early parent-based intervention for conduct problems and adhd

238 Pages·2017·10.22 MB·English

EARLY PARENT-BASED INTERVENTION FOR
CONDUCT PROBLEMS AND ADHD
Karen Jones
Bangor University in fulfilment
Thesis to of the requirements
submitted
Degree Doctor Philosophy
the
of of of
School University
Psychology, Bangor
of
January 2008
EarlY Intervention for Preschool ADHD Conduct Problems
and
ACKNOWLEDGEMENTS
This thesis dissertation marks the end of a long and eventful journey, for which there
I like for friendship
are many people that would to acknowledge, their support and
the Firstly I like Dr David Daley, Professor Judy
along way. would to thank and
Hutchings for
their throughout
excellent supervision, enthusiasm, and encouragement
the course of my studies. Without their guidance on the practical, methodological and
theoretical I have this
aspects of research, would never completed piece of work.
Discussions during feedback I have,
the
supervision meetings and on work produced
in been in from I draw.
themselves, thought,
a course critical which will always
Thank both for I like
you so much giving me this opportunity. would also to express
Chris Whitaker, for his Dr
to to
my gratitude ever-patient statistical guidance, and
Carl Hughes, I have been have been
to
chair of my supervisory committee. privileged
by Indeed, best have
the things that
surrounded wonderful colleagues. one of
is I have found lifelong friends in fellow
that
emerged as a result of my studies my
Ph. D. Pam Martin Catrin Eames I have the 'journey'
and with whom shared
students,
have helped data Nia Griffith
from beginning,
the and who me with collection, and
has her Ph. D., I look forward to
who recently embarked on and with whom working
Thank Pam, Catrin Nia for
with over the next eighteen months. you and your
friendship, for lots fun the for
encouragement, of memories along way, and saving my
difficult Thanks Michelle O'Brien, James Birchwood, for
sanity at times! also to and
friendship kindness. I like best luck
their and would to wish all of you the very of
Ph. D. Thanks Incredible Years Wales:
with your s. also to the rest of the great team at
Dr Tracey Bywater, for her friendship, help
with ethics applications and producing
draft
Dilys Williams Kath
papers, and calm words of encouragement, and to and
Chitty for
their friendly A thank be to the
support. massive you must extended
iv
Early Intervention for Preschool ADIID Conduct Problems
and
families took in the North Wales Sure Start trial, this thesis
who part without whom
have been
would not possible.
I deeply indebted family: husband, leuan, for believing in
am to my my always me;
Marilyn David; Lisa, late Sidney;
my parents and my grandmother, and grandfather,
Arthur Dilys, for love, I
and my parents-in-law and their support, and generosity. am
for help last for
grateful to all of them their with childcare over the eight years, and
in I have Most
often stepping at short-notice. could not managed without you. of all,
in life: lovely daughters Freya
thanks to the two most special people my my and
Carla, I dedicate Thanks for love,
to whom this thesis. your unconditional your
happiness, for being how
truly the
and a constant reminder of precious gift of
is. I love I both.
parenting you and am so proud of you
Social
The funded by "CASE" by Economic
the and
study was a studentship,
Research Council, North West Wales NHS Trust.
and
Early Intervention for Preschool ADHD Conduct Problems
and v
CONTENTS
LIST OF TABLES
xi
LIST OF FIGURES
xii
LIST OF APPENDICES
xiii
SUMMARY
xiv
1. GENERAL INTRODUCTION I
Substantial 2
to
amendment proposed study plan
General Introduction 7
The Incredible Years Series 7
Incredible Years Parent Training Programmes 8
Incredible Years BASIC Parent Training Programme 8
Structure Content 8
and
Theoretical Grounding 9
Programme Delivery 10
Barriers Attendance II
to
Supporting Research 12
Implementation Fidelity 13
North Wales Sure Start Trial 15
Incredible Years Wales 15
Evaluation Aims 15
Methodology 16
Implementation Fidelity 17
Main Findings 18
Rationale for Examining Efficacy IY for ADHD 19
the
of symptoms
Structure Thesis 20
of
Literature Review (Chapter 2) 20
Study One (Chapter 3) 21
Study Two (Chapter 4) 22
Study Three (Chapter 5) 22
Early Intervention for Preschool ADIID Conduct Problems
vi
and
2. LITERATURE REVIEW: Attention Deficit Hyperactivity Disorder (ADHD) in
Current findings, interventions,
preschool children: recommended andfuture
directions 24
Abstract 25
Introduction 26
ADHD 26
Developmental 26
course
Co-Morbidity 27
ADI ID in Preschool Years 27
the
Aetiology ADIID During Preschool Years 28
the
of
Neuropsychological. Models 29
Dual Pathway Model 30
Parenting Influences 31
Which Treatment is Appropriate for Preschool ADIID? 32
New Forest Parent-Training Package 34
Triple P Parent-Training Programme 35
Incredible Years Parent-Training Programme 36
Theoretical Grounding PT 38
of programmes
Why interventions Targetting Preschool ADHD? 44
these successful at
are
Is Evidence-Base Supports ADHD Robust? 45
the which
Outcome 48
Moderators
of
49
Mode Delivery
of
50
Barriers Implementation
to
