Modelling correlated data : multilevel models and generalized estimating equations and their use with data from research in developmental disabilities

Background: The use of Multilevel Models (MLM) and Generalized Estimating Equations (GEE) for analysing clustered data in the field of intellectual and developmental disability (IDD) research is still limited. Method: We present some important features of MLMs and GEEs: main function, assumptions, model specification and estimators, sample size and power. We provide an overview of the ways MLMs and GEEs have been used in IDD research. Results: While MLMs and GEEs are both appropriate for longitudinal and/or clustered data, they differ in the assumptions they impose on the data, and the inferences made. Estimators in MLMs require appropriate model specification, while GEEs are more resilient to misspecification at the expense of model complexity. Studies on sample size seem to suggest that Level 1 coefficients are robust to small samples/clusters, with any higher-level coefficients less so. MLMs have been used more frequently than GEEs in IDD research, especially for fitting developmental trajectories. Conclusions: Clustered data from research in the IDD field can be analysed flexibly using MLMs and GEEs. These models would be more widely used if journals required the inclusion of technical specification detail, simulation studies examined power for IDD study characteristics, and researchers developed core skills during basic studies

The effectiveness of universal parenting programmes : the CANparent trial

Background: There is substantial evidence for the efficacy and effectiveness of targeted parenting programmes but much less evidence regarding universal parenting programmes. The aim of the present study was to evaluate the effectiveness of the CANparent Trial of 12 universal parenting programmes, which were made available to parents of all children aged 0-6 years in three local authorities in England. To the best of our knowledge, this is the first study of universal parenting programmes on this scale. Methods: Parents accessed a voucher, value £100, to attend an accredited programme of parenting classes. Parents completed measures of their mental well-being, parenting efficacy, parenting satisfaction, and parenting stress, at pre- and post-course. Comparative data were derived from a sample of non-participant parents in 16 local authorities not providing CANparent programmes. A quasi-experimental design was adopted following estimation of propensity scores to balance the two groups on socio-demographic variables. Results: Following their programme, changes in parenting stress were small and nonsignificant (Cohen’s d frequency 0.07; intensity, 0.17). Participating parents showed significantly greater improvements than the comparison group for parenting efficacy (0.89) but not parenting satisfaction (-0.01). Mental well-being improved from 0.29 SD below the national norm to the national norm after the course. Parents were overwhelmingly positive about their course (88-94%) but this was lower for improvement in their relationship with their child (74%) and being a better parent (76%). Conclusions: The CANparent Trial demonstrated that universal parenting programmes can be effective in improving parents’ sense of parenting efficacy and mental well-being when delivered to the full range of parents in community settings. However, there was no evidence of a reduction in levels of parenting stress; nor was there a significant improvement in satisfaction with being a parent. This is the first study of its kind in the UK; although the results point to a population benefit, more research is needed to determine whether benefits can be maintained in the longer term and whether they will translate into better parenting practices

Comparing the effectiveness of evidence-based parenting programmes on families with and without children with special educational needs; short term and longer term gains

Parents of children with a disability or special educational needs (SEN) have three available options when accessing parenting programmes: (a) to access a parenting programme that has been adapted for use by families with a child with disability, (b) to access a disability-specific parenting programme, or (c) to access a parenting programme developed for typically developing children. The aim of the present study was to examine whether accessing evidence-based parenting programmes (EBPPs) developed for typically developed children (option c) could benefit families of children with SEN, and whether benefits could be maintained when programme delivery takes place as part of sustained service implementation. Using data from an effectiveness trial, we found that there was no evidence of differential effectiveness: i.e., families of children with SEN experienced similar gains to families whose child did not have SEN with respect to child behaviour problems, parenting style and parental mental well-being. Using data from services’ sustained implementation, our findings indicated that gains during the implementation phase were of similar magnitude to gains during the research trial: following EBPPs, families of children with SEN experienced small to moderate improvements in behaviour problems and moderate to large improvements in parenting and parental mental well-being across the two phases. One year later, gains were significantly maintained in families who had accessed EBPPs as part of the research trial. While the study is not proposing that EBPPs developed for typically developing children are a replacement for disability-adapted or disability-specific parenting programmes, there was a pragmatic need to evaluate the effectiveness of EBPPs that are in practice accessed by families with a child with SEN. Overall, families of children with SEN can benefit from EBPPs similarly to families whose child does not have SEN, and the gains are significant and substantial even when EBPPs are offered as part of regular service provision. Longer-term maintenance of gains (one year) in service-led implementation of EBPPs likely requires more input

The construct of maternal positivity in mothers of children with intellectual disability

Despite the elevated levels of stress, anxiety and depression reported by mothers of children with intellectual disabilities (ID), these mothers also experience positive well-being and describe positive perceptions of their child. To date, maternal positivity has been operationalised in different ways by using a variety of measures. In the present study, we tested whether a latent construct of maternal positivity could be derived from different measures of positivity. Method One hundred and thirty-five mothers of 89 boys and 46 girls with ID between 3 and 18 years of age completed measures on parental self-efficacy, their satisfaction with life, family satisfaction, their positive affect and their positive perceptions of their child with ID. We conducted a confirmatory factor analysis of latent positivity and subsequently tested its association with child social skills and behaviour problems, and maternal mental health. Results A latent maternal positivity factor achieved a statistically good fit by using the five observed indicators of positivity. Parental self-efficacy had the strongest loading on the latent factor. Maternal positivity was significantly negatively associated with maternal psychological distress, maternal stress and child problem behaviours and positively associated with child positive social behaviour. Conclusions These findings lend support to the importance of examining parental positivity in families raising a child with ID, and using multiple indicators of positivity. Associations with negative psychological outcomes suggest that interventions focused on increasing parental positivity may have beneficial effects for parents. Further research is needed, especially in relation to such interventions

