Research suggests that an individual's optimistic or pessimistic outlook on the world affects numerous outcomes, such as overall health (Aspinwall & Brunhart, 2000) and motivation to achieve goals (Carver & Scheier, 1990). Indeed, the influence of parental characteristics on treatment may be greater than previously noted; in a review of the literature on child and adolescent treatment, Morrissey-Kane and Prinz (1999) noted that parental cognitions and attributions were found to influence three aspects of treatment: help seeking, treatment engagement and retention, and treatment outcome.
This research on the impact of attitudes in treatment participation and outcomes points to an important consideration that has not been adequately addressed in behavioral parent training (BPT). In fact, there is reason to believe that interventions may only be effective with the portion of our population that has the ability and motivation to complete all aspects of the intervention (Durand, Hieneman, Clarke, & Zona, 2009). If so, we need to begin to focus our attention on interventions designed to overcome such barriers.
Dr. Durand conducted a multisite randomized clinical trial designed to develop and assess the effectiveness of a treatment package that integrates cognitive-behavioral intervention with function-based BPT; this approach is referred to as "positive family intervention" (PFI).
Families from throughout the Tampa Bay region in Florida (through the University of South Florida St. Petersburg) and the capitol region in New York (through the University at Albany, State University of New York) participated in this project. The study selected at-risk families as defined as having a child with a developmental disability and severe behavior problems and who scored high on a measure of pessimism.
These families were assigned to one of two groups: family members who received training in BPT for their child and individuals who received BPT along with a cognitive-behavioral component (PFI). A manualized approach was employed (Durand & Hieneman, 2008). The study evaluated if PFI would increase family participation in training and if it would successfully prevent child behavior problems from escalating into more severe problems. Follow-up of the children was conducted up to 2 years following initial intervention at home.
Both groups improved in scores of parental pessimism as well as on standardized measures and direct observations of child challenging behavior (Durand, Hieneman, Clarke, Wang, & Rinaldi, 2013). The PFI intervention resulted in significantly improved scores on the General Maladaptive Index of the Scales of Independent Behavior–Revised when compared with the BPT alone group. Subsequent analyses showed that the BPT group reduced behavior problems at home by avoiding problem situations, while the PFI group confronted difficult situations and used the skills taught during training (Durand, 2011). Importantly, significant improvements in child behavior at home were achieved through a clinic-based approach.
PFI is a clinically based approach to provide family members with the skills they need to cope with the stressors associated with everyday life along with the added stress of having a child with significant challenges. More specifically, Durand adapts cognitive-behavioral intervention techniques to meet the specific needs of these families and combine this approach with the components of BPT.
PFI integrates a modification of Seligman's work ("Learned Optimism") for use with families of children with disabilities and challenging behavior. For example, parents who score high on a measure of pessimism might describe a child's difficult trip to the supermarket this way: "Shopping with my child is a disaster." On the other hand, parents scoring high on optimism might describe it this way: "My child is not ready yet for long shopping trips."
The former pessimistic description suggests that the problem is pervasive (all shopping is a problem) and permanent (shopping may never get better), while the latter optimistic view is local (it is just long shopping trips that are a problem) and temporary (someday, the child will be ready). Presenting families with their styles of describing situations and having them practice more adaptive optimistic styles — referred to as PFI — is proving to be quite successful.
PFI involves eight weekly individual sessions, lasting 90 minutes each.
The sessions adhere to the following sequence:
- Session 1 - Introduction and goal setting
- Session 2 - Gathering information on challenging behavior
- Session 3 - Analyzing data and plan design
- Session 4 - Using prevention strategies
- Session 5 - Using consequences
- Session 6 - Replacing challenging behavior with appropriate alternatives
- Session 7 - Implementing the strategies
- Session 8 - Monitoring the results
(Durand, 1990; Hieneman et al., 2006).
The cognitive behavioral intervention component is integrated into the same sessions. So, in addition to teaching parents how to identify patterns in their child's behavior and develop intervention strategies, they are also helped to identify patterns in their own thoughts and feelings and taught strategies for cognitive restructuring.
Practice on identifying thoughts and feelings associated with their child's behavior (e.g., "I feel out of control" and "I must be a bad parent") along with strategies for looking at these situations in a better way is incorporated into these sessions according to the following sequence:
- Session 1 - Identifying situations and associated self-talk
- Session 2 - Determining consequences of beliefs
- Session 3 - Disputing current thinking
- Session 4 - Using distraction to interrupt negative thinking
- Session 5 - Substituting pessimistic thoughts with positive, productive thoughts
- Session 6 - Practicing skills to recognize/modify self-talk
- Session 7 - Practicing skills to recognize/modify self-talk
- Session 8 - Maintaining positive changes in self-talk
For example, if a problem situation is being described (e.g., child screaming at a store), in addition to discussing the possible reason for the difficulty (e.g., child wanting attention), the therapist would also help the parent identify self-talk (e.g., "My child is out of control.") and problem solve how this self-talk influenced the parent's behavior (e.g., "I yelled at my child and then spent a great deal of time lecturing on proper behavior.).
In later sessions, parents are helped to create alternative strategies for both dealing with the child problem (e.g., attending to the child for good behavior) as well as their unproductive self-talk (e.g., using an alternative thought such as "This is a situation I can handle.").
References
- Aspinwall, L. G., & Brunhart, S. M. (2000). What I do know won't hurt me: Optimism, attention to negative information, coping, and health. In J. E. Gillham (Ed.), The science of optimism and hope: Research essays in honor of Martin E. P. Seligman. Laws of life symposia series (pp. 163–200). West Conshohocken, PA: Templeton Foundation Press.
- Carver, C. S., & Scheier, M. F. (1990). Origins and functions of positive and negative affect: A control-process view. Psychological Review, 97(1), 19–35.
- Durand, V. M. (2011). The concession process: A new framework for understanding the development and treatment of challenging behavior in autism spectrum disorders. Paper presented at the American Psychological Association, Washington, D.C.
- Durand, V. M., & Hieneman, M. (2008). Helping parents with challenging children: Positive family intervention, Facilitator's guide. New York: Oxford University Press.
- Durand, V. M., Hieneman, M., Clarke, S., Wang, M., & Rinaldi, M. (2013). Positive family intervention for severe challenging behavior I: A multi-site randomized clinical trial. Journal of Positive Behavior Interventions, 15(3), 133–143. doi: 10.1177/1098300712458324
- Durand, V. M., Hieneman, M., Clarke, S., & Zona, M. (2009). Optimistic parenting: Hope and help for parents with challenging children. In W. Sailor, G. Dunlap, G. Sugai & R. H. Horner (Eds.), Handbook of positive behavior support (pp. 233–256). New York: Springer.
- Morrissey-Kane, E., & Prinz, R. J. (1999). Engagement in child and adolescent treatment: The role of parental cognitions and attributions. Clinical Child and Family Psychology Review, 2(3), 183–198.
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