Treatment Integrity Implementation Fidelity 51
and
52
Future Directions
Conclusions 54
3. STUDY 1: fficacy The Incredible Years Basic Parent-Training Programme
of as
A DHD 56
interventionfor
an early children with conduct problems and
Abstract 57
Introduction 58
Intervention 59
Evidence for Psychosocial Intervention for Preschool Children
Early Intervention for Preschool ADHD Conduct Problems
and vii
60
ADHD
with
Rationale for Examining IY for ADHD 61
62
Aims Study
the
of
Methods 63
63
Participants
64
Measures
Screening: Parent Report Measures 64
Eyberg Child Behaviour Inventory 64
Strengths Difficulties Questionnaire 65
and
Outcome: Parent Report 65
Conners Abbreviated Parent/Teacher Rating
Scale 65
Observation Mother Child Behaviour 66
of and
Design 67
67
Randomisation
68
Procedure
Intervention Treatment Integrity 68
and
69
Results
69
Attrition
69
Attendance
Intervention Conduct Problems 69
impact
on
of
69
Preliminary Analysis (Equivalence)
Short-Term Intervention Effects 70
Short-Term Intervention Effects (Controlling for Change in Child
70
Deviance)
Clinical Significance Change 72
of
Discussion 73
Limitations 73
Clinical implications 74
Future 74
studies
4. STUDY 2: Efficacy Incredible Years Programme intervention
of the as an early
for Long-term follow-up 78
children with conductprohlems andADIID:
Early Intervention for Preschool ADHD Conduct Problems
and viii
79
Abstract
80
Introduction
80
Course
80
Co-Morbidity
81
Treatment
82
Parent-Training
The Incredible Years Basic Parent-Training Programme 83
Present Study 85
86
Methods
86
Participants
Measures 88
Screening: Parent Report Measures 88
Eyberg Child Behaviour Inventory 88
Strengths Difficulties Questionnaire 89
and
Primary Outcome Measure 89
Conners Abbreviated Parent/Teacher Rating Scale 89
Observation Mother Child Behaviour 90
of and
91
Procedure
Intervention Treatment Integrity 91
and
92
Results
92
Attrition
92
Attendance
92
Conduct Problems
Impact Intervention
on
of
Short-Term Findings: Impact Intervention
of on
92
ADHD Symptoms
93
Preliminary Analyses
94
Long-Tenn Findings
Long-Term Findings (Controlling For Observed Child
95
Deviance Scores)
Clinical Significance Change in Children's Disruptive
of
90
Behaviour
90
Magnitude Improvement
of
Discussion 98
99
Limitations
ix
Early Intervention for Preschool ADHD Conduct Problems
and
101
Clinical Implications
5. STUDY 3: The Incredible Years Programme interventionfor
as an early children
102
ADHD: Moderators
with conduct problems and and mediators of outcome
103
Abstract
Introduction 105
105
Interventions for Preschool ADHD
Moderators And Predictors Outcome 106
of
Child-Specific Moderators 107
Parent / Psychosocial Factors 108
Mediators Outcome 109
of
Background Study 110
to
Present Study 110
Methods 112
Participants 112
Measures 113
Demographic information: The Personal Data Health
and
Questionnaire 113
Maternal Depression: The Beck Depression Inventory 113
Eyberg Child Behaviour Inventory 114
Conners Parent Rating Scale 114
Strengths Difficulties Questionnaire 114
and
Observation Mother Child Behaviour 115
of and
115
Randomisation
116
Procedure
Intervention Treatment Integrity 116
and
118
Results
118
Attrition
Attendance 118
Equivalence 118
Predictor Short-term Outcome (Baseline Follow-up 1) 119
of
-
Intervention Group 119
119
Control Group
Predictors Long-Term Outcome (Intervention Group
at
of
121
Follow-ups 2 3)
and
Early Intervention for Preschool ADI ID Conduct Problems
x
and
Moderators 122
Mediators 123
123
Positive Parenting
Critical Parenting 125
Discussion 126
Predictors (Baseline Follow-up 1) 126
to
Predictors Long-Term Outcome (Intervention Group) 127
of
Moderators Outcome 129
of
Mediators 129
Limitations 130
Clinical Implications 131
6. GENERAL DISCUSSION
Summary findings 132
of main
Overview Main Objectives 133
of
Study 1 133
Study 2 134
Study 3 136
Methodological Issues 141
Clinical Implications 146
147
Future Directions
149
Conclusions
156
REFERENCES
189
APPENDICES
Early Intervention for Preschool ADHD Conduct Problems
and xi
Tables
Table I Demographic 57
characteristics of participants
Table 2 Equivalence 64
of groups
Table 3 Indices 89
of clinically significant change
Table 4 Standardised in 112
the
regression coefficients simultaneous
treatment
regression of outcome on candidate predictors
(intervention &
control group)
Table 5 Standardised in 114
the
regression coefficients simultaneous
treatment
regression of outcome on candidate predictors
(intervention follow-ups
two three)
group at and
Table 6 Moderator between improvements in 115
analyses: association
factors.
ADIID
symptoms and risk
Table 7 Correlations between Conners
change scores and child
follow-ups 204
deviance two, three
change scores at one, and
Table 8: Correlations between Conners baseline follow-up I for
scores at and
intervention
and control group
Table 9: Correlations between Conners follow-up I follow-up 2,
scores at and
follow-up 2 follow-up 3 (intervention
to
and group only)*.
Table 10: Correlations between Conners baseline follow-up 1,
scores at and and
baseline follow-up I for
observed positive parenting at and all cases
(intervention
and control)*