Preventing behavioural and emotional problems in children who have a developmental disability: A public health approach

doi:10.1016/j.ridd.2011.07.022

Research in Developmental Disabilities

Volume 32, Issue 6, November–December 2011, Pages 2148-2156

https://doi.org/10.1016/j.ridd.2011.07.022 Get rights and content

Abstract

Children with developmental disabilities are at substantially greater risk of developing emotional and behavioural problems compared to their typically developing peers. While the quality of parenting that children receive has a major effect on their development, empirically supported parenting programs reach relatively few parents. A recent trend in parenting intervention research has been the adoption of a public health approach to improve the quality of parenting at a population level. This has involved delivering parenting interventions on a large scale and in a cost-effective manner. Such trials have been demonstrated to reduce negative parenting practices, prevent child maltreatment, and reduce child behavioural and emotional problems. However, these trials have been restricted to parents of children who are developing typically. This paper explores the rational for the extension of a population health approach to parenting interventions for children with developmental disabilities. It is argued that a population-based implementation and evaluation trial of an empirically supported system of interventions is needed to determine whether this approach is viable and can have a positive impact on parents and their children in a disability context. The Stepping Stones Triple P—Positive Parenting Program is presented as an example of a parenting intervention that satisfies the requirements for such a trial. Tasks and challenges of such a trial are discussed.

Highlights

► Children with disability are at much greater risk of showing behavioural problems. ► Parenting programs can be effective for these children, but reach few families. ► A public health approach to parenting could reduce problems at a population level. ► Many of the tasks required for a public health approach have been accomplished. ► A public health model of parenting children with disability is urgently needed.

Section snippets

Evidence supporting the effectiveness of a public health approach to parenting

The Triple P—Positive Parenting Program developed by Sanders and colleagues (Sanders, 1999) is one of the few examples of a public health approach to parenting. Triple P was designed as a comprehensive population-level system of parenting and family support. This multilevel system includes five intervention levels of increasing intensity and narrowing population reach. Evidence-based interventions within the system range from the use of the media (Sanders, Calam, Durand, Liversidge, & Carmont,

Large-scale implementation of positive parenting for children who have a disability

Sanders (2008) identified a number of tasks that need to be accomplished if a public health approach to parenting is to work. Reviewing these tasks in a disability context, it is evident that many of them have already been accomplished.

Potential barriers

A range of barriers and problems can be anticipated in implementing a population health approach to strengthening parenting of children with a developmental disability. These range from issues that might interfere with the access or uptake of a parenting intervention, obstacles that might make it difficult for parents to complete a parenting program, or problems that might cause a program to be less effective than its potential.

Is the public health approach cost effective?

A public health approach to parenting interventions within a disability context would involve the adoption of population-wide strategies to optimise impact and reach a larger segment of the population of families who have a child with a disability. This approach could be conceived as simply targeting the disability sector; however, greater synergies might be achieved if this approach is embedded within a larger strategy focused on the entire population of families with children.

Research has

Conclusion

Children with developmental disabilities are at substantially greater risk for developing emotional and behavioural problems compared to their typically developing peers. These problems can be complex and challenging for parents and are one of the best predictors of burden of care or parental distress. While the quality of parenting that children receive has a major effect on their development, empirically supported parenting programs reach relatively few parents. The present paper has

References (59)

