ABSTRACT Objective Behavioral parent training (BPT) is the first line of treatment for preschool-aged children with attention-deficit hyperactivity disorder (ADHD); however, clinically significant improvements are not universal. In the current study, we employ a person-centered approach to create subgroups of families based on the intersection of multiple parent, child, and family pre-treatment factors. Further, we explore the utility of pre-treatment family profiles in predicting post-treatment differences in observed parenting behavior (i.e., behavioral control, parental warmth) and clinically significant change in child ADHD and oppositional symptoms. Method Longitudinal data were collected using observational and parent-, teacher- and clinician-reported assessments from 130 parent-child dyads (M age= 3.57, range = 3.0– 4.11, 73.8% male, 69.2% White, 25.6% Hispanic) participating in BPT. Results Findings from the current study suggest three distinct family profiles, which consisted of one profile with high family stress (HFS) as evidenced by elevated symptomatology across parent, child, and family-level domains, a second profile with elevated parental anxiety (PA), and a final profile with elevated parental depression (PD). These family-centered profiles were differentially associated with changes in observed parenting practices. Specifically, the PD profile (39%) demonstrated minimal improvements in behavioral control and warmth following treatment. In contrast, the HFS profile (30%) only improved in behavioral control and the PA profile (31%) improved in both parenting domains following treatment. In addition, marginally significant differences in child oppositional and ADHD symptoms were observed across profiles. Conclusions Family-centered approaches may be useful for selecting and implementing interventions.

As mental health professionals, it is important to be aware of emerging trends that have the potential to significantly influence mental health services for children. Doing so increases our ability to more accurately anticipate and, hopefully, more effectively address future challenges in our field. In this regard, I will address two trends—both of which are being influenced by advances in genomic research—that I believe have the potential to profoundly impact child and family mental health services over the coming decades. These trends are (1) the growth of personalized medicine and (2) the increasing focus on toxic stress during childhood.

Parent training involves teaching parents and primary caregivers how to address and intervene with their children’s problem behaviors. These types of interventions have gained increasing popularity over the past several decades. Additionally, they have a strong evidence base supporting positive outcomes for both parents’ and children’s behavior, from different theoretical orientations, and across a number of populations and problems. Several behavioral parent training programs have been developed that teach a number of different skills including attending, rewarding, giving effective instructions, ignoring, and time-out. This chapter discusses and reviews many of these parent training programs and their supporting evidence. Current and anticipated trends such as the increasing use of technology in parent training and the dissemination of parent training programs to different countries and cultures are also discussed. Overall, while the field of parent training and its future looks bright, more work is needed to better understand what specific variables contribute to the effectiveness of parent training programs and what works best for whom.

Previous studies have suggested that children with Attention-Deficit/Hyperactivity Disorder (ADHD) may benefit less from behavioral parent training (BPT) if their parents have high levels of ADHD symptoms. We conducted a secondary analysis of data from a randomized controlled trial to test the hypothesis that parental ADHD symptoms reduce the efficacy of two BPT programs in a sample of preschoolers with ADHD. One intervention was specifically designed for children with ADHD (NFPP: New Forest Parenting Programme) and one was designed for children with Oppositional Defiant Disorder (ODD) (HNC: Helping the Noncompliant Child). Neither intervention was adapted to address parental ADHD symptoms. This secondary analysis included data from 164 parents and their 3-4 year-old children who were randomly assigned to one of the two programs or a waitlist group. Children were compared on ADHD and ODD outcomes at post-intervention and a 6-month follow-up. The presence of parent ADHD symptoms reduced the efficacy of BPT in only one of 16 analyses. Implications and limitations (e.g., low baseline rate of parental ADHD symptoms) of the findings are provided.

The present study examined whether the presence of comorbid ODD differentially moderated the outcome of two Behavioral Parent Training (BPT) programs in a sample of preschoolers with ADHD: One designed specifically for ADHD (NFPP: New Forest Parenting Programme) and one designed primarily for ODD (HNC: Helping the Noncompliant Child). In a secondary analysis, 130 parents and their 3–4 year-old children diagnosed with ADHD were assigned to one of the two programs. 44.6 % of the children also met criteria for ODD. Significant interactions between treatment conditions (NFPP vs. HNC) and child ODD diagnosis (presence vs. absence) indicated that based on some parent and teacher reports, HNC was more effective with disruptive behaviors than NFPP but only when children had a comorbid diagnosis. Further, based on teacher report, NFPP was more effective with these behaviors when children had a diagnosis of only ADHD whereas HNC was equally effective across ADHD only and comorbid ODD diagnoses. Comorbidity profile did not interact with treatment program when parent or teacher reported ADHD symptoms served as the outcome. Implications for clinical interventions are discussed and directions for future work are provided.

