Preventing Problems Among Children of Substance Abusers

描述(由申请人提供)：该R21项目的目的是开发和试行一种干预措施，以改善滥用药物的父母的育儿和家庭沟通技能，从而降低其子女结局不佳的风险。药物滥用者的孩子有行为问题的风险。父母培训在减少儿童行为问题方面是有效的，但父母滥用药物预示着父母培训试验的结果不佳。这些发现表明，仅靠父母培训对滥用药物的父母不太有效，需要对这一群体采取创新的策略。这个项目将扩展斯坦格博士目前的流行病学研究结果，该研究表明父母滥用药物和儿童结果之间的关系是由父母的精神病理、家庭冲突和父母养育问题所调节的。我们将开发一种新的干预措施，将韦伯斯特-斯特拉顿针对行为问题的经验证的育儿疗法与针对物质依赖父母的基于激励的应急管理干预相结合。我们假设，激励措施将提高对育儿干预(每天监测育儿和儿童行为，完成小组间家庭作业)的遵从性，并增加治疗强度和保留率(参加治疗的次数，完成治疗的家庭数量)。 40名有药物滥用史的母亲和她们的伴侣将被随机分配到：(1)行为父母培训加应急管理，或(2)没有应急管理的父母培训。PTI组和PT组将被随机分配接受立即或延迟治疗。主要结果指标将包括：积极和消极的父母教育，家庭问题，以及儿童的攻击性和犯罪行为。我们还将评估影响治疗结果的重要因素，包括母体物质使用和精神病理学。一种创新的电话计算机辅助访谈系统将收集父母养育和儿童攻击性和违法行为的每日评级，以测试父母养育方式的日常变化对儿童行为问题的影响。这项研究将在药物滥用父母的高危样本中初步测试针对育儿的创新多组分干预的有效性。通过将父母养育和儿童问题之间关系的流行病学研究与干预研究联系起来，这些发现将促进对发展精神病理学的理解。

DESCRIPTION (provided by applicant): The aim of this R21 project is to develop and pilot test an intervention to improve parenting and family communication skills among substance-abusing parents, thereby reducing the risk of poor outcomes among their children. Children of substance abusers are at risk for conduct problems. Parent training is effective in reducing children's conduct problems, but parental substance abuse predicts poor outcomes in parent training trials. These findings suggest that parent training alone is less effective for substance abusing parents and that innovative strategies will be necessary for this population. This project will extend findings from Dr. Stanger's current epidemiologic research indicating that relations between parental substance abuse and children's outcomes are mediated by parental psychopathology, family conflict, and parenting problems. We will develop a new intervention integrating Webster-Stratton's empirically validated parenting treatment for conduct problems with an incentive-based, contingency-management intervention for substance dependent parents. We hypothesize that incentives will enhance compliance with the parenting intervention (daily monitoring of parenting and children's behavior, completion of between-group homework assignments) and increase treatment strength and retention (number of sessions attended, number of families completing treatment). Forty mothers with substance abuse histories and their partners will be randomly assigned to either: (1) behavioral parent training plus contingency management, or (2) parent training without contingency management. PTI and PT groups will be randomly assigned to receive either immediate or delayed treatment. Primary outcome measures will include: positive and negative parenting, family problems, and children's aggressive and delinquent behavior. We will also assess important mediators of treatment outcome, including parent substance use and psychopathology. An innovative telephone computer assisted interview system will collect daily ratings of parenting and children's aggressive and delinquent behavior in order to test the impact of daily variations in parenting on children's conduct problems. This study will provide an initial test of the efficacy of an innovative multicomponent intervention targeting parenting in a high-risk sample of substance abusing parents. Findings will advance understanding of developmental psychopathology by linking epidemiologic research on relations between parenting and children's problems to intervention research.