Does Giving Parents Their Choice of Interventions for Child Behavior Problems Improve Child Outcomes?
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Empowering consumers to be active decision-makers in their own care is a core tenet of personalized, or precision medicine. Nonetheless, there is a dearth of research on intervention preferences in families seeking interventions for a child with behavior problems. Specifically, the evidence is inconclusive as to whether providing parents with choice of intervention improves child/youth outcomes (i.e., reduces externalizing problems). In this study, 129 families presenting to community mental health clinics for child conduct problems were enrolled in a doubly randomized preference study and initially randomized to choice or no-choice conditions. Families assigned to the choice condition were offered their choice of intervention from among three different formats of the Parent Management Training-Oregon Model/PMTO (group, individual clinic, home based) and services-as-usual (child-focused therapy). Those assigned to the no-choice condition were again randomized, to one of the four intervention conditions. Intent-to-treat analyses revealed partial support for the effect of parental choice on child intervention outcomes. Assignment to the choice condition predicted teacher-reported improved child hyperactivity/inattention outcomes at 6 months post-treatment completion. No main effect of choice on parent reported child outcomes was found. Moderation analyses indicated that among parents who selected PMTO, teacher report of hyperactivity/inattention was significantly improved compared with parents selecting SAU, and compared with those assigned to PMTO within the no-choice condition. Contrary to hypotheses, teacher report of hyperactivity/inattention was also significantly improved for families assigned to SAU within the no-choice condition, indicating that within the no-choice condition, SAU outperformed the parenting interventions. Implications for prevention research are discussed.
KeywordsPMTO Choice of intervention Parenting Child outcomes
The research reported here was funded by grant no. P20 MH 079906 from the National Institute of Mental Health to Gerald August (Center PI) and Abigail Gewirtz (PI of this study)
Compliance with Ethical Standards
Conflict of Interest
The authors declare they have no conflicts of interest.
This study was approved by the University of Minnesota IRB and the Human Subjects Research Protection Board of the State of Michigan’s Department of Community Health. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all participants included in the study.
- Arnkoff, D. B., Glass, C. R., & Shapiro, S. J. (2002). Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. In J. C. Norcross (Ed.), Expectations and preferences (pp. 335–356). New York: Oxford University Press.Google Scholar
- Bierman, K. L., Nix, R. L., Maples, J. J., Murphy, S. A., & Conduct Problems Prevention Research Group. (2006). Examining clinical judgment in an adaptive intervention design: The fast track program. Journal of Consulting and Clinical Psychology, 74, 468–481.CrossRefPubMedPubMedCentralGoogle Scholar
- Chilvers, C., Dewey, M., Fielding, K., Gretton, V., Miller, P., Palmer, B., … Counselling versus Antidepressants in Primary Care Study Group. (2001). Antidepressant drugs and generic counselling for treatment of major depression in primary care: Randomised trial with patient preference arms. BMJ , 322, 772–775.
- Derogatis, L. R., & Savitz, K. L. (2000). The SCL–90–R and Brief Symptom Inventory (BSI) in primary care. Lawrence Erlbaum Associates Publishers.
- Derogatis, L. R. (2001). BSI 18, Brief symptom inventory 18: administration, scoring and procedures manual. Minneapolis: NCS Pearson Incorporated.Google Scholar
- Dishion, T. J., Shaw, D., Connell, A., Gardner, F., Weaver, C., & Wilson, M. (2008). The family check-up with high-risk indigent families: Preventing problem behavior by increasing parents’ positive behavior support in early childhood. Child Development, 79, 1395–1414.CrossRefPubMedPubMedCentralGoogle Scholar
- Forgatch, M. S., & Gewirtz, A. H. (2017). Evidence-based psychotherapies for children and adolescents, 3rd ed. In J. R. Weisz & A. E. Kazdin (Eds.), Evolution of Parent Management Training-Oregon Model. New York: Guildford Press.Google Scholar
- Forgatch, M. S., Knutson, N., & Mayne, T. (1992). Coder impressions of ODS lab tasks. Eugene, OR: Oregon Social Learning Center.
- Gewirtz, A.H. (2014-2019). Comparing web, group, and telehealth formats of a military parenting program. Grant # W81XWH141014, Department of Defense.Google Scholar
- Kocsis, J. H., Leon, A. C., Markowitz, J. C., Manber, R., Arnow, B., Klein, D. N., & Thase, M. E. (2009). Patient preference as a moderator of outcome for chronic forms of major depressive disorder treated with nefazodone, cognitive behavioral analysis system of psychotherapy, or their combination. Journal of Clinical Psychiatry, 70, 354–361.CrossRefPubMedGoogle Scholar
- Webster-Stratton, C., Reid, M. J., Hammond, M. (2001). Preventing conduct problems, promoting social competence: a parent and teacher training partnership in Head Start. Journal of Clinical Child Psychology, 30(3),283-302.Google Scholar
- Winston, K., Grendarova, P., & Rabi, D. (2017). Video-based patient decision aids: A scoping review. Patient Education and Counseling.Google Scholar
- Wymbs, F. A., Cunningham, C. E., Chen, Y., Rimas, H. M., Deal, K., Waschbusch, D. A., & Pelham, W. E., Jr. (2015). Examining parents’ preferences for group and individual parent training for children with ADHD symptoms. Journal of Clinical Child and Adolescent Psychology, 1–18.Google Scholar