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1.  Preliminary Efficacy of a Cognitive-Behavioral Treatment Program for Anxious Youth with Autism Spectrum Disorders 
Journal of autism and developmental disorders  2009;10.1007/s10803-009-0801-9.
Anxiety is a commonly occurring psychiatric concern in adolescents with autism spectrum disorders (ASD). This pilot study examined the preliminary efficacy of a manual-based intervention targeting anxiety and social competence in four adolescents with high-functioning ASD. Anxiety and social functioning were assessed at baseline, midpoint, endpoint, and 6 months following treatment. Treatment consisted of cognitive-behavioral therapy, supplemented with parent education and group social skills training. The treatment program was effective in reducing anxiety in three of the four subjects and improving the social skills in all four subjects. Recommendations for the assessment and treatment of anxiety youth with ASD such as use of self-report measures to complement clinician and parent-reports and adaptations to traditional child-based CBT, are offered.
doi:10.1007/s10803-009-0801-9
PMCID: PMC2907432  PMID: 19568924
Cognitive-behavioral therapy; Autism; Treatment; Anxiety
2.  Supporting Parents of Very Young Children with Type 1 Diabetes: Results from a Pilot Study 
Patient education and counseling  2011;82(2):271-274.
Objective
To assess initial efficacy and feasibility of a telephone-based supportive intervention for parents of young children with type 1 diabetes (T1D) designed to improve parental quality of life (QOL) through decreased parental stress, increased social support, and improved daily management of their child's diabetes.
Methods
The research team developed a brief program based on Social Cognitive Theory for parents of young children with T1D. Twenty-four parents (88% mothers) of young children with T1D (ages 2 – 5 years) participated in a pilot study of the program and completed psychosocial questionnaires and a program satisfaction survey.
Results
Paired t tests of pre- and post-intervention scores suggested a favorable within-group impact for the intervention group, as evidenced by decreased pediatric parenting stress and a trend for increased perceived social support. The program was well-received, with the majority of participants rating it as helpful and interesting.
Conclusion
Assisting parents with the unique challenges of diabetes management in young children through implementation of a structured intervention is promising.
Practice Implications
A telephone-based intervention focused on child development, coping, and problem-solving skills has the potential to positively impact parents' QOL and may have implications for children's health.
doi:10.1016/j.pec.2010.04.007
PMCID: PMC2965294  PMID: 20434293
Type 1 Diabetes; Parenting; Randomized Controlled Trial
3.  Effects of 2 Prevention Programs on High-Risk Behaviors Among African American Youth 
Objective
To test the efficacy of 2 programs designed to reduce high-risk behaviors among inner-city African American youth.
Design
Cluster randomized trial.
Setting
Twelve metropolitan Chicago, Ill, schools and the communities they serve, 1994 through 1998.
Participants
Students in grades 5 through 8 and their parents and teachers.
Interventions
The social development curriculum (SDC) consisted of 16 to 21 lessons per year focusing on social competence skills necessary to manage situations in which high-risk behaviors occur. The school/community intervention (SCI) consisted of SDC and school-wide climate and parent and community components. The control group received an attention-placebo health enhancement curriculum (HEC) of equal intensity to the SDC focusing on nutrition, physical activity, and general health care.
Main Outcome Measures
Student self-reports of violence, provocative behavior, school delinquency, substance use, and sexual behaviors (intercourse and condom use).
Results
For boys, the SDC and SCI significantly reduced the rate of increase in violent behavior (by 35% and 47% compared with HEC, respectively), provoking behavior (41% and 59%), school delinquency (31% and 66%), drug use (32% and 34%), and recent sexual intercourse (44% and 65%), and improved the rate of increase in condom use (95% and 165%). The SCI was significantly more effective than the SDC for a combined behavioral measure (79% improvement vs 51%). There were no significant effects for girls.
Conclusions
Theoretically derived social-emotional programs that are culturally sensitive, developmentally appropriate, and offered in multiple grades can reduce multiple risk behaviors for inner-city African American boys in grades 5 through 8. The lack of effects for girls deserves further research.
doi:10.1001/archpedi.158.4.377
PMCID: PMC2386246  PMID: 15066879
4.  Application of integrated yoga therapy to increase imitation skills in children with autism spectrum disorder 
International Journal of Yoga  2010;3(1):26-30.