E.M. Foster et al.
The costs of a public health infrastructure for delivering parenting and family support
Children and Youth Services Review
(2008)
M. Matson et al.
Parent training: A review of methods for children with autism spectrum disorders
Research in Autism Spectrum Disorders
(2009)
K.M. Plant et al.
Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities
Research in Developmental Disabilities
(2007)
A.N. Singh et al.
The use of risperidone among individuals with mental retardation: Clinically supported or not?
Research in Developmental Disabilities
(2005)
P.M. Sullivan et al.
Maltreatment and disabilities: A population-based epidemiological study
Child Abuse & Neglect
(2000)
B.J Tonge et al.
Psychopathology and intellectual disability: The Australian child to adult longitudinal study
K.M.T. Turner et al.
Help when it's needed first: A controlled evaluation of brief, preventive behavioral family intervention in a primary care setting
Behavior Therapy
(2006)
K. Whittingham et al.
Stepping Stones Triple P: A pilot study to evaluate acceptability of the program by parents of a child diagnosed with an autism spectrum disorder
Research in Developmental Disabilities
(2006)
Australian Institute of Health and Welfare. (2008). Disability in Australia: Intellectual disability (AIHW Bulletin No....
B.L. Baker et al.
Pre-school children with and without developmental delay: Behavior problems and parenting stress over time
Journal of Intellectual Disability Research
(2003)

A. Beck et al.

Mothers’ expressed emotion towards children with and without intellectual disabilities

Journal of Intellectual Disability Research

(2004)

A. Biglan

Translating what we know about the context of antisocial behavior into a lower prevalence of such behavior

Journal of Applied Behavior Analysis

(1995)

L.M.G. Curfs et al.

Prader–Willi syndrome: A review with special attention to the cognitive and behavioural profile

Birth Defects: Original Articles Series

(1992)

S.L. Einfeld et al.

Psychopathology in young people with intellectual disability

Journal of the American Medical Association

(2006)

S.L. Einfeld et al.

Population prevalence of psychopathology in children and adolescents with intellectual disability: II epidemiological findings

Journal of Intellectual Disability Research

(1996)

A.S. Eisenhower et al.

Preschool children with intellectual disability: Syndrome specificity, behaviour problems, and maternal well-being

Journal of Intellectual Disability Research

(2005)

E. Emerson

Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability

Journal of Intellectual Disability Research

(2003)

D.L. Fixsen et al.

Core implementation components

Research on Social Work Practice

(2009)

B.R. Flay et al.

Standards of evidence: Criteria for efficacy, effectiveness and dissemination

Prevention Science

(2005)

P. Gerhardt et al.

Social policy on the use of aversive interventions: Empirical, ethical, and legal considerations

Journal of Autism and Developmental Disorders

(1991)

O.A. Hampel et al.

Evaluation von Stepping Stones Triple P: Zwischenergebnisse der Stepping-Stones-SPZ-Multicenterstudie

Klinische Padiatrie

(2010)

Harrison, J. (2006). Evaluation of a group behavioural family intervention for families of young children with...

R.P. Hastings et al.

Coping strategies and the impact of challenging behaviors on special educators’ burnout

Mental Retardation

(2002)

Jahnel, D. V. (2010). Stepping Stones Triple P workshop: Evaluation of a parenting intervention for parents of a child...

G. King et al.

The application of a transdisciplinary model for early intervention services

Infants & Young Children

(2009)

M. Knapp et al.

Intellectual disability, challenging behaviour and cost in care accommodation: What are the links?

Health and Social Care in the Community

(2005)

C. Leung et al.

An outcome evaluation of the implementation of the Triple P—Positive Parenting Program in Hong Kong

Family Process

(2003)

Y. Matsumoto et al.

Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society

Journal of Family Psychology

(2010)

T.G. Mazzucchelli et al.

Facilitating practitioner flexibility within evidence based practice: Lessons from a system of parenting support

Clinical Psychology: Science and Practice

(2010)

Cited by (28)

