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Alan E. Kazdin - One of the best experts on this subject based on the ideXlab platform.
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Parent Management Training for conduct problems in children: Enhancing treatment to improve therapeutic change
International Journal of Clinical and Health Psychology, 2018Co-Authors: Alan E. Kazdin, Adam Glick, Jennifer V. Pope, Ted J. Kaptchuk, Bernadette Lecza, Erin Carrubba, Emily Mcwhinney, Natasha HamiltonAbstract:Abstract Background/Objective: The study evaluated two variations of Parent Management Training (PMT) for children referred to treatment for oppositional, aggressive, and antisocial behavior. The goal was to evaluate the impact of multiple enhancements to optimize common and placebo factors to augment therapeutic change. Method: The families of all children (N=138, 39 girls and 99 boys, ages 6-13) received PMT. One half of the families were assigned to receive an enhanced version with multiple additions designed to increase bonding of the Parent to the therapist, professionalism of treatment and setting, credibility of the intervention, and expectancies for therapeutic change. Assessment included multiple treatment outcome measures of the child (problem behaviors, psychiatric symptoms, social competence, and adaptive functioning) and Parents (depression, stress, and family relations) showed marked improvements over the course of treatment, and several process measures (therapeutic alliance, credibility of the procedures, expectancy for change). Results: The results indicated that children and Parents made marked improvement in all the treatment outcome measures. The vast majority of children fell within the normative range at posttreatment on problem and prosocial behaviors. The two treatment conditions were no different in outcomes for children or Parents. Conclusion: PMT led to marked changes in treatment outcome.
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Psychosocial Treatments for Conduct Disorder in Children and Adolescents
A Guide to Treatments that Work, 2007Co-Authors: Alan E. KazdinAbstract:Antisocial and aggressive behavior in children (conduct disorder) is extremely difficult to treat in light of the stability of the problem, untoward long-term prognosis, and the diverse domains of dysfunction in the child, Parent, and family with which the problem is associated. Significant advances have been made in treatment. Seven treatments with strong evidence in their behalf with children and adolescents are reviewed and include Parent Management Training, multisystemic therapy, multidimensional treatment foster care, cognitive problem-solving skills Training, anger control Training, functional family therapy, and brief strategic family therapy. Parent Management Training is directed at altering Parent-child interactions in the home, particularly those interactions related to child-rearing practices and coercive interchanges. Multisystemic therapy focuses on the individual, family, and extrafamilial systems and their interrelations as a way to reduce symptoms and to promote prosocial behavior. The multidimensional treatment foster care model focuses on youth who are in placement and who are to return to their Parents or more permanent foster care. Behavioral treatments in the placement and in the setting to which the child is returned are part of a comprehensive effort to integrate treatment and community life. Cognitive problem-solving skills Training focuses on cognitive processes that underlie social behavior and response repertoires in interpersonal situations. Also cognitively based, anger control Training includes problem-solving skills Training in the context of groups in the schools. The program has an additional component that includes Parent Management Training. Functional family therapy utilizes principles of systems theory and behavior modification for altering interaction, communication patterns, and problem solving among family members. Brief strategic family therapy focuses on the structure of the family and concrete strategies that can be used to promote improved patterns of interaction. This treatment has been developed with Hispanic children and adolescents and has integrated culturally pertinent issues to engage the families. Questions remain about the long-term impact of various treatments, the persons for whom one or more of these treatments is well suited, and how to optimize therapeutic change. Even so, the extensive evidence indicates that there are several viable treatments for conduct disorder. Disseminating these to professionals and children and families remains a key challenge.
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Pretreatment social relations, therapeutic alliance, and improvements in Parenting practices in Parent Management Training.
Journal of Consulting and Clinical Psychology, 2006Co-Authors: Alan E. Kazdin, Moira K. WhitleyAbstract:The authors examined the Parent-therapist alliance in Parent Management Training for children (N = 218; 53 girls and 165 boys, ages 2-14) referred clinically for oppositional, aggressive, and antisocial behavior. The interrelations of pretreatment Parent social relationships, the Parent-therapist alliance over the course of treatment, and improvements in Parenting practices at the end of treatment were evaluated by different raters. As expected, the better the quality of the Parent-therapist alliance, the greater the improvements in Parenting practices by the end of treatment. Social relations of the Parents prior to treatment were associated with the Parent-therapist alliance during treatment and Parental improvements at the end of treatment. The relation between the therapeutic alliance and improvement in Parenting practices was partially explained by pretreatment Parent social relations.
