• By Laura Whybra
  • Posted on Thursday 12th June, 2014

Combined parenting programs help children with acquired brain injuries and their families

strong>Childhood brain injuries can not only harm children’s health and development, but also lead to family disruption as parents suffer severe and worsening distress. Research in Australia suggests that a specialist intervention combining two established parenting programs can help.Researchers at the University of Queensland tested a combination of Stepping Stones Triple P – an evidence-based parenting program for parents of children with disabilities – and a cognitive-behavioral intervention for parents known as Acceptance and Commitment Therapy. Their randomized controlled trial (RCT), involving 59 families of children with a range of pediatric acquired brain injuries (ABI), produced encouraging results for both children and parents.As many as half the children who acquire a brain injury during childhood – whether through an accident or illness – experience significant behavioral difficulties that tend to persist or worsen over time. The same is true of mood, anxiety and other psychiatric disorders. High levels of parental distress can contribute to a two-way interaction in which parenting practices and the child’s behavior both deteriorate.Evidence-based programsGiven known problems faced by families, the study authors find it surprising that only limited research has previously been conducted on behavior management and parental adjustment. Previous studies have included behavioral parent training as a small component with a treatment package, the latest research is unique in evaluating the use of an existing, evidence-based parenting intervention with families of children with pediatric ABI.Stepping Stones Triple P (SSTP) is an adaptation of the widely used Triple P parenting program designed for parents of children aged 2 to 12 with disabilities. Trials have found that it enhances parenting skills and effectiveness, improving child behavior. Acceptance and Commitment Therapy (ACT) makes use of “mindfulness” methods, seeking to alter the way parents manage their emotions, while addressing their reluctance to engage with negative thoughts and feelings about their child (“experiential avoidance”).Clinical psychologists, who were themselves supervised, delivered the combined 10-week intervention to groups of 3 to 6 parents in Brisbane. The course consisted of eight two-hour group sessions – six of SSTP and two of ACT – together with three 90-minute telephone sessions of SSTP. Parents who missed any of the group meetings were offered “make-up” sessions.Results from the trial showed significant reductions in behavioral and emotional problems among children who received the intervention. There was no significant reduction among control group families. Similarly, significant improvements were found among intervention group parents on “laxness” and “over-reactivity” scales measuring dysfunctional parenting.There was also significant reduction in the numbers of both children and parents whose problems were originally assessed as severe enough to fall within a “clinical” range. Although most of the improvements were being maintained six months after the intervention, there was one exception: children’s emotional symptoms returned to levels recorded before the program started. Next stepsAlthough the results suggest the intervention produced medium-to-large beneficial effects, the researchers acknowledge that the study was a relatively small-scale and leaves a number of potentially important questions unanswered.Larger trials could, for example, shed light on the specific contributions that SSTP and ACT make to the intervention’s overall impact. They could also test its use with a more ethnically diverse population than was recruited in Brisbane and how well it would work in an everyday rehabilitation setting, with fewer highly-trained staff available, or opportunities for “make-up” sessions.Since one in five participants in the intervention did not complete the Brisbane program, it would also make sense to investigate indications form this and other studies that parents of children with an ABI are particularly hard to retain in treatment programs – especially those in the greatest distress. Booster sessions could also be tested as a way of preventing improvements in children’s emotional symptoms from washing out over time.As a further step forward, using third-party observations as well as self-report questionnaires in a replication trial would potentially strengthen the evidence available. The Brisbane study, nonetheless, demonstrates the promise of using parent training in improving emotional and behavior difficulties among children with ABI. ************Reference: Brown, F. L., Whittingham, K., Boyd, R. N., McKinlay, L., & Sofronoff, K. (2014). Improving child and parenting outcomes following paediatric acquired brain injury: a randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy. Journal of Child Psychology and Psychiatry. doi: 10.1111/jcpp.12227

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