Building Bridges Triple P: Pilot study of a behavioural family intervention for adolescents with autism spectrum disorder
2018, Research in Developmental Disabilities
Citation Excerpt :
Parents’ individual goals formed an important outcome measure in the current study, allowing the reader to assess the impact of the intervention to goals that are important and meaningful to families. Mazzucchelli and Sanders (2011) argue that successful parenting programs should be able to be flexibly tailored to the needs of families. In the present study, for those parents who completed monitoring of one of their teenager’s behaviours, 80% achieved or exceeded their personally selected goals.
Many parents of adolescents with autism spectrum disorder (ASD) report that they are ill-equipped to support their children’s behaviour, and these youths are known to be at substantially greater risk of emotional or behavioural problems compared to their typically developing peers. There is a need for an efficient and tailored parenting program for parents of adolescents with ASD that includes guidance on how to best support these youths’ development and well-being.
The current study examined the feasibility of Building Bridges Triple P (BBTP), an eight-week (11.5 h) parenting program specifically targeted to the needs of parents of adolescents with a developmental disability.
A pretest-posttest single group design was used to evaluate the feasibility and acceptability of BBTP, and the potential of the program to have desired intervention effects, with nine parents of adolescents with ASD.
After participating in BBTP, parents reported significant reductions in their adolescent’s behaviour problems, increased parenting confidence, decreased lax and overreactive responding, and decreased symptoms of depression and stress. These effects were mostly observed at post-test but were more pronounced at 3-month follow-up. Parents reported that they were satisfied with the content and format of BBTP.
Results provide preliminary support for the feasibility and acceptability of BBTP, and that the program has a number of desired intervention effects.
Parenting and family adjustment scales (PAFAS): validation of a brief parent-report measure for use with families who have a child with a developmental disability
2018, Research in Developmental Disabilities
Citation Excerpt :
Significantly, a bidirectional relationship has been found between parenting stress and child behaviour problems: high parenting stress contributing to a worsening in child behaviour problems over time, and child behaviour problems exacerbating parental stress (Neece, Green, & Baker, 2012; Woodman et al., 2015). Developers of evidence-based parenting programs recommend the use of parent and teacher report outcome measures to assist with treatment planning and to monitor the effects of parenting interventions (e.g., Mazzucchelli & Sanders, 2011). Child outcome measures that have been employed in intervention studies for children with a developmental disability include the Child Adjustment and Parent Efficacy Scale—Developmental Disability (Mazzucchelli, Sanders, & Morawska, 2011, see Emser et al., 2016), the Developmental Behaviour Checklist (Einfeld & Tonge, 1995), the Eyberg Child Behavior Inventory (Eyberg & Pincus, 1999), and the Strengths and Difficulties Questionnaire (Goodman, 1997).
Children with a developmental disability are three to four times more likely than their typically developing peers of developing significant emotional and behavioural problems. There is strong evidence to suggest that individual biological and psychological factors interact with family functioning to precipitate and perpetuate these problems.
This study examined the psychometric properties of a brief measure, the Parent and Family Adjustment Scales (PAFAS) for use with parents of children with a developmental disability.
A sample of 914 parents of children (M = 6.27 years) with a developmental disability participated in the study. Disabilities included Autism Spectrum Disorder and Intellectual Disability
A confirmatory factor analysis supported a 16-item, four factor model of PAFAS Parenting, and an 11-item, three factor model of PAFAS Family Adjustment. The Parenting Scale measures parental consistency, coercive practices, use of encouragement and the quality of parent-child relationship. The Family Adjustment Scale measures parental emotional adjustment and partner and family support in parenting.
The current study indicated that the PAFAS demonstrates promise as a brief measure of multiple domains of family functioning important for families who have a child with a developmental disability.
Child Adjustment and Parent Efficacy Scale-Developmental Disability (CAPES-DD): First psychometric evaluation of a new child and parenting assessment tool for children with a developmental disability
2016, Research in Developmental Disabilities
This study examined the psychometric properties of the Child Adjustment and Parent Efficacy Scale-Developmental Disability (CAPES-DD), a brief inventory for assessing emotional and behavioral problems of children with developmental disabilities aged 2- to 16-years, as well as caregivers’ self-efficacy in managing these problems. A sample of 636 parents participated in the study. Children's ages ranged from 2 to 15. Exploratory and confirmatory factor analyses supported a 21-item, three-factor model of CAPES-DD child adjustment with 13 items describing behavioral (10 items) and emotional (3 items) problems and 8 items describing prosocial behavior. Three additional items were included due to their clinical usefulness and contributed to a Total Problem Score. Factor analyses also supported a 16-item, one factor model of CAPES-DD self-efficacy. Psychometric evaluation of the CAPES-DD revealed scales had satisfactory to very good internal consistency, as well as very good convergent and predictive validity. The instrument is to be in the public domain and free for practitioners and researchers to use. Potential uses of the measure and implications for future validation studies are discussed.