Background/Aim:
Children with autism exhibit significant deficits in imitation skills, which impede the acquisition of more complex behavior and socialization. Imitation is often targeted early in intervention plans and continues to be addressed throughout the child’s treatment. The use of integrated approach to yoga therapy (IAYT) as a complementary therapy for children diagnosed with autism spectrum disorder (ASD) is rarely reported and little is known on the effectiveness of such therapies. This study investigated IAYT as a treatment method with children with ASD to increase imitative skills.
Materials and Methods:
Parents and six children with ASD participated in a 10-month program of 5-weekly sessions and regular practice at home. Pre, mid and post treatment assessments included observers and parent ratings of children’s imitation skills in tasks related to imitation skills such as gross motor actions, vocalization, complex imitation, oral facial movements and imitating breathing exercises.
Results:
Improvement in children’s imitation skills especially pointing to body, postural and oral facial movements. Parents reported change in the play pattern of these children with toys, peers and objects at home.
Conclusions:
This study indicates that IAYT may offer benefits as an effective tool to increase imitation, cognitive skills and social-communicative behaviors in children with ASD. In addition, children exhibited increased skills in eye contact, sitting tolerance, non-verbal communication and receptive skills to verbal commands related to spatial relationship.
doi:10.4103/0973-6131.66775
PMCID: PMC2952122  PMID: 20948898
Autism; Yoga; Imitation
5.  Enhancing youth outcomes following parental divorce: A longitudinal study of the effects of the New Beginnings Program on educational and occupational goals 
This study examined whether the New Beginnings Program for divorced families led to improvements in youth’s educational goals and job aspirations six years following participation and tested whether several parenting and youth variables mediated the program effects. Participants were 240 youth aged 9–12 years at the initial assessment, and data were part of a randomized, experimental trial of a parenting skills preventive intervention targeting children’s post-divorce adjustment. The results revealed positive effects of the program on youth’s educational goals and job aspirations six years after participation for those who were at high risk for developing later problems at program entry. Further, intervention-induced changes in mother-child relationship quality and youth externalizing problems, internalizing problems, self-esteem, and academic competence at the six-year follow-up mediated the effects of the program on the educational expectations of high-risk youth. Intervention-induced changes in youth externalizing problems and academic competence at the six-year follow-up mediated the effects of the program on the job aspirations of high-risk youth. Implications of the present findings for research with youth from divorced families and for the public health burden of divorce are discussed.
doi:10.1080/15374416.2012.651992
PMCID: PMC3306131  PMID: 22417189
6.  Direct and Indirect Psychosocial Outcomes for Children with Autism Spectrum Disorder and their Parents Following a Parent-involved Social Skills Group Intervention 
Objective:
This study examined the direct and indirect outcomes of a social skills group intervention for children with high functioning autism spectrum disorders and their parents.
Method:
Thirty-five children and their parents participated in the program evaluation. Children and parents completed measures of child social skills and problem behaviors. Children reported on their self-concept, and parents reported on their psychological acceptance and empowerment.
Results:
Results indicate significant increases in overall child social skills according to parent and child report, in child general self-worth, and in parent service empowerment and psychological acceptance.
Conclusion:
While past program evaluations of social skills groups highlight changes in social competence, taking a broader perspective on the types of positive outcomes suggests potential benefits for both child and parent.
PMCID: PMC3825471  PMID: 24223050
social skills; autism spectrum disorders; group intervention; parent intervention; aptitudes sociales; troubles du spectre de l’autisme; intervention de groupe; intervention des parents
7.  Wide Awake Parenting: study protocol for a randomised controlled trial of a parenting program for the management of post-partum fatigue 
BMC Public Health  2013;13:26.
Background
Exhaustion and fatigue are commonly experienced by parents during the post-partum period, and can have implications for daily functioning, mental health and parenting practices. There is a need for the development of effective interventions to assist parents with the management of fatigue. This paper outlines the procedure for a randomised controlled study which aims to test the efficacy of Wide Awake Parenting, a program for the management of fatigue in the postnatal period.
