The severely impaired do profit most: short-term and long-term predictors of therapeutic change for a parent management training under routine care conditions for children with externalizing problem behavior

Abstract

Short-term and long-term predictors of therapeutic change due to parent management training were investigated. Therapeutic change was defined as the change in outcome measures [externalizing problem behavior and parenting self-efficacy (PSE)] from before treatment to afterward. Three different types of predictors were analyzed: child variables (gender, age, and initial externalizing and internalizing behavior), parent variables (age, initial PSE and parental psychopathology) and socioeconomic status and other sociodemographic characteristics of the family (parental school education, employment, family status, language). The parent management training was part of the Prevention Program for Externalizing Problem Behavior, which was evaluated as an effectiveness trial under routine care conditions using a within-subject control group design. Between 78 and 270 families were included in the analysis, which investigated therapeutic change over two time intervals: (1) immediate change from the pre-treatment to the post-treatment assessments, and (2) long-term-change from pre-treatment to 1-year follow-up. Throughout several analyses, the only predictor of therapeutic change that was consistently significant over the two time periods for the externalizing problem behavior of the child was the initial externalizing problem behavior. More impaired children improved more. Similarly, the only predictor of therapeutic change for the two time periods in PSE was the initial level of PSE. Parents with less PSE gained more during the course of the training

The Severely Impaired Do Profit Most: Differential Effectiveness of a Parent Management Training for Children with Externalizing Behavior Problems in a Natural Setting

“…For disruptive behavior, children who were initially more impaired profited most from behavior-based treatment (August et al 2001;Kazdin and Whitley 2006;Lundahl et al 2006;Reid et al 1999;Stoolmiller et al 2000). This was confirmed by our analyses of predictors of therapeutic change in response to our parent management training for children with externalizing problem behavior (Hautmann et al 2010a). Furthermore, the Conduct Problems Prevention Research Group (2007) reported that only children with the highest initial risk for conduct problems showed significant improvements following intervention, which is why the authors recommended screening.…”

Effektivität und Erfolgsprädiktoren in der kognitiven Verhaltenstherapie unter Praxisbedingungen

“…Gerade schwer beeinträch-tigte Patienten profitierten von den kognitiv-verhaltenstherapeutischen Interventionen und fühlten sich am Ende der Behandlung stabiler. Dieses Ergebnis deckt sich mit den Befunden der Prädik-torstudien von Nakao et al [2001], Hautmann et al [2010] und . Zu beachten ist jedoch, dass das Ausmaß der Symptomveränderung von der Schwere der Belastungsstärke zu Beginn der Therapie abhängig ist.…”

“…Höhere Eingangsbelastungen korrelieren in verschiedenen Therapiestudien mit besserem Therapieoutcome. Eine Erklärung hierfür könnte ein höherer Leidensdruck sein, der ein wichtiger motivationaler Faktor für das Behandlungsergebnis in Psychotherapien ist [Nakao et al, 2001;Kampman et al, 2008;Hautmann et al, 2010;. Ein weiterer Grund für den geringeren Behandlungserfolg bei Angstpatienten kann ebenfalls eine niedrige Häufigkeit an durchgeführten In-vivoExpositionen sein.…”

“…Die Befunde sind jedoch widersprüchlich und unter anderem von den jeweiligen Untersuchungsinstrumenten für die Messung des Therapieoutcomes abhängig. So wird die Schwere der Symptomatik vor Behandlungsbeginn in Studien von Nakao et al [2001], Hautmann et al [2010] und als positiver Prädiktor für den Therapieerfolg nachgewiesen. Hingegen konnten Clarkin und Levy [2004] diesen Zusammenhang nicht nachweisen.…”

Predictors of discipline severity among at-risk toddlers

“…There is some support in the literature that parents who attend classes and interact with others through socialization can impact parenting in a positive way, especially with at-risk samples (Deutscher, Fewell, & Gross, 2006;Hautmann et al, 2009;Mayer & Blome, 2013). Some of the most important types of interventions are those that target emotional responsivity, especially on the part of the mother.…”