BACKGROUND:The 'New Forest Parenting Package' (NFPP), an 8-week home-based intervention for parents of preschoolers with attention-deficit/hyperactivity disorder (ADHD), fosters constructive parenting to target ADHD-related dysfunctions in attention and impulse control. Although NFPP has improved parent and laboratory measures of ADHD in community samples of children with ADHD-like problems, its efficacy in a clinical sample, and relative to an active treatment comparator, is unknown. The aims are to evaluate the short- and long-term efficacy and generalization effects of NFPP compared to an established clinic-based parenting intervention for treating noncompliant behavior ['Helping the Noncompliant Child' (HNC)] in young children with ADHD.METHODS:A randomized controlled trial with three parallel arms was the design for this study. A total of 164 3-4-year-olds, 73.8% male, meeting DSM-IV ADHD diagnostic criteria were randomized to NFPP (N = 67), HNC (N = 63), or wait-list control (WL, N = 34). All participants were assessed at post-treatment. NFPP and HNC participants were assessed at follow-up in the next school year. Primary outcomes were ADHD ratings by teachers blind to and uninvolved in treatment, and by parents. Secondary ADHD outcomes included clinician assessments, and laboratory measures of on-task behavior and delay of gratification. Other outcomes included parent and teacher ratings of oppositional behavior, and parenting measures. (Trial name: Home-Based Parent Training in ADHD Preschoolers; Registry: ClinicalTrials.gov Identifier: NCT01320098; URL: http://www/clinicaltrials.gov/ct2/show/NCT01320098).RESULTS:In both treatment groups, children's ADHD and ODD behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes significantly less effective, than HNC.CONCLUSIONS:The results do not support the claim that NFPP addresses putative dysfunctions underlying ADHD, bringing about generalized change in ADHD, and its underpinning self-regulatory processes. The findings support documented difficulties in achieving generalization across nontargeted settings, and the importance of using blinded measures to provide meaningful assessments of treatment effects.

This paper discusses the impact of stress and family economic hardship on children, parents, and parenting. Specific topics covered include the long-term impact of toxic stress on children, the mechanisms through which stressors appear to impact children, the impact of economic hardship, the role of parental depression, and implications for pediatric dentists.

Parental tolerance has been defined as the degree to which a parent tends to be annoyed by his or her child’s disruptive behavior. The purpose of the current study is to examine the relation of both parent and child gender to parental tolerance of child disruptive behaviors. Participants were 150 parents with 3–6 year-old at-risk children (47.5 % girls) who sought help with parenting of their child’s oppositional defiant behaviors. Tolerance was measured by the difference between parent ratings of intensity on 36 disruptive behaviors and whether each behavior was identified as a problem (resulting in a score of either high, expected, or low tolerance). A 2 (child gender) by 2 (parent gender) analysis of variance was conducted on the tolerance score. A significant interaction between child and parent gender emerged: Mothers were equally tolerant of boys’ and girls’ oppositional defiant behavior but fathers were more tolerant of boys’ than girls’ oppositional behavior. Exploratory analyses suggested that this interaction may be qualified by clinical status of the child. Implications and future directions are discussed.

The role of parenting in child disruptive behaviors has received substantial support; however, the findings as to differential effects of specific parenting behaviors (e.g., discipline) on boys’ and girls’ disruptive behavior problems have not been consistent. The current study examined the individual, unique, and interactive relation of two types of ineffective discipline (i.e., harsh & permissive) with child disruptive behavior for at-risk boys and girls separately. Participants were 160 parents with 3- to 6-year-old at-risk children (47.5% girls). Findings revealed that higher levels of harsh discipline were related to more intense disruptive behavior of both boys and girls, whereas higher levels of permissive discipline were related to more intense disruptive behavior of only boys. Additionally, results indicated that harsh and permissive discipline did not interact to predict child disruptive behavior problems. Clinical implications and directions for future research are discussed.

