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Children in conflict-affected settings are at increased risk for exposure to violence, placing particular importance on caregiving environments. This study first describes parenting in urban Liberia by evaluating parent-child interactions, the use and acceptance of harsh and nonharsh discipline, discipline preferences, and the co-occurrence of positive interactions and harsh discipline. The relationship between parenting stress and harsh discipline attitudes and behaviors is then tested. Participants included 813 parents with a child aged 3 or 4 years old. A quantitative survey battery assessed parent-child interactions; discipline practices, preferences, and attitudes; and parenting stress. Parents reported frequent use and high acceptance of nonharsh discipline, as well as frequent positive interactions with their child. Though parents reported less frequent use and low acceptance of harsh discipline, preference for harsh discipline-based on hypothetical situations rather than self-report-was common. There was co-occurrence of frequent positive interactions and frequent harsh discipline, with one third reporting high frequency of both. Regression analysis revealed greater parenting stress (β = .15

Evidence-based treatments (EBTs) for childhood disruptive behavior disorders, such as Parent-Child Interaction Therapy (PCIT), have limited availability in community settings. Recent research highlights the importance of implementation support models to ensure full adoption and sustainability of an EBT. Although other EBT protocols have been disseminated using the learning collaborative (LC) model, these methods are only now being applied to PCIT. This paper will describe the first PCIT learning collaborative conducted in the US. Community clinicians successfully completing the program demonstrated high levels of treatment fidelity and coding reliability, and families who completed treatment through the program reported significant improvements in child internalizing and externalizing behaviors and parenting behaviors and stress. These preliminary results suggest community clinicians are successful in implementing PCIT with the support of the LC.

Background.This paper uses data from a cohort of parents and guardians of young children living in Monrovia, Liberia collected before and after the 2014 outbreak of Ebola virus disease (EVD) to estimate the impact of EVD exposure on implicit preferences for harsh discipline. We hypothesized that parents exposed to EVD-related sickness or death would exhibit a stronger preference for harsh discipline practices compared with non-exposed parents.Methods.The data for this analysis come from two survey rounds conducted in Liberia as part of an intervention trial of a behavioral parenting skills intervention. Following a baseline assessment of 201 enrolled parents in July 2014, all program and study activities were halted due to the outbreak of EVD. Following the EVD crisis, we conducted a tracking survey with parents who completed the baseline survey 12 months prior. In both rounds, we presented parents with 12 digital comic strips of a child misbehaving and asked them to indicate how they would react if they were the parent in the stories.Results.Parents from households with reported EVD sickness or death became more ‘harsh’ (Glass's delta = 1.41) in their hypothetical decision-making compared with non-exposed parents,t(167)=−2.3,p Conclusions.Results support the need for family-based interventions, including strategies to help parents learn alternatives to harsh punishment.

Parenting interventions can reduce child maltreatment and improve child outcomes in high-risk settings, but little is known about mechanisms underlying effects. This study presents qualitative findings on mechanisms of change from a randomized trial of a parenting intervention in Liberia. Participants (N = 30) completed semi-structured interviews, and thematic content analysis was conducted from transcripts. Results suggest that learning about effects of violence on child development and discussing the value of empathy for children strengthened caregivers’ sense of identity as nurturers and protectors. This in turn drove efforts to decrease harsh discipline. As a result, children expressed less fear, increasing opportunities for positive interactions; shared enjoyment maintained reduced harsh treatment. Caregivers also described recognizing that physical punishment was often ineffective and using new non-violent discipline skills alongside emotion regulation skills to facilitate behavior change. Participants also described reduced couples conflict and more peaceful home environments associated with increased self-identification as role models.

Objective Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method Racially/ethnically diverse children ages 3-5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent-child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed "treatment response" after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show "treatment response" at 6-month follow-up. Both treatments had significant effects on children's symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment "excellent response" was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. (PsycINFO Database Record

This study compared the relative efficacy of intensive versus weekly panic control treatment (PCT) for adolescent panic disorder with agoraphobia (PDA). Twenty-six adolescents participated in weekly sessions and 25 received intensive treatment involving daily sessions. Both groups demonstrated significant and comparable reductions in panic disorder severity and general anxiety symptoms, which maintained over time. Participants receiving weekly treatment showed significant decreases in depressive symptoms, whereas those in the intensive program reported no change. Findings support the efficacy of the intensive approach for adolescent PDA, but suggest that adolescents receiving intensive treatment may benefit from a brief course of additional weekly sessions.

This study examined the prevalence and patterns of sleep problems in a sample of children with anxiety disorders. Participants were 175 children, aged 6 to 18 years, with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, social phobia, or obsessive-compulsive disorder, presenting for assessment at an anxiety specialty clinic. Ninety percent of the sample demonstrated at least one sleep-related problem (SRP), and 82% experienced two or more. Frequencies of sleep problems did not differ between males and females or across younger and older children. However, type of sleep problems varied by diagnostic category. Findings also revealed strong associations between SRPs and a range of child anxiety measures, as well as a predictive relationship whereby number of anxiety disorders predicted number of sleep problems. Results highlight the high co-occurrence of sleep and anxiety problems, emphasizing the need for assessment and intervention efforts targeting sleep disturbance in this population.

The present study analyzed rates of peer victimization in children with a chronic tic disorder as compared to children with type 1 diabetes and healthy controls. The associations among peer victimization, tic symptom severity, and psychological symptoms, as well as the potential mediating relationship between peer victimization, tic severity, and child internalizing symptoms, were also explored. Children with tics displayed higher rates of peer victimization than control groups, and peer victimization in children with tics was positively correlated with tic symptom severity, loneliness, anxiety symptoms, and parent report of child internalizing symptoms. Results also supported the hypothesis that peer victimization mediates the relationship between tic symptom severity and loneliness. Findings highlight the importance of the assessment and treatment of psychosocial variables in children with chronic tic disorders, including social functioning and peer relationships.

Given the enormous individual, familial, and societal costs associated with early disruptive behavior disorders, transformative efforts are needed to develop innovative options for overcoming traditional barriers to effective care and for broadening the availability of supported interventions. This paper presents the rationale and key considerations for a promising innovation in the treatment of early-onset disruptive behavior disorders—that is, the development of an Internet-based format for the delivery of Parent–Child Interaction Therapy (PCIT) directly to families in their own homes. Specifically, we consider traditional barriers to effective care, and discuss how technological innovations can overcome problems of treatment availability, accessibility, and acceptability. We then detail our current Internet-delivered PCIT treatment program (I-PCIT), which is currently being evaluated across multiple randomized clinical trials relative to waitlist comparison, and to traditional in-office PCIT. Embedded video clips of children treated with I-PCIT are used to illustrate novel aspects of the treatment.

This study examined the effects of comorbid separation anxiety disorder (SAD) on the expression of externalizing symptoms in children presenting with oppositional defiant disorder (ODD) as well as the treatment effects on anxiety and internalizing symptoms. Participants were 64 children with ODD seen in parent-child interaction therapy (PCIT), including 15 children with comorbid SAD. Children with ODD+SAD did not differ from children with ODD only in disruptive behavior severity at pre-treatment assessment, and children with ODD+SAD showed significant decreases in SAD symptoms at post-treatment. Additionally, children with clinical levels of internalizing behavior demonstrated significant reductions in these symptoms, along with reduction of externalizing symptoms targeted in treatment. We discuss the possibility that treatments focusing on parent-child interactions and certain parenting skills may generalize across specific child symptom constellations.