Program

May 22, 2015

OVERVIEW

Targeting parents of preschoolers with externalizing problem behavior (EPB), this telephone-assisted intervention involves parent use of a self-help book, augmented with weekly telephone consultations, to gain the skills needed to deal with EPB. Information on how to manage problem behavior is broken into units that parents discuss by phone with a trained child psychologist. In a randomized controlled trial of the program, children in the treatment group had significantly improved markers related to problem behavior after the intervention was complete, while children in the control group experienced no change. Outcomes that were significantly improved in the treatment group included externalizing and internalizing problem behavior, indicators of ADHD, and indicators of oppositional defiant disorder.

DESCRIPTION OF PROGRAM

Target population: Preschool children with externalizing problem behavior

This home-based intervention uses a self-help book for parents of hyperactive and oppositional children, as well as brief, weekly telephone consultations, to provide parents of children with externalizing problem behavior with skills that could reduce the incidence of these behaviors. Externalizing problem behavior (EPB) includes aggressive, defiant, hyperactive, inattentive, impulsive, or oppositional behaviors, and is associated with an increased risk of delinquency and crime later in life. For the each of the 11 weeks of the program, parents read a chapter of Wackelpeter und Trotzkopf, apply the skills they learned in interactions with their children, and discuss them in a 20-minute phone conversation with a child psychologist. The program aims to improve both child and parent outcomes: child outcomes include incidence of externalizing or internalizing problem behavior, and parent outcomes revolve around parenting skills, as well as mental health issues such as stress.

EVALUATION OF PROGRAM

Kierfeld, F., Ise, E., Hanisch, C., Görtz-Dorten, A., & Döpfner, M. (2013). Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: A randomized controlled trial. European Child & Adolescent Psychiatry, 22, 553-565.

Evaluated population: Forty-eight preschoolers and their parents formed the sample for this study. Children were identified as exhibiting mild to moderate EPB (75th to 85th percentiles) in a large-scale prevention study looking at 62 kindergartens in Cologne, Germany. On average, children were five years old. Seventeen percent of the children were living with one parent, and 15 percent exhibited some degree of language problem. The sample was split equally between boys and girls. Overall, 40 percent of parents had a college degree, 46 percent were trained workers, and 15 percent were untrained workers. The majority (83 percent) of families were German.

Approach: Researchers initially asked 241 families to participate in the study, but 189 declined participation, citing language problems or a lack of time or interest. The remaining 48 children were assigned, using block randomization, to either the treatment group or a control group. While the treatment group received the intervention in the 11 weeks of the study, the control group was placed on a waitlist and received the intervention after the study concluded. Parents in the treatment group received a copy of Wackelpeter und Trotzkopf ,and read one section per week. Once a week, a child psychologist (the same for all parents) called for a brief discussion of the week’s reading; she answered questions about the material, and determined if the program had been adhered to, in terms of reading the assigned chapter and applying the new skills. Although 44 percent of families in the treatment group needed more than the allotted 11 weeks to complete the intervention, only one family dropped out of the program.

Using scales to quantify behavioral outcomes, researchers measured externalizing and internalizing problem behavior (internalizing behavior includes depression, withdrawal, and anxiety), ADHD-related behavior, and behavior associated with oppositional defiant disorder (ODD). Data related to these outcomes consisted of parent-reported accounts of behavior, and were collected pre- and post-test. Children in the treatment and control groups differed only in their gender composition: while the treatment group was 39 percent male, boys made up 64 percent of the control group.

Results: In the post-test evaluation, outcomes for the children in the treatment group were significantly improved, compared with those of the control group. Researchers found children of families receiving the intervention scored lower on the measures of externalizing and internalizing problem behavior, and behaviors associated with ADHD and ODD (effect sizesof at least 0.79 for all outcomes). Similarly, the percent of children in the treatment group scoring above average on these measures dropped significantly between pre- and post-test, while those in the control group experienced no such impact. However, researchers note that families participating in the evaluation may have been particularly receptive to the treatment. Participating parents were relatively well-educated, and a book-based treatment such as this may not be as effective with less-educated families. Similarly, low attrition rates indicate high motivation in the participating families; however, as noted earlier, 189 of 237 invited families declined to take part.

SOURCES FOR MORE INFORMATION

References

Kierfeld, F., Ise, E., Hanisch, C., Görtz-Dorten, A., & Döpfner, M. (2013). Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: A randomized controlled trial. European Child & Adolescent Psychiatry, 22, 553-565.

KEYWORDS: Children (3-11), males and females (co-ed), preschool, home-based, parent or family component, parent training/education, skills training, conduct/disruptive disorders, aggression.

Program information last updated on 5/1/15.