Methods/design
Parents with an infant less than 6 months of age, and from seven Local Government Areas in Melbourne, Australia were invited to participate in this study. Parents were randomised to receive the Wide Awake Parenting program (intervention groups) or usual care (control group) offered by health services. The Wide Awake Parenting program provides parents with psycho-education and information about fatigue, and strategies to reduce its effects either via a self-directed method, or professionally led with a home visit and telephone support. Baseline data will be collected prior to randomisation, and further data will be collected at 2- and 6-weeks post intervention.
Discussion
To our knowledge this is the first randomised controlled trial of a program which compares the efficacy of a self-management approach and health professional assistance for the management of fatigue in the early post-partum period. If effective, it could offer an important, universal public health management approach to this common health concern.
Trial registration number
Australian New Zealand Clinical Trials Registry, ACTRN12611000133932.
doi:10.1186/1471-2458-13-26
PMCID: PMC3553020  PMID: 23311498
Fatigue; Parents; Post-partum; Pycho-educational Intervention
8.  Intervention Targeting Development of Socially Synchronous Engagement in Toddlers with Autism Spectrum Disorder: A Randomized Controlled Trial 
Background
Social and communication impairments are core deficits and prognostic indicators of autism. We evaluated the impact of supplementing a comprehensive intervention with a curriculum targeting socially synchronous behavior on social outcomes of toddlers with autism spectrum disorders (ASD).
Methods
Fifty toddlers with ASD, ages 21 to 33 months, were randomized to one of two 6-month interventions: Interpersonal Synchrony or Non-Interpersonal Synchrony. The interventions provided identical intensity (10 hours per week in classroom), student-to-teacher ratio, schedule, home-based parent training (1.5 hours per month), parent education (38 hours), and instructional strategies, except the Interpersonal Synchrony condition provided a supplementary curriculum targeting socially engaged imitation, joint attention, and affect sharing; measures of these were primary outcomes. Assessments were conducted pre-intervention, immediately post-intervention, and, to assess maintenance, at six-month follow-up. Random effects models were used to examine differences between groups over time. Secondary analyses examined gains in expressive language and nonverbal cognition, and time effects during the intervention and follow-up periods.
Results
A significant treatment effect was found for socially engaged imitation (p=0.02), with more than doubling (17% to 42%) of imitated acts paired with eye contact in the Interpersonal Synchrony group after the intervention. This skill was generalized to unfamiliar contexts and maintained through follow-up. Similar gains were observed for initiation of joint attention and shared positive affect, but between-group differences did not reach statistical significance. A significant time effect was found for all outcomes (p<0.001); greatest change occurred during the intervention period, particularly in the Interpersonal Synchrony group.
Conclusions
This is the first ASD randomized trial involving toddlers to identify an active ingredient for enhancing socially engaged imitation. Adding social engagement targets to intervention improves short-term outcome at no additional cost to the intervention. The social, language, and cognitive gains in our participants provide evidence for plasticity of these developmental systems in toddlers with ASD. http://www.clinicaltrials.gov/ct2/show/NCT00106210?term=landa&rank=3
doi:10.1111/j.1469-7610.2010.02288.x
PMCID: PMC3059234  PMID: 21126245
Autistic Disorder; Intervention
9.  Changing Parent’s Mindfulness, Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial 
We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.
doi:10.1007/s10826-009-9304-8
PMCID: PMC3765025  PMID: 24013587
Mindfulness; Parenting; Intervention; Efficacy; Adolescence
10.  Initial Impact of the Fast Track Prevention Trial for Conduct Problems: I. The High-Risk Sample 
Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model intervention included a universal-level classroom program plus social skills training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. At the end of Grade 1, there were moderate positive effects on children's social, emotional, and academic skills; peer interactions and social status; and conduct problems and special-education use. Parents reported less-physical discipline and greater parenting satisfaction/ease of parenting and engaged in more appropriate/consistent discipline, warmth/positive involvement, and involvement with the school. Evidence of differential intervention effects across child gender, race, site, and cohort was minimal.
PMCID: PMC2762610  PMID: 10535230
11.  Parenting-related stress and psychological distress in mothers of toddlers with autism spectrum disorders 
Brain & development  2012;35(2):133-138.
Background
Parents of children with autism spectrum disorders (ASDs) are at risk for higher stress levels than parents of children with other developmental disabilities and typical development. Recent advances in early diagnosis have resulted in younger children being diagnosed with ASDs but factors associated with parent stress in this age group are not well understood.
