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

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

International comparisons of behavioral and emotional problems in preschool children: parents’ reports from 24 societies

International comparisons were conducted of preschool children’s behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1½–5 by parents in 24 societies (N¼19,850). Item ratings were aggregated into scores on syndromes; Diagnostic and Statistical Manual of Mental Disorders–oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3–12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0–198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes<1%). Across all pairs of societies, correlations between mean item ratings averaged .78, and correlations between internal consistency alphas for the scales averaged .92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies

Die Erfassung von Verhaltensauffälligkeiten im Vorschulalter mit dem Elternfragebogen für Klein- und Vorschulkinder (CBCL/1 / – 5)

Plück J, Beiling M, Hautmann C, et al. Die Erfassung von Verhaltensauffälligkeiten im Vorschulalter mit dem Elternfragebogen für Klein- und Vorschulkinder (CBCL/1 / – 5). Diagnostica. 2013;59(3):155-166.Der Elternfragebogen für Klein- und Vorschulkinder CBCL/11/2 – 5, die Übersetzung des englischsprachigen Originals aus der Fragebogenfamilie von Thomas Achenbach, wird anhand von Daten aus dem deutschsprachigen Raum hinsichtlich seiner Anwendbarkeit überprüft. Diese umfasst die Überprüfung der faktoriellen Struktur, der internen Konsistenzen der Skalen und ihrer Korrelationen untereinander sowie Mittelwertvergleiche verschiedener Teilstichproben. Die Ergebnisse lassen die Anwendung des Fragebogens für gruppenstatistische Analysen im Rahmen verschiedener Forschungsfragestellungen gerechtfertigt scheinen. Die übergeordneten Dimensionen Externales Problem und Internales Problem sowie die Problemskalen Aufmerksamkeitsprobleme und Aggressives Verhalten können auch in der klinischen Einzelfalldiagnostik zuverlässig eingesetzt werden

Detecting effects of the indicated prevention Programme for Externalizing Problem behaviour (PEP) on child symptoms, parenting, and parental quality of life in a randomized controlled trial

Background: Behavioural parent training is effective in improving child disruptive behavioural problems in preschool children by increasing parenting competence. The indicated Prevention Programme for Externalizing Problem behaviour (PEP) is a group training programme for parents and kindergarten teachers of children aged 3-6 years with externalizing behavioural problems. Aims: To evaluate the effects of PEP on child problem behaviour, parenting practices, parent-child interactions, and parental quality of life. Method: Parents and kindergarten teachers of 155 children were randomly assigned to an intervention group (n = 91) and a nontreated control group (n = 64). They rated children&apos;s problem behaviour before and after PEP training; parents also reported on their parenting practices and quality of life. Standardized play situations were video-taped and rated for parent-child interactions, e.g. parental warmth. Results: In the intention to treat analysis, mothers of the intervention group described less disruptive child behaviour and better parenting strategies, and showed more parental warmth during a standardized parent-child interaction. Dosage analyses confirmed these results for parents who attended at least five training sessions. Children were also rated to show less behaviour problems by their kindergarten teachers. Conclusions: Training effects were especially positive for parents who attended at least half of the training sessions

Guideline adherence in German routine care of children and adolescents with ADHD: an observational study

Although guidelines for the assessment and treatment of mental disorders in childhood and adolescence have been available in Germany for several years, there are barely any data on adherence to guidelines in national routine care. Therefore, the study aimed at a nationwide evaluation of guideline adherence (GA) for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in German routine care in various groups of health care providers (HCPs). Besides a detailed description of GA, the study focused on examining possible differences between professional groups. Furthermore, data based on global self-reports of clinicians were compared with ratings of documented care in individual patients. Protocols of 73 clinicians regarding their handling of ADHD in routine care for 167 patients were rated according to German guideline recommendations for ADHD care. GA was measured as the proportion of components fulfilled in each individual patient as documented by the HCP. The results were compared to a preceding interview with clinicians regarding their GA. Multilevel models were constructed to detect differences in GA between professional groups. Based on mandatory guideline components, adherence rates of 38.9-72.7% were found and classified as moderate (33.3% &amp;lt; GA &amp;lt;= 66.6%) to high (GA &amp;gt; 66.6%). The comparison of the GA between the professional groups generally yielded only small differences. Correlations between GA reported globally by the HCPs and GA documented and rated for individual cases were low. Overall, most rates of GA for ADHD in German routine care lay within a moderate range. Targets for enhancement of GA may be the involvement of teachers and schools in the treatment process, the implementation of psychoeducational methods in general, as well as a careful examination of patients, including monitoring of treatment effects during titration trials. The development of further strategies to monitor the quality of ADHD routine care is needed

