In the absence of clear confirmation or refutation of the results of the earlier study and in an attempt to meet some of the criticisms, we undertook the current study using a similar design, but with improved methodology and clearly defined outcome measures.
MethodsChildren were referred by general practitioners, paediatricians, and psychiatrists to a special diet and behaviour clinic set up at the Hospital for Sick Children. All children accepted for the study met DSM III criteria for attention deficit disorder with hyperactivity,10 were between 3 and 12 years old, and had IQs above 70. Where children were already on diets their parents were asked to take them off the diet for a week before the initial interview.
Parents' views about acting as cotherapists in a home-based behavioral treatment for their autistic child were investigated. Three areas were studied: (1) the demands involved in being a cotherapist, (2) whether parents felt more able to cope with their child after treatment, and (3) whether they had the same conception of the treatment's aims as did the therapists involved. Parents viewed their treatment more favorably than a comparison group of parents receiving more usual forms of treatment. Most had an accurate impression of treatment but half found it hard to use the methods suggested. Although parents felt that their child improved as a result of treatment, several had stopped using the techniques or felt unable to apply them to new problems.
The study aimed to examine the influence of initial mode of assessment on attendance, and later assessment and treatment. 100 children newly referred to a child mental health service were randomly assigned to (i) initial family assessment; child and family seen together, or (ii) individual assessment, child and parents seen in parallel. Those invited were more likely to attend following "individual" appointment letters because parents did not always bring all the children in response to "family" appointment letters. Failure to attend the second appointment occurred twice as often if there was a change in who was asked to attend. Psychometric assessment was more often requested following an initial family interview. Long term mode of therapy appeared to be partly but not wholly influenced by initial assessment method. Results suggest that sustained co-operation with long term therapy is more likely to occur when clinicians vary the family members they are working with according to the needs of the case.
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