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GenerationPMTO

Blueprints Program Rating: Model

A group- or individual-based parent training program that teaches effective family management strategies and parenting skills, including skill encouragement, setting limits/positive discipline, monitoring, problem solving, and positive involvement, in order to reduce antisocial and behavior problems in children.

  • Marion Forgatch
  • Implementation Sciences International, Inc.
  • 10 Shelton McMurphey Blvd
  • Eugene, OR 97401
  • (541) 485-2711
  • (541) 338-9963
  • marionf@oslc.org
  • isii.net
  • Antisocial-aggressive Behavior
  • Anxiety
  • Conduct Problems
  • Delinquency and Criminal Behavior
  • Externalizing
  • Illicit Drug Use
  • Internalizing
  • Mental Health - Other

    Program Type

    • Parent Training

    Program Setting

    • Community (e.g., religious, recreation)
    • Mental Health/Treatment Center

    Continuum of Intervention

    • Selective Prevention (Elevated Risk)
    • Indicated Prevention (Early Symptoms of Problem)

    A group- or individual-based parent training program that teaches effective family management strategies and parenting skills, including skill encouragement, setting limits/positive discipline, monitoring, problem solving, and positive involvement, in order to reduce antisocial and behavior problems in children.

      Population Demographics

      Evaluated studies have only included children and adolescents from ages 3 through 16; however, program developers prefer to focus on children ages 4-12.

      Age

      • Early Childhood (3-4) - Preschool
      • Late Childhood (5-11) - K/Elementary
      • Early Adolescence (12-14) - Middle School
      • Late Adolescence (15-18) - High School

      Gender

      • Male and Female

      Gender Specific Findings

      • Male
      • Female

      Race/Ethnicity

      • All Race/Ethnicity, Hispanic or Latino

      Race/Ethnicity/Gender Details

      Evaluations have been conducted in the U.S. with White samples and Spanish-speaking, Latino families, as well as in Norway and Iceland with Scandinavian families (one of which targeted immigrant Pakistani and Somali families).

      Risk factors relate to adverse family contexts, including family structure transitions, poverty, stress, distress, antisocial parental qualities, parental depression, and child removal. Protective factors include effective parenting practices.

      • Individual
      • Peer
      • Family
      Risk Factors
      • Peer: Interaction with antisocial peers*
      • Family: Low socioeconomic status*, Parent stress*, Poor family management*
      Protective Factors
      • Individual: Clear standards for behavior, Prosocial behavior, Prosocial involvement, Rewards for prosocial involvement, Skills for social interaction*
      • Peer: Interaction with prosocial peers
      • Family: Attachment to parents, Opportunities for prosocial involvement with parents, Parental involvement in education, Rewards for prosocial involvement with parents

      *Risk/Protective Factor was significantly impacted by the program.

      See also: GenerationPMTO Logic Model (PDF)

      Parent Management Training – Oregon Model (rebranded as GenerationPMTO) is a group of theory-based parent training interventions that can be implemented in a variety of family contexts. The program aims to teach effective family management skills in order to reduce antisocial and problematic behavior in children who range in age from 3 through 16 years. GenerationPMTO is delivered in group and individual family formats, in diverse settings (e.g., clinics, homes, schools, community centers, homeless shelters), over varied lengths of time depending on families’ needs. Typically sessions are one week apart to optimize the opportunity for learning and rehearsing new practices. The number of sessions provided in parent groups ranges from 6 to 14; in clinical samples the mean number of individual treatment sessions is 25.

      The central role of the GenerationPMTO therapist is to teach and coach parents in the use of effective parenting strategies, namely skill encouragement, setting limits or effective discipline, monitoring, problem solving, and positive involvement. In addition to the core parenting practices, GenerationPMTO incorporates the supporting parenting components of identifying and regulating emotions, enhancing communication, giving clear directions, and tracking behavior. Promoting school success is a factor that is woven into the program throughout relevant components.

      Parent Management Training – Oregon Model (rebranded as GenerationPMTO) is a group of theory-based parent training interventions that can be implemented in many family contexts including two-parent, single-parent, re-partnered, grandparent, and foster families. It aims to teach effective family management skills in order to reduce antisocial and problematic behavior in children. Populations of focal youngsters have ranged in age from 3 through 16 years with specific clinical problems or at risk for problems, such as antisocial behavior, conduct problems, theft, delinquency, substance abuse, and child neglect and abuse. GenerationPMTO is delivered in group and individual formats, in diverse settings (e.g., clinics, homes, schools, community centers, homeless shelters), and over varied lengths of time depending on families’ needs. Typically sessions are one week apart to optimize the opportunity for learning and rehearsing new practices. The number of sessions provided in parent groups ranges from 6 to 14. In clinical samples, the mean number of individual treatment sessions is about 25.

      The central role of the GenerationPMTO therapist is to teach and coach parents in the use of effective parenting strategies, namely skill encouragement, setting limits or effective discipline, monitoring, problem solving, and positive involvement. Skill encouragement incorporates ways in which caregivers promote competencies using scaffolding and contingent positive reinforcement (e.g., establishing reasonable goals, breaking goals into achievable steps, use of praise, tokens, and incentive charts). Setting limits or effective discipline involves the establishment of appropriate rules with the application of mild contingent sanctions for rule violations. Monitoring (supervision) involves keeping track of the youngsters’ activities, associates, and whereabouts, as well as arranging for appropriate childcare, transportation, and supervision of youngsters when away from home. Problem solving involves skills that help family members communicate well and negotiate disagreements, establish rules, and specify consequences for following or violating rules. Positive involvement reflects the many ways parents invest time and plan activities with their youngsters.

      In addition to the core parenting practices, GenerationPMTO incorporates the supporting parenting components of identifying and regulating emotions, enhancing communication, giving good directions, and tracking behavior. Promoting school success is a factor that is woven into the program through all the components.

      While traditionally the program is delivered in-person, Rabbitt et al. (2016) introduced two 8-session online versions of GenerationPMTO that reduce the amount of contact between the therapist and client. One version, “Full Contact PMT,” closely resembles the traditionally administered in-person program, except that all direct contact in the treatment sessions occurs over videoconferencing software. The other version, “Reduced Contact PMT,” reduces direct interaction with the therapist by approximately 80%. Rather than meeting face-to-face with therapists, clients are emailed weekly pre-recorded treatment sessions that look much like the videoconference calls. Professionally taped role-plays take the place of parents participating directly with their therapists, and the only direct contact that parents have with the therapist is through regular telephone conversations designed to address questions or concerns that arise as parents implement the program in their homes.

      Parent Management Training--Oregon Model (rebranded as GenerationPMTO) rests solidly on the theoretical foundation of Social Interaction Learning (SIL), which fuses social interaction, social learning, and behavioral perspectives (Forgatch & Patterson, 2010). As shown in Figure 1, child/adolescent adjustment is the central focus of the model, with parenting practices standing between contextual factors and youth adjustment. A series of passive longitudinal studies yield support for the hypothesis that parenting practices mediate various contexts, including divorce and repartnering, maternal depression, low socioeconomic status, and high stress (DeGarmo & Forgatch, 1999); DeGarmo, Forgatch, & Martineez, 1999; Bank, Forgatch, Patterson, & Fetrow, 1993; Larzelere & Patterson, 1990; Reid, Patterson & Snyder, 2002). A number of RCTs have validated the theory, showing that the intervention improves child and family outcomes, and these effects are mediated by the intervention effects on parenting practices.

      • Behavioral
      • Skill Oriented
      • Social Learning

      The Forgatch and DeGarmo (1999) and related studies utilized an experimental longitudinal design, which included random assignment into the PMT group or a non-intervention control group. The participants were 238 recently separated mothers and their sons in grades 1-3. Mothers in the experimental group (n = 153) received the PMT intervention and mothers in the control group (n = 85) received no intervention. In this study the participants received extensive multiple-method, -setting, and -agent assessment at several time points: baseline, 6 months, 12 months, 18 months, 30 months (DeGarmo et al., 2004; Forgatch & DeGarmo, 2007; Martinez & Forgatch, 2001), and 6, 7, 8, & 9 years (Forgatch et al., 2009; Patterson et al., 2010).

      The Bank et al. (1991) study, conducted in the 1970's, used a randomized trial of Parent Training (PT), which included 60 boys referred by the Lane County (Oregon) Juvenile Court. Participants were assigned to either the Oregon Social Learning Center OSLC) PT Intervention (n = 28) or Community Control (n = 27) treatment conditions. Offense data were collected for the year prior to intake, the treatment year, and the three years following treatment.

      The Patterson, Chamberlain, and Reid (1982) study utilized a randomized design in which 46 families were referred to OSLC by pediatricians, school or mental health personnel, or parents. Nineteen families that were not excluded and did not drop from the study were randomly assigned to experimental treatment (n = 10) or a comparison group (n = 9). Observations were conducted during baseline (2 week duration) and when experimental families were terminated (after an average of 17 hours of therapy time).

      The Martinez and Eddy (2005) study randomized 73 Spanish-speaking, Latino families to a treatment or control condition and the program was adapted to meet the needs of this specific cultural population.

      The study by Ogden and Hagen (2008) and Hagen, Ogden, and Bjornebekk (2011) utilized a randomized design in which 59 Norwegian families were assigned to the PMTO group and 53 families were assigned to a regular services (RS) comparison group. Data were collected at intake (baseline) and at post-treatment (approximately 11 to 12 months later), and one year follow-up.

      The Forgatch, DeGarmo, and Beldavs (2005) and related studies (Bullard et al., 2010; DeGarmo & Forgatch, 2007; Wachlarowicz, Snyder, Low, Forgatch, & DeGarmo, 2012) examined the effects of the PMTO program to prevent conduct problems in children in 110 families whose mother was recently married using randomized controlled assignment. Added components to the program included material addressing stepfamily issues and measures were collected at 6-, 12-, and 24-months post baseline.

      The Bjørknes et al. (2012) and Bjørknes and Manger (2012) studies used an RCT method to determine the effect of PMTO on parent practices as mediators of change on child conduct problems among 96 Pakistani and Somali immigrant families in Norway. Cultural adaptations (translations) were made to the program to accommodate the needs of the targeted population.

      The Sigmarsdóttir et al. (2013, 2014) study was a randomized controlled trial of 102 families in Iceland. Cultural adaptations (translations) were made to the program to accommodate the needs of the targeted population. Results for treatment families were compared to a group that received usual services for children with behavioral problems.

      Kjobli and Ogden (2012) conducted a randomized trial of brief parent training (3-5 sessions) in primary care settings among 216 Norwegian families whose children were exhibiting signs of problem behaviors.

      Kjøbli et al. (2013) used a randomized controlled trial of group-based PMTO with 137 families assigned to PMTO or a comparison group. Twelve 2.5-hour group sessions were provided to parents in the PMTO group to promote parenting skills in families whose children exhibited conduct problems in Norway.

      Ollendick et al. (2015) used a U.S.-based randomized control trial that compared the program (N= 63) to both a similar parent training intervention, Collaborative & Proactive Solutions (N=60), and a waitlist control group (N=11). Participants assigned to these 3 groups were assessed at baseline (N=134) and posttest (N=100; 75%), 6 weeks later. Relatively few in the full baseline sample were retained at 6-month follow-up (N=55; 41%) to compare longer-term outcomes of the two programs.

      The Rabbitt et al. (2016) study used a U.S.-based QED with some randomization to compare two new online versions of the program, “Full Contact PMT” (N=40) and “Reduced Contact PMT” (N=46), to a separate, matched sample that had previously received the traditional in-person delivery model. Only families that completed treatment were included in the study, so while 86 were initially enrolled in the online versions of the program, only the 60 (70%) that completed posttest measures were compared to those that had previously received traditional PMT (N=60).

      In the Netherlands, Schoorl et al (2017) used a non-matched quasi-experimental design to test the intervention’s effects on aggression in boys with oppositional defiant disorder/conduct disorder. Participants were recruited from medical clinics, special education schools, and regular elementary schools. There were a total of 64 participants assigned to the intervention group (n=22) or the control group (n=42). Primary outcome measures included parent- and teacher-reported child aggression. This study also included measures of salivary cortisol reactivity as a measure of neurobiology.

      Posttest results in a study of divorced mothers (Forgatch & DeGarmo, 1999) showed that the intervention reduced coercive parenting, negative reinforcement, and child noncompliance, and it increased positive parenting, effective parenting practices, and adaptive functioning. Results at the 30-month follow-up (DeGarmo et al., 2004; Forgatch & DeGarmo, 2007; Martinez & Forgatch, 2001) showed that the intervention resulted in an increase in income and rise out of poverty and reduced maternal depression and child noncompliance, externalizing and internalizing, and it showed mediating influences of parenting practices on mother and child outcomes. Results at the 36-month follow-up (DeGarmo & Forgatch, 2005) showed that the program reduced boys' delinquency and deviant peer association and that the intervention effect on delinquency operated through growth in effective parenting and reduction in deviant peer association. At the 9-year follow-up (Forgatch et al., 2009; Patterson et al., 2010), assignment to the intervention group yielded beneficial effects on average levels and growth of teacher ratings of delinquency. These intervention effects on the outcome were mediated when deviant peer association and parenting practices were included in the models. However, change in parenting was not associated with reductions in deviant peer association. When averaging the data from nine years, children in the experimental group had a lower rate of arrests than the control group. However, there was no significant difference between the groups in rate of arrest per year. Also at the 9-year follow-up, mothers had an improved standard of living and fewer police arrests.

      Study 2 (Bank et al., 1991) results showed significant decreases in rates and prevalence of juvenile arrests for both groups, but the parent training treatment produced quicker results that were at least as strong as those produced by community control treatment and were obtained with one-third less reliance on incarceration. Study 3 findings should be interpreted with extreme caution as only 19 participants were measured and the group sizes were very small (experimental group n = 10; control group n = 9). Those findings included a 63% reduction in the intervention children’s mean rate of deviant behavior, compared to a 17% reduction for control children. Additionally, 70% of the experimental children tested within the normal range on deviant behaviors at termination, compared to 33% of the control subjects. On parent report measures of problem behavior, the experimental groups mean scores decreased from 3.19 per day to 1.66 per day, compared to 3.20 and 1.96, respectively, for the control group.

      Study 3 (Patterson et al., 1982) showed significant reductions in deviant behavior among treatment children, compared to control children (63% vs. 19%). There were significant differences in observations of aversive behaviors between groups, with 70% of treatment children testing within the normal range post-intervention, compared to 33% of control group children.

      A study with Spanish-speaking Latino parents (Study 4--Martinez & Eddy, 2005) revealed that the intervention produced benefits in three of seven parenting outcomes (i.e., general parenting, skill encouragement, overall effective parenting) and three of seven youth outcomes (i.e., aggression, externalizing, likelihood of smoking).

