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，考察以小组为基础的父母培训计划作为早期干预(二级预防)的效果，对象为200名患有轻度/中度发育障碍的学龄前儿童的父母。《不可思议的岁月》家长培训系列(IYPT；Webster-Stratton，1984,1994)与常规治疗的疗效进行比较。IYPT-DD是一项为期12周的以小组为基础的强化干预(每周2.5小时)，使用小组讨论和视频片段来针对5个课程领域：儿童游戏、赞扬、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的个别儿童和家庭服务。IYPT系列已被证明对减少典型发育儿童的行为问题是有效的(Webster-Stratton，1984,1994)；然而，这种方法还没有在有发育障碍的幼儿的家庭中得到充分的调查，他们也面临着严重问题行为的风险。PI已经成功地通过DD修改对有发育障碍的学龄前儿童的父母进行了这一干预的试行测试。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初步试点工作的基础上，并使用纵向设计和随机对照试验来测试IYPT-DD在以下方面的有效性：(A)在治疗后立即以及在6个月、12个月和18个月的跟踪评估中减少儿童适应不良行为和增加儿童适应行为；(B)减少不适当/负面的亲子互动，增加积极的父母养育方式，并在治疗后立即和在6个月、12个月和18个月的跟踪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儿童对学校的适应程度；(D)确定儿童适应不良和适应行为的变化是否是育儿行为变化的结果；以及(E)确定环境影响，如育儿压力、母亲抑郁和伴侣支持/关系质量，是否适度影响儿童的结果。多变量数据分析的进展，如一般生长混合模型，将被用来研究与适应性和非适应性发展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、收益-成本分析和成本-效果分析，将用于确定干预措施相对于成本负担的影响，并确定在社区环境中采用的可行性。 公共卫生相关性：这项研究检验了这样一个假设，即一个为期12周的、基于小组的家长培训计划，令人难以置信的年限父母培训与发育障碍修改(IYPT-DD；McIntyre，2008a，2008b)可以用于学龄前儿童的父母，并可以减少儿童的适应不良行为，增加适应行为，促进积极的父母养育做法，并促进学校的早期适应。如果干预成功，可以在美国各地的早期教育和医疗服务系统中以经济高效的方式实施。这项研究还将大大有助于我们理解儿童行为障碍和精神健康问题在发育障碍男孩和女孩中的出现。

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.