Effective Intervention Strategies for Behavior Problems
This article will describe empirically supported family and parenting interventions that can be offered by schools to reduce conduct problems and promote social and academic competence. "Empirically supported" interventions will be defined here based on the Chambless and Hollon criteria (1998), a standard that is generally accepted in the scientific community (APA Task Force on Psychological Intervention Guidelines, 1995). This standard relies on interventions being evaluated in randomized control designs, demonstrating changes in observations of behavior (not only in parent or teacher reports), replication by an independent research group, provision of detailed training manuals and intervention materials, and publication in peer-reviewed journals. These criteria promote selection of interventions that are based on evidence about what is proven to work for conduct problem children and their families.
Rationale for Parent Training. Parenting interactions are clearly the most well-researched and proximal causes of conduct problems in children. Research shows that some parents of children who are highly aggressive lack certain fundamental parenting skills (Patterson, 1982). For example, parents of such children may be less positive and more coercive, permissive, erratic, and inconsistent. They are less likely to monitor behavior and more likely to reinforce inappropriate and ignore prosocial behaviors (Chamberlain, Reid, Ray, Capaldi, & Fisher, 1997; Reid & Eddy, 1997). These parental constructs at age 10 predict later antisocial behavior and drug abuse (Patterson, Crosby, & Vuchinich, 1992). Many factors disrupt parenting, including family life stressors (often associated with socioeconomic disadvantage) (Forgatch, 1989; Forgatch, Patterson, & Skinner, 1988; Wahler & Sansbury, 1990; Webster-Stratton, 1990a); maternal insularity and lack of support (Wahler, 1980); parental psychopathology or substance abuse (Kazdin, 1987); and marital discord (Cummings & Davies, 1994; McMahon & Forehand, 1984; Webster-Stratton & Hammond, 1999). Low parent involvement in school also puts children at risk for academic failure and antisocial behavior (Reid & Eddy, 1997).
Parent training programs help counteract the parent and family risk factors by teaching positive, nonviolent discipline methods and supportive parenting that promotes children's self-confidence, prosocial behaviors, problem-solving skills, and academic success. Parent interventions help parents respond effectively to normal behavior problems so that these problems do not escalate. Parents learn to provide support for their children's cognitive, social, and emotional growth. Parent training programs can also help parents communicate effectively with teachers and advocate for their child's social and academic development. Group format parent training that also focuses on family issues such as communication and problem-solving skills addresses some of these family risk factors by facilitating parent support, decreasing parents' isolation, and providing strategies to cope with stressful life events.
Empirical Validation for Parent Training Programs. Extensive research indicates that parent training is the single most effective intervention available for reducing early conduct problems (Kazdin, 1985; Tanaka, 1987; Taylor & Biglan, 1998). In a review of 82 empirically tested psychosocial interventions for conduct problem children and adolescents (Brestan & Eyberg, 1998), the two found to be effective were parent training programs: a program derived directly from Patterson's social learning model (Patterson & Chamberlain, 1988) and a program based on videotape modeling developed by Webster-Stratton (Webster-Stratton, 1996; Webster-Stratton & Hancock, 1998). Of the 10 additional programs judged to be "probably efficacious," three were parent training or family therapy programs. Likewise, a review by Kazdin and Kendall (1998) of interventions for treating antisocial children found that two of four interventions showing the greatest promise emphasized the family.
The successful short-term outcome of parent training has been repeatedly verified by significant changes in parents' and children's behavior and adjustment (Dishion & Andrews, 1995; Eyberg, Boggs, & Algina, 1995; Kazdin & Kendall, 1998; Patterson & Narrett, 1990; Webster-Stratton & Hammond, 1997). Home observations indicate reductions in children's levels of aggression by 20% to 60% (Patterson, Chamberlain, & Reid, 1982; Webster-Stratton & Hammond, 1997). Researchers have found improvements in other outcomes, including school dropout and attendance, disruptive behavior, and criminal activity (Kazdin, Siegel, & Bass, 1992). Generalization of behavior improvements from the clinic setting to the home over reasonable follow-up periods (1–4 years) and to untreated child behaviors have also been demonstrated (Taylor & Bilan, 1998). Studies typically find that approximately two-thirds of children show clinically significant improvements, which means that their behavior falls in the normal range following the family intervention (Webster-Stratton, Hollinsworth, & Kolpacoff, 1989). There is mixed evidence on generalization of improvements from home to school; parent training studies have indicated that improvements in the child's behavior at home are not necessarily associated with improved peer relationships, particularly if teachers are not involved in the intervention. Evidence does indicate that early intervention has longer-lasting effects when parent programs incorporate a cognitive/academic component (Yoshikawa, 1994). Programs are also more likely to generalize when parent training is combined with child and teacher training (Kazdin, Esveldt-Dawson, French, & Unis, 1987; Kazdin et al., 1992; Webster-Stratton & Hammond, 1997; Webster-Stratton & Reid, 1999c).
For older adolescents with conduct disorders, an intensive parent component, as a part of a more comprehensive therapeutic program, is necessary for reducing violence. In addition to parent education program, research supports the effectiveness of multisystemic therapy (MST) (Henggeler, Melton, & Smith, 1992; Henggeler, Schoenwald, & Pickrel, 1995) and functional family therapy (Alexander & Parsons, 1982; Morris, Alexander, & Waldron, 1990). MST is a comprehensive, family-oriented program that has been effective in reducing a variety of antisocial and delinquent outcomes (Henggeler, Schoenwald, Borduin, & Rowland, 1998). Programs based on this model use individualized wraparound service plans for each child and family, an approach familiar to school psychologists (Eber & Nelson, 1997). See Eber and Nelson (1997) for an example of how schools can assume the lead role in a system of care. Although family therapy is critical for older students with chronic behavior problems, less intensive parent interventions are sufficient for most younger students. Christenson, Rounds, and Franklin (1992) and Sheridan, Kratochwill, and Bergan (1996) present thorough reviews of home–school collaboration strategies found to be effective in preventing and reducing children's academic and social problems.
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