      Study 5 (Ogden & Hagen, 2008; Hagen et al., 2011) found that Norwegian children in the PMTO group scored significantly lower on parent-rated (but not teacher-rated) externalizing behavior problems at the end of treatment than did the children in the regular services (RS) group. PMTO children also received significantly lower scores on the Child Behavior Checklist (CBCL) total problem scale than did RS children. Scores on the Parent Daily Report across 3 days indicated that significantly fewer problems were reported for children younger than 8 in the PMTO group compared with their Regular Service group counterparts. Younger children in the PMTO group scored significantly lower on the Teacher Report Form (TRF) externalizing and total problem scales than did younger children in the RS group. Children of families assigned to the PMTO group were rated as significantly more socially competent by their teachers at the end of treatment than were children of families assigned to the RS group. Parents who received PMTO scored significantly higher on effective discipline than did their counterparts in the RS group at the end of treatment as rated by coders. PMTO parents with younger children scored significantly higher on parental monitoring than did the parents of younger children in the RS group. RS parents of older children scored higher on problem solving than did parents of older children in the PMTO group, a negative effect.

      Three other studies conducted in Norway, one of which targeted immigrant Pakistani and Somali families, and one in Iceland, showed significant improvements in child conduct behavior and parenting outcomes.

      Study 11 (Ollendick et al., 2015) focused on a rural U.S.-based sample and found that, at posttest, Parent Management Training and a similar parent-training program (Collaborative & Proactive Solutions) both significantly improved clinical severity ratings of oppositional defiant disorder (ODD), decreased global impairment, reduced the severity of parent-reported ODD symptoms, and decreased parent reports of aggression more than a waitlist control group; however, neither active treatment performed better than the other. These gains were largely maintained at 6-month follow-up, though tests lacked a control group comparison.

      A study (Rabbitt et al., 2016) comparing two online versions of the program with varying therapist contact to those receiving traditionally delivered PMT found no significant differences across a few behavioral outcomes between the online and in-person groups, suggesting that the program could be delivered online with much less therapist contact without compromising treatment effectiveness. However, a separate comparison of the two online interventions revealed significantly greater decreases in parent-reported child internalizing symptoms in the “Full Contact” online group than the “Reduced Contact” online group.

      A meta-analysis of three studies and seven articles (see Notes below) found a small but statistically significant mean effect size of .20. When examined separately by outcome, the mean effect sizes were similarly small: .11 for total problems, .15 for arrests, .15 for substance use, .20 for deviant peers, .21 for delinquency, .22 for externalizing, and .24 for internalizing.

      In the Netherlands, Schoorl et al. (2017) found significant reductions in parent-reported aggression over time for the intervention group compared to the control group.

      In a nine year study with divorced parents, parent training participants compared to controls experienced:

      • Posttest (12 months) reductions in coercive parenting and negative reinforcement (Forgatch & DeGarmo, 1999).
      • Posttest increases in positive parenting, effective parenting practices, and adaptive functioning.
      • Posttest decreases in boys' noncompliance.
      • Reduced maternal depression and child internalizing and externalizing at 30-month followup (DeGarmo et al., 2004; Martinez & Forgatch, 2001).
      • Reduction in poverty and greater rise out of poverty at 30 months follow-up (Forgatch & DeGarmo, 2007).
      • Lower levels and lower growth in teacher-rated delinquency at nine year follow-up (Forgatch et al., 2009).
      • Reduction in average levels (but not growth) of deviant peer association.
      • Lower rates of arrest and delayed age at first arrest at nine year follow-up (Forgatch et al., 2009).
      • Fewer police arrests among mothers at nine year follow-up (Patterson et al., 2010).
      • Increased socioeconomic status levels among mothers at nine year follow-up (Patterson et al., 2010, Forgatch & DeGarmo, 2007).

      Bank et al., 1991:

      • Parent Training participants had faster decreases in rates and prevalence of juvenile arrests than community controls.

      Patterson et al., 1982:

      • Significant reductions in deviant behavior among treatment children, compared to control group children (63% vs. 19%).
      • Significant differences in observations of aversive behaviors between groups, with 70% of treatment children testing within the normal range post-intervention, compared to 33% of control group children.

      Martinez and Eddy, 2005:

      • Parent Training participants had reductions in 3 of 7 youth outcomes (aggression, externalizing behaviors, and likelihood of using tobacco) and 3 of 7 parenting outcomes (general parenting, skill encouragement, overall effective parenting).

      Ogden and Hagen, 2008; Hagen et al., 2011:

      • Children in the PMTO group scored significantly lower than Regular Service (RS) group children at end of treatment on parent-rated externalizing behavior problems and had significantly lower scores on the CBCL total problem scale.
      • Parent Daily Report scores across 3 days indicated that significantly fewer problems were reported for PMTO children younger than 8 compared with the RS group, and younger PMTO children scored significantly lower on the TRF externalizing and total problem scales than did younger RS children.
      • Children of families assigned to the PMTO group were rated as significantly more socially competent by their teachers at the end of treatment than RS children.
      • Parents who received PMTO scored significantly higher on effective discipline than did their counterparts in the RS group at the end of treatment as rated by coders.
      • PMTO parents with younger children scored significantly higher on parental monitoring than did the parents of younger children in the RS group.
      • Long-term results showed benefits only for total aversive behavior in two-parent families.

      Forgatch et al, 2005; DeGarmo & Forgatch, 2007; Bullard et al., 2010; Wachlarowicz et al., 2012

      • Stepparent families receiving PTMO showed a significant increase in positive parenting and stepfathering practices, and a significant decline in child behavior problems and depression.
      • Parents reported improved marital interaction and mothers' marital satisfaction (but not fathers')
      • Significant decline in coercive parenting.

      Bjørknes et al., 2012; Bjørknes & Manger, 2012:

      • Among immigrant mothers from Pakistan and Somalia now living in Norway, the program improved positive parenting practices and child conduct problems.

      Sigmarsdóttir et al., 2014

      • Significant program effects on child adjustment problems, compared to families who received Services as Usual.

      Kjobli & Ogden, 2012 (Brief Parent Training):

      • Parents reported that their children in the intervention group had fewer behavioral problems, externalizing, and Anxiety/Depression and improved social competence.
      • Intervention parents, relative to control parents, reported more positive parenting practices, and lower scores on harsh discipline, harsh for age, and inconsistent discipline.

      Kjøbli, et al., 2013:

      • Two of the five variables of parent-reported child outcomes (intensity and social competence) and one variable of parent-reported parenting practices (harsh discipline) were significantly improved in the intervention group compared to the control group at posttest and 6-month follow-up.
      • The parent distress measure was significantly different between groups at posttest.
      • One of the three teacher-report measures (social competence) was significantly improved in the intervention group compared to the control group at posttest but not at 6-month follow-up.

      Ollendick et al., 2015 found that, compared to a waitlist control group, Parent Management Training and another parent-training program (Collaborative & Proactive Solutions) similarly improved posttest:

      • Oppositional defiant disorder (clinically rated and parent reported).
      • Parent-reported aggression.

      Rabbitt et al., 2016 found no differences on three behavioral outcomes between two online versions of the program and traditional in-person PMT, though a comparison between the online programs showed:

      • Greater decreases in parent-reported child internalizing symptoms for Full Contact PMT than Reduced Contact PMT.

      Schoorl et al., 2017 found that compared to the control group, intervention group participants had significant reductions in:

      • Frequency of parent reported aggression

      In a study of recently separated mothers and their young sons (DeGarmo, Patterson, & Forgatch, 2004), with a 30-month mediational analysis, 238 families in the experimental longitudinal design received extensive multiple-method, -setting, and -agent assessment five times: baseline, 6 months, 12 months, 18 months, and 30 months. Effect sizes indicated that parenting changed first within 12 months, followed by changes in boy behaviors and finally changes in maternal depression within 30 months. Follow-up findings indicated that intervention effects on reductions in maternal depression were mediated by reductions in boy externalizing; growth reduction in externalizing behavior was mediated by growth reduction in boy internalizing behaviors. PMTO effects on internalizing were direct and indirect, partially mediated by parenting practices.

      In a study of stepparent families, Forgatch et al. (2005) showed that the program improved couple parenting, which in turn reduced home problems and school problems of children; Bullard et al. (2011) found that the program improved parenting practices and indirectly improved child externalizing through parenting practices.

      In studies of immigrant Somali and Pakistani mothers in Norway, Bjørknes et al. (2012) showed that the program reduced harsh discipline and increased positive parenting, and indirectly improved conduct problems via better discipline and positive parenting; marital interaction was improved through improved parenting practices, which in turn was associated with improved marital satisfaction.

      In a Norwegian study of families (Hagen et al., 2011), effective discipline and family cohesion were examined as mediators of child behavior. The program significantly improved effective discipline at posttest, which in turn significantly predicted less child aggression, opposition and aversive behavior and greater parent-reported social skills at one-year follow-up. The program significantly improved family cohesion at posttest, which significantly predicted less child delinquency and externalizing behavior and greater teacher-reported social skills at one-year follow-up.

      In studies of stepfamilies, Forgatch et al. (2005) reported an eta-squared measure for the intervention of .14, which indicated a medium-to-large effect size.

      In studies of immigrant women in Norway, Bjørknes et al. (2012) found effect sizes for the significant outcomes ranging from .27 to .54.

      In the study of Iceland, Sigmarsdóttir (2014) found small to moderate effect sizes of .31 and .54.

      In another Norwegian study (Kjøbli et al., 2013), Cohen’s d effect sizes ranged between .34 (for parent-reported child problem behavior) and .88 (for parent-reported positive parenting) at posttest and between .34 (for parent-reported inconsistent discipline) and .88 (for parent-reported positive parenting) at 6-month follow-up.

      In a U.S.-based, rural sample (Ollendick et al., 2015), large effects were observed for all clinical and parent-reported outcomes (d = .92-1.81).

      In a Blueprints meta-analysis of three studies and seven articles (see Notes below), the average effect size was small -- .20.

      In a small Dutch study, Schoorl et al (2017) report eta2 of .10-.11, indicating medium program effects on aggression reduction in boys with conduct problems.

      Studies have been conducted primarily with White and Latino populations in Oregon, Spanish-speaking Latino parents in the U.S., a rural sample in Virginia, Scandinavian families in Norway and Iceland, and Somali and Pakistani immigrant mothers in Norway. The Norwegian study (Kjøbli & Ogden, 2012) examined interactions by age and gender. The program works for both males and females and in clinical and prevention samples. In two samples (Hagen et al., 2011; Ollendick et al., 2015), the program worked better for parents with younger children, with one study also finding the program was especially effective for those diagnosed with anxiety disorders (Ollendick et al., 2015). The program generalizes to samples of single mother families, stepfather families, and mixed family structures.

      Study 1: The sample was drawn from an ethnically limited pool. Because there was a two-year hiatus between phases one and two, the transition into adolescence was missed for some of the youth in the study. Also, by design, the study only examined boys living in one type of family situation (single mother families). Although participating families self-selected to participate in the study, they were then randomly assigned to intervention or control groups.

      Studies 2-5: There were few effects in Study 2, and Study 3 had high attrition leaving only a sample of 19 to analyze. Study 4 also had high attrition (participation rate of 46%) and significant baseline differences. In a fifth study, the treatment(s) provided to participants in the Regular Service condition lacked a clear definition for comparison purposes. There was a very small number of girls present in the study (n = 22). There were no treatment effects on internalizing problems, academic competence, or teacher-rated externalizing behavior. Finally, parents of older RS children scored higher on problem-solving than did parents of older children in the PMTO group, a negative effect. Long-term results show benefits only for total aversive behavior in two-parent families.

      Study 6

      • Baseline equivalence was not discussed, despite results in one study (Bullard et al., 2010) that gave some indication of group differences at baseline on one outcome – marital satisfaction reported by the mother.
      • Differential attrition was examined in DeGarmo & Forgatch, 2007, and authors state that there were no signficant differences on predictors or outcomes when comparing families retained and families not assessed at follow-up, however, no descriptive statistics are provided.

      Study 7

      • All significant intervention effects occurred for mother self-reports about home behavior, while independent reports from teachers on classroom behaviors showed no effects of the program.
      • Tests for baseline equivalence found one difference on baseline outcomes.

      Study 8

      • Ratings from parents, who helped deliver the program, were dominant in measure of child adjustment
      • Tests found no program influence on mediating factor of parenting practices

      Study 9

      • All significant results come from parent report and because parents were the recipients of the intervention are subject to bias. None of the teacher-reported child outcomes were significant.
      • Baseline differences between groups were found on all teacher measures and one demographic variable.
      • Parents who dropped out of the study had significantly lower levels of education than parents who remained in the study, although imputation of missing data helped adjust for differential attrition.
      • This is a drastic adaptation to the program, using only 3-5 sessions to promote parenting skills. Nevertheless, the mediational models indicated that changes occurred through the intervention's impact on the core parenting practices.

      Study 10

      • Most statistically significant results in this study come from parent reports, and because parents delivered the intervention, these are subject to bias.
      • No long-term data were collected.
      • Generalizability is limited given that this is a Norwegian sample with a high gross annual family income, and the proportion of single parents (36.5%) in the study is higher than the Norwegian average (20%). Also, all subjects were highly motivated to change, having first contacted an agency on their own for help.

      Study 11 (Ollendick et al., 2015)

      • Several measures reported by parents, who helped deliver the program.
      • Groups differed on race/ethnicity and age at baseline.
      • Those retained for the duration of the study differed on income, parents' education, and family structure (at 6-month follow-up, only) from dropouts.
      • The rural, high-income and education sample has limited generalizability.
      • The reliability of some measures was not reported.

      Study 12 (Rabbitt et al., 2016)

      • QED with limited randomization and a non-randomly matched comparison group
      • All measures came from therapists and parents who deliver the intervention
      • Measures’ psychometric properties were not calculated for the present sample
      • Completers-only analysis violates intent-to-treat
      • Analyses of baseline equivalence and differential attrition were incomplete
      • Used a selective, upper-middle class sample with limited generalizability

      Study 13 (Schoorl et al., 2017)

      • Apparent nonrandom assignment with no matching
      • Only outcome showing improvement was rated by parents who deliver the intervention
      • Some issues with baseline equivalence with no accompanying controls in models

      Other Studies. For more information on Parent Management Training in combination with other treatments, see the write-up on Interventions for Boys with Conduct Problems (Patterson, G., 1974) and the write-up on Problem Solving Skills Training (PSST) and Parent Management Training (PMT): Combined Treatment (Kazdin, A. et al., 1987).

      Parra Cardona et al. (2012) showed that the program can be culturally adapted in ways that make it acceptable to Latino populations, but the study did not present results on the efficacy of the program.

      Meta-Analysis. Blueprints completed a meta-analysis of coefficients from 8 articles in three studies (citations below) that the Blueprints Board deemed as high quality. The combined articles and studies list 72 coefficients for seven child outcomes. The studies differ considerably in the samples. Study 1 followed 238 single mothers and their sons in Oregon for up to 9 years, study 7 examined posttest outcomes for 96 Somali and Pakistani immigrant mothers and their children in Norway, and study 8 examined posttest outcomes for 102 families in Iceland with a child showing behavioral problems in home or school.

      Across all coefficients and outcomes, the mean effect size for Cohen’s d with the Hedges adjustment and weights based on the inverse of the standard error squared equals .20. The mean effect size differs significantly from zero, with a confidence interval of .17 to .23. The minimum observed value is -.08 and the observed maximum value is .60.