Aims
The present study examined parenting-related stress and psychological distress in mothers of toddlers with ASD, developmental delay without ASD (DD), and typical development. The impact of child problem behavior and daily living skills on parenting-stress and psychological distress were further investigated.
Methods
Participants were part of a larger research study on early ASD intervention. Parent self-report of parenting-related stress and psychological distress was utilized.
Results
Parents of toddlers with ASD demonstrated increased parenting-related stress compared with parents of toddlers with DD and typical development. However, psychological distress did not differ significantly between the groups. Child behavior problems, but not daily living skills emerged as a significant predictor of parenting-related stress and psychological distress. This was true for both mothers of children with ASD and DD.
Conclusions
These finding suggest that parents’ abilities to manage and reduce behavior problems is a critical target for interventions for young children with ASD and DD in order to improve child functioning and decrease parenting-related stress.
doi:10.1016/j.braindev.2012.10.004
PMCID: PMC3552060  PMID: 23146332
Autism Spectrum Disorder; parents; distress; toddlers; parenting-stress
12.  The Impact of a Behavioral Weight Management Program on Disordered Eating Attitudes and Behaviors in Overweight Children 
Background
Behavioral interventions targeting overweight children have been successful in facilitating weight loss; however, there is concern that these programs produce disordered eating attitudes among youth.
Objective
The purpose was to (1) to determine if overweight youth receiving one of two behavioral interventions were more likely to report an increase in disordered eating attitudes over time compared to a waitlist control; and (2) to determine psychosocial predictors of eating disordered attitudes at six-month follow-up.
Design
Participants were randomized to one of two behavioral lifestyle interventions or a waitlist control. Data was collected at baseline, post-treatment, and six-month follow-up.
Participants/Setting
Participants were 68 overweight youths, ages 8–13, and their parent(s) who lived in rural north central Florida. The project ran from January 2006 to January 2008.
Intervention
Each treatment condition consisted of 12 group sessions over 16 weeks.
Main outcome measures
Parents completed a demographic form and the Child Feeding Questionnaire. Children completed the Children's Eating Attitudes Test, Schwartz Peer Victimization Scale, and Children's Body Image Scale.
Statistical Analyses Performed
Mixed 2×2 ANOVAs were used to examine the effect of treatment on eating attitudes. Hierarchical linear regression was used to assess whether baseline levels of psychosocial variables predicted disordered eating attitudes at follow-up, controlling for baseline eating attitudes and treatment condition.
Results
Youth who participated in the behavioral interventions did not report significant increases in disordered eating attitudes over time compared to the waitlist control. Across all conditions, higher levels of body dissatisfaction, peer victimization, parent restrictive feeding practices and concern for child weight at baseline predicted higher levels of disordered eating attitudes at follow-up.
Conclusion
These findings do not provide evidence that behavioral interventions lead to an increase in unhealthy eating attitudes and behaviors. Future research should examine the impact of incorporating eating disorder prevention in pediatric weight management programs.
doi:10.1016/j.jada.2010.08.005
PMCID: PMC3038551  PMID: 21034878
pediatric obesity; behavioral weight management; rural health; weight control behaviors
13.  Reasons for non-participation in a parental program concerning underage drinking: a mixed-method study 
BMC Public Health  2009;9:478.
Background
Alcohol consumption among adolescents is a serious public health concern. Research has shown that prevention programs targeting parents can help prevent underage drinking. The problem is that parental participation in these kinds of interventions is generally low. Therefore, the aim of the present study is to examine non-participation in a parental support program aiming to prevent underage alcohol drinking. The Health Belief Model has been used as a tool for the analysis.
Methods
To understand non-participation in a parental program a quasi-experimental mixed-method design was used. The participants in the study were invited to participate in a parental program targeting parents with children in school years 7-9. A questionnaire was sent home to the parents before the program started. Two follow-up surveys were also carried out. The inclusion criteria for the study were that the parents had answered the questionnaire in school year 7 and either of the questionnaires in the two subsequent school years (n = 455). Multinomial logistic regression analysis was used to examine reasons for non-participation. The final follow-up questionnaire included an opened-ended question about reasons for non-participation. A qualitative content analysis was carried out and the two largest categories were included in the third model of the multinomial logistic regression analysis.
