children's explanations of medications for ADHD and colds. METHODS: A semi-structured interview was used to assess children's understanding of ADHD and colds. Interviews were coded separately for each of 3 categories: principles (e.g., biological or psychological) used to explain cause and treatment; ideas about the intentionality of symptoms; and articulation of mechanisms underlying the action of medications. RESULTS: Younger children without ADHD demonstrated a belief that children with ADHD have control over and choose to exhibit their symptoms. Younger children with ADHD used nonintentional psychology (e.g., learning or early childhood experiences) or biological principles in their responses whereas older children with ADHD combined both of these categories in their accounts of ADHD. Older children without ADHD favored purely biological explanations of ADHD. Both age and experience were related to the complexity of children's responses to questions about the action of medications for ADHD and colds. DISCUSSION: Findings highlight the need for educational interventions to rework the notion that children with ADHD intentionally display their symptoms. Educational interventions should clearly be tailored to children's developmental level as well as their experience with a condition.

What do suicide survivors tell us they need? Results of a pilot study.

Few studies have examined the natural coping efforts used by suicide survivors, or have identified specific problems and needs survivors experience following the death of a significant other by suicide. In the present study, we used a newly developed needs assessment survey to examine four areas of natural coping efforts: practical, psychological, and social difficulties; formal and informal sources of support; resources utilized in healing; and barriers to finding support since the loss. Sixty-three adult survivors of suicide were recruited from suicide survivor conferences and support groups. Results indicate that participants experienced high levels of psychological distress since the suicide, including elevated symptoms of depression, guilt, anxiety, and trauma. Participants experienced substantial difficulties in the social arena (e.g., talking with others about the suicide). The majority of the sample viewed professional help as beneficial; although many informal sources of support were also valued (e.g., one-to-one contact with other survivors). Depression and a lack of information about where to find help served as barriers to help-seeking behaviors for our participants. Participants who reported higher levels of functional impairment were more likely to report higher levels of psychological distress, social isolation, and barriers to seeking help. Future research with a longitudinal and more inclusive sample is needed to build on these preliminary findings and to provide a solid foundation for evidenced-based interventions with survivors.

Filling the GAPS: description and evaluation of a primary care intervention for children with chronic health conditions.

OBJECTIVES: Consistent with the "medical home" model, the GAPS program was developed to provide expanded care for children with a range of chronic health conditions within the context of primary care pediatric offices. Parents, pediatricians, and representatives from local Title V agencies participated to assess the child's and family's needs and to identify ways of addressing them. METHODS: Eleven pediatricians in 5 pediatric practices participated in the 4 main activities of the GAPS project: a) needs assessment; b) planning meeting among parents and pediatricians; c) practice-based advisory group; and d) Department of Public Health consultation. A telephone interview of parents and 2 needs assessment questionnaires completed by families were the 2 evaluation methods used. RESULTS: Parents were able to meet desires for "information" and "specific help." Moderate amounts of success were reported for meeting "contact" and "counseling" needs. Parents' explanations of unmet needs included lack of follow-through in obtaining services, unavailability of services, change of mind regarding needs, and pragmatic barriers. Socioeconomic status, the diagnosis and severity of the child's condition, and maternal psychological status were not significant predictors of success in families' ability to get their needs met. CONCLUSIONS: Active collaboration among parents, pediatricians, and Department of Public Health staff helps to ensure comprehensive coordinated care for families of children with chronic health conditions. Considerable challenges remain in implementing effective medical homes.