One pressing issue facing parenting interventions for disruptive behaviors of young children is forecasting who will benefit from participation. The purpose of this study was to examine four personal and interpersonal predictors (i.e., parent depressive symptoms, parent education, coparent conflict, and marital status) of engagement (i.e., number of sessions attended) in and child outcome (i.e., problematic behavior) of a parenting group curriculum program targeting young children's disruptive behaviors. Participants were 39 parents (34 mothers and 5 fathers; M = 38.6 years) who expressed an interest in improving the behavior of their 3- to 6-year-old child (19 females and 20 males; M = 4.50 years). Findings indicated that one baseline personal variable, parent depressive symptoms, predicted change in child disruptive behavior at follow-up, and two baseline interpersonal variables, marital status and coparent conflict, predicted engagement in treatment (i.e., number of sessions attended). Implications and directions for future research are discussed.

This study examined effectiveness of a Group Curriculum (GC) for parents of 3- to 6- year-old children with disruptive behavior. The curriculum is based on the book Parenting the Strong-Willed Child. A total of 39 parents were randomly assigned to the GC condition or a wait-list control condition. Assessments occurred at baseline, postintervention (6 weeks after baseline), and 2-month follow-up. Findings indicated that the GC condition was associated with lower levels of child problem behavior and improved parenting at postintervention relative to the control condition. Parents were also satisfied with the intervention. Uncontrolled 2-month follow-up data suggested that changes were maintained from postintervention to follow-up for all outcome measures.

Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents' Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = .68, CI:0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success.

The purpose of this study was to address the following question: Why do parents first seek help with parenting when they report their child’s disruptive behaviors are within normative levels? Two groups were selected for study from a sample of 91 parents of 3- to 6-year-olds who sought help with parenting: Parents reporting disruptive behavior problems in the normative range ( n = 22) or above a clinical cutoff ( n = 19). Logistic regression was used to examine two competing hypotheses about family variables which may account for why parents seek help when reporting normative levels of disruptive behaviors: Alternative family stress (i.e., high levels of family stress other than child disruptive behavior) and parent enhancement and validation (i.e., enhance and validate parenting although child behavior is in normal range). No support emerged for the alternative family stress hypothesis whereas multiple indicators (better use of disciplinary strategies, seeking services for a first born child, and being more highly educated) provided support for the parent enhancement and validation hypothesis.

We examine efficacy of the Parents Matter! Program (PMP), a program to teach African-American parents of preadolescents sexual communication and HIV-prevention skills, through a multicenter, randomized control trial. A total of 1115 parent-child participants were randomized to one of three intervention arms (enhanced, brief, control). Percentages and 95% confidence intervals compare parents' perception of child readiness to learn about sexual issues, communication effectiveness, and dyad concordance from baseline to 12 months postintervention. Wilcoxon rank sum tests compare the changes in scores measuring communication content in HIV/AIDS, abstinence, and condom use. Compared to control, parents in the enhanced arm increased perception of child readiness to learn about sex (16% vs. 29%; p < .001), and a greater proportion of parent-child dyads reported concordant responses on communication topics: HIV/AIDS (15%, 95% CI = 8-21%; p < .001), abstinence (13%, 95% CI = 7-20%; p < .001), condoms (15%, 95% CI = 9-22%; p < .001). Increases in communication scores in HIV/AIDS, abstinence, and condom use were greater in the enhanced arm than control (p < 0.01). We conclude that the enhanced PMP can help parents educate children about HIV and prepare children to avoid sexual risk.

This study examined the Parenting the Strong-Willed Child (PSWC) book as a self-directed program for parents of 3- to 6-year-olds. Fifty-two parents were randomly assigned to PSWC or a comparison book, Touchpoints: Three to Six. Assessments occurred at baseline, postintervention (6 weeks after baseline), and 2-month follow-up. The findings indicated both books, but particularly PSWC, were associated with lower levels of child problem behavior after intervention. PSWC was associated with greater decreases in child problem behaviors on certain measures when amount of reading completed was taken into account. Parents reading PSWC reported that they were satisfied with the book and found the book useful and easy to implement. The findings are discussed in the contexts of both the percentage of parents who read the PSWC book and the cost-effectiveness of a self-directed intervention.