Results
Educational level was the most important socio-demographic factor for predicting non-participation. Parents with a lower level of education were less likely to participate than those who were more educated. Factors associated with adolescents and alcohol did not seem to be of significant importance. Instead, program-related factors predicted non-participation, e.g. parents who did not perceive any need for the intervention and who did not attend the information meeting were more likely to be non-participants. Practical issues, like time demands, also seemed to be important.
Conclusion
To design a parental program that attracts parents independently of educational level seems to be an important challenge for the future as well as program marketing. This is something that must be considered when implementing prevention programs.
doi:10.1186/1471-2458-9-478
PMCID: PMC2809065  PMID: 20025743
14.  Connecting parents of children with chronic pain through art therapy 
Objectives
To help address the unique needs of parents of children with chronic pain, a four module, parent-only, group art therapy curriculum was designed and implemented within an interdisciplinary pain rehabilitation treatment program. We evaluated perceived satisfaction and helpfulness of the group intervention.
Methods
Fifty-three parents of children experiencing chronic pain enrolled in a day hospital interdisciplinary pain rehabilitation program participated. The voluntary parent art therapy group was offered one time per week for one hour. Participants completed a measure of satisfaction, helpfulness, and perceived social support at the end of each group session.
Results
Parents enjoyed participating in the group, agreed that they would try art therapy again, and found it to be a helpful, supportive, and validating experience.
Conclusions
Initial results are promising that group art therapy is an appropriate and helpful means of supporting parents of children with chronic pain during interdisciplinary pain rehabilitation.
doi:10.1037/cpp0000026
PMCID: PMC3931442  PMID: 24563827
chronic pain; art therapy; child and adolescent; parents; pain rehabilitation; treatment intervention
15.  Brief Report: A Web-Based Mental Health Program: Reaching Parents at Work 
Journal of Pediatric Psychology  2008;34(5):488-494.
Objective The purpose of the project was to test a web-based program providing working parents with the knowledge and skills necessary for prevention and early intervention of mental health problems in youth. Method Study sample consisted of 99 parents who were randomized into either an experimental (program use) or waitlist control condition. Analysis of covariance and paired t-tests were used to compare response outcomes for the two groups. Results Parents receiving the intervention had greater knowledge of youth mental health issues and greater self-efficacy in handling these issues compared to controls. Conclusions Findings suggest that referring parents to a multimedia web-based program can improve parents’ knowledge of children's’ mental health and their confidence in addressing mental health issues. Web-based programs can be offered to individuals in multiple settings, including the workplace, thereby reaching large numbers of parents.
doi:10.1093/jpepsy/jsn108
PMCID: PMC2722138  PMID: 18845585
parenting; parent empowerment; web-based education; web-based training; workplace; youth mental health
16.  A randomised controlled trial of the efficacy of the ABCD Parenting Young Adolescents Program: rationale and methodology 
Background
The transition to adolescence is a time of increased vulnerability for risk taking and poor health, social and academic outcomes. Parents have an important role in protecting their children from these potential harms. While the effectiveness of parenting programs in reducing problem behavior has been demonstrated, it is not known if parenting programs that target families prior to the onset of significant behavioral difficulties in early adolescence (9-14 years) improve the wellbeing of adolescents and their parents. This paper describes the rationale and methodology of a randomised controlled trial testing the efficacy of a parenting program for the promotion of factors known to be associated with positive adolescent outcomes, such as positive parenting practices, parent-adolescent relationships and adolescent behavior.
Methods/Design
One hundred and eighty parents were randomly allocated to an intervention or wait list control group. Parents in the intervention group participated in the ABCD Parenting Young Adolescents Program, a 6-session behavioral family intervention program which also incorporates acceptance-based strategies. Participants in the Wait List control group did not receive the intervention during a six month waiting period. The study was designed to comply with recommendations of the CONSORT statement. The primary outcome measures were reduction in parent-adolescent conflict and improvements in parent-adolescent relationships. Secondary outcomes included improvements in parent psychosocial wellbeing, parenting self-efficacy and perceived effectiveness, parent-adolescent communication and adolescent behavior.
Conclusions
Despite the effectiveness of parenting programs in reducing child behavioral difficulties, very few parenting programs for preventing problems in adolescents have been described in the peer reviewed literature. This study will provide data which can be used to examine the efficacy of a universal parenting interventions for the promotion of protective factors associated with adolescent wellbeing and will add to the literature regarding the relationships between parent, parenting and adolescent factors.