Online-Elterntraining für die Behandlung von Kindern mit externalisierenden Verhaltensproblemen und affektiver Dysregulation

Hintergrund: Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) oder oppositionelle Verhaltensstörung (OPP) gehen mit unruhigem, oppositionellem und aggressivem Verhalten, negativen Interaktionen zwischen Kind und Eltern und langfristig häufig mit belasteten Eltern-Kind-Beziehungen einher. Kognitiv-behaviorale Elterntrainings, die für die Behandlung externaler Störungen als evidenzbasiert gelten, versuchen problematische situative und Verstärkerbedingungen sowie negative Interaktionen zwischen Eltern und Kindern zu verändern. Ziel: Es sollen Online-Selbsthilfetrainings für Eltern von Kindern mit externalisierenden Verhaltensproblemen entwickelt werden. Methode: Bestehende Face-to-face-Elterntrainings wurden in Online-Formate überführt und inhaltlich erweitert. Eine Wirksamkeitsuntersuchung erfolgt im Rahmen von randomisierten Kontrollstudien. Ergebnisse: Der ADHS-Elterntrainer richtet sich an Eltern von Kindern mit subklinischen sowie klinisch relevanten ADHS-Symptomen sowie ggf. komorbid weiteren externalen Symptomen. Er zielt darauf ab, Störungsverständnis aufzubauen, die elterliche Steuerung zu erhöhen und die Eltern-Kind-Beziehung zu verbessern. Bei Kindern mit Emotionsregulationsstörungen, sog. affektiver Dysregulation, ist darüber hinaus die elterliche Unterstützung beim Erwerb funktionaler Emotionsregulationsstrategien nötig. Für das ADOPT-Online-Elterntraining (affektive Dysregulation - Optimierung von Prävention und Therapie), das sich an Eltern von Kindern mit affektiver Dysregulation richtet, wurde das Konzept des ADHS-Elterntrainers um Interventionen zum Umgang mit negativen Gefühlen des Kindes und der Eltern erweitert. Diskussion: Bei entsprechend positiven Effekten auf die kindliche Symptomatik innerhalb der Evaluationsstudien könnte das ADOPT-Online-Elterntraining wie bereits beim ADHS-Elterntrainer geschehen im präventiven oder therapeutischen Setting eingesetzt werden

Parent-Adolescent Cross-Informant Agreement in Clinically Referred Samples: Findings From Seven Societies

To conduct international comparisons of parent-adolescent cross-informant agreement in clinical samples, we analyzed ratings on the Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) for 6,762 clinically referred adolescents ages 11-18 from 7 societies (M = 14.5 years, SD = 2.0 years; 51% boys). Using CBCL and YSR data, we asked the following questions: (a) Do parents report more problems for their adolescent children than the adolescents report about themselves? (b) How do cross-informant correlations (rs) for scale scores differ by problem type and by society? (c) How well do parents and adolescents, on average, agree regarding which problems they rate as low, medium, or high? (d) How does within-dyad item agreement vary within and between societies? (e) How do societies vary in dichotomous cross-informant agreement with respect to the deviance status of the adolescents? CBCL and YSR scores were quite similar, with small and inconsistent informant effects across societies. Cross-informant rs averaged .47 across scales and societies. On average, parents and adolescents agreed well regarding which problem items received low, medium, or high ratings (M r = .87). Mean within-dyad item agreement was moderate across all societies, but dyadic agreement varied widely within every society. In most societies, adolescent noncorroboration of parent-reported deviance was more common than parental noncorroboration of adolescent-reported deviance. Overall, somewhat better parent-adolescent agreement and more consistency in agreement patterns across diverse societies were found in these seven clinical samples than in population samples studied using the same methods