      When examined separately by outcome, the mean effect sizes were .11 for total problems (n = 1, a teacher rating based on 113 items), .15 for arrests (n = 9), .15 for substance use (n = 4), .20 for deviant peers (n = 15), .21 for delinquency (n = 14), .22 for externalizing (n = 14), and .24 for internalizing (n = 15). However, tests show that the effect sizes do not vary significantly across outcomes. Nor do the effect sizes vary significantly across study, article, time span, or source of measure.

      Overall, the meta-analysis results from high-quality studies indicate a small but consistent positive effect of the program on multiple outcomes.

      Study 1

      Forgatch, M., & DeGarmo, D. (1999). Parenting Through Change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67(5), 711-724. Journal of Consulting and Clinical Psychology, 67 (5), 711-724.

      Martinez, C., & Forgatch, M. (2001) Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69 (3), 416-428.

      DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 73-89.

      Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21 (5), 637-660.

      Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949-970.

      Study 7

      Bjørknes, R., & Manger, T. (2012). Can parent training alter parent practices and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science, published online.

      Bjørknes, R., Kjøbli, J., Manger, T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114.

      Study 8

      Sigmarsdóttir, M., Thorlacius, O., Guõmundsdóttir, E. V., & DeGarmo, D. S. (2014). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Child outcome in a nationwide randomized controlled trial. Family Process, 54, 498-517.

      Sigmarsdóttir, M., DeGarmo, D. S., Forgatch, M. S., & Guõmundsdóttir, E. V. (2013). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial. Scandinavian Journal of Psychology, 54, 468-476.

      • Blueprints: Model
      • Coalition for Evidence-Based Policy: Near Top Tier

      Kansas
      Becci A. Akin, PhD, MSW
      Assistant Professor
      University of Kansas
      School of Social Welfare
      Phone: 785-864-2647
      Email: becciakin@ku.edu

      Latino populations in the U.S.
      J. Ruben Parra-Cardona, Ph.D.
      Associate Director, MSU Research Consortium on Gender-Based Violence
      Associate Professor, Couple and Family Therapy Program Human Development and Family Studies
      552 W. Circle Drive, 3 D Human Ecology
      Michigan State University
      East Lansing, MI, 48824
      Phone: 517-432-2269
      Email: parracar@msu.edu
      http://vaw.msu.edu/people/parra

      Iceland
      Margrét Sigmarsdóttir
      margret@bvs.is

      Mexico City, CAPAS
      CAPAS-MX "Criando con Amor Promoviendo Armonía y Superación en México"
      Nancy Gigliola Amador Buenabad
      Medical Science Research
      National Institute of Psychiatry "Ramón de la Fuente Muñiz"
      nagy@imp.edu.mx
      naagy14@yahoo.com.mx
      011 52 55 4160 5139 (office)
      011 521 55 40116159 (movil)

      Bank, L., Marlowe, J. H., Reid, J. B., Patterson, G. R., & Weinrott, M. R. (1991). A comparative evaluation of parent-training interventions for families of chronic delinquents. Journal of Abnormal Child Psychology, 19(1), 15-33.

      Bjørknes, R., Kjøbli, J., Manger, T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114.

      Bjørknes, R., & Manger, T. (2012). Can parent training alter parent practices and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science, published online.

      Bullard, L., Wachlarowicz, M., DeLeeuw, J., Snyder, J., Low, S., Forgatch, M., & DeGarmo, D. (2010). Effects of the Oregon Model of Parent Management Training (PTMO) on marital adjustment in new stepfamilies: A randomized trial. Journal of Family Psychology, 24(4), 485-496.

      DeGarmo, D. S., & Forgatch, M. S. (2007). Efficacy of parent training for stepfathers: From playful spectator and polite stranger to effective stepfathering. Parenting Science and Practice, 7(4), 331-353.

      DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 73-89.

      Forgatch, M., & DeGarmo, D. (1999). Parenting Through Change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67(5), 711-724.

      Forgatch, M. S., & DeGarmo, D. S. (2002). Extending and testing the social interaction learning model with divorce samples. In J. B. Reid, G. R. Patterson, & J. Snyder (eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention(pp. 235-256). Washington, DC: American Psychological Association.

      Forgatch, M. S., & DeGarmo, D. S. (2007). Accelerating recovery from poverty: Prevention effects for recently separated mothers. Journal of Early and Intensive Behavioral Intervention, 4(4), 681-702.

      Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z. G. (2005). An efficacious theory-based intervention for stepfamilies. Behavior Therapy, 36(4), 357-365.

      Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21(5), 637-660.

      Hagen, K. A., Ogden, T., & Bjørnebekk, G. (2011). Treatment outcomes and mediators of parent management training: A one-year follow-up of children with conduct problems. Journal of Clinical Child and Adolescent Psychology, 40(2), 165-178.

      Kjøbli, J., & Ogden, T. (2012). A randomized effectiveness trial of brief parent training in primary care settings. Prevention Science, 13, 616-626.

      Kjøbli, J., Hukkelberg, S., & Ogden, T. (2013). A randomized trial of group parent training: Reducing child conduct problems in real-world settings. Behavior Research and Therapy, 51, 113-121.

      Martinez, C., & Eddy, M. (2005). Effects of culturally adapted Parent Management Training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology, 73(4), 841-851.

      Martinez, C., & Forgatch, M. (2001) Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69(3), 416-428.

      Ogden, T., & Hagen, K. A. (2008). Treatment effectiveness of parent management training in Norway: A randomized controlled trial of children with conduct problems. Journal of Consulting and Clinical Psychology, 76, 607-623.

      Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., ... Wolff, J. C. (2015). Parent Management Training and Collaborative & Proactive Solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology, 0(0), 1-14.

      Parra Cardona, J. R., Domenech-Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., ... Bernal, G. (2012). Culturally adapting an evidence-based parenting intervention for Latino immigrants: The need to integrate fidelity and cultural relevance. Family Process, 51(1), 56-72.

      Patterson, G. R., Chamberlain, P., & Reid, J. B. (1982). A comparative evaluation of a parent-training program. Behavior Therapy 13, 638-650.

      Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949-970.

      Rabbit, S. M., Carrubba, E., Lecza, B., MacWhinney, E., Pope, J., & Kazdin, A. E. (2016). Reducing therapist contact in parenting programs: Evaluation of internet-based treatments for child conduct problems. Journal of Child and Family Studies, 25, 2001-2020.

      Reed, A., Snyder, J., Staats, S., Forgatch, M., DeGarmo, D., Patterson, G., ... Schmidt, N. (2013). Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27(3), 343-354.

      Sigmarsdóttir, M., Thorlacius, O., Guõmundsdóttir, E. V., & DeGarmo, D. S. (2014). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Child outcome in a nationwide randomized controlled trial. Family Process, 54, 498-517.

      Sigmarsdóttir, M., DeGarmo, D. S., Forgatch, M. S., & Guõmundsdóttir, E. V. (2013). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial. Scandinavian Journal of Psychology, 54, 468-476.

      Wachlarowicz, M., Snyder, J., Low, S., Forgatch, M. S., & DeGarmo, D. A. (2012). The moderating effects of parent antisocial characteristics on the effects of Parent Management Training - Oregon (PMTO), Prevention Science, 13, 229-240.

      Anna Suski
      Implementation Sciences International, Inc. (ISII)
      10 Shelton McMurphey Blvd
      Eugene OR 97401 USA
      Phone: (541) 485-2711
      Fax: (541) 338-9963
      Email: annas@oslc.org
      Website: www.isii.net

      Study 1

      DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 73-89.

      Forgatch, M., & DeGarmo, D. (1999). Parenting Through Change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67(5), 711-724.

      Forgatch, M. S., & DeGarmo, D. S. (2007). Accelerating recovery from poverty: Prevention effects for recently separated mothers. Journal of Early and Intensive Behavioral Intervention, 4(4), 681-702.

      Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21(5), 637-660.

      Martinez, C., & Forgatch, M. (2001). Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69(3), 416-428.

      Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949-970.

      Reed, A., Snyder, J., Staats, S., Forgatch, M., DeGarmo, D., Patterson, G., ... Schmidt, N. (2013). Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27(3), 343-354.

      Study 7

      Bjørknes, R., Kjøbli, J., Manger, T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114.

      Bjørknes, R., & Manger, T. (2012). Can parent training alter parent practices and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science, published online.

      Study 8

      Sigmarsdóttir, M., DeGarmo, D. S., Forgatch, M. S., & Guõmundsdóttir, E. V. (2013). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial. Scandinavian Journal of Psychology, 54, 468-476.

      Sigmarsdóttir, M., Thorlacius, O., Guõmundsdóttir, E. V., & DeGarmo, D. S. (2014). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Child outcome in a nationwide randomized controlled trial. Family Process, 54, 498-517.

      DeGarmo, D. S., Patterson, G. R., & Forgatch, M. S. (2004). How do outcomes in a specified parent training intervention maintain or wane over time? Prevention Science, 5, 73-89.

      Forgatch, M. & DeGarmo, D. (1999). Parenting Through Change: An effective prevention program for single mothers. Journal of Consulting and Clinical Psychology, 67 (5), 711-724. Journal of Consulting and Clinical Psychology, 67 (5), 711-724.

      Forgatch, M. S., & DeGarmo, D. S. (2007).Accelerating recovery from poverty: Prevention effects for recently separated mothers. Journal of Early and Intensive Behavioral Intervention, 4 (4), 681-702.

      Forgatch, M. S., Patterson, G. R., DeGarmo, D. S., & Beldavs, Z. (2009). Testing the Oregon delinquency model with 9-year follow-up of the Oregon Divorce Study. Development and Psychopathology, 21 (5), 637-660.

      Martinez, C. & Forgatch, M. (2001) Preventing problems with boys' noncompliance: Effects of a parent training intervention for divorcing mothers. Journal of Consulting and Clinical Psychology, 69 (3), 416-428.

      Patterson, G. R., Forgatch, M. S., & DeGarmo, D. S. (2010). Cascading effects following intervention. Development and Psychopathology, 22, 949-970.

      Reed, A., Snyder, J., Staats, S., Forgatch, M., DeGarmo, D., Patterson, G., Low, S., Sinclair, R., & Schmidt, N. (2013). Duration and mutual entrainment of changes in parenting practices engendered by behavioral parent training targeting recently separated mothers. Journal of Family Psychology, 27 (3), 343-354.

      Design: The study used an experimental longitudinal design, which included random assignment into the PMT group or a non-intervention control group. The participants were 238 recently separated mothers and their sons in grades 1-3. The participants were all residing in a medium-sized city in the Pacific Northwest; they were recruited through media advertisement, flyers and divorce court records. Mothers in the experimental group (n = 153) were randomly assigned to receive the PMTO intervention and the mothers in the control group (n = 85) received no intervention. The unequal assignment to group conditions was done to provide sufficient sample size within the experimental group to examine potential full implementation effects of the intervention. Families received extensive multiple-method, multiple-setting and multiple-agent assessment at baseline, 6 months and 12 months. The first four parent groups participated in a 16-session program; the program was then condensed into 14 sessions. Of the 13 parent groups, 31% were exposed to the 16-session program and 69% to the 14-session program. By 12 months, 28 families of the 153 assigned to the experimental condition did not participate, for an attrition rate of 18%. In the control condition, 15 of the 85 families did not participate (18%). Differential attrition analyses revealed no differences in the rate of attrition between the experimental and control conditions. There was a main effect discovered for SES and negative reinforcement. Those mothers who did not participate in the study at 12 months scored higher on baseline negative reinforcement than did those who continued participation and they were of lower SES. There were no differences on any of the outcome variables by condition. The analyses of pretest group differences revealed one difference between experimental and control mothers. Mothers in the experimental group had higher levels of negative reciprocity at baseline than did mothers in the control group.

      Sample: The sample was restricted to boys because research suggests boys are more likely than girls to exhibit adverse effects of divorce as preadolescents. At baseline, mothers had been separated for an average of 9.2 months. Mothers’ mean age was 34.8 years and sample boys' mean age was 7.8 years. The ethnic composition of the boys in the sample was 86% White, 1% African American, 2% Latino, 2% Native American, and 9% from “other” racial/ethnic groups including those who were identified as belonging to more than one group. The mean annual family income was $14,900 and 76% of the families were receiving public assistance. The majority of mothers (76%) had some academic or vocational training beyond high school, although only 17% had completed a 4-year college degree or higher. Approximately 20% of the women completed their education with high school graduation; 4% had not completed high school. Most mothers were classified within the lower and working-class ranges in terms of occupation: 32% unskilled, 21% semiskilled, 23% clerical/skilled, 22% minor professional to medium business, and 3% major business/major professional.

      Measures: The measures utilized in this evaluation included: parenting practices measures (negative reinforcement, negative reciprocity, positive involvement, skills encouragement, monitoring, and problem-solving outcomes); child-rated adjustment variables (depressed mood, peer adjustment, deviant peer association); mother-rated child adjustment variables (anxiety, depressed mood and externalizing) and teacher report (externalizing, delinquency, prosocial behavior and adaptive functioning); police arrests for mothers/boys; maternal depression; and maternal standard of living.

      One study (Reed et al., 2013) created three constructs: 1) poor discipline from separate measures of negative reinforcement, negative reciprocity, and bad discipline; 2) positive parenting from separate measures of skill encouragement, problem solving, and positive involvement; and 3) monitoring.

      Analysis: Intervention effects in most studies were tested using a repeated measure ANOVA or using path analyses (to test for predictors of child adjustment), structural equation modeling (SEM), and latent growth curve modeling (LGM). One study of parenting (Reed et al., 2013) used linear growth models to compare changes in outcomes from baseline to the 30-month assessment and used cross-lagged structural equation models to examine the bi-directional relationships over time between measures of parenting.

      Outcomes

      Posttest:

      Parenting Practices: The intervention group experienced reductions in observed coercive parenting, reductions in negative reinforcement, reductions in negative reciprocity, prevented decay (evidenced in higher scores of parental positive involvement) in positive parenting and generally improved effective parenting practices in comparison to mothers in the control group. Improved parenting practices were correlated significantly with improvements in teacher-reported school adjustment, child-reported maladjustment and mother-reported maladjustment. There were some effects in the opposite direction: Reductions were found for positive parenting practices and a sample-wide reduction was discovered for positive parent involvement and skill encouragement (however, follow-up analyses described below showed greater improvement in parenting practices in the intervention group). There were no significant differences between groups for skill involvement, parent problem solving or child problem solving.

      Teacher-Rated Child Adjustment: The analyses revealed no significant differences between groups for externalizing and prosocial behavioral measures. There was a marginally significant effect found for adaptive functioning, indicating that the experimental group was rated slightly higher (better functioning) than controls on this measure.

      Child- and Mother-Rated Child Adjustment: The analyses revealed no differences between the experimental and control groups on any of the child (peer adjustment and depressed mood) and mother (anxiety, depressed mood and externalizing) rated adjustment measures. The intervention did not produce direct effects on child outcomes, in mother or child-rated domains of child adjustment. There was a significant indirect effect on child rated adjustment through improved parenting practices.