Trial Registration
Australian New Zealand Clinical Trials Registry ACTRN12609000194268.
doi:10.1186/1753-2000-4-22
PMCID: PMC2936870  PMID: 20723219
17.  Tracing Changes in Families Who Participated in the Home-Start Parenting Program: Parental Sense of Competence as Mechanism of Change 
Prevention Science  2010;11(3):263-274.
The present study aimed to (1) determine the long-term effectiveness of Home-Start, a preventive parenting program, and (2) test the hypothesis that changes in maternal sense of competence mediate the program’s effects. Participants were 124 mothers (n = 66 intervention, n = 58 comparison). Four assessments took place during a 1-year period. Latent growth modeling showed that Home-Start enhanced growth in maternal sense of competence and supportive parenting, and led to a decrease in the use of inept discipline. Results of mediational and cross-lagged analyses were consistent with the hypothesized model: Participation in Home-Start was related to the changes in maternal sense of competence, which in turn predicted changes in parenting. The results affirm the importance of directly targeting parental sense of competence in the context of prevention work with parents.
doi:10.1007/s11121-009-0166-5
PMCID: PMC2904452  PMID: 20101464
Home-Start; Parental sense of competence; Mediators of program effects
18.  Promoting CARE 
Family & community health  2012;35(3):225-235.
This study evaluated the effectiveness of augmenting a youth suicide-preventive intervention with a brief, home-based parent program. A total of 615 high school youth and their parents participated. Three suicide prevention protocols, a youth intervention, a parent intervention, and a combination of youth and parent intervention, were compared with an “intervention as usual” (IAU) group. All groups experienced a decline in risk factors and an increase in protective factors during the intervention period, and sustained these improvements over 15 months. Results reveal that the youth intervention and combined youth and parent intervention produced significantly greater reductions in suicide risk factors and increases in protective factors than IAU comparison group.
doi:10.1097/FCH.0b013e318250bcf9
PMCID: PMC3616767  PMID: 22617413
adolescent suicide risk; brief intervention; family support; indicated suicide prevention
19.  Comparison of Program costs for Parent-Only and Family-Based Interventions for Pediatric Obesity in Medically Underserved Rural settings 
Purpose
To compare the costs of parent-only and family-based group interventions for childhood obesity delivered through Cooperative Extension Services in rural communities.
Methods
Ninety-three ovenueight or obese children (aged 8 to 14 years) and their parent(s) participated in this randomized controlled trial, which included a 4-month intervention and 6-month follow-up. Families were randomized to either a behavioral family-based intervention (n = 33), a behavioral parent-only intervention (n = 34), or a waitlist control condition (n = 26). Only program costs data for the parent-only and family-based programs are reported here (n = 67). Assessments were completed at baseline, post-treatment (month 4) and follow-up (month 10). The primary outcome measures were total program costs and cost per child for the parent-only and family interventions.
Findings
Twenty-six families in the parent-only intervention and 24 families in the family intervention completed all 3 assessments. As reported previously, both intervention programs led to significantly greater decreases in weight status relative to the control condition at month 10 follow-up. There was no significant difference in weight status change between the parent-only and family interventions. Total program costs for the parent-only and family interventions were $13,546 and $20,928, respectively. Total cost per child for the parent-only and family interventions were $521 and $872, respectively.
Conclusions
Parent-only interventions may be a cost-effective alternative treatment for pediatric obesity, especially for families in medically underserved settings.
doi:10.1111/j.1748-0361.2009.00238.x
PMCID: PMC3782094  PMID: 19566621
20.  Comparative Study on Self-perceived Health of Parents of Children with Autism Spectrum Disorders and Parents of Non-disabled Children in Croatia 
Croatian Medical Journal  2009;50(4):403-409.
Aim
To assess self-perceived health of parents of children with autism spectrum disorders (ASD) in comparison with those of parents of non-disabled children.
Methods
A total of 350 parents participated in the study: 178 parents of children with ASD (71% response rate) and 172 parents of non-disabled children matched by age, education, and place of living. Parents’ self-perceived health was assessed using the Croatian version of the health status questionnaire SF-36, while socio-demographic information, chronic medical conditions, and needs were assessed by a general questionnaire.
