Parent Training and Emotion Coaching for Children with Limited Prosocial Emotions

针对亲社会情绪有限的儿童的家长培训和情绪辅导

• 批准号: 9054933
• 负责人: LYNN Fainsilber KATZ
• 金额: $ 17.49万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9054933
• 关键词: 7 year old; Acting Out; Address; Adolescence; Adult; Affective; Aftercare; Age; Antisocial Personality Disorder; Awareness; Behavior; Child; Child Rearing; Childhood; Clinic; Clinical; Clinical Trials; Communication; Community Mental Health Centers; Conduct Disorder; DSM-IV; Data; Development; Diagnosis; Early Intervention; Educational process of instructing; Effectiveness; Emotional; Emotions; Empathy; Family; Goals; Guilt; Individual; Interpersonal Relations; Intervention; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Mothers; Occupational; Oppositional Defiant Disorder; Outcome; Outcome Study; Parents; Participant; Pilot Projects; Population; Public Health; Randomized; Research; Research Proposals; Risk; Role; Sampling; Statistical Models; Substance Use Disorder; Testing; Theft; Time; Training; Training Programs; Youth; antisocial behavior; base; behavioral outcome; boys; callous unemotional trait; conduct problem; cost; design; early childhood; early onset; economic cost; effective therapy; evidence base; fighting; follow-up; high risk sexual behavior; improved; improved outcome; mortality; non-compliance; programs; response; satisfaction; skills; social; social learning; trend

Children with oppositional defiant disorder (ODD) are at significantly increased risk for a host of negative outcomes in later childhood, adolescence, and adulthood. These outcomes can include delinquency, early and risky sexual behavior, poor academic and occupational adjustment, poor interpersonal relations, and increased risk for various mental disorders. Effective treatment for ODD has typically been based on a social learning-based �parent management training� (PMT) model. Despite strong evidence for PMT, it is not effective with all children, with up to one third failing to show reliable and sustained improvement. Having limited prosocial emotions (e.g., lack of guilt and empathy, callous use of others) appears to be one factor that mitigates the effects of traditional PMT. Children with ODD with limited prosocial emotions present with more severe conduct problems and have poorer behavioral outcomes. It is therefore important to develop empirically based methods to enhance the efficacy of �traditional� PMT for those children with ODD and limited prosocial emotions. Recent meta-analytic research indicates that one key component of successful family based intervention approaches involves teaching parents skills related to emotional communication. Given evidence that children with ODD with limited prosocial emotions have deficits in the awareness/recognition of emotion and in empathy, incorporating an emotion-focused intervention (which has not been a focus of PMT) into traditional PMT should enhance outcomes for these children. Consistent with the aims of the R34 mechanism, the primary goal of this application is to develop and test the feasibility of a brief emotion-coaching (EC) intervention in combination with an evidence-based PMT program, Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), for use with clinic-referred children with ODD who have limited prosocial emotions. The Specific Aims are to: 1) develop and refine an empirically based combined HNC-EC parenting intervention to reduce CP in children with ODD and limited prosocial emotions; and 2) assess the viability of a later clinical trial by a) pilot testing the newly developed HNC-EC intervention compared to HNC alone with mothers and their 3-7 year-old children who have been referred for treatment of significant levels of oppositional behavior (and who also have limited prosocial emotions) in a community mental health center setting, and b) establishing the treatment feasibility (family and therapist-level feasibility, treatment fidelity, participant satisfaction) and research feasibility of the HNC-EC intervention compared to HNC alone. While pilot studies should not be used to estimate effect sizes, (Kraemer et al., 2006; Sherrill et al., 2009), we will explore trends in the data to facilitate consideration of possible designs for later statistical modeling in a larger trial. Promising findings would form the basis of a research proposal for a randomized clinical outcome study comparing HNC alone and in combination with an EC intervention for children with ODD and limited prosocial emotions. Should this combined intervention (which is focused on improving outcomes in this hard-to-treat population) prove to be effective, it will be one of the first interventions targeting known developmental mechanisms related to limited prosocial emotions in children. Given the increased likelihood that children with an early onset of CP and limited prosocial emotions are at increased likelihood of multiple negative outcomes extending into adulthood, at extraordinary social and economic cost, improving response rates to PMT (which is a low-cost, low-restrictiveness intervention) will have substantial public health impact.

在儿童期，青少年和成年期，患有反对反抗疾病（ODD）的儿童患有许多负面结果的风险显着增加。这些结果可能包括犯罪，早期和风险的性行为，学术调整差，人际关系不良以及各种精神障碍的风险增加。 ODD的有效治疗方法通常基于基于社会学习的父母管理培训（PMT）模型。尽管有PMT的有力证据，但对于所有儿童来说，它并不有效，最多三分之一未能显示出可靠和持续的改善。亲社会情绪有限（例如，缺乏内gui和同理心，对他人的冷漠使用）似乎是减轻传统PMT影响的一个因素。具有有限的亲社会情绪的奇数儿童出现了更严重的行为问题，行为结果较差。因此，重要的是开发基于经验的方法来提高传统PMT的效率，以使那些具有奇怪和有限的亲社会情绪的儿童。最近的荟萃分析研究表明，成功的家庭干预方法的一个关键组成部分是教授与情感交流有关的父母技能。有证据表明，有限的亲社会情绪的奇怪儿童在对情绪和同理心的认识/认识中定义了，将以情感为中心的干预措施（这不是PMT的重点）纳入传统PMT，这应该增强这些孩子的结果。 Consistent with the aims of the R34 mechanism, the primary goal of this application is to develop and test the feasibility of a brief emotion-coaching (EC) intervention in combination with an evidence-based PMT program, Helping the Noncompliant Child (HNC; Forehand & McMahon, 1981; McMahon & Forehand, 2003), for use with clinic-referred children with ODD who have limited prosocial emotions.具体目的是：1）开发和完善基于经验的HNC-EC育儿干预措施，以减少具有奇怪和有限的亲社会情绪儿童的CP；和2）与单独使用母亲及其3-7岁的孩子相比，新开发的HNC-EC干预措施的试验测试评估后来的临床试验的生存能力与仅HNC相比，HNC-EC干预的可行性。虽然试验研究不应用于估计效应大小（Kraemer等，2006; Sherrill等，2009），我们将探索数据中的趋势，以促进在较大的试验中考虑以后的统计建模的可能设计。有希望的发现将构成一项研究建议的基础，该研究对单独HNC并与具有奇怪和有限的亲社会情绪的儿童进行EC干预进行了比较，以进行随机临床结果研究。如果这种综合干预措施（重点是改善这种难以治疗的人群的结果）是有效的，那么它将是针对与儿童有限的亲社会情绪有关的已知发展机制的首批干预措施之一。鉴于有可能早期发作和亲社会情绪发作的儿童的可能性增加，其可能性增加了多种负面结果，延伸到成年期，以非凡的社会和经济成本，提高了对PMT的反应率（这是一种低成本，低限制性的干预措施），将对公共卫生产生重大的公共卫生影响。