      Mediational Analyses: (DeGarmo, Patterson & Forgatch, 2004)

      In this study with a 30-month mediational analysis, the same 238 families in the experimental longitudinal design received extensive multiple-method, -setting, and -agent assessment five times: baseline, 6 months, 12 months, 18 months, and 30 months. Effect sizes indicated that parenting changed first within 12 months, followed by changes in boy behaviors and finally changes in maternal depression within 30 months. Follow-up findings indicated that intervention effects on reductions in maternal depression were mediated by reductions in boy externalizing; growth reduction in externalizing behavior was mediated by growth reduction in boys' internalizing behaviors. PMTO effects on internalizing were direct and indirect, partially mediated by parenting practices. The findings were consistent with prior findings testing the coercion model, which indicated that effective parenting practices predicted reductions in child behavior problems. Child externalizing served as a mediator for intervention effects on maternal depression.

      2-Year Follow-up: (Martinez & Forgatch, 2001; Reed et al., 2013)

      In this study with a 30-month mediational analysis, the same 238 families in the experimental longitudinal design received extensive multiple-method, -setting, and -agent assessment five times: baseline, 6 months, 12 months, 18 months, and 30 months. The intervention produced enduring benefits to coercive discipline (effect was significant at 12 months and weakened at 30 months), positive parenting (significant at 12 and 30 months) and boys' noncompliance (significant at 30 months).

      In Martinez and Forgatch (2001), the results indicated that the intervention protected the experimental group from the increases in noncompliance and coercive discipline and decreases in positive parenting that were experienced by the control group. However, the intervention did not produce improvements in noncompliance, coercive discipline or positive parenting. Mothers and sons in the experimental group maintained stable outcome trajectories, whereas those in the control group deteriorated. The intervention's impact on boys' noncompliance was mediated independently by its impact on coercive discipline and positive parenting. Change in positive parenting was more strongly associated with change in noncompliance than was change in coercive discipline.

      In Reed et al. (2013), the intervention increased positive parenting and prevented deterioration in discipline and monitoring over the 30-month period. Over time, the improvements reinforced one another: Improved positive parenting supported better subsequent monitoring, and improved positive parenting and monitoring supported subsequent effective discipline.

      9-Year Follow-up: (Forgatch et al., 2009; Patterson et al., 2010)

      In Forgatch et al. (2009), the intervention significantly reduced the 9-year average of teacher-reported delinquency and the 9-year rate of growth in teacher-reported delinquency. The direct effects on delinquency were tested in mediational models with longitudinal sequencing of the predictors. Assignment to the experimental group was associated with improvements in parenting from baseline to 12 months, which in turn was associated with reductions in average levels of delinquency and individual variance in growth rates in delinquency. Assignment to the experimental group was also associated with reductions in average levels of deviant peer association from baseline to 8 years, but not growth rates in deviant peer association. Both average levels and growth of deviant peer association over 8 years were in turn significantly associated with average levels of delinquency.

      For arrests, the study found more mixed support for the mediation hypotheses. The program significantly reduced the average number of arrests over time but not the growth rate in frequency of arrests. In addition, the intervention indirectly influenced average arrest frequency (but not growth rate in arrests) through average deviant peers.

      Survival analyses showed a 37% reduced risk of earlier timing of first arrest for the intervention group in comparison to the control group. Change in effective parenting from baseline to 12 months reduced the size of the intervention effect, thus demonstrating the mediating influence of parenting.

      In Patterson et al. (2010), mothers experienced benefits as measured by standard of living (i.e., income, occupation, education, and financial stress) and frequency of police arrest over nine years. In terms of direct effects, linear growth models showed a higher average effect of the intervention than the control group, but the linear and quadratic change over time was not significantly different for the two groups. In terms of mediated effects, structural equation models indicated that the program reduced coercive parenting over one year; reduction in coercive parenting in 12 months mediated the intervention's effect on growth in positive parenting over 2.5 years, which then mediated the direct effect of the intervention on the 9-year average standard of living. This long chain of relationships produced an indirect effect of .04. The structural equation model for mother total arrest probability indicated a similar indirect effect.

      Bank, L., Marlowe, J. H., Reid, J. B., Patterson, G. R., & Weinrott, M. R. (1991). A comparative evaluation of parent-training interventions for families of chronic delinquents. Journal of Abnormal Child Psychology, 19 (1), 15-33.

      Study two is a randomized trial of Parent Management Training, which included 60 boys referred by the Lane County (Oregon) Juvenile Court.

      Design: The referred youth met the following criteria: repeat offender (minimum of two recorded offenses, at least one of which was a nonstatus offense), less than 16 years old at intake (mean age of 14), and living within 20 miles of the Oregon Social Learning Center (OSLC). The participants’ families were extremely distressed, most suffering external crises, marital discord, and parent depression or antisocial behavior.

      Participants were randomly assigned to either the OSLC or Community Control (CC) treatment conditions. Five subjects who were incarcerated for 11 consecutive months or longer (after assignment but before treatment) were dropped from the original sample for a final total of 55. Treatment began six months after intake. The OSLC treatment condition (n = 28) was originally designed for youth up to age 12, and was somewhat modified for the older subjects. Therapy sessions were conducted with each family individually and incorporated manuals and videos. Parents were trained to identify prosocial and antisocial behaviors including class attendance, defiance, homework, hanging out with kids in trouble, curfew violations, and drug use. The CC treatment condition (n = 27) included intensive family therapy (weekly 90-minute sessions combining behavioral and family systems counseling), group therapy (2 hours per week, focused on drug use, which half the subjects attended), and monitoring of school attendance and performance by the family therapist or probation officer. Therapy lasted 5 months and averaged 50 hours of direct treatment plus optional follow-up sessions.

      Measures: Delinquency was measured using offense records from the Lane County Juvenile Court and from other juvenile courts for those who moved during the follow-up years; if multiple offenses occurred at the same time, only the most serious was counted. Three offense types were tracked: total offenses, status offenses, and nonstatus offenses (felonies and misdemeanors). Offense data was collected for the year prior to intake (BL), the treatment year (TX), and the three years following treatment (FU1, FU2, FU3). Data on time spent in incarceration was collected for the BL, TX, FU1, and FU2 years.

      Observation data from the home and brief daily telephone interviews (PDR) with the parents were taken for the OSLC treatment group only. The former was measured using the Family Interaction Coding System to capture positive, negative, and neutral behaviors of family members and focused primarily on boys’ Total Aversive Behavior (TAB, e.g. negative commands, disapproval, destructiveness, negativism, humiliation, and whining) and parents’ "Abusive Cluster" (AC, e.g. threats, humiliation, physical punishment and yelling). The PDR interviews recorded the number of child problem behaviors during the past 24 hours and were conducted during the week prior to treatment and in the week before termination.

      Outcomes

      A MANOVA analysis of groups by years revealed a significant difference in nonstatus offenses between the two groups during treatment time in the expected direction, but there were no significant differences in status or nonstatus offense rates at any other time. Overall offense rates for youth in both groups declined significantly after the onset of treatment, and reductions were produced significantly faster by the OSLC treatment. Prevalence rates showed a significant decrease over the 5 years for both groups and no significant differences between groups, except at FU3 for nonstatus offenses in the expected direction. OSLC youth spent significantly less time incarcerated during TX (28.5 days per year vs. 45.4) and FU1 (33.9 vs. 69.3 days), and less time during FU2 (p<.068, 34.4 vs. 37.7 days).

      For OSLC youth in which family data were collected, there were no significant changes in TAB observations from intake to termination, but PDR data indicated that delinquent behaviors reported by parents were significantly reduced at termination (especially for stealing, in which no stealing incidents were reported).

      Summary: Overall, the results show significant decreases in rates and prevalence of juvenile arrests for both groups, but the OSLC treatment produced quicker results that were at least as strong as those produced by CC treatment and were obtained with one-third less reliance on incarceration.

      Patterson, G. R., Chamberlain, P., & Reid, J. B. (1982). A comparative evaluation of a parent-training program. Behavior Therapy 13, 638-650.

      Study three is an evaluation of Parent Management Training in nineteen families with preadolescent antisocial children.

      Design: The study was a randomized design in which 46 families were referred to the Oregon Social Learning Center (OSLC) by pediatricians, school or mental health personnel, or parents. Participants were included in the study if they met the following criteria: age (3-12 years); residing within a 25-mile radius of the Center (located in Eugene, OR); the primary referral problem was aggression (children had to rate above the 90th percentile on the Total Aversive Behavior scale); parents agreed to home visitations, telephone interviews, and attendance at therapy sessions; and neither parents nor children had previously been diagnosed as psychotic, severely retarded, or autistic.

      Of the 46 family referred to the OSLC, 10 dropped out and 17 of the referred subjects had low rates of observed aggression, leaving 19 families who were randomly assigned to experimental treatment (n=10) or a comparison group (n=9). Analyses of pretest group equivalence revealed no differences between experimental and control groups at baseline. There is no report of differential attrition analyses.

      The families assigned to the control group received mixed treatment including: an eclectic approach (3); behavior modification training (2); an Adlerian approach (1); structural family systems approach (1), and a combination of relaxation and physical exercise (1). One family, although referred for treatment, received none. The average treatment time was 11.75 sessions. Observations for both groups were conducted during baseline (2 week duration) and at termination (after an average of 17 hours of therapy time, experimental families were terminated) of treatment.

      Sample Characteristics: The children were described as having a mean age of 6.80 years (experimental group) and 6.78 years (control group). Gender was described as 60% male (experimental) and 77% male (control). The mean unemployment for heads of household was 11% (experimental) and 25% (control). The mean monthly income was $931 (experimental) and $570 (control). The father was absent approximately 52.5% of the time in both groups and the percentage of parents reporting school problems at intake was 80% (experimental) and 55% (control).

      Measures: The Family Interaction Coding System (FICS), completed by staff observing family interactions at baseline and termination; the Total Aversive Behavior (TAB), which included a summed score of 14 noxious behaviors; the Parent Daily Report (PDR), completed by parents and assessing the frequency of 34 problem behaviors during the prior 24-hour period, and administered by telephone five times weekly for 2 weeks during baseline and three times weekly for 2 weeks at termination.

      Analysis: A two-way repeated measures ANOVA was conducted on outcome measures (TAB scores). TAB scores were based on observations in the home during baseline and termination; the rates for the 14 deviant behavior codes were summed to form the composite TAB score. Frequency analyses were utilized for the parent report data.

      Posttest: An evaluation conducted at termination demonstrated a 63% reduction in the intervention children’s mean rate of deviant behavior (from .92 to .32), compared to a 17% reduction (from .89 to .74) for control children. An analysis of TAB scores revealed that 70% of the experimental children tested within the normal range at termination (although none had done so at baseline), compared to 33% of the control subjects.

      Analysis of PDR data assessing problem behaviors showed significant decreases from baseline to termination for both groups: the experimental mean decreased from 3.19 per day to 1.66 per day, compared to 3.20 and 1.96, respectively, for the control group. When parents rated their satisfaction with treatment at termination, 90% of the experimental group’s parents rated the treatment as "very effective," compared to 25% of the parents of control children.

      Generalizability: There was no report given on the participants' ethnicity, so it is not known to whom these results generalize. There was also a skewed distribution in family income (the Parent Training participants earned much higher monthly incomes) and all participants were recruited from Eugene, OR. Future research would need to include reports of participants’ ethnicity, along with more geographic and economic diversity in order to improve the generalizability of the findings.

      Limitations: One limitation is the high attrition. Of the original 46 families who were referred, only 19 families (41%) participated. Ten families (22%) dropped from the study and 17 families (37%) were excluded on the basis of low observed aversive behavior in the children. There was also no differential attrition analysis conducted to compare program completers with program non-completers. The participants were not randomly selected and the study had small group sizes, creating problems with generalizability and the possibility of missed effects.

      Martinez, C., & Eddy, M. (2005). Effects of culturally adapted Parent Management Training on Latino youth behavioral health outcomes. Journal of Consulting and Clinical Psychology, 73 (4), 841-851.

      Study four was a randomized experimental test of the implementation feasibility and the efficacy of the culturally adapted Parent Management Training intervention.

      Design: The study was conducted with a sample of Spanish-speaking Latino parents with middle-school-aged youth at risk for problem behaviors. Project staff identified 314 potential participant families during the recruitment phase. In terms of recruitment source for the participating families, 22 (30%) were referred by schools or social service programs that serve the Latino community, 22 (30%) were recruited by staff from attending Latino community events, 17 (23%) were referred by person-to-person contacts, 10 (13%) were referred through flyers, and 2 (4%) were recruited through presentations by staff to middle school classes. Of the 314 family contacts, 159 (51%) agreed to screening and were determined to be eligible for the study (i.e., parents were Spanish-speaking, had a youth in middle school, were in two-parent or established step family households, and agreed to random assignment; both parents agreed to intervention if so assigned). Of the 155 families not included in the eligible pool, 65 (42%) were screened out as ineligible, 32 (21%) were not reachable at the provided telephone number or address, 23 (15%) were not eligible for other reasons (e.g., divorce after screening, family move, other changes of life circumstances), and 35 (22%) families were not reached until after enrollment in the study was closed. Of the 159 families in the eligible pool, 73 families were successfully recruited and participated in baseline assessments, yielding an overall study participation rate of 46%. Among those eligible families who chose not to participate, most (72%) declined because they were not interested in the study or intervention at that time, 24% declined actively or passively because of schedule conflicts, and 3% had irresolvable transportation difficulties. There was no report of differential attrition analyses.

      The project manager of the study randomly assigned 50% of participating families to the PMT intervention condition and 50% to the control condition. The intervention families received the culturally adapted Parent Management Training intervention. The 36 families randomly assigned to the control condition received no project-related intervention services during the course of the study. Baseline analyses were conducted to determine if there were any significant differences between intervention and control families on a variety of variables that could operate as confounds in the study. Those analyses did not detect any significant differences between intervention and control families for these variables, including education level of the parents, age of the youngster, age of the parents, number of years the parents had resided in the United States, and English proficiency.

      Measures: Intervention feasibility was evaluated through weekly parent satisfaction ratings, intervention participation and attendance, and overall program satisfaction. Intervention effects were evaluated by examining changes (utilizing a series of mixed factorial ANCOVAs) in parenting and youth adjustment for the intervention and control groups between baseline and intervention termination approximately 5 months later.

      Parenting Practices: Measures of parenting practices were taken from responses to questions from the parent interview, completed separately for mothers and fathers. In addition, an overall effective parenting score was computed by averaging scores across the following indicators. Positive involvement was an average summative index of parent responses to 21 questions that reflected whether parents had engaged in a variety of positive activities with the target youth during the past week. Monitoring was an average scale score of 12 items from the parent interview that assessed parent supervision and tracking of the youth’s activities. Homework engagement was a summative index of 16 items reflecting whether parents engaged in specific activities to help the focal youth complete homework. Skill encouragement was an average parent scale score of eight items reflecting the frequency of specific contingent positive reinforcement responses when the youth engaged in prosocial behavior. Appropriate discipline was an average scale score of 12 items reflecting the frequency of using effective limit setting strategies in response to specific youth misbehavior. General parenting was an average scale score of eight items reflecting general use of effective parenting strategies during the past month with the focal youth. Overall effective parenting was an average scale score that aggregated the monitoring, skill encouragement, appropriate discipline, and general parenting scales described above.