Results
For all dimensions of health, except physical health, parents of children with ASD had significantly poorer self-perceived health and reported significantly more deteriorated health in the last year than the control group (P < 0.001). They also reported more psychological disorders (11% vs 4%), which was the largest difference in specified chronic medical conditions. Hundred twenty six (71%) parents of children with ASD thought that enhancing different policy measures (economic, social, educational) could advance their and their children’s health and well-being.
Conclusion
Parents of children with ASD had poorer health than the control group in all components, except physical health. Because parents are the main providers of support for children with ASD, preserving parents' good health and well-being is a precondition for an optimal care for children. Therefore, current system for treating children with ASD in Croatia should also include permanent improvement of parents’ health and well-being.
doi:10.3325/cmj.2009.50.403
PMCID: PMC2728381  PMID: 19673041
21.  Identifying Barriers That Hinder Onsite Parental Involvement in a School-Based Health Promotion Program 
Health promotion practice  2009;11(5):703-713.
We investigated whether barriers to onsite parental involvement in the Bienestar Health Program Parent Component could be identified and whether participation rates could be increased by addressing these barriers. All nonparticipating parents of fourth-grade students of San Antonio Independent School District from 4 schools, which were selected randomly from 20 intervention schools in Bienestar, were invited to take part in this study. A total of 47 of 223 (21%) parents engaged in one of four focus groups offered. Parents identified barriers to their involvement in Bienestar that fit into five descriptive categories: (a) low value, (b) high cost, (c) competing family demands, (d) concerns about the program design, and (e) social role norms. The Bienestar Parent Component was then modified according to the focus group findings, which resulted in a marked increase in parental involvement from 17% to 37% overall. These findings suggest that even when parents are involved in the initial design of parent-friendly and culturally sensitive programs, as was the case for Bienestar, maximizing parental involvement may require additional assessment, identification, and remediation of barriers.
doi:10.1177/1524839909331909
PMCID: PMC2888659  PMID: 19339644
parental involvement; barriers to parental involvement; school-based health programs; type 2 diabetes mellitus in children; effective strategies
22.  Construct validity of the FOCUS© (Focus on the Outcomes of Communication Under Six): a communicative participation outcome measure for preschool children 
Child  2013;39(4):481-489.
Objective
The aim of this study was to establish the construct validity of the Focus on the Outcomes of Communication Under Six (FOCUS©). This measure is reflective of concepts in the International Classification of Functioning Disability and Health – Children and Youth framework. It was developed to capture ‘real-world’ changes (e.g. communicative participation) in preschoolers' communication following speech-language intervention.
Method
A pre–post design was used. Fifty-two parents of 3- to 6-year-old preschoolers attending speech-language therapy were included as participants. Speech-language therapists provided individual and/or group intervention to preschoolers. Intervention targeted: articulation/phonology, voice/resonance, expressive/receptive language, play, and use of augmentative devices. Construct validity for communicative participation was assessed using pre-intervention and post-intervention parent interviews using the FOCUS© and the communication and socialization domains of the Vineland Adaptive Behavior Scales-II (VABS-II).
Results
Significant associations were found between the FOCUS©, measuring communicative participation, and the VABS-II domains for: (i) pre-intervention scores in communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and socialization (r = 0.67, P < 0.001; 95% CI 0.48–0.80); (ii) change scores over-time in communication (r = 0.45, P < 0.001; 95% CI 0.201–0.65) and socialization (r = 0.39, P = 0.002; 95% CI 0.13–0.60); and (iii) scores at post-intervention for communication (r = 0.53, P < 0.001; 95% CI 0.30–0.70) and for socialization (r = 0.37, P = 0.003; 95% CI 0.11–0.50).
Conclusions
The study provided evidence on construct validity of the FOCUS© for evaluating real-world changes in communication. We believe that the FOCUS© is a useful measure of communicative participation.
doi:10.1111/cch.12043
PMCID: PMC3736218  PMID: 23763249
communicative participation; construct validity; FOCUS©; outcome measures; preschoolers; speech-language intervention; World Health Organization
23.  Early Intervention in Pediatrics Offices for Emerging Disruptive Behavior in Toddlers 
Background
This study provides preliminary data about a parenting intervention for families of preschoolers with early ADHD/ODD symptoms carried out in two diverse primary care pediatric offices.