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randomized controlled trial of a brief intervention for increasing participation in Parent Management Training
Journal of Consulting and Clinical Psychology, 2005Co-Authors: Matthew K Nock, Alan E. KazdinAbstract:Evidence-based treatments exist for a range of child and adolescent behavior problems; however, effects are often limited by poor treatment attendance and adherence. The authors developed and evaluated the efficacy of a brief (5 to 45 min) intervention designed to increase treatment attendance and adherence in a sample of 76 Parents referred for treatment of their child's oppositional, aggressive, and antisocial behavior. The results of this randomized controlled trial showed that Parents who received this brief intervention had greater treatment motivation, attended significantly more treatment sessions, and had greater adherence to treatment according to both Parent and therapist report. This study provides researchers and clinicians with a brief and efficacious method of increasing motivation, attendance, and adherence for treatment.
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Parent Management Training treatment for oppositional aggressive and antisocial behavior in children and adolescents
2005Co-Authors: Alan E. KazdinAbstract:1. Introduction 2. Underlying principles and concepts 3. From principles to techniques: positive reinforcement 4. From principles to techniques: punishment and extinction 5. Characteristics of treatment 6. Evidence: key findings, strengths and limitations 7. Critical issues in applying and implementing treatment 8. Parent Management Training in perspective Parent Management Training TREATMENT MANUAL 9. Pre-treatment introduction and orientation 10. Defining, observing and recording behaviour 11. Positive reinforcement: point incentive chart and praise 12. Time out from reinforcement 13. Attending and planned ignoring 14. Shaping and school program 15. Review and problem solving 16. Family meeting 17. Low-rate behaviours 18. Reprimands 19. Compromising (1st session) 20. Compromising (2nd session) 21. Skill review, practice, and termination
Terje Ogden - One of the best experts on this subject based on the ideXlab platform.
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Parent Training: Effects beyond conduct problems
Children and Youth Services Review, 2019Co-Authors: Silje Hukkelberg, Truls Tømmerås, Terje OgdenAbstract:Abstract The Parent Management Training - Oregon model (PMTO) and the adaption of PMTO, the Brief Parent Training (BPT), are two versions of Parent Management Training, proven effective to reduce emerging or present child conduct problems through modifying child-Parent interaction. Research, however, indicates substantial comorbidity between high levels of conduct problems, low social competence, and depression/anxiety. The aim of this study was to examine to what extent PMTO and BPT have treatment effects beyond conduct problems, that is, additionally reduce the level of depression/anxiety and increase social competence. We investigated cross-domain effects in two independent randomized-controlled samples, receiving either PMTO or BPT, which differed with regard to treatment mode, intensity, and target groups. Participants (BPT: N = 216, PMTO: N = 137) were Norwegian Parents of children (age 3–12) with emerging or present conduct problems, randomly assigned to either the intervention or control condition. Results showed that both BPT and PMTO reduced conduct problems and increased social competence, but only BPT reduced the level of depression/anxiety. Implications and limitations of the results are discussed.
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Predictors of changes in child behaviour following Parent Management Training: Child, context, and therapy factors
International Journal of Psychology, 2016Co-Authors: Kristine Amlund Hagen, Terje OgdenAbstract:This non-randomised study examined a set of predictive factors of changes in child behaviour following Parent Management Training (PMTO). Families of 331 Norwegian girls (26%) and boys with clinic-level conduct problems participated. The children ranged in age from 3 to 12 years (Mage = 8.69). Retention rate was 72.2% at post-assessment. Child-, Parent- and therapy-level variables were entered as predictors of multi-informant reported change in externalising behaviour and social skills. Behavioural improvements following PMTO amounted to 1 standard deviation on Parent rated and ½ standard deviation on teacher rated externalising behaviour, while social skills improvements were more modest. Results suggested that children with higher symptom scores and lower social skills score at pre-treatment were more likely to show improvements in these areas. According to both Parent- and teacher-ratings, girls tended to show greater improvements in externalising behaviour and social skills following treatment and, according to Parents, ADHD symptomology appeared to inhibit improvements in social skills. Finally, observed increases in Parental skill encouragement, therapists' satisfaction with treatment and the number of hours spent in therapy by children were also positive and significant predictors of child outcomes.
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Is There a Scale-up Penalty? Testing Behavioral Change in the Scaling up of Parent Management Training in Norway.
Administration and Policy in Mental Health and Mental Health Services Research, 2015Co-Authors: Truls Tommeraas, Terje OgdenAbstract:In the present study, the scaling up of Parent Management Training, Oregon Model (PMTO) in Norway was examined by investigating how large-scale dissemination affected the composition of the target group and the service providers by comparing child behavioral outcomes in the effectiveness and dissemination phases of implementation. Despite the larger heterogeneity of the service providers and the intake characteristics of the target group, which are contrary to the expectations that were derived from the literature, no attenuation of program effects was detected when scaling up PMTO. In Norway, a long-term-funded centralized center, combined with an active implementation strategy, seems to have affected the quality of PMTO delivered system-wide in services for children with behavior problems.
