Child Externalizing Behavior
Conditions
Keywords
Parenting, Parent-Child Relations, Child Behavior
Brief summary
This study aimed to examine if technology could enhance the treatment engagement and outcomes of low income parents of 3 to 8 children with externalizing problems.
Detailed description
The aim of this pilot study is to determine whether a technology-enhanced version of an established behavioral treatment protocol, Helping the Noncompliant Child (HNC; McMahon & Forehand), enhances the engagement and treatment outcomes of lower income parents of 3 to 8 children with externalizing problems in treatment. It is predicted that families in both the HNC and technology-enhanced HNC (TE-HNC) programs will evidence significant improvement in parenting behavior and child externalizing problems; however, it is predicted that parent-child dyads in the TE-HNC program will require fewer sessions, will be more likely to be retained in the program, will be more likely to remain engaged in the program (e.g., practicing skills between sessions etc.), and will be more likely to have active involvement from their coparenting partners (i.e., other adults and family members who participate in childrearing).In turn, it is expected that the TE-HNC program will boost treatment outcomes.
Interventions
BEHAVIORALHelping the Noncompliant Child (HNC)
Well-established behavioral parent training program (McMahon & Forehand) for parents of 3 to 8 y.o. children with externalizing problems
BEHAVIORALTechnology-Enhanced Helping the Noncompliant Child (TE-HNC)
Standard HNC program plus technology-enhancements (see description under Arm)
Sponsors
National Institute of Mental Health (NIMH)
University of North Carolina, Chapel Hill
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
3 Years to 8 Years
Healthy volunteers
Yes
Inclusion criteria
* Lower income * caregiver/parent is legal guardian * 3 to 8 year old child * child meets criteria for externalizing disorder or significant externalizing symptoms
Exclusion criteria
* Prior report of child abuse or neglect * current substance abuse/dependence * legal guardian reading level less than 8th grade * child has developmental disability that precludes caregiver utilizing the skills
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Retention | Baseline to Post-Intervention (average 8 to 12 weeks) | Retention assesses whether or not the family completed the full treatment program. |
| Mean % Sessions Attended as Scheduled | Baseline to Post-Intervention (average 8 to 12 weeks) | Participation in each weekly session as scheduled was recorded for each family. Mean attendance of scheduled sessions was computed for each parent-child dyad and then for each group. For example, if a parent-child dyad required 8 sessions to master the program skills and attended all 8 sessions as scheduled they would have 100%. If instead, another parent-child dyad also required 8 sessions to complete the program, but half of those were rescheduled at least once. Then the overall average attendance is calculated across the parent-child dyads in each group. Greater scheduled attendance = optimal outcome. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Mean Post-treatment Score Eyberg Child Behavior Inventory (ECBI) | Baseline to Post-Intervention (average 8 to 12 weeks) | The ECBI is a 36 item measure frequently used in treatment outcome research with young children, as it it reflects problem behavior in this age range and is sensitive to change. Parents rate the frequency of each problem behavior as occurring 0 = never to 7 = always. Scores can range from 0 to 252 with higher scores reflecting greater problem behaviors. |
| Mean Sessions for Complete Treatment | Baseline to Post-Intervention (Average 8 to 12 weeks) | Mean number of sessions that parent-child dyads in each group required to master the program skills and complete treatment (Fewer sessions to complete treatment considered more cost-effective as parent-child dyads learning skills more efficiently). |
| Mean Consumer Satisfaction | Post-Intervention (Average 8 to 12 weeks) | Average parent-reported satisfaction with the treatment program on a project-developed consumer satisfaction scale (Possible range = 11 -77; Higher score = greater satisfaction). |
Countries
United States
Participant flow
Pre-assignment details
Children are participants (i.e., N = # children); however, parents participate with young children in BPT (i.e., reference to parent-child dyads throughout). 22 parent-child dyads enrolled, 3 assigned as practice cases, given the pilot nature of the study (i.e., 19 for analyses), & 4 drop-outs, yielded N = 15 for analysis.