      Youth adjustment measures: Youth and parents reported on seven outcome domains for youth adjustment: aggression, externalizing behavior, academic success, depression, and likelihood of using tobacco, alcohol, and marijuana and other drugs. Aggression and externalizing measures were taken from average parent ratings from the Child Behavior Checklist. Academic success was an average scale score reflecting parent ratings of youth school subject performance (i.e., five items concerning performance in math, science, language arts, social studies, and other subjects) and youth homework diligence (i.e., three items concerning homework completion and quality and the youngster’s interest in homework assignments). Depression was measured by youth responses to the Child Depression Inventory. Likelihood of the youth using tobacco, alcohol, and marijuana and other drugs was indicated by the youth’s response to a substance use questionnaire.

      Outcomes

      Findings provided strong evidence for the feasibility of delivering the intervention in a larger community context. The intervention produced benefits in three of seven parenting outcomes (i.e., general parenting, skill encouragement, overall effective parenting) and three of seven youth outcomes (i.e., aggression, externalizing, likelihood of smoking). On parenting practices measures (general parenting, skill encouragement, overall effective parenting), the intervention parents scored significantly higher than the control parents. Intervention children scored significantly lower in aggression, externalizing and likelihood of tobacco use than the control children.

      Limitations: Most of the tables reveal that intervention children had elevated baseline scores on the measures found significant, so the use of the extreme scores at baseline could have resulted in the significance rather than the intervention itself. Additionally, the overall study participation rate was only 46% (of the 159 families in the eligible pool, only 73 families were successfully recruited) and there was no report of differential attrition analyses. Lastly, parents from 18 of the participating families reported receiving parenting education programs in the past.

      Ogden, T. & Hagen, K. A. (2008). Treatment effectiveness of parent management training in Norway: A randomized controlled trial of children with conduct problems. Journal of Consulting and Clinical Psychology, 76, 607-623.

      Hagen, K. A., Ogden, T., & Bjørnebekk, G. (2011). Treatment outcomes and mediators of parent management training: a one-year follow-up of children with conduct problems. Journal of Clinical Child and Adolescent Psychology, 40 (2), 165-178.

      Study five is a randomized controlled trial of Parent Management Training-The Oregon Model in Norway. This study evaluated the effectiveness of PMTO in a nationwide sample of Norwegian families treated in children's services agencies. The second article provides information on a one-year follow-up that examined effective discipline and family cohesion as mediators of child behavior at follow-up.

      Design: Participants were 112 children and their parents recruited to the study via existing child services agencies. The recruitment period lasted from January 2001 to April 2005. After completion of the intake battery, families were randomly assigned to either the PMTO group or the regular services (RS) comparison group. The randomization was pairwise and was carried out locally by therapists with the use of sealed envelopes. The randomization procedure resulted in 59 families assigned to PMTO and 53 families assigned to the RS comparison group. Twelve families who were in the pipeline at the time therapists were instructed to stop the recruitment process were included in the study. This resulted in a slightly unequal sample size in the two treatment conditions as therapists were told to go through with the pending family, but not to wait for the second family of the pair. As such, the last 12 families recruited to the study were randomly assigned, but not in a pairwise fashion.

      Families eligible for participation in the project had contacted the agencies because of child conduct problems, including any behavior listed in the DSM-IV as a symptom of oppositional defiant disorder, conduct disorder, or a problem description consistent or synonymous with these symptoms, such as aggression, delinquency, or disruptive classroom behavior. Children were deemed ineligible for participation if they were autistic, had severe mental retardation, had documented sexual abuse, or had custodial parents with severe mental retardation or psychopathology. No child was actually excluded from the study on the basis of these restrictions, however. Families were recruited using the regular referral procedures of the existing service agencies. The standard procedure for acceptance was based on clinical judgments of the therapists rather than formal screening, and the same procedure was used to include children and families in all agencies in the study. Written informed consent was obtained from parents prior to inclusion in the study.

      Post-treatment assessments were conducted between October 2001 and May 2006 (approximately 11 to 12 months after the intake assessment battery was administered) and follow-up assessments were conducted between January 2003 and July 2007 (approximately a year after posttest). Of the 112 children and families who completed the intake assessment battery, 97 (87%) participated in the post-treatment assessment and 75 (67%) participated in the one-year follow-up. There were no significant differences on any of the main outcome variables or on characteristics such as age, gender, recruitment site, or parent demographics between families who completed the post-treatment assessment and those who were lost. Children in the PMTO group were on average significantly older than were children in the RS group, and PMTO children were also significantly more likely to have an older sibling. There were significantly more single-parent households in the RS group than the PMTO group. There were no other significant baseline differences between treatment conditions on main outcome variables, demographics, or other child characteristics.

      Manuals from two Oregon Social Learning Center preventive interventions were used to train the PMTO therapists: Parenting Through Change and Marriage and Parenting in Stepfamilies. These manuals were translated by the Norwegian Implementation Team. PMTO candidates underwent 18 months of training and had to complete 3 to 5 full-scale PMTO therapy cases during their training periods. PMTO candidates also participated in regular booster sessions and regular meetings with their supervisors in which they discussed their performance, treatment challenges, and clinical outcomes. A total of 33 PMTO therapists from children's service agencies representing all regions of Norway contributed to the study.

      For cases with partial data on a given measure, expectation maximization procedure was carried out to predict the overall score on that variable. A missing-completely-at-random test was conducted for each expectation maximization. If this failed, or if the solution did not converge, regression was used to predict single values that would be used in the computation of the total score.

      Sample Characteristics: The sample was 80.4% male and 19.6% female with ages ranging from 4 to 12 years. Children in the sample demonstrated serious behavioral problems according to their T -scores on the Child Behavior Checklist (CBCL) and the Teacher Report Form (TRF) at intake. The mean family income was the equivalent of approximately $57,380, which represents middle to lower income level in Norway. The mean age of the primary caregiver was 39.07 years, and 43.3% of the families were married or cohabiting with the other biological parent of the child, 40.4% were single parents, and 16.3% were married or cohabiting with another adult. Information was missing for 8 families on civil status. Information about ethnic background was provided by 67 respondents, and of these, 94% were Norwegian and 6% were from other western European countries.

      Measures: The instruments administered in this study included the Child Behavior Checklist (CBCL), the Teacher Report Form (TRF), the Social Skills Rating System (SSRS), the Family Satisfaction Survey, the Parent Daily Report (PDR), the Fidelity of Implementation (FIMP) system, the Coders Impression (CI), the Structural Interaction Tasks (SITs), and its coding manual, the Family and Peer Process Code (FPPC).

      Observed assessment of child-initiated negative interactions (chains): Parents and children participated in a series of videotaped structured interaction tasks (SITs) for the purpose of assessing parenting practices and child behavior. The SITs lasted 30 minutes for children older than age 8 and 25 minutes for children younger than age 8. Both age groups included (a) a problem-solving task in which the family was asked to resolve an identified source of conflict in the family and (b) an evaluation task in which the family discussed how well they had cooperated during the lab procedure. Families with children younger than 8 years also participated in a free-play and clean-up task and a waiting task. Families with children older than 8 years spent more time in the problem-solving task; they were also asked to plan a fun family activity for the upcoming week. Parent-child interactions were coded using the FPPC, which numerically records interpersonal exchanges in real time using duration and sequence. The code scores the initiator, the recipient, and the verbal and behavioral content, and valence. Negative child-initiated engagement behavior had to be reciprocated with negative behavior by the parent within a 6-second window for it to qualify as a chain. The chain was terminated once a non-negative engagement episode occurred. At Wave 1, the PMTO group had 6.8 SITs missing, while the RS group had 1.9% missing; at Wave 2, the PMTO group had 6.8% missing, and the RS group had 20.8% missing. The follow-up study focused on a composite score derived from the FPPC focusing on total aversive behavior (TAB) among target children and parents. Separate TAB scores were calculated for two-parent and single-parent families.

      The CI measure was a questionnaire completed by coders immediately after scoring the SIT videotapes. Each of the five parenting dimensions (discipline, problem-solving, monitoring, positive involvement, and skill encouragement) was scored with subscales, as was the level of child compliance. Skill encouragement was found to be psychometrically unreliable for this sample, however, and it was thus excluded from further analysis.

      The Externalizing Problems and Internalizing Problems scales, along with the Total Problems scale of the CBCL and the TRF were used in this evaluation. Items were rated on a 3-point Likert scale. The Total Problems scale included all behavioral items on the CBCL/TRF and covered externalizing and internalizing problems, thought problems, attention difficulties, and social problems.

      The SSRS is a standardized, multirater, and multifactorial instrument that assesses social skills and academic competence in children and youths. The original response choices were modified from a 3-point to a 4-point Likert scale. The parent version has 38 items assessing cooperation, assertion, responsibility, and self-control domains. The teacher version has 30 items measuring cooperation, self-control, and assertion. Academic competence was measured by teacher ratings on the nine-item scale of the SSRS, which assesses general academic performance, reading and mathematics, motivation, and cognitive functioning. Items were rated on a 5-point scale according to the teacher's rank order of the student (1 = lowest 10%, 2 = next lowest 20%, 3 = middle 40%, 4 = next highest 20%, and 5 = highest 10%). The academic competence scale was missing for 44% of the sample, but this was primarily due to the fact that the scale is only applicable to children age 6 and older attending school.

      The PDR is an index of observable child behavior problems in the U.S. that was translated into 34 culturally appropriate and age sensitive items. Parents were asked to answer yes or no to whether particular behaviors on the part of the child had taken place within the past 24 hours. The index includes both serious transgressions and less extreme behaviors. The instrument was administered by phone to the primary caregiver on 3 consecutive days at baseline and again at post-treatment.

      Parents completed the Family Satisfaction Survey, a 12-item questionnaire, at treatment termination. Caregivers were asked to rate treatment effectiveness, the quality of their interaction with the therapists, and whether they would recommend the treatment to others on a 4-point scale.

      Competent adherence to the PMTO treatment protocol was assessed from evaluations of videotaped therapy sessions using the FIMP system. The FIMP system measures treatment fidelity and evaluates the PMTO therapist on the following 5 dimensions: PMTO knowledge, structuring, teaching practices, process skills and overall quality. Raters use a 9-point scale on which the therapeutic skills central to PMTO treatments are evaluated. Ten-minute segments of four different sessions were coded (introduction to and troubleshooting sessions on both discipline and encouragement). Scores were averaged across the 4 sessions.

      Analysis: A series of analyses of covariance were used to test treatment effects in the intention-to-treat design. Dosage, (combining parents' and children's hours in treatment) pre-treatment scores, age level, and gender were entered as covariates. The three main externalizing behavior measures, the CBCL externalizing scale, the TRF externalizing scale, and the PDR were analyzed separately in the analysis of covariance models using T scores and raw scores. A path model using maximum likelihood estimation, testing both specific indirect and individual effects with bootstrapped standard errors was also tested. In the model, treatment condition predicted effective discipline, and effective discipline predicted three key child outcomes: child compliance, child-initiated negative chain, and an externalizing composite variable. The composite variable included z scores of the externalizing subscales of the CBCL and TRF and the summed 3-day PDR score. The standardization was carried out separately for each assessment point. Pre-treatment score for all child outcomes were entered as control variables.

      Treatment effects on outcome variables using the intent-to-treat design were analyzed using regressions with bootstrapped standard errors. Baseline scores on outcome measures, age, gender, dosage and time between posttest and follow-up were used as controls. A completer’s analysis was also conducted but not reported in the write-up.

      Outcomes

      Posttest:

      Child adjustment: Children in the PMTO group scored significantly lower on parent-rated externalizing behavior problems at the end of treatment than did the children in the RS group. PMTO children also received significantly lower scores on the CBCL total problem scale than did RS children. Scores on the PDR across 3 days indicated that significantly fewer problems were reported for children younger than 8 in the PMTO group compared with their RS group counterparts. There was no significant difference between the two treatment conditions for children older than 8 on the PDR across three days.

      There was no main effect of treatment on the TRF externalizing problem scale at the post-treatment assessment, but a significant Treatment X Age interaction emerged. Younger children in the PMTO group scored significantly lower on the TRF externalizing scale than did younger children in the RS group. There was no significant simple effect for the older children. Younger children in the PMTO condition also scored significantly lower on the TRF total problem scale than did their RS counterparts. There was no significant group difference for the older children.

      Children of families assigned to the PMTO group were rated as significantly more socially competent by their teachers at the end of treatment than were children of families assigned to the RS group. There was no main effect of treatment on the parent-reported social competence measure, but a Treatment X Gender interaction effect emerged. When pursuing this interaction effect, however, it was found that neither of the simple main effects was significant, although the difference in SSRS scores appeared to be greatest between the PMTO and RS girls. No age effect was found for this measure.

      Finally, no direct treatment effect was found for the variables of observed child-initiated negative chain, internalizing symptoms, or academic competence.

      Parenting skills: Parents who received PMTO scored significantly better than the RS group on one of four observed parenting outcomes (effective discipline) at the end of treatment. There was a simple main effect of treatment on parental monitoring in which PMTO parents with younger children scored significantly higher than did the parents of younger children in the RS group. There was no significant difference between PMTO and RS parents of older children on this measure. RS parents of older children scored higher on problem-solving than did parents of older children in the PMTO group, a negative effect. There was no significant difference between groups on the parenting dimension of positive involvement.

      Family satisfaction survey: A one-way ANOVA showed that parents in the PMTO group were significantly more satisfied with the treatment they received than were parents in the RS group. In families in which a second parent informant was present, the second parent informants in the PMTO group were more satisfied with their treatment than were their RS group counterparts. There was no significant difference in therapists' scores between the two conditions on their reported satisfaction with treatment.

      Treatment attendance (dosage)
      : PMTO parents received more hours of treatment than did RS parents. RS children, however, received more hours of treatment than did PMTO children. Thus, dosage was defined as the combined parent and child hours of treatment. Reports on treatment attendance were available for 89 families.

      Test of indirect effects model
      : A path model was tested in order to investigate whether the effects of group assignment on measures of child functioning were indirectly affected by improved parenting skills. The model estimated individual and specific indirect effects with bootstrapped standard errors. Discipline was chosen as the parenting dimension to be entered into the model as this is considered the most important parenting skill in reducing externalizing behavior and non-compliance in children with conduct problems. The child externalizing composite, frequency of child-initiated negative chain during the SIT, and child compliance were entered as the dependent variable in the model. These were three key child outcomes, and they represented three different assessment methods. Age level, SIT condition, and pre-treatment scores on parental discipline and on the child variables were entered as control variables. The model showed excellent fit. Treatment condition was found to be significantly associated with effective discipline in favor of parents in the PMTO group. Moreover, better parental disciplinary skills predicted greater child compliance, fewer child-initiated negative chains, and lower child externalizing scores. The specific indirect effects of all predictors on the three child outcomes, via parental discipline, with bootstrapped standard errors were also tested. A significant indirect effect emerged for treatment condition on child compliance, via parental discipline.

      Long-term:

      Only one of the 21 measures examined was significantly different between groups using data at posttest and one-year follow-up. The composite measure of total aversive behavior (TAB) for two-parent families was significantly lower (p<.01) for families in the PMTO group.