Fatal and non-fatal child maltreatment in the US: An analysis of child, caregiver, and service utilization with the National Child Abuse and Neglect Data Set
2014, Child Abuse and Neglect
Citation Excerpt :
This article also makes a new contribution in the areas of child and parent disability status as a potential risk factor for fatal maltreatment. Research has shown that children with a disability are at an increased risk for maltreatment (Mazzucchelli & Sanders, 2011; Murphy, 2011) and that there is a high proportion of children involved with child welfare services who have a disability (Lightfoot, Hill, & LaLiberte, 2011). A modest level of research has shown that under some conditions, parents with a disability are at an increased risk for maltreating their children (McGaw, Scully, & Pritchard, 2010).
The purpose of this study was to compare children who are fatally and non-fatally maltreated in the United States. In this first national-comparison study, we used the Child Abuse and Neglect Data Set of children and families who encounter/receive support from child welfare services. We found that children who were fatally maltreated were younger, were more likely to live with both their parents, and that their families experienced more financial and housing instability compared to non-fatally maltreated children. Overall, families in which children die use/receive fewer social services, as compared to families in which children live. We discuss the results with regard to child welfare practice and research.
Experience and outcomes of stepping stones triple P for families of children with autism
2013, Research in Developmental Disabilities
Citation Excerpt :
Families of children with autism often experience considerable care loads, above and beyond normal parental care demands, including energy directed towards navigating, coordinating and participating in therapeutic services. Mazzucchelli and Sanders (2011) acknowledge the potential for help seeking strain amongst parents of children with developmental disabilities, and recognize that coordination of services may help decrease strain. However, access to coordinated services is not the lived reality for families at this time, and was reported by one participant as the reason for not completing SSTP.
This study investigated the experience and perceived outcomes of a behavioural family intervention, standard stepping stones triple P (SSTP), for parents of children with autism. An indepth, prospective, mixed-methods, multiple case-study design was employed. Parent participants and SSTP practitioners took part. Participation in SSTP was consistently associated with improved parental self-efficacy, and was also associated with improved parental psychological well-being and decreased perceived need for behavioural services for some families. Three key themes emerged from the qualitative interview data, reflecting changes attributed to participation in SSTP: (1) changes in the “attribution of cause” of misbehaviour, (2) “Who's the boss?” reflecting a change to parents feeling more in charge of their child's behaviour, daily routines and choices, and (3) “Rewarding is rewarding!” reflecting appreciation of a positive approach to behaviour management. Practitioners discussed their impressions of appropriate participants, timing, structure, and session preferences for SSTP, and implications related to the professional qualifications of practitioners delivering SSTP. Clinical implications for the use of SSTP with families of children with autism are discussed.
Stepping Stones Triple P-Positive Parenting Program for children with disability: A systematic review and meta-analysis
2013, Research in Developmental Disabilities
Citation Excerpt :
SSTP is a parallel version of the Triple P-Positive Parenting Program (Sanders, 2012) for typically developing children that has been shown to be efficacious and effective across four meta-analyses (de Graff, Speetjens, Smit, De Wolff, & Tavecchio, 2008a, 2008b; Nowak & Heinrichs, 2008; Thomas & Zimmer-Gembeck, 2007). The SSTP system uses a public health approach to parenting in order to promote widespread dissemination of programs and provide the minimally sufficient level of intervention required to meet the needs of each individual family (Mazzucchelli & Sanders, 2011). The SSTP programs vary according to the level of intensity of the intervention, and the mode and context of delivery.
This systematic review and meta-analysis evaluated the treatment effects of a behavioral family intervention, Stepping Stones Triple P (SSTP) for parents of children with disabilities. SSTP is a system of five intervention levels of increasing intensity and narrowing population reach. Twelve studies, including a total of 659 families, met eligibility criteria. Studies needed to have evaluated SSTP, be written in English or German, contribute original data, and have sufficient data for analyses. No restrictions were placed on study design. A series of meta-analyses were performed for seven different outcome categories. Analyses were conducted on the combination of all four levels of SSTP for which evidence exists (Levels 2–5), and were also conducted separately for each level of SSTP. Significant moderate effect sizes were found for all levels of SSTP for reducing child problems, the primary outcome of interest. On secondary outcomes, significant overall effect sizes were found for parenting styles, parenting satisfaction and efficacy, parental adjustment, parental relationship, and observed child behaviors. No significant treatment effects were found for observed parenting behaviors. Moderator analyses showed no significant differences in effect sizes across the levels of SSTP intervention, with the exception of child observations. Risk of bias within and across studies was assessed. Analyses suggested that publication bias and selective reporting bias were not likely to have heavily influenced the findings. The overall evidence base supported the effectiveness of SSTP as an intervention for improving child and parent outcomes in families of children with disabilities. Limitations and future research directions are discussed.