Participants by arm
| Arm | Count |
|---|---|
| Helping the Noncompliant Child Helping the Noncompliant Child (HNC) is a well-established behavioral parent training (BPTP program for parents of 3 to 8 year old children with externalizing problems. Children are the target of treatment; however, parents are the mechanism of change. Therefore, parent-child dyads participate. | 10 |
| TE-HNC Standard HNC (see HNC Arm/Title) Program plus Technology-Enhancement (smartphones, which are being used for mid-week video calls to check-in re: skill-building, videotaping of family practice of skills at home, daily surveys re: skills practice & child behavior, reminders re: practice & sessions. | 9 |
| Total | 19 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Withdrawal by Subject | 2 | 2 |
Baseline characteristics
| Characteristic | Helping the Noncompliant Child | TE-HNC | Total |
|---|---|---|---|
| Age, Continuous | 5.75 Years STANDARD_DEVIATION 2.12 | 5.57 Years STANDARD_DEVIATION 1.27 | 5.67 Years STANDARD_DEVIATION 1.72 |
| Race/Ethnicity, Customized Minority (Racial and/or Ethnic) | 6 Participants | 5 Participants | 11 Participants |
| Sex: Female, Male Female | 5 Participants | 4 Participants | 9 Participants |
| Sex: Female, Male Male | 5 Participants | 5 Participants | 10 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 10 | 0 / 9 |
| other Total, other adverse events | 0 / 10 | 0 / 9 |
| serious Total, serious adverse events | 0 / 10 | 0 / 9 |
Outcome results
Primary
Mean % Sessions Attended as Scheduled
Participation in each weekly session as scheduled was recorded for each family. Mean attendance of scheduled sessions was computed for each parent-child dyad and then for each group. For example, if a parent-child dyad required 8 sessions to master the program skills and attended all 8 sessions as scheduled they would have 100%. If instead, another parent-child dyad also required 8 sessions to complete the program, but half of those were rescheduled at least once. Then the overall average attendance is calculated across the parent-child dyads in each group. Greater scheduled attendance = optimal outcome.
Time frame: Baseline to Post-Intervention (average 8 to 12 weeks)
Population: Given the pilot nature of study and smalll sample size, intent to treat analyses were not conducted. Rather, analyses were conducted on those parent-child dyads who completed all sessions within each group.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Helping the Noncompliant Child | Mean % Sessions Attended as Scheduled | 90 percentage of scheduled sessions | Standard Deviation 11 |
| TE-HNC | Mean % Sessions Attended as Scheduled | 97 percentage of scheduled sessions | Standard Deviation 5 |
Primary
Retention
Retention assesses whether or not the family completed the full treatment program.
Time frame: Baseline to Post-Intervention (average 8 to 12 weeks)
Population: Given that these analyses focus on retention, the analysis sample is the 19 enrolled parent-child dyads (i.e., including the drop-outs)
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Helping the Noncompliant Child | Retention | 8 Participants |
| TE-HNC | Retention | 7 Participants |
Secondary
Mean Consumer Satisfaction
Average parent-reported satisfaction with the treatment program on a project-developed consumer satisfaction scale (Possible range = 11 -77; Higher score = greater satisfaction).
Time frame: Post-Intervention (Average 8 to 12 weeks)
Population: N = 15 parent-child dyads who completed the treatment program.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Helping the Noncompliant Child | Mean Consumer Satisfaction | 56.56 score on a scale | Standard Deviation 2.47 |
| TE-HNC | Mean Consumer Satisfaction | 59.83 score on a scale | Standard Deviation 1.94 |
Secondary
Mean Post-treatment Score Eyberg Child Behavior Inventory (ECBI)
The ECBI is a 36 item measure frequently used in treatment outcome research with young children, as it it reflects problem behavior in this age range and is sensitive to change. Parents rate the frequency of each problem behavior as occurring 0 = never to 7 = always. Scores can range from 0 to 252 with higher scores reflecting greater problem behaviors.
Time frame: Baseline to Post-Intervention (average 8 to 12 weeks)
Population: N = 15 parent-child dyads who completed the treatment program.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Helping the Noncompliant Child | Mean Post-treatment Score Eyberg Child Behavior Inventory (ECBI) | 91.63 units on a scale | Standard Deviation 21.25 |
| TE-HNC | Mean Post-treatment Score Eyberg Child Behavior Inventory (ECBI) | 83.00 units on a scale | Standard Deviation 15.34 |
Secondary
Mean Sessions for Complete Treatment
Mean number of sessions that parent-child dyads in each group required to master the program skills and complete treatment (Fewer sessions to complete treatment considered more cost-effective as parent-child dyads learning skills more efficiently).
Time frame: Baseline to Post-Intervention (Average 8 to 12 weeks)
Population: N = 15 parent-child dyads who completed the treatment program.
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Helping the Noncompliant Child | Mean Sessions for Complete Treatment | 10 Sessions |
| TE-HNC | Mean Sessions for Complete Treatment | 8 Sessions |