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Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training
Child & Family Behavior Therapy, 2015Co-Authors: Gunnar Bjørnebekk, John Kjøbli, Terje OgdenAbstract:To scale up evidence-based treatment of conduct problems, Parent Management Training, Oregon model (PMTO) has been disseminated throughout Norway. This study examined whether Attention Deficit Hyperactivity Disorder (ADHD) predicted the outcomes of PMTO. Of 253 children and families, 97 were reported to have an ADHD diagnosis. Although different at intake, the groups with and without ADHD had close to an equal change in behavioral status following treatment. Maternal depression and family income predicted the combined group's behavior following PMTO. The study indicates that reductions in conduct problems following PMTO are of the same magnitude in children with or without ADHD. However, some characteristics may differentially predict outcomes for children with combined problems.
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Working alliance and treatment fidelity as predictors of externalizing problem behaviors in Parent Management Training.
Journal of Consulting and Clinical Psychology, 2013Co-Authors: Silje Hukkelberg, Terje OgdenAbstract:OBJECTIVE The study investigated treatment fidelity and working alliance in the Parent Management Training-Oregon model (PMTO) and investigated how these relate to children's externalizing problem behaviors, as reported by Parents and teachers. METHOD Participants were 331 Norwegian Parents who rated the client-therapist working alliance at 3 time points (Sessions 3, 12, and 20). Competent adherence to the PMTO treatment protocol was assessed by PMTO specialists from evaluations of videotaped therapy sessions using the Fidelity of Implementation (FIMP) system (Knutson, Forgatch, & Rains, 2003). Parents and teachers reported children's problem behaviors at baseline and at the end of therapy. Structural equation modeling was used to analyze the repeated measures data. RESULTS Parents reported high and stable levels of alliance and fidelity from Time 1 to Time 3, with no correlational or direct relations between the 2. Treatment fidelity predicted reductions in Parent-reported externalizing behavior, whereas working alliance was related to less change in problem behavior. Alliance and fidelity were unrelated to teacher-reported behavior problems. CONCLUSIONS The findings point to treatment fidelity as an active ingredient in PMTO and working alliance as a negative predictor of postassessment Parent-reported externalizing behavior. More research is needed to investigate whether these findings can be replicated and extended beyond PMTO.
Manfred Döpfner - One of the best experts on this subject based on the ideXlab platform.
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any indication for bias due to participation comparison of the effects of a Parent Management Training rated by participating and non participating Parents
Clinical Psychology & Psychotherapy, 2012Co-Authors: Christopher Hautmann, Charlotte Hanisch, Ilka Eichelberger, Julia Plück, Daniel Walter, Herbert Hoijtink, Anja Gortzdorten, Manfred DöpfnerAbstract:Ratings of Parents that have participated in a Parent Training for child externalizing behaviour problems might be biased (e.g., they may report symptom reduction to reward their own endeavours for attending the Training). The potential for bias in Parent ratings was investigated in a secondary analysis of an effectiveness study of a Parent Management Training for children (aged 3–10 years) with externalizing behaviour problems under routine care conditions. For the 56 families included in the current analysis, we compared the ratings of Training participants (predominately mothers) and Training non-participants (predominately fathers). A 3-month waiting period prior to treatment served as the control condition. Outcome measures were attention problems and conduct problems of the children and perceived Parental self-efficacy rated by both the mothers and fathers. Child attention problems and conduct problems both decreased significantly during the treatment period for participating and non-participating Parents, and the changes in ratings during treatment were of a similar magnitude for participants compared with non-participants. Taking into account the methodological limitations of the current analysis, no indication was found that treatment effects are strongly biased due to participation in the Training. Copyright © 2012 John Wiley & Sons, Ltd. Key Practitioner Messages Previous positive findings of mothers' and fathers' ratings on Parent Management Training for children with externalizing problem behaviour have mostly come from Parents who also attended the Training. For child behavioural problems, the results of the current analysis demonstrate similar perceived changes by Parents who did and did not participate in the Training. Our findings underscore the relevance and importance of Parent ratings for treatment evaluation.
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The Severely Impaired Do Profit Most: Differential Effectiveness of a Parent Management Training for Children with Externalizing Behavior Problems in a Natural Setting.