      Differential attrition: No significant main effect of retention was found (i.e., none of baseline measures differed significantly between completers and attriters). However, there was an interaction between condition and retention. Families with children with higher delinquency scores and lower teacher-rated social skills at baseline were more likely to be retained in the control group than the PMTO group.

      Mediation analysis: Effective discipline and family cohesion were examined as mediators of child behavior. The program significantly improved effective discipline at posttest, which in turn significantly predicted less child aggression, opposition and aversive behavior and greater parent-reported social skills at one-year follow-up. The program significantly improved family cohesion at posttest, which significantly predicted less child delinquency and externalizing behavior and greater teacher-reported social skills at one-year follow-up.

      Bulleted Outcomes

      • Children in the PMTO group scored significantly lower than Regular Service group (RS) children at end of treatment on parent-rated externalizing behavior problems and had significantly lower scores on the CBCL total problem scale.
      • Parent Daily Report scores across 3 days indicated that significantly fewer problems were reported for PMTO children younger than 8 compared with the RS group, and younger PMTO children scored significantly lower on the TRF externalizing and total problem scales than did younger RS children.
      • Children of families assigned to the PMTO group were rated as significantly more socially competent by their teachers at the end of treatment than RS children.
      • Parents who received PMTO scored significantly higher on effective discipline than did their counterparts in the RS group at the end of treatment as rated by coders.
      • PMTO parents with younger children scored significantly higher on parental monitoring than did the parents of younger children in the RS group.
      • Long-term results show benefits only for total aversive behavior in two-parent families.

      Limitations: The treatment(s) provided to participants in the RS condition lacked a clear definition for comparison purposes. There was a very small number of girls present in the study (n = 22). There were some baseline differences. There were no treatment effects on internalizing problems, academic competence, or teacher-rated externalizing problems. Only one of four observed parenting outcomes was significant. Finally, parents of older RS children scored higher on problem-solving than did parents of older children in the PMTO group, a negative effect. Across the posttest and one-year follow-up, only one measure (aversive behavior) was significantly different between groups and this particular measure was not part of the original measures used.

      Forgatch, M. S., DeGarmo, D. S., & Beldavs, Z. G. (2005). An efficacious theory-based intervention for stepfamilies. Behavior Therapy, 36 (4), 357-365.

      DeGarmo, D. S., & Forgatch, M. S. (2007). Efficacy of parent training for stepfathers: From playful spectator and polite stranger to effective stepfathering. Parenting Science and Practice, 7 (4), 331-353.

      Bullard, L., Wachlarowicz, M., DeLeeuw, J., Snyder, J., Low, S., Forgatch, M. & DeGarmo, D. (2010). Effects of the Oregon Model of Parent Management Training (PTMO) on marital adjustment in new stepfamilies: A randomized trial. Journal of Family Psychology, 24 (4), 485-496.

      Wachlarowicz, M., Snyder, J., Low, S., Forgatch, M. S., & DeGarmo, D. A. (2012). The moderating effects of parent antisocial characteristics on the effects of Parent Management Training - Oregon (PMTO), Prevention Science, 13, 229-240.

      This study examined the effects of the Oregon model of Parent Management Training (PTMO) on recently married couples and their families. The family unit consisted of a biological mother, a stepfather, and at least one child, and the training included effective parenting practices with extra materials to address the problems of stepfamilies.

      Design: Mothers and stepfathers had to be married within the previous two years, cohabitating, and have a 5- to 10-year-old biological child of the mother. The focal child had to reside in the stepfamily at least 50% of the time and had to display five or more mother-reported conduct problems. Of the 121 respondents to the advertisement, 113 met study criteria, and three of these families agreed to participate in a planned intensive single subject design and were not used in this study, leaving 110 families agreeing to participate in the study.

      Of the 110 participating families, 67 (61%) were randomly assigned to PTMO. Although more subjects were assigned to the intervention group to increase the power of the tests, the assignment was random. Intervention families received the standard, manualized version of the PMTO program as well as a stepparent component that added material addressing stepfamily issues (e.g., presenting a united parenting front and the role of stepparents). The remaining 43 families were assigned to the non-intervention control condition. These families received no PMTO but received a resource guide of family services available in the community.

      Effects of the intervention were assessed via measurements taken at baseline, and at 6-, 12- and 24-months after baseline. With the program lasting approximately 27 weeks, the 24-month assessment occurs more than one year after the end of the program. Attrition occurred across the assessments. About 91% of baseline subjects completed the 6-month assessment, 91% completed the 12-month assessment, and 82% completed the 24-month assessment.

      Sample: Couples had been married an average of 15.58 months. Most mothers and stepfathers had some education beyond high school. The average gross annual income was $39,432, and the average age for mothers and stepfathers was 31.3 and 32.7, respectively.

      Measures: Measures of parenting practices, child externalizing problems, marital relationship processes, and marital satisfaction were collected at baseline (prior to intervention), and at 6, 12, and 24-months after baseline.

      Measures of parenting practices were assessed using data derived from videotaped parent-child interactions and coded using the Family and Peer Process code (FPP). Observers rating the child-parent interactions were blind to condition, and blind reliability checks on tapes of 15% of the sessions showed acceptable levels of agreement. Scales developed from the observations included positive parenting (defined by skill encouragement, positive involvement, problem solving and monitoring) and coercive parenting (defined as frequency of negative reinforcement, negative reciprocity and inept discipline). A special construct for stepfathers combined measures of positive involvement, problem solving, monitoring and supervision, coercive discipline, negative reciprocity, negative engagement, and negative reinforcement.

      Measures of child externalizing behavior problems were assessed using mother and stepfather-reported scores of the Child Behavior Checklist as well as using teacher reports. Both child aggression and delinquent behavior measures were used to assess overall child externalizing behavior. A measure of child depression used symptoms reported by the child on the Child Depression Inventory.

      Measures of marital relationship process were derived from observers' ratings of couples' problem solving in regards to parenting. This scale included measures of quality and outcome of problem solving as well as overall relationship quality.

      Measures of marital satisfaction were derived from the Dyadic Adjustment Scale (DAS) as reported by mothers and stepfathers. The DAS scale is a 32-item scale that reflects satisfaction, cohesion, consensus and affection.

      Analysis: Intent-to-treat analyses included data from all families assigned to PMTO regardless of whether they attended the PMTO sessions. Hypotheses were tested using structural equation modeling with the full information maximum likelihood (FIML) estimation method that uses data on all available assessments of subjects and, under the assumption of random missing data, produces optimally efficient estimates of standard errors.

      In Forgatch et al. (2005), structural equation models showed the effect of the intervention on latent factors for the outcomes with controls for the latent factors at baseline.

      In DeGarmo & Forgatch (2007), regressions were used to test for program effects on the change in outcomes at 12 months and 24 months. The change over time implicitly controlled for baseline outcome values.

      In Bullard et al. (2010), tests of the program effects came from comparing the average change over time (i.e., mean slope) for the intervention group to the treatment group. The change over time implicitly controlled for baseline outcome values.

      In Wachlarowicz (2012), intent to treat growth models tested the degree to which parent antisocial characteristics modered the effects of PMTO.

      Outcomes:

      Implementation Fidelity: The families in the treatment condition had the opportunity to attend PMTO sessions over an approximate 27-week period. Of the 67 families in the treatment condition, 11 attended no sessions, 7 attended 1 to 5 sessions, 10 attended 6 to 10 sessions, 22 attended 11 to 15 sessions, and 17 attended more than 15 sessions.

      Using an observational measure of the therapy sessions called the Fidelity of Implementation Code (FIMP), Forgatch et al. (2005) evaluated adherence to the training. The measure predicted changes in observed parenting outcomes, suggesting its validity as a measure of adherence, but no other information was presented.

      Baseline Equivalence: Baseline equivalence was not discussed in any of the studies, although results for group differences in the mean intercepts in Bullard et al. (2010) suggest that one outcome differed at baseline: Marital satisfaction reported by the mother was significantly higher at baseline for the intervention group.

      Differential Attrition: The articles reported that data were missing completely at random, and two of the three articles used full information maximum likelihood (FIML) estimation that adjusts estimates for missing data. The article not using FIML, DeGarmo & Forgatch (2007), said that attrition did not differ significantly across conditions and that there were no significant differences on predictors or outcomes when comparing families retained and families not assessed at follow-up.

      Posttest: Forgatch et al. (2005) found that the intervention significantly improved couple parenting (i.e., a latent factor measuring positive and non-coercive parenting of stepfather and stepmother) at posttest with controls for the baseline latent factor. The eta-squared measure of the intervention of .14 indicated a medium-to-large effect size. The intervention did not directly influence measures of child home and school problems, but a mediation model showed indirect effects. The intervention improved couple parenting at one year, which in turn reduced noncompliance and home problems of children at one year.

      DeGarmo & Forgatch (2007) focused on stepfathering rather than couple parenting. The intervention significantly improved a composite measure of stepfather parenting but on average did not improve child depression or noncompliance to mother at posttest (12 months). However, the program showed benefits for child depression and child noncompliance among stepfathers who showed improved parenting skills at 6 months.

      Bullard et al. (2010) showed significant differences across the intervention and control groups in the improvement over time for 4 of 8 outcomes: coercive parenting, marital relationship processes, mother’s marital satisfaction, and teacher rating of child externalizing problems. Changes in parenting practices, stepfather’s marital satisfaction, mother’s rating of child externalizing problems, and father’s rating of child externalizing problems did not differ across groups. In addition, the program effect on child externalizing behavior was mediated by parenting practices. Improved parenting practices were also related to improved marital relationships and marital satisfaction.

      Wachlarowicz et al (2012) found that PMTO was reliably related to growth in positive parenting and to decreases in coercive parenting. Parent antisocial characteristics moderated the effect of PMTO on coercive but not on positive parenting practices. PMTO resulted in greater reductions in coercive parenting as parent antisocial histories were more extensive, and this moderator effect was found for both mothers and stepfathers.

      Long-Term: Although the studies generally did not separate the posttest results (one year after baseline) from follow-up results (two years after baseline), some evidence suggests that the intervention effects fade. Forgatch et al. (2005) found a significant indirect effect of the program on home problems at posttest but not on school problems at follow-up. DeGarmo & Forgatch (2007) showed significant improvement in stepparenting at posttest but not follow-up.

      Limitations:

      • Baseline equivalence was not discussed, despite results in one study (Bullard et al., 2010) that gave some indication of group differences at baseline on one outcome – marital satisfaction reported by the mother.
      • Differential attrition was examined in DeGarmo & Forgatch, 2007, and authors state that there were no signficant differences on predictors or outcomes when comparing families retained and families not assessed at follow-up, however, these results are not tabled.

      Bjørknes, R., & Manger, T. (2012). Can parent training alter parent practices and reduce conduct problems in ethnic minority children? A randomized controlled trial. Prevention Science, published online.

      Bjørknes, R., Kjøbli, J., Manger, T., & Jakobsen, R. (2012). Parent training among ethnic minorities: Parenting practices as mediators of change in child conduct problems. Family Relations, 61, 101-114.

      Using a sample of Pakistani and Somali immigrant women in Norway, this study examined the effects of the Parent Management Training Oregon model on parent practices as mediators of change on child conduct problems. Specifically, this study hypothesized that reductions in child conduct problems were fully mediated by reduced harsh maternal discipline and increased positive parenting. The program differed in meeting with groups of mothers from different families rather than with mothers, fathers, and children in one family. This group-based approach replicates the approach described in Study 1 and also in Study 10.

      Design: Study participants were 96 Somali and Pakistani immigrant families in Norway. These two nationalities were chosen because they constitute the two largest immigrant groups in Norway and because of a known need for services for these families. Participants were recruited through professional referrals (school, child care, or child welfare system), through community information meetings, or by staff from the study recruitment team in 2007-2008. Participation in the study was determined by families having a child with or at risk of developing conduct problems. Mother-reported scores on the Eyberg Child Behavior Inventory at baseline indicated 30% of children within the clinical range. A total of 118 mothers were assessed for eligibility, and 96 enrolled in the study. Mothers were randomly assigned to either a Parent Management Training Oregon Model (PMTO) treatment group (n=50) or a waitlist (WL) control group (n=46). Randomization was stratified by community and ethnicity.

      Treatment mothers received the intervention in various community-care centers in Oslo, and attended an average of 10.75 sessions (out of 18). The sessions were group sessions, and were ethnically homogeneous, comprised of 8-12 mothers per group. Sessions were adapted to be culturally appropriate, and were taught by two Norwegian PMTO therapists in coordination with link workers, who were trained to work as bilingual PMTO assistants. All therapists were trained psychologists or social workers with postgraduate training in PMTO. Fidelity checklists were completed to monitor implementation adherence.

      At posttest, 13 of the 96 mothers (13%) were lost to attrition.

      Sample Characteristics: The majority of the families were from Pakistan (59%, compared to 41% from Somalia). All were Muslim, and had lived in Norway for an average of 11.69 years. The majority of the study children were male (63%) and the children had a mean age of 5.9 years. The mean age of the mothers in the study was 33.6 years. Among parents, 7% had a college or university degree, 38% had completed high school, 32% had completed only elementary school, and 23% had received no school education. The majority of mothers (77%) were married, and 20% of the families received public financial support (compared to 2.3% nationally). About 23% of the subjects were single mothers.

      Measures: Measures were collected at baseline and post-intervention, largely in the form of self-reports. Assessments were completed by bilingual interviewers, and assessment tools were in Norwegian and Urdu/Somali. Outcome measures on child conduct problems included the Intensity Score on the Eyberg Child Behavior Inventory and the Parent Daily Report (PDR). The PDR was conducted by telephone on three consecutive days, and scores were summed to a final score. Both measures were completed by the mothers. Reliability on both measures at both time points was .93 and higher.

      Mediating measures of maternal parenting practices (harsh discipline and positive parenting) were assessed using the Parent Practices Interview questionnaire, also completed by the mothers. Reliability scores pre/post were high (harsh discipline scale = .81-.84; positive parenting scale = .69-.74).

      Teacher reports assessed child behavior to measure total problems and externalizing. Teachers also rated social skills of the children (cooperation, assertion, self-control). Alpha coefficients all exceeded .90.

      Analysis: Bjørknes & Manger (2012) used an intent-to-treat analysis with baseline outcomes treated as covariates in analysis of covariance. The estimates adjusted for missing data by using the statistical method of expectation maximization or by using the last-observation-carried forward approach.

      Bjørknes et al. (2012) also used an intent-to-treat analysis. Participants lost to follow-up were included in the analysis using the full-information maximum likelihood (FIML) approach. Change scores on outcome variables were calculated as post-assessment sum scores minus pre-assessment sum scores. Path analysis was used to determine the effect of the predictor variable (group assignment) on the outcome variable (changes in child conduct problems) by two mediators (changes in maternal harsh discipline and positive parenting). A multiple group comparison test was also conducted to determine potential differences in the mediational pathways in the two ethnic groups.

