Enhancement of social learning family interventions for childhood conduct disorder.

Abstract

Social learning family intervention (SLFI) is the treatment of choice for young children exhibiting severe conduct disorder and antisocial behavior. Despite the reported success of this intervention, high levels of resistance, poor engagement, and inadequate maintenance of improvements are observed for a substantial proportion of distressed families. These obstacles have inspired enhancement efforts to improve basic social learning family-intervention models. The present review identifies promising approaches for maximizing treatment gains for the conduct-disordered child. Relevant studies were organized into 3 approaches: enhancements and expansions (a) within a dyadic (parent-child) interaction model, (b) within a broad-based model that acknowledges a wider range of family influences, and (c) through a multisystems model. SLFI enhancements within the dyadic model have centered on either the strengthening of parental skills already included in the SLFI regimen or the adding of new interactional strategies. Some gains, but only partial success, have been achieved with the dyadic model supplements. SLFI expansions from a broad-based model have focused on parental adjustment, parental expectations during treatment, and social-environmental stressors. The multisystems adjuncts to SLFI include cognitive-behavioral interventions to affect peer relations and ecological approaches to sweep across domains. The broad-based and multisystems expansions have produced promising but undertested treatment regimens. Related areas of investigation included therapy process research, medication combined with SLFI, and the involvement of fathers in treatment. Recommendations are offered for improvement of SLFI research. The apparent theoretical crossroads for SLFI treatment of childhood conduct disorder are discussed.

A Pilot Study of the Feasibility and Efficacy of the Strategies to Enhance Positive Parenting (STEPP) Program for Single Mothers of Children With ADHD

“…These additions to traditional BPT programs were developed to address several major areas identified in the research literature as being important to target with multiply stressed single mothers: practical barriers to treatment participation, maladaptive cognitions regarding their children and treatment, depression, social support, and life stressors (Chronis et al, 2004;Miller & Prinz, 1990). Targeting these areas may have multiple effects in terms of attendance to, engagement in, and outcomes following BPT as well as maintenance of treatment gains for single mothers of children with ADHD.…”

“…Specifically, several family, parent, and child characteristics often predict poor attendance to, engagement during, as well as limited benefits following BPT (Chronis et al, 2004;Miller & Prinz, 1990). One risk factor for poor progress during and following BPT is being a single mother (Bagner & Eyberg, 2003;Dumas & Wahler, 1983;Kazdin & Mazurick, 1994;Kazdin, Mazurick, & Bass, 1993;Lundahl, Risser, & Lovejoy, 2006;Miller & Prinz, 1990;Webster-Stratton & Hammond, 1990).…”

“…Single mothers experience multiple, putative risk factors for poor attendance, increased dropout, and restricted therapeutic gains in BPT (Miller & Prinz, 1990), including higher rates of depression (Brown & Moran, 1997;Cairney, Boyle, Offord, & Racine, 2003;Lipman, MacMillan, & Boyle, 2001;Lipman, Offord, & Boyle, 1997;Turner, Wheaton, & Lloyd, 1995;Wang, 2004), less social support (Cairney et al, 2003;Weinraub, Horvath, & Gringlas, 2002;Weinraub & Wolf, 1983), and higher rates of stress (Brown & Moran, 1997;Cairney et al, 2003;Compas & Williams, 1990). These multiply stressed mothers are more likely to have greater practical barriers to treatment participation (e.g., Kazdin, Holland, Crowley, & Brenton, 1997;Kazdin & Wassell, 2000) and maladaptive cognitions regarding treatment and their children (Nock & Kazdin, 2001), often resulting in additional difficulties faced by these families during and following BPT.…”

Enhancing Traditional Behavioral Parent Training for Single Mothers of Children with ADHD

“…In particular, the STEPP program focused on enhancements to the format, delivery, and content of traditional BPT including (a) an enhanced intake procedure that addressed practical barriers to treatment participation, maternal cognitions regarding expectations for treatment, and attributions regarding their children's behavior; (b) incorporating a subgroup, coping-modeling, problem-solving format within the traditional large group format to improve social support between parents and to increase participation among parents; and (c) incorporation of a systematic, problem-solving treatment to address parent-initiated problems. These additions to traditional BPT were included to address several major areas identified in the literature as being important to target with multiply stressed, single mothers: practical barriers to participation, maladaptive cognitions regarding their child and treatment, depression, social support, and life stressors (Chronis et al, 2004;Miller & Prinz, 1990).…”

Preventative Behavioral Parent Training: A Preliminary Investigation of Strategies for Preventing At-Risk Children From Developing Later Conduct Problems

“…Although there are a number of different versions of BPT interventions, they share a number of commonalities (Dumas, 1989;Kazdin, 1995;Miller & Prinz, 1990). Within the various BPT programs, one common characteristic they share is that the intervention is conducted primarily with the parents.…”