Method
Parents of toddlers completed behavioral screening questionnaires at well-child visits. Eligible parents participated in a 10-week parenting education group using the Incredible Years Program. Mothers completed several outcome measures at three time points - before participating in the group, immediately after the group ended, and six months thereafter. These measures assessed changes in parenting practices, parenting stress, and child symptoms. Parent and provider satisfaction were also assessed.
Results
Mothers reported improvements in parenting skills and decreases in stress. They also reported decreases in child aggression and increases in compliance. Mothers and providers reported high levels of satisfaction.
Conclusions
Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.
doi:10.1016/j.pedhc.2009.08.008
PMCID: PMC3045763  PMID: 21320679
pediatrics; intervention; parenting; parenting education; disruptive behavior; ADHD; ODD
24.  Parent–Adolescent Discrepancies in Perceived Parenting Characteristics and Adolescent Developmental Outcomes in Poor Chinese Families 
We examined the relationships between parent–adolescent discrepancies in perceived parenting characteristics (indexed by parental responsiveness, parental demandingness, and parental control) and adolescent developmental outcomes (indexed by achievement motivation and psychological competence) in poor families in Hong Kong. A sample of 275 intact families having at least one child aged 11–16 experiencing economic disadvantage were invited to participate in the study. Fathers and mothers completed the Parenting Style Scale and Chinese Parental Control Scale, and adolescents completed the Social-Oriented Achievement Motivation Scale and Chinese Positive Youth Development Scale in addition to paternal and maternal Parenting Style Scale and Chinese Parental Control Scale. Results indicated that parents and adolescents had different perceptions of parental responsiveness, parental demandingness, and paternal control, with adolescents generally perceived lower levels of parenting behaviors than did their parents. While father–adolescent discrepancy in perceived paternal responsiveness and mother–adolescent discrepancy in perceived maternal control negatively predicted adolescent achievement motivation, mother–adolescent discrepancy in perceptions of maternal responsiveness negatively predicted psychological competence in adolescents experiencing economic disadvantage. The present findings provided support that parent–child discrepancies in perceived parenting characteristics have negative impacts on the developmental outcomes of adolescents experiencing economic disadvantage. The present study addresses parent–child discrepancies in perceived parental behaviors as “legitimate” constructs, and explores their links with adolescent psychosocial development, which sheds light for researchers and clinical practitioners in helping the Chinese families experiencing economic disadvantage.
doi:10.1007/s10826-013-9775-5
PMCID: PMC3890555  PMID: 24482569
Poverty; Parenting; Parental control; Achievement motivation; Psychological competence; Adolescent
25.  A Brief Parenting Intervention to Enhance the Parent–Child Relationship in Hong Kong: Harmony@Home 
There is a dearth of high-level evidence for brief programs designed to promote positive parent–child relationships in nonwestern cultures. We present a pilot randomized controlled trial of a four-session intervention to enhance the parenting skills that promote a positive relationship with pre-adolescent children in Hong Kong. Our intervention, Harmony@Home, utilized Cunningham’s culturally appropriate coping modeling, problem-solving approach to change parental behavior. Our objective was to evaluate the feasibility, acceptability and initial evidence of benefit of the intervention. We blindly randomized 150 Hong Kong parents of children 10–13 years of age to (a) a Harmony@Home intervention group, (b) a waitlist control group, or (c) a third active intervention which shared the control group. Immediately following the intervention, we report increases in satisfaction with the parent–child relationship, one of the targeted parenting behaviors and family harmony, for the Harmony@Home group versus control group. However, only the results from satisfaction with the parent–child relationship were significant at 3-months post intervention. Most respondents reported high levels of program satisfaction. The results provide preliminary evidence that this parenting intervention is culturally acceptable for a nonwestern general population, is feasible for implementation in a community setting and shows evidence of benefit. This intervention is concordant with public health priorities because of the global importance of the parent–child relationship as a protective factor for adolescent outcomes, the need for culturally-appropriate interventions for nonwestern populations, and design characteristics that promote dissemination.
doi:10.1007/s10826-012-9614-0
PMCID: PMC3679413  PMID: 23772172
Parenting; Parent–child relationships; Nonwestern culture; Family; Prevention

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