      Outcomes

      Baseline Equivalence: Bjørknes & Manger (2012) found no significant baseline differences on sociodemographic characteristics but found one significant difference on baseline outcomes: the parenting practice measure of harsh discipline for age. Bjørknes et al. (2012) reported no differences between the intervention and control groups at baseline on the three latent outcome scales of harsh discipline, positive parenting, and child conduct problems.

      Differential Attrition: Bjørknes & Manger (2012) reported that there were no significant differences on baseline outcomes between attending and dropout mothers. They also reported that there were no significant differences between subjects with and without complete teacher data. Bjørknes et al. (2012) reported that missing data, including that due to respondent attrition, was missing completely at random. That implies no differential attrition. Further, FIML estimation included all subjects, including those with missing data.

      Posttest: Bjørknes & Manger (2012) found that the intervention significantly improved 2 of 4 parenting practices and 2 of 5 child behaviors. For parenting practices, use of harsh discipline declined and positive parenting improved relative to the control group. For child behavior, the conduct problem composite and Eyberg Child Behavior Inventory improved relative to the control group. Effect sizes for the significant outcomes ranged from .27 to .54. Also, effect sizes proved larger for women who attended at least half the group sessions.

      However, the benefits at home did not extend to school. The intervention did not significantly influence the teacher-reported total scale, externalizing behavior scales, or Social Skills Rating System total scale.

      Bjørknes et al. (2012) found significant correlations between group assignment and the three outcome variables (child conduct problems, harsh discipline, and positive parenting), where intervention group mothers showed significantly increased positive parenting and reduced harsh discipline, and their children showed reduced conduct problems, compared to control group participants.

      Results of the path analysis in Bjørknes et al. (2012) showed a significant direct effect of group assignment on change in child conduct problems, where intervention children had significantly reduced child conduct problems, compared to their waitlist control counterparts. The overall path model showed significant path coefficients from group assignment to changes in harsh discipline and positive parenting, where positive outcomes significantly predicted changes in child conduct problems. When comparing the overall model to a model in which the direct path from the group assignment to changes in the children's conduct problems was not constrained to zero, results were not significant, indicating that the direct path was not crucial and that the effect of group assignment on child outcomes was mediated by the two parenting measures. Additionally, both paths were tested separately and testing revealed significant indirect effects of both parenting measures on child outcomes, indicating that the intervention effects on child conduct problems were fully mediated by the changes in harsh discipline and positive parenting. There were no significant differences between ethnic groups.

      Long-term: Not examined.

      Limitations:

      • All significant intervention effects occurred for mother self-reports about home behavior, while independent reports from teachers on classroom behaviors showed no effects of the program.
      • Tests for baseline equivalence found one difference on baseline outcomes.

      Sigmarsdóttir, M., Thorlacius, O., Guõmundsdóttir, E. V., & DeGarmo, D. S. (2014). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Child outcome in a nationwide randomized controlled trial. Family Process, 54, 498-517.

      Sigmarsdóttir, M., DeGarmo, D. S., Forgatch, M. S., & Guõmundsdóttir, E. V. (2013). Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial. Scandinavian Journal of Psychology, 54, 468-476.

      This study evaluated an Icelandic version of the program that followed the PMTO protocol, but families underwent an average of 22.6 sessions (with a maximum of 38).

      Evaluation Methodology

      Design: Participants for this study were recruited from five municipalities throughout Iceland in 2007 and referred to the study by professionals in the community (schools, educational services, social services). Criteria for study participation included a child displaying behavioral problems at home and/or in school, having no history of sexual abuse, and not meeting diagnostic criteria for autism. All 102 families who were referred agreed to participate.

      Families were randomly assigned to either the treatment (PMTO; n=51) or a Services as Usual (SAU; n=51) control condition. Subjects in the control condition received a variety of community services normally provided for children with behavioral problems, including diagnosis and/or counseling from a psychologist or school counselor, and services offered by social services or the health care system. In addition, 60% of the children attended schools where Positive Behavioral Support was being implemented (63% of the treatment and 59% of the SAU group).

      The posttest occurred at the end of the treatment, approximately one year after baseline. A follow-up assessment is planned but not reported in this study. Overall, 95% of the sample completed the posttest (98% in the intervention group and 92% in the control group).

      Sample Characteristics: Children in the sample had high scores on measures of problem behavior and externalizing. They ranged in age from 5 to 12 (mean age was 8 years). Of the 102 participant children, 52% lived with both biological parents, while 21% were from combined families, and 27% were from single parent households (this matched national demographic data). Among parents, 28% had a college or higher university degree, 43% had completed high school or occupational school, and 28% had only completed elementary or junior high school. The majority of the families in the sample (77%) had a socioeconomic status below the national average (U.S. equivalent of $70,000 a year).

      Measures: The main outcome measure of child adjustment in Sigmarsdóttir et al. (2014) came from parents, teachers, and children. However, independent teacher ratings had the weakest loading on the latent construct of child adjustment, while non-independent parent ratings has the strongest loadings. Problem behavior was measured using the Child Behavior Checklist - Parent Report (the CBCL 1-5 version was used for families whose children were in kindergarten). Reliability scores for this measure were above .90 on both pre- and post-treatment measures. Social Skills was measured using the Social Skills Rating System (SSRS), which measured children's problem behaviors and children's adaptive functioning in social situations, and was completed by both parents and teachers. Reliability scores were high (.87 and .79 for pre- and post-treatment parent measures, respectively, and .90 for teacher measures at both time periods). Child depression was measured using the Children's Depression Inventory, completed by the children (reliability = .93).

      A measure of parenting practices in Sigmarsdóttir et al. (2013) focused on mothers only and came from direct observations of interaction that were coded by researchers unaware of condition. The observations defined a latent variable construct based on four components: skill encouragement, discipline, problem solving, and positive involvement. Researchers coded family interactions during five or six tasks (5–10 minutes each). The tool has been used in previous research and reportedly has good predictive validity. To check on reliability, 20% of randomly selected videos of family behavior showed acceptable inter-rater agreement (0.80 to 0.85 at pretreatment and 0.82 to 0.88 at post treatment). Cronbach’s alphas for each of the four scales used in the latent construct exceeded .80

      Analysis: Structural Equation Modeling was used to create latent constructs for child adjustment and parenting practices at pretest and posttest and then examine the effect of condition on the posttest latent factors while controlling for the pretest latent factors.

      Intent to Treat: The SEM analysis used Full Information Maximum Likelihood estimation that employed available information from all cases.

      Outcomes

      Implementation Fidelity. The PMTO manuals and parent materials were translated into Icelandic and adapted to be culturally appropriate. Parents in the treatment condition attended an average of 22.63 weekly sessions of 38 possible. An observation-based rating system scored therapists in training with a mean of 7.2 on a scale ranging from 6 to 9.

      Baseline Equivalence: There were no baseline differences between groups on any of the demographic variables, nor on baseline child outcome indicators.

      Differential Attrition: There were also no baseline differences between those retained at and not retained at posttest. The Little test further showed that data were missing completely at random.

      Posttest: Sigmarsdóttir et al. (2014) found a significant reduction in child adjustment problems (construct comprised of behavior problems, social skills, and depressive symptoms) among children whose parents received the PMTO treatment, compared to the Services as Usual children. The program had weak-to-moderate effect sizes of .31 and .54.

      Sigmarsdóttir et al. (2013) failed to find a significant treatment effect on the outcome measure of change in mothers’ parenting. However, moderation tests indicated that the program buffered the harm for parenting practices of high depressive symptoms among mothers.

      Long-term: Not examined.

      Limitations:

      • Ratings from parents, who helped deliver the program, were dominant in measure of child adjustment
      • Tests found no program influence on mediating factor of parenting practices

      Kjøbli, J. & Ogden, T. (2012). A randomized effectiveness trial of brief parent training in primary care settings. Prevention Science, 13, 616-626.

      This study, conducted in Norway, examined the effectiveness of Brief Parent Training, a short-term intervention and adaptation of Parent Management Training - Oregon model, that uses 3-5 sessions to promote parenting skills in families whose children are exhibiting signs of problem behavior.

      Design: The study used an individual-level randomized control design with data gathered at baseline and within two weeks post-intervention. Families were recruited for participation in the study if they had children between the ages of 3 and 12 who exhibited signs of problem behavior at home, daycare or school and had contacted, or been contacted by, a primary care agency due to these behavioral problems. A total of 228 families were assessed for eligibility and 216 families were randomly assigned to Brief Parent Training (n=108) or regular services (n=108). Of the 12 families excluded, 10 refused to participate and 2 did not meet criteria due to age or existing autism diagnosis.

      Brief Parent Training (BPT) was delivered to families individually over 3-5 hours and was tailored to match the needs of the family and the behavior problems of the child.

      At post-assessment 95 intervention families (88% retention) and 92 control families (85% retention) participated in the posttest. Posttest data were gathered from parents and teachers.

      Sample characteristics: The average age of the children in the study was 7.28 years; 31.9% of the children were girls, 51% lived with both biological parents and 36.6% lived with single parents. Parents had an average age of 35.3 years; 39.4% had a college or higher degree, 93.5% reported a Norwegian background and their average income was $88,815 which represents an upper-middle income level.

      Measures: A total of fifteen variables were measured across three areas: parent-reported child outcomes (5 variables); parent-reported parenting practices (6 variables plus one additional measure of parent distress); and, teacher-reported child outcomes (3 variables).

      Parent-reported child outcomes (5 variables) were gathered with the Eyberg Child Behavior Inventory (ECBI) using the Intensity (pretest alpha=.91; posttest alpha=.93) and Problem scales (pretest alpha=.87; posttest alpha=.90), the Home and Community Social Behavior Scales (HCSBS) to measure externalizing behavior (pretest alpha=.93; posttest alpha=.94) and social competence (pretest alpha=.93; posttest alpha=.95); and the Child Behavior Checklist (CBCL) to measure anxiety/depression (pretest alpha=.83; posttest alpha=.88).

      Parent-reported parenting practices (6 variables plus one additional measure of parent distress) were gathered using six scales from the Parenting Practices Interview: Harsh for Age (pretest alpha=.70; posttest alpha=.77), Harsh Discipline (pretest alpha=.78; posttest alpha=.80), Inconsistent Discipline (pretest alpha=.74; posttest alpha=.64), Appropriate Discipline (pretest alpha=.79; posttest alpha=.83), Positive Parenting (pretest alpha=.69; posttest alpha=.73), and Clear Expectations (pretest alpha=.61; posttest alpha=.64). An additional measure of parental distress was assessed using Symptom Checklist-5 (pretest alpha=.88; posttest alpha=.85).

      Teacher-reported outcomes (3 variables) were gathered using the School Social Behavior Scales for externalizing behavior (pretest and posttest alpha=.97) and social competence (pretest and posttest alpha=.97) and the Teacher Report Form to measure anxiety/depression in children (pretest alpha=.85; posttest alpha=.87).

      All measures and scales have been used in prior published work and reliability and validity have been established.

      Researchers who gathered the data were not involved in intervention delivery; however, they were not blind to the participant condition.

      Analysis: Three multivariate analyses of variance (MANCOVA) were conducted to examine the intervention effects across the three areas: parent-reported child outcomes; parent-reported parenting practices; and, teacher-reported child outcomes. If the composite scores were found to be significant, post-hoc analyses were conducted to examine which variables produced an effect. An ANCOVA was run to examine intervention effects on parent mental distress.

      For cases with completely missing data, MANCOVAs were run with the entire sample and were analyzed with the last observation carried forward (pretest scores were inserted at posttest). For missing data at the item level, imputation used the expectation maximization (EM) procedure. Little’s MCAR test was conducted for each EM, which found that data were missing completely at random. Further analyses were conducted without imputations and yielded similar results.

      Intention-to-treat: The study complied with the intent-to-treat principle by analyzing all participants randomized to the condition regardless of dose received.

      Outcomes

      Implementation fidelity: Interventionists who delivered the sessions received a standardized 9-day training, a manual and supervision/instruction by trained therapists. They also received group-based supervision meetings every 6-months.

      Reports of practitioner fidelity to the model were gathered from parents using a 32-item survey (alpha=.96) asking parents to indicate the degree to which the interventionists covered topics and core components of the intervention. Fidelity was high with a mean score of 4.49 on a scale from 1 to 5.

      Baseline Equivalence: Based on parent and teacher reports, one demographic variable was significantly different between groups at baseline: families in the intervention group had a higher level of education than families in the control group and therefore education level was used as a control variable in the analysis. Further, based on teacher-report, the intervention group scored lower on teacher-reported social competence (p=0.008), higher on externalizing problems (p=0.007), and higher on anxiety/depression (p=0.04). These variables were also controlled for in all teacher-reported main analyses.

      Differential attrition: No differences were found between those who completed pre- and posttests on all outcome variables and most demographic variables except that parents who completed both pre- and posttests had a higher level of education (p=.02) than those parents who did not complete posttests.

      Posttest: Multivariate tests revealed that two of the three areas examined (parent-reported child outcomes, p=.04 and parent-reported parenting practices, p=.00) were significantly different between the control and intervention groups. No significant differences were found for teacher-reported child outcomes, neither for the area as a whole nor for the three variables used to measure it. Of the 15 variables examined, 9 were significantly different between intervention and control groups: all five variables (p’s<.041) of parent-reported child outcomes and four variables (harsh for age, harsh discipline, inconsistent discipline, positive parenting; all p’s<.021) of parent-reported parenting practices were significant (measures that were not significant were: appropriate discipline and clear expectations). The parent distress measure was not significantly different between groups.

      Long-term effects: The study did not collect long-term, follow-up data and therefore was not able to demonstrate sustained effects.

      Effect size

      Effect sizes were small to medium-large, were reported as Cohen’s d and ranged between .29 (for parent-reported child anxiety/depression) and .65 (for parent-reported positive parenting).

      Limitations

      • All statistically significant results in this study come from parent reports, and because parents were the recipients of the intervention, these are subject to bias.
      • None of the teacher-reported outcomes were significant.
      • No long-term data were collected.
      • Baseline differences between groups were found on all teacher measures and one demographic variable.
      • Parents who dropped out of the study had significantly lower levels of education than parents who remained in the study, although imputation of missing data helped adjust for differential attrition.

      Kjøbli, J., Hukkelberg, S., & Ogden, T. (2013). A randomized trial of group parent training: Reducing child conduct problems in real-world settings. Behavior Research and Therapy, 51, 113-121.

      This study, conducted in Norway, examined the effectiveness of group-based Parent Management Training, the Oregon model using 12 2.5-hour group sessions to promote parenting skills in families whose children exhibited conduct problems.

      Design: Using a randomized controlled design, researchers sought to evaluate the program's effectiveness at improving conduct problems and social competence of children and parenting practices and mental health of parents. Families with children between the ages of 2 and 12 who exhibited problem behavior or had developed conduct problems were recruited after they had contacted one of 11 agencies across Norway. Of the 153 families assessed for eligibility, 137 (90%) agreed to participate and were randomized to the PMTO intervention (n=72) and control conditions (n=65). The control group was offered PMTO after study termination and was free to seek and receive any available intervention offered in regular services except for closely related interventions based on the same principles. Because some families chose to wait and receive PMTO after the study period and because some agencies did not offer any other types of services or interventions, 33 (51%) families in the control group did not receive any intervention. Five families (7%) in the PMTO group refused the intervention after randomization.