Maternal stress and the functions of positivity in mothers of children with intellectual disability

Although mothers raising children with Intellectual Disability (ID) report poorer mental health than parents raising typically developing children, they also report feelings of positivity; both generally and specific to their child. To date little is known about the function of maternal positivity thus, we explored the putative compensatory and protective functions of maternal positivity, within both a cross-sectional and one-year longitudinal framework that examined the relationship between children’s behaviour and mental health problems with maternal mental health problems. Participants included 135 mothers of children with severe ID who were between 3 and 18 years of age. Multiple linear regression models investigated the potential function of maternal positivity. At a cross-sectional level, maternal positivity was found to be a significant independent predictor of maternal stress and moderated the impact of child behaviour problems on maternal parenting stress. Longitudinally, maternal positivity did not have a direct effect on later parenting stress nor function as a moderator. Findings from our cross-sectional analysis are consistent with the view that positivity serves a compensatory function. Further exploration is needed to understand the longitudinal function of maternal positivity

Parental relationship satisfaction in families of children with autism spectrum disorders (ASD) : a multilevel analysis

Couples raising a child with Autism Spectrum Disorder (ASD) face many challenges. Research so far has focused on whether these couples are more or less likely to separate or divorce compared to other couples whose children do not have ASD. While this is important, we argue that the quality of the couple relationship is equally- if not more- important to research. Systematic evidence from typical development has shown that the quality of the couple’s relationship is related to parenting and also to long-term behavioral and emotional outcomes of children. With this study, we wanted to explore whether mothers and fathers of children with ASD are satisfied with their relationship, and what individual or family-level factors are related to the couple’s relationship satisfaction levels. Our data from 146 couples suggested that mothers and fathers agree on how satisfied they are with their relationship, and that relationship satisfaction appears to be related to parents’ depressive symptoms and the behavior problems of their child with ASD. The higher the depression levels, the lower the parent reported on the dependent variable relationship satisfaction, for both mothers and fathers. Also, as behavior problems increased, relationship satisfaction decreased. Interestingly, relationship satisfaction was not related to the behavior problems of a sibling, the number of children in the household, or the socioeconomic position of families (SEP). Families include interconnected systems whereby an individual’s well-being and behavior can have an impact (positive or negative) on other family dyads such as the couple relationship

Sustained Effectiveness of Evidence-Based Parenting Programs After the Research Trial Ends

Despite ample evidence of the efficacy and effectiveness of evidence-based parenting programs (EBPPs) within research-led environments, there is very little evidence of maintenance of effectiveness when programs are delivered as part of regular service provision. The present study examined the effectiveness of EBPPs provided during a period of sustained service-led implementation in comparison to research-led effectiveness evaluation. Data from 3706 parents who received EBPPs during sustained implementation by services were compared to data from 1390 parents who had participated in an earlier researcher-led effectiveness trial of a national roll-out of EBPPs in England. In both phases, parents completed measures of child behavior problems, parenting style and parental mental well-being prior to starting parenting programs (pre-test), at the end of the programs (post) and at 12-months follow up. Results from Generalized Estimating Equations controlling for potential covariates indicated significant improvements in child behavior problems during sustained implementation, similar to the effectiveness phase; significant improvements in parenting style which were larger than the effectiveness phase at 12-month follow up; and significant improvements in parental mental well- being. Our findings demonstrate effective maintenance of gains when EBPPs are provided as part of regular provision across a large sample of English parents. Successful long-term implementation should consider effectiveness of EBPPs across the population, given the large contextual changes that take place between researcher-led evaluations and service take-up. Our findings support the integration of EBPPs in public health approaches to addressing child behavior problems and parent well-being

A population-based study of the behavioral and emotional adjustment of older siblings of children with and without intellectual disability

This is the first study on the behavioral and emotional adjustment of siblings of children with intellectual disabilities (ID) to use a population-based sample, from the third wave of the Millennium Cohort Study (MCS); a UK longitudinal birth cohort study. We examined differences between nearest-in-age older siblings (age 5–15) of MCS children (likely mainly with mild to moderate ID) identified with ID (n = 257 siblings) or not (n = 7246 siblings). The Strengths and Difficulties Questionnaire (SDQ) measured all children’s adjustment. For SDQ total problems, 13.9% of siblings of children with ID and 8.9% of siblings of children without had elevated scores (OR 1.65; 95% CI 1.04, 2.62; p = 0.031). Similar group differences were found for SDQ peer and conduct problems. In logistic regression models, variables consistently associated with older sibling adjustment were: adjustment of the MCS cohort child, older sibling being male, family socio-economic position, primary carer psychological distress, and being from a single parent household. The ID grouping variable was no longer associated with adjustment for all SDQ domains, except siblings of children with ID were less likely to be identified as hyperactive (OR 0.30; 95% CI 0.10, 0.87; p = 0.027). Some older siblings of children with ID may be at additional risk for behavioral and emotional problems. Group differences were related mainly to social and family contextual factors. Future longitudinal research should address developmental pathways by which children with ID may affect sibling adjustment

Early Years Parenting Mediates Early Adversity Effects on Problem Behaviors in Intellectual Disability

A family developmental framework was applied to data from families of children with intellectual disabilities to understand the role of parenting in the path from early adversity to problem behaviors in mid-childhood. Data from 9 months to 11 years tested the Family Stress Model in families of 555 children. Adversarial parenting between 3 and 5 years mediated the path from early adversity (family poverty and maternal psychological distress at nine months) to problem behaviors at 7 and 11 years. Positive parent-child relationship only mediated the path to conduct problems. Multiple mediation was not present. Early adversity impacts both positive parent-child relationship and adversarial parenting between three and five, but the latter is crucial for problem behaviors in mid-childhood