View all citing articles on Scopus

View full text

Review articlePreventing behavioural and emotional problems in children who have a developmental disability: A public health approach

Abstract

Highlights

Section snippets

Evidence supporting the effectiveness of a public health approach to parenting

Large-scale implementation of positive parenting for children who have a disability

Potential barriers

Is the public health approach cost effective?

Conclusion

Children and Youth Services Review

Research in Autism Spectrum Disorders

Research in Developmental Disabilities

Research in Developmental Disabilities

Child Abuse & Neglect

Behavior Therapy

Research in Developmental Disabilities

Pre-school children with and without developmental delay: Behavior problems and parenting stress over time

Journal of Intellectual Disability Research

Mothers’ expressed emotion towards children with and without intellectual disabilities

Journal of Intellectual Disability Research

Translating what we know about the context of antisocial behavior into a lower prevalence of such behavior

Journal of Applied Behavior Analysis

Prader–Willi syndrome: A review with special attention to the cognitive and behavioural profile

Birth Defects: Original Articles Series

Psychopathology in young people with intellectual disability

Journal of the American Medical Association

Population prevalence of psychopathology in children and adolescents with intellectual disability: II epidemiological findings

Journal of Intellectual Disability Research

Preschool children with intellectual disability: Syndrome specificity, behaviour problems, and maternal well-being

Journal of Intellectual Disability Research

Prevalence of psychiatric disorders in children and adolescents with and without intellectual disability

Journal of Intellectual Disability Research

Core implementation components

Research on Social Work Practice

Standards of evidence: Criteria for efficacy, effectiveness and dissemination

Prevention Science

Social policy on the use of aversive interventions: Empirical, ethical, and legal considerations

Journal of Autism and Developmental Disorders

Evaluation von Stepping Stones Triple P: Zwischenergebnisse der Stepping-Stones-SPZ-Multicenterstudie

Klinische Padiatrie

Coping strategies and the impact of challenging behaviors on special educators’ burnout

Mental Retardation

The application of a transdisciplinary model for early intervention services

Infants & Young Children

Intellectual disability, challenging behaviour and cost in care accommodation: What are the links?

Health and Social Care in the Community

An outcome evaluation of the implementation of the Triple P—Positive Parenting Program in Hong Kong

Family Process

Investigation of the effectiveness and social validity of the Triple P Positive Parenting Program in Japanese society

Journal of Family Psychology

Facilitating practitioner flexibility within evidence based practice: Lessons from a system of parenting support

Clinical Psychology: Science and Practice

Review article
Preventing behavioural and emotional problems in children who have a developmental disability: A public health approach