      Assessments were done at baseline, posttest, and 6-month follow-up. From the intervention group, 92% of families completed the posttest and 89% completed the 6-month follow-up. In the control group, 92% of families completed the posttest and 91% completed the 6-month follow-up.

      Sample Characteristics: The average age of the 137 children was 8.56 years, 36.5% were girls, 48.2% lived with both biological parents and 36.5% lived with single parents. The average age of the participating parent was 37.42 years, 92% had a Norwegian background and 60.6% had finished high school.

      Measures: A total of fourteen variables were measured: parent-reported child outcomes (5 variables); parent-reported parenting practices (5 variables); parental mental distress (1 variable); and, teacher-reported child outcomes (3 variables).

      Parent-reported child outcomes (5 variables) were gathered with the Eyberg Child Behavior Inventory (ECBI) using the Intensity (alphas=..92-.93) and Problem scales (alphas=.88-.90), the Home and Community Social Behavior Scales (HCSBS) to measure externalizing behavior (alphas=.94) and social competence (alphas=.95-.96); and the Child Behavior Checklist (CBCL) to measure anxiety/depression (alphas=.82-.85).

      Parent-reported parenting practices (5 variables) were gathered using five scales from the Parenting Practices Interview: Harsh Discipline, Inconsistent Discipline, Appropriate Discipline, Positive Parenting, and Clear Expectations (all alphas ranged between .67 and .89).

      An additional measure of parental distress was assessed using Symptom Checklist-5 (alphas=.87-.90).

      Teacher-reported outcomes (3 variables) were gathered using the School Social Behavior Scales for externalizing behavior and social competence and the Teacher Report Form to measure anxiety/depression in children (all alphas ranged between .87 and .96).

      All measures and scales have been used in prior published work and reliability and validity have been established.

      It was unclear if the researchers who gathered the data were blind to the participant condition, but the measures from the parents, who in effect deliver the program, lacked independence.

      Analysis: Linear mixed models were used to analyze the effects of the intervention using an intent-to-treat analysis. The models allowed use of all subjects, including those with incomplete data, and adjusted for overtime correlations within subjects. Tests for group-by-time interaction terms implicitly included controls for baseline outcomes.

      Because the parents in the intervention condition were nested within groups, further analysis was conducted to examine the effect of group nesting on outcomes. Group nesting influenced the outcome of one of the measures and therefore the interaction term of group nesting-by-time was included in an analysis but did little to change the results.

      Effect sizes were calculated based on t-tests and were reported as Cohen’s d.

      Outcomes

      Implementation Fidelity: Parents completed an evaluation of the degree to which the therapists covered the topics and the core components of the intervention (e.g., “We have practiced how to give my child good directions” and “We practiced how to use timeout”). Adherence was high with a mean score of 4.84 of 5. Therapists were provided a two-day training in the intervention and received group supervision every six months.

      Baseline Equivalence: The authors provided no figures but stated that no significant differences were found between groups at baseline on demographic or outcome variables.

      Differential Attrition: The authors provided no figures but stated that no differences were found between completers and non-completers on demographic or outcome variables at baseline.

      Posttest and 6-month follow-up: Eight of the 14 outcomes were significantly different between the intervention and control groups at immediate posttest. Three of the five variables of parent-reported child outcomes (intensity, problem behavior and social competence; p<.05) and three variables of parent-reported parenting practices (harsh discipline, positive parenting and clear expectations; p<.01) were significantly improved in the intervention group compared to the control group. The parent distress measure was significantly different between groups (p=.03) at posttest. One of the three teacher-report measures (social competence; p=.01) was significantly improved in the intervention group compared to the control group.

      Seven of the 14 outcomes were significantly different between the intervention and control groups at 6-month follow-up. Three of the five variables of parent-reported child outcomes (intensity, externalizing and social competence; p<.03) and three variables of parent-reported parenting practices (harsh discipline, inconsistent parenting and positive parenting; p<.05) were significantly improved in the intervention group compared to the control group. The parent distress measure was significantly different between groups (p=.04). None of the three teacher-report measures was significantly different between groups at 6-month follow-up.

      Analysis of interaction by time effects from baseline to 6-month follow-up revealed that 6 of the 14 outcomes were significant. Results were similar to the posttest results reported above with two exceptions – problem behavior and parent distress measures were not significantly different between groups overall despite significant differences at either the posttest or follow-up.

      Long-term effects: The study did not collect long-term, follow-up data and therefore was not able to demonstrate sustained effects.

      Effect size

      Cohen’s d effect sizes ranged between .34 (for parent-reported child problem behavior) and .88 (for parent-reported positive parenting) at posttest and between .34 (for parent-reported inconsistent discipline) and .88 (for parent-reported positive parenting) at 6-month follow-up.

      Limitations

      • Most statistically significant results in this study came from parent reports that, because parents delivered the intervention, are subject to bias.
      • No long-term data were collected.
      • Generalizability is limited given that this is a Norwegian sample with a high gross annual family income and the proportion of single parents (36.5%) in the study is higher than the Norwegian average (20%). Also, all subjects were highly motivated to change, having first contacted an agency on their own for help.

      Ollendick, T. H., Greene, R. W., Austin, K. E., Fraire, M. G., Halldorsdottir, T., Allen, K. B., Jarrett, M. A., Lewis, K. M., Smith, M. W., Cunningham, N. R., Noguchi, R. J. P., Canavera, K., Wolff, J. C. (2015). Parent Management Training and Collaborative & Proactive Solutions: A randomized control trial for oppositional youth. Journal of Clinical Child and Adolescent Psychology, 0 (0), 1-14.

      Design

      Recruitment: Parents of youth with oppositional defiant disorder (ODD) in rural southwest Virginia were referred by mental health professionals, family practice physicians, and school personnel, as well as recruited through newspaper advertisements and television programs, for participation in the program. Parents of 275 youth were assessed for eligibility using brief telephone screenings that determined 164 were of targeted age (7-14) and had symptoms of ODD. These parent-child dyads then underwent a comprehensive clinical assessment to confirm ODD diagnosis and determine associated comorbid disorders. In total, 134 (82%) participants were deemed eligible, with ODD as a primary, secondary, or tertiary diagnosis.

      Assignment/ Conditions: After completing baseline measures, youth were randomly assigned to Parent Management Training (N=63), a similar parent-training program (Collaborative & Proactive Solutions; N=60), or a waitlist control group (N=11). After posttest assessment, the waitlist control group was randomly reallocated, disproportionately, to the two active conditions resulting in equal groups of 67 for the follow-up period.

      Collaborative & Proactive Solutions is a similar intervention focused on improving the functioning of youth with ODD through parent training. However, rather than helping parents become more consistent in their behavior management practices through the use of “clear and direct commands, this program focuses on fostering a collaborative and proactive approach to parenting that directly targets skills that children are lagging on.

      Assessment: The baseline assessment was followed by a posttest assessment plus a 6-month follow-up that did not include the no-treatment control group. Of the 134 randomized subjects, 100 (75%) completed posttest measures 6 weeks later and 55 (41%) were retained at 6-month follow-up.

      Sample

      Just over 60% of participating youth were male, averaging about 10 years of age, with the majority (>80%) identifying as Caucasian. Most (~80%) came from two-parent families whose average income was just under $70,000, and over half of mothers and fathers graduated from college.

      Measures

      Separate clinicians from those delivering the program completed assessments at baseline, posttest, and 6-month follow-up unless otherwise noted. However, clinician assessments were based on interviews with both parents and children, and several other measures came directly from parents (who helped deliver the program).

      Clinical Severity Ratings of ODD, attention-deficit hyperactivity disorder (ADHD), anxiety, and affective disorder were obtained using the Anxiety Disorders Interview Schedule for DSM-IV, child and parent versions. This yielded two measures: 1) An overall rating of a child’s frequency and intensity of symptoms associated with these disorders at baseline, posttest, and 6-month follow-up (though only disorders presenting at pretreatment were examined at posttest), and 2) the diagnostic status (presence or absence) of these disorders. While the instrument “has been found to be reliable and valid,” no figures were given for the present sample.

      Overall Impairment was assessed using the Clinical Global Impression-Severity scale. The measure consists of a single Likert scale ranking, with no psychometric properties described.

      Parent-Rated Severity of Behavior Disorders came from the Disruptive Behavior Disorders Rating Scale, which had parents rate the severity of 8 ODD symptoms. The scale displayed good internal consistency in the present sample (a = .90).

      Parent-Rated Child Aggressiveness was measured using the Aggression scale of the Behavior Assessment System for Children-Second Edition. The measure also had good validity in the present sample (a = .90).

      Global Symptom Improvement was rated by clinicians using the Clinical Global Impression-Improvement scale, which measures the degree to which the child’s symptoms have improved since the start of treatment. Psychometric properties were not described.

      Analysis

      The analysis used mixed-models with “full maximum likelihood estimation to deal with missing data,” a random intercept, and a random slope for time to deal with the nesting of time points within participants. Tests for treatment-by-time implicitly included baseline controls. In all models, the equivalence of the two active treatment groups was determined using a 90% confidence interval around the Parent Management Training group’s mean, as this was “considered necessary to demonstrate a meaningful difference.” Finally, potential moderators were examined using interaction terms to determine whether treatment effects differed by age, presence of anxiety disorders, gender, race/ethnicity, socioeconomic status, and presence of attention deficit hyperactivity disorder.

      In accordance with intent-to-treat, data from the full baseline sample was used in all analyses with FIML estimation and multiple imputation.

      Outcomes

      Implementation Fidelity: Families reported being similarly satisfied with both active treatment conditions at posttest and follow-up, and both treatments reported completion (at least 50% of sessions attended) rates of about 80%, with an average attendance of 12 sessions among completers. Supervisor ratings of coverage averaged 2.93 of a maximum of 3.

      Baseline Equivalence: Baseline characteristics were only described for the randomized sample of 134. For this group, there were no differences in outcome measures between the active treatment and control conditions, but there were significant differences in race/ethnicity and age.

      Differential Attrition: Those who were retained at posttest differed significantly from the pretest sample on income, mothers’ education, and fathers’ education, such that the socioeconomic status of dropouts was lower than that of completers. At 6-month follow-up, those retained differed significantly on family structure, income, mothers’ education, and fathers’ education from dropouts. Attrition did not differ significantly by treatment condition, but the study did not test for differences in baseline measures by condition.

      Posttest & 6-Month Follow-Up: Compared to the waitlist control group, both the Parent Management Training and Collaborative & Proactive Solutions conditions significantly improved 4 of 4 behavioral outcomes at posttest. Specifically, the two interventions reduced the overall clinical severity ratings of ODD, decreased global impairment, reduced the severity of parent-reported ODD symptoms, and decreased parent reports of aggression more than the waitlist control group, though neither active intervention performed better than the other. Similarly, both active treatment groups experienced comparable (non-significant) improvements on remission outcomes (being diagnosis-free or experiencing clinical improvement in ODD), though these outcomes were not tested against the control group.

      Furthermore, once the waitlist control group was reallocated to the two interventions, there were no significant differences on any outcomes at 6-month follow-up, suggesting that both groups maintained similar treatment gains over the follow-up period.

      Both age and presence of an anxiety disorder significantly moderated the effects of the two active interventions, such that younger children and those diagnosed with an anxiety disorder experienced significantly greater improvement on the two clinical ODD measures than older children and those without an anxiety diagnosis. While not significant, the parent-reported measures showed trends (p= .09-.10) in the same direction.

      Rabbit, S. M., Carrubba, E., Lecza, B., MacWhinney, E., Pope, J., & Kazdin, A. E. (2016). Reducing Therapist Contact in Parenting Programs: Evaluation of Internet-Based Treatments for Child Conduct Problems. Journal of Child and Family Studies, 25, 2001-2020.

      Intervention

      Although PMT is typically provided in-person, this study tested two internet-based treatment versions created to reduce professional therapist time, full contact and reduced contact. Full contact was structured similarly to traditional PMT in which parents and therapists engaged in face-to-face interactions over the internet. Reduced contact PMT did not involve any face-to-face interactions with a therapist; rather, parents were emailed a link to a pre-recorded treatment session.

      Design

      Recruitment: Antisocial, oppositional, or aggressive (but not developmentally disabled) children aged 6-12 with families living in Connecticut, having a computer and high-speed Internet access, and fluent in English, but not receiving other forms of psychotherapy, experiencing suicidality, or any other acute crises were allowed to enroll in the trial. Of 280 deemed eligible for screening, only 86 (31%) consented, met all inclusion criteria, and provided baseline measures. A separate sample of 60 control families came from a separate database of program participants from other studies.

      Assignment: Although randomized in some ways, the study also relied on non-random assignment and can be seen as a QED. First, due to technical difficulties, the “first 20 participants who entered the study were assigned non-randomly to one of the two treatment groups” (N=10 to both online treatments), with the remaining 66 randomly assigned to either the Full Contact PMT (N=30) or Reduced Contact PMT (N=36) conditions.

      Second, the “benchmark” comparison group of 60 families had previously completed the traditional, in-person PMT intervention, and were “selected from a large database compiled through several past RCTs.” These participants do not appear to have been randomly selected, but were rather “selected to match the online sample (N=60) in terms of age and race.”

      Attrition: Treatment group participants were assessed at baseline, mid-treatment, and posttest, with the analytic sample consisting of only those that completed measures at all time points. Of the 86 families initially allocated to the two online treatment groups, 81 (94%) completed the pretest, 70 (81%) provided mid-treatment measures, and 60 (70%) were retained at posttest. The assessment schedule of the in-person PMT comparison group was not described.

      Sample

      Children participating in the two online treatments were mostly boys (58%) averaging 8.5 years of age. The majority identified as European American (87%), of which 8% were Hispanic or Latino/a, with the remainder identifying as African American (5%), Asian American (5%), or multiracial (2%). Most children’s caregivers were married (82%), had a college or graduate-level degree (77%), and were employed either full- (37%) or part-time (33%), with a median monthly income between $2500 and $3000. Sample characteristics of the comparison group were not described.

      Measures

      All measures were completed by parents at baseline, mid-treatment, and posttest or by therapists at baseline and posttest. Because both parents and therapists delivered the program, their ratings of children may be biased. Most measures have been well validated, but psychometric properties in the current sample were not reported for any measures.

      Internalizing and Externalizing Symptoms were assessed using appropriate subscales of the 118-item Child Behavior Checklist. The instrument also yielded a total problem score, for the severity of dysfunction across a number of symptom domains.

      Antisocial Behavior was measured at baseline and posttest, only, with the 30-item Interview for Antisocial Behavior. Severity and duration scores were summed to yield the overall measure.

      Overall Impairment was scored by therapists at baseline and posttest, only, using the single-item Child Global Assessment Scale.

      Total Psychiatric Symptoms were scored as the total number of symptoms present across all diagnoses in structured Research Diagnostic Interviews conducted between parents and therapists at baseline and posttest.

      Parent Depressive Symptoms were obtained at baseline and posttest using the 21-item Beck Depression Inventory.

      Parent Stress was assessed at baseline and posttest using the 120-item Parenting Stress