Change in Families Participating in Parent Management Training Oregon: a Replicated Single Case Experimental Study:Verandering in families die een PMTO behandeling volgen: een herhaalde single case experimentele studie

Abstract

Objectives : Several randomized controlled trials showed positive effects of the behavioral parent training Parent Management Training Oregon (PMTI) on child behavior, parenting stress and parenting behavior. However, we do know less about the processes of change. In this study we therefore aimed to unravel individual processes of change in families receiving PMTO. Study design: We conducted a replicated single case experimental study with 5 families(children aged between 4-12 years). We followed the families regarding their parenting, parenting stress, child behavior and motivation to use the learned parenting strategies in three ways: 1) standardized questionnaires pre, post, and 4 months after ending PMTO, 2) assessments during each sessions, 3) daily assessments (baseline, during treatment and after PMTO ended). In addition to assessing changes in every construct, we assessed how changes in a construct were related to changes in the other constructs over time. Reliable change indices were calculated for individual pre-to post- and follow-up PMTO changes. Individual treatment effect sizes, using Simulation Modeling Analysis, were calculated for both level and slope changes from baseline to the PMTO phase, but also during PMTO, and to post-PMTO. Cross-lagged correlations were calculated as to identify how unique courses of change unfolded over time. Results: The results showed that each participating family, and mothers, fathers and children within these families, had unique individual trajectories of change. While post-assessment showed improvements during PMTO, the directions of changes between post-test and follow-up varied (sustained, further improvements, or deteriorations). Some participants changed on multiple outcomes, others on just a few. Patterns of change were sometimes linear, but sometimes showed ups and downs. When relationships between parental perceptions of parenting, parenting stress, child behavior and motivation to use the learned parenting strategies were observed, the correlations mostly (and for some families only) indicated moment-to moment associations, but hardly any associations over time. Conclusions : The five families all experienced improvements on the primary goal of PMTO: the childs’ behavior or the escalations between children and the parents. Among the 5 families who participated in PMTO, no general pattern of change could be identified. Each family and each family member seem to encounter own and unique change at its own pace