Parental Training and Contingency Contracting for Overweight Children
OVERVIEW
A program was conducted with the intention of treating overweight children. Fifteen girls were randomly assigned to one of two experimental conditions or a control group. The goal of the treatment was to teach behavioral techniques that would impact children's eating and exercise habits and thus lead to weight loss. Some parents were also contracted to reinforcement and stimulus control techniques which might facilitate their child's weight loss. At the end of the treatment, both experimental groups had lost significantly more weight than the control group. However, at the first follow-up, it was found that some of the lost weight was regained, the treatment group in which parents were also contracted to use reinforcement techniques was still significantly below the control group. At the 31-week follow-up, no significant differences were found.
DESCRIPTION OF PROGRAM
Target population: Overweight children 5-10 years of age.
This program attempted behavioral techniques to treat overweight children. Parents were taught behavior-modification procedures that might change their children's eating and exercise habits. Parents were also encouraged to reinforce their child's weight loss through contingency training (response-cost) with the program. In this situation, parents were penalized if their children did not meet the weight loss goals.
EVALUATION(S) OF PROGRAM
Aragona, J., Cassady, J., Drabman, R.S. (1975). Treating Overweight Children Through Parental Training and Contingency Contracting. Journal of Applied Behavioral Analysis, 8(3), 269-278.
Evaluated population: Fifteen overweight girls, ages 5-10. Children were determined to be overweight if both their physician and their parents recommended that they take part in the weight-loss program. Children were not allowed to participate if they were currently undergoing psychotherapy, drug therapy, or were involved in a weight-loss program elsewhere. It was necessary for all families in the program to own a bathroom scale.
Approach: Participants were randomly assigned to one of three groups: Group 1 was a response-cost (or contingency contracting) plus reinforcement; Group 2 was response-cost only, and group 3 was a control group. For participation in the program, a physician permission form was required in which it was indicated that it was safe for the child to participate over the course of 12 weeks.
The parents of the children in both experimental groups were provided with daily weight and calorie graphs, a calorie counter guide, and an eating diary. They were also given a weight reduction program behavioral contract, as well as daily exercise instructions and program. Finally, they received nutritional information and instructions for stimulus control techniques.
The parents of the children in the response-cost plus reinforcement group were provided with a copy of Living with Children (Patterson and Gullion, 1971), information on reinforcement techniques, as well as a reinforcement diary.
Baseline information for both experimental groups was obtained over a 2 week period. Measurements of height were also taken at the first baseline meeting. Those in the control group were measured the same day but were then told the program was currently closed and they would have to wait to participate at a later time. Parents in both experimental groups received similar response-cost contracts at the second baseline meeting, and were also asked to decide on weekly weight-loss goals for their children, between 1 and 2 pounds. The deposit asked of the parents ranged from $12-30 and depended on the family income and number of dependents. At the third baseline meeting, more information was provided, signed forms and contracts were collected, and children were weighed once again. After this, a 12-week treatment period began.
Those in group 1 (response-cost plus reinforcement) received the exercise program, nutritional information, and stimulus control information. Parents of children in this group were also required to keep a daily food diary and to graph their child's caloric intake and weight daily. The deposit they made at the beginning of the program was returned in 12 weekly installments; they received 25% weekly for attendance, 25% for bringing completed graphs and charts to the meeting, and 50% if their child lost the predetermined amount of weight set by the contract. These parents also received instructions on reinforcement and changing their child's behavior; they discussed the text they were provided at each meeting, they set a weekly reinforcer for losing weight (for their child) and they kept a reinforcement diary in which they recorded the specific reinforced, the behavior being reinforced, and when the reinforcer was given.
Those in group 2 (response-cost only) received the same treatment as those in group 1, except for the reinforcement component. Parents in this group did not receive information in reinforcement and procedures for it were not discussed.
Every six weeks, any unearned money was divided among successful parents and their progress was discussed and verbally reinforced, but any lack of success was ignored.
Those in the control group were weighed and height was measured before and after the program duration. They received no contract. All 3 groups were followed-up 8 and 31 weeks after the end of the program.
Results: Of the 15 participants initially recruited, 3 dropped out (one from group 1 and two from group 2). Mean baseline weight for those in group 1 was 105.5 pounds; for group 2, it was 105.3 pounds; for group 3 it was 99.3 pounds, with no significant difference between groups analyzed. At the end of the program, significant differences in weight were found. Children in group 1 had lost an average of 11.3 pounds. Those in group 2 had lost an average on 9.5 pounds, and those in the control group had gained an average of 0.9 pounds. Both experimental groups lost significantly more weight than the control group.
At the week 8 follow-up, information was analyzed for only 11 children, since one of the control group members had started another treatment program, which undermines the intent-to-treat evaluation design. At this time, those in group 1 maintained an average weight loss of 7.9 pounds. Children in group 2 maintained an average weight loss of 5 pounds, while those in the control group had a gain of 3.6 pounds. Analyses show that those in group 1 had gained back significantly less weight than those in the control group.
At the 31 week follow-up it was not possible to obtain information on those in the control group, but it was found that the two experimental groups were not significantly different at this time. Findings are undermined by the small sample size and attrition.
SOURCES FOR MORE INFORMATION
References
Aragona, J., Cassady, J., Drabman, R.S. (1975). Treating Overweight Children Through Parental Training and Contingency Contracting. Journal of Applied Behavioral Analysis, 8(3), 269-278.
Patterson, G.R and
Program categorized in this guide according to the following:
Evaluated participant ages: 5-11
Program age ranges in the guide: Middle Childhood
Program components: Parent/Family Component
Measured outcomes: Physical Health
KEYWORDS: Physical Health, Overweight, Nutrition, Physical Activity/Fitness, Exercise, Weight Loss, Life Skills Training, Early Childhood (0-5), Middle Childhood (6-11), Parent or Family Component, Children, Behavior-Modification.
Program information last updated 04/01/08.
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© Child Trends 2003 |
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