Journal of Child and Family Studies, 2010Co-Authors: Christopher Hautmann, Petra Stein, Charlotte Hanisch, Ilka Eichelberger, Julia Plück, Daniel Walter, Manfred DöpfnerAbstract:We investigated the differential effectiveness of a Parent Management Training program for children with externalizing problem behavior. The Parent Management Training was tested using a within-subject control group design. 270 families with children aged 3–10 years were included and assessments were made at 3 months before treatment, immediately before treatment, immediately after treatment, and at 12 months follow-up. We analyzed data using growth mixture modeling. For attention problems, we obtained a two-subgroup solution. One subgroup started with high initial values indicating more severe impairment, and the other subgroup had low initial values. The more impaired group showed stronger treatment effects. For disruptive behavior problems, our analyses revealed a three-subgroup solution. Two subgroups exhibited high initial levels of disruptive behavior problems and the third subgroup had low initial levels. One of the more impaired groups exhibited a strong decrease in problem behavior during treatment, while the other two groups only showed moderate decreases. For attention problems and disruptive behavior problems, some of the most impaired children gained the most from Parent Training.
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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
European child & adolescent psychiatry, 2009Co-Authors: Christopher Hautmann, Charlotte Hanisch, Ilka Eichelberger, Julia Plück, Daniel Walter, Manfred DöpfnerAbstract: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.
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Does Parent Management Training for Children with Externalizing Problem Behavior in Routine Care Result in Clinically Significant Changes
Psychotherapy Research, 2009Co-Authors: Christopher Hautmann, Petra Stein, Charlotte Hanisch, Ilka Eichelberger, Julia Plück, Daniel Walter, Manfred DöpfnerAbstract:The clinical significance of a Parent Management Training that is part of the Prevention Program for Externalizing Problem Behavior (PEP) was assessed in an effectiveness trial. Parent Management Training was offered under routine care conditions in a setting where a high proportion of children were expected to show clinically relevant symptoms of externalizing problem behavior. At the beginning of the study, 32.6% to 60.7% of children were classified as clinical cases (dysfunctional) on three outcome measures of child behavior problems. Three months after treatment, 24.8% to 60.4% of children were judged to be recovered. Parent Management Training can result in clinically significant changes in children with externalizing behavior problems.
Edda Vikar Guðmundsdóttir - One of the best experts on this subject based on the ideXlab platform.
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implementation of Parent Management Training oregon model pmtotm in iceland building sustained fidelity
Family Process, 2013Co-Authors: Margrét Sigmarsdóttir, Edda Vikar GuðmundsdóttirAbstract:Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered Training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening Training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.
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Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity
Family Process, 2012Co-Authors: Margrét Sigmarsdóttir, Edda Vikar GuðmundsdóttirAbstract:Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered Training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening Training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.
Margrét Sigmarsdóttir - One of the best experts on this subject based on the ideXlab platform.
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Parent Management Training - Oregon Model to treat behavior problems
2013Co-Authors: Margrét SigmarsdóttirAbstract:This book represtents a work which evaluates the treatment effects and implementation of Parent Management Training – the Oregon model (PMTO™) to treat children´s behavior problems in Iceland. The intervention is an Empirically Supported Treatment (EST), and originally developed by Gerald Patterson and his colleagues in the United States. Its main goal is to improve Parents´ child-rearing methods by breaking coercive patterns between Parents and children. The book is built on four papers. The first two papers explored the influences of the implementation and the second two papers evaluated the effects of PMTO in a randomized controlled trial (RCT) in community settings nationwide in Iceland. The main findings of the book are that PMTO led to greater reductions in child adjustment problems relative to the comparison group, which indicates that PMTO is an effective method to treat children´s behavior problems in Iceland and supply evidence for the method´s successful implementation in community settings in the country. Findings also indicate a further need to adapt observational measures to Icelandic cultures.
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implementation of Parent Management Training oregon model pmtotm in iceland building sustained fidelity
Family Process, 2013Co-Authors: Margrét Sigmarsdóttir, Edda Vikar GuðmundsdóttirAbstract:Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered Training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening Training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.
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Implementation of Parent Management Training—Oregon Model (PMTOTM) in Iceland: Building Sustained Fidelity
Family Process, 2012Co-Authors: Margrét Sigmarsdóttir, Edda Vikar GuðmundsdóttirAbstract:Bringing empirically supported treatments (ESTs) into community settings is a challenge because of threats to therapy adherence. The nationwide implementation of Parent Management Training-the Oregon Model (PMTO) in Iceland was studied by comparing therapists' competent adherence to PMTO across three generations of therapists. To assess therapists' competence and adherence to the PMTO method, the Fidelity of Implementation Rating System (FIMP) was used as the measuring device. Of 16 therapists across three generations who entered Training, 12 completed with certification. As expected, each of the three generations obtained adequate FIMP scores. Generations 1 and 3 showed equivalent levels of performance on FIMP scores at certification. A small drop in FIMP scores for Generation 2 was explained in terms of translating and culturally adjusting materials and strengthening Training procedures. Results are parallel to earlier findings from the nationwide PMTO implementation in Norway and support the idea that PMTO can be implemented in community settings with high fidelity even when resources are scarce.
