Training adults to have more effective parenting skills is the most potent tool available and should remain the standard of care in treating preadolescent children with serious conduct behavior problems.
That finding comes from a new study that indicates for the first time that the same interventions used to treat boys with conduct problems also can be utilized to help girls with similar problems, said Theodore Beauchaine. He is a University of Washington associate professor of psychology and lead author of the paper appearing in the current issue of the Journal of Consulting and Clinical Psychology.
“You don’t treat conduct disorder or delinquency just by treating the child,” Beauchaine said. “This study shows that parent training is the most effective tool in dealing with conduct disorder. We compared a great number of variables and there was not a single condition where a treatment without parent training was more effective.”
However, Beauchaine said all things being equal, more treatment is better than less and programs that also target children and their teachers also help youngsters with conduct problems.
“Children’s behavior also is formed and maintained outside the home. So if you work with parents and teachers, as well as give a child social skills, you are addressing three different areas and have the best chance of improving behavior.”
Problem behaviors stemming from conduct disorder and the less severe oppositional defiant disorder are estimated to affect between 4 percent and 5 percent of children in the United States.
Collaborating on the study was Carolyn Webster-Stratton, director of the UW’s Parenting Research Clinic and a professor of Family and Child Nursing, who has designed interventions evaluated in this study to help parents, children and teachers improve child problem behavior. The new study combined data from more than 500 children and their families in six randomized clinical trials previously conducted by Webster-Stratton. It was designed to examine proven programs and identify those factors that enhance or negatively affect treatment under specific conditions. In addition, the study sought to identify those children who are most likely to benefit from an intervention since even the most successful programs for conduct problems are effective only for about two-thirds of participants. There were 402 boys and 112 girls in the study ranging in age from 3 to 8½.
The study also found that:
Those children who also had symptoms of depression or anxiety responded more positively to treatment.
Impulsive children with concurrent behavior problems and attention-deficit/hyperactivity disorder responded best to interventions when teacher training was added to parent training.
Children with younger, rather than older, mothers showed more improvement. This surprising finding may stem from more flexible behavior by younger mothers than older mothers, who may have more children and less patience to deal with disruptive behaviors.
Children whose parents were less harsh and less critical at the beginning of the project and showed the most improvement in these areas as a result of parent training, tended to respond better to the interventions.
“This study tells us where to put our resources in treating conduct problems,” said Beauchaine, “and that we can do the same things with girls as we have been doing for boys. We didn’t know this before because there have been so few girls included in previous studies.
“Treating conduct disorder is not something we want to skimp on. Dealing with the conduct disorder is the most expensive mental health problem in this country. Identifying and treating young children when problems first occur is more likely to be successful and cost effective than waiting until these children become adolescents and have a chronic history of antisocial behavior.
“If a young child has a hitting problem, for example, he or she is less likely to grow out of that behavior than most parents think,” he said.
The parent training program used in the study taught parents child-directed play skills, effective parenting, communication and problem solving skills, strategies for coping with stress and ways to boost children’s social skills and manage aggressive and problematic behaviors. The child training program included teaching youngsters how to follow school rules, doing one’s best in school, coping with feelings, problem solving, anger management, making friends and engaging in teamwork. The teacher program included training in building positive relationships with students, strategies to promote parent-teacher collaboration, the importance of positive attention and praise, proactive strategies for preventing problem behavior, limit-setting, classroom management strategies and methods for increasing appropriate social behavior among students.
Co-author of the study was M. Jamila Reid, a researcher in the UW’s Parenting Research Clinic. The study was funded in part by the National Institute of Mental Health.