An RCT of Parent Training for Preschoolers with Delays

描述（由申请人提供）：修订后的申请提出了一项为期 5 年的研究，对 200 名患有轻度/中度发育障碍学龄前儿童的家长进行以小组为基础的家长培训计划作为早期干预（二级预防）的效果。难以置信的岁月家长培训系列（IYPT；Webster-Stratton，1984，1994）与发育障碍修改（IYPT-DD；McIntyre，2008a，2008b）的功效将与常规治疗进行比较。 IYPT-DD 是一项为期 12 周的基于小组的强化干预（每周 2.5 小时），利用小组讨论和录像片段来针对 5 个课程领域：儿童游戏、表扬、奖励、有效限制设置和处理挑战性行为。照常治疗将包括在学前班和社区环境中为发育障碍儿童提供个别儿童和家庭服务。 IYPT 系列已被证明可以有效减少典型发育儿童的行为问题（Webster-Stratton，1984，1994）；然而，这种方法尚未在有发育障碍幼儿的家庭中得到充分调查，这些幼儿也面临严重行为问题的风险。 PI 已成功对有学龄前儿童发育障碍的家长进行了 DD 修改后的试点测试。 R03 资助的初步证据表明，在减少儿童行为问题和负面亲子互动方面具有可行性、可接受性和有效性（McIntyre，2008a，2008b；McIntyre & Phaneuf，2007；Phaneuf & McIntyre，2007）。这项拟议的研究将建立在最初的试点工作的基础上，并使用纵向设计和随机对照试验来测试 IYPT-DD 的功效：(a) 在治疗后立即以及 6 个月、12 个月和 18 个月的随访评估中减少儿童适应不良行为并增加儿童适应行为； (b) 减少不适当/消极的亲子互动，增加积极的养育做法，并在治疗后和 6 个月、12 个月和 18 个月的后续评估中提高父母的能力和自我效能； (c) 通过教师对幼儿园儿童早期社会行为适应的评估来衡量，提高对学校的适应程度； (d) 确定儿童适应不良和适应行为的变化是否是养育行为变化的函数； (e) 确定环境影响（例如养育压力、母亲抑郁和伴侣支持/关系质量）是否会调节儿童的结局。多变量数据分析的进步，例如一般生长混合模型，将用于研究与适应性和适应不良发育轨迹形成相关的环境因素，以及确定与改变这些轨迹相关的父母干预的有效性。经济分析，包括成本分析、效益成本分析和成本效益分析，将用于确定干预措施相对于成本负担的影响，并确定社区环境中采取干预措施的可行性。 公共健康相关性：本研究检验了这样的假设：为期 12 周、以小组为基础的家长培训计划、发展性障碍难以置信的岁月家长培训修改版（IYPT-DD；McIntyre，2008a，2008b）可用于有发展性障碍的学龄前儿童的家长，并且可以减少儿童的适应不良行为，增加适应行为，促进积极的养育做法，并促进在学校的早期适应。如果成功，干预措施可以在美国各地的早期教育和卫生服务系统中经济高效地实施。这项研究还将极大地有助于我们了解发育障碍男孩和女孩的儿童行为障碍和心理健康问题的出现。

DESCRIPTION (provided by applicant): The revised application proposes a 5-year study examining the effects of a group-based parent training program as early intervention (secondary prevention) with 200 parents with preschool children who have mild/moderate developmental disabilities. The efficacy of the Incredible Years Parent Training series (IYPT; Webster-Stratton, 1984, 1994) with developmental disabilities modifications (IYPT-DD; McIntyre, 2008a, 2008b) will be compared with treatment as usual. The IYPT-DD is an intensive 12-week group-based intervention (2.5 hours per week) that uses group discussion and videotape vignettes to target 5 curricular areas: child play, praise, rewards, effective limit setting, and handling challenging behavior. The treatment as usual condition will include individual child and family services afforded to children with developmental disabilities in preschool and community settings. The IYPT series has been demonstrated to be efficacious for decreasing behavior problems in typically developing children (Webster-Stratton, 1984, 1994); however, this approach has not been fully investigated with families of young children with developmental disabilities, who are also at risk for significant problem behavior. The PI has successfully pilot tested this intervention with DD modifications with parents who have preschool-age children with developmental disabilities. Preliminary evidence from a funded R03 grant suggests feasibility, acceptability, and efficacy in terms of reducing child behavior problems and negative parent-child interactions (McIntyre, 2008a, 2008b; McIntyre & Phaneuf, 2007; Phaneuf & McIntyre, 2007). This proposed study will build on the initial pilot work and use a longitudinal design and randomized controlled trial to test the efficacy of IYPT-DD for (a) reducing child maladaptive behavior and increasing child adaptive behavior immediately posttreatment and at 6-month, 12-month, and 18-month follow- up assessments; (b) reducing inappropriate/negative parent-child interactions, increasing positive parenting practices, and increasing parental competence and self-efficacy immediately posttreatment and at 6-month, 12-month, and 18-month follow-up assessments; (c) increasing adaptation to school as measured by teacher assessments of children's early sociobehavioral adjustment in kindergarten; (d) determining if changes in child maladaptive and adaptive behavior are a function of changes in parenting behavior; and (e) determining if contextual influences, such as parenting stress, maternal depression, and partner support/relationship quality, moderate child outcomes. Advancements in multivariate data analysis, such as general growth mixture modeling, will be used to study the environmental factors associated with the formation of adaptive and maladaptive developmental trajectories, as well as to determine the efficacy of the parent intervention relevant to altering those trajectories. Economic analyses, including cost analysis, benefit-cost analysis, and cost- effectiveness analysis, will be used to determine the impact of the intervention relative to cost burden and determine the feasibility of uptake in community settings. PUBLIC HEALTH RELEVANCE: This study examines the hypothesis that a 12-week, group-based parent training program, Incredible Years Parent Training with Developmental Disabilities modifications (IYPT-DD; McIntyre, 2008a, 2008b) can be used with parents of preschool children with developmental disabilities and can reduce child maladaptive behavior, increase adaptive behavior, promote positive parenting practices, and promote early adjustment in school. The intervention, if successful, could be cost-effectively implemented across the United States within early education and health delivery systems. The study will also significantly contribute to our understanding of the emergence of childhood behavior disorders and mental health problems in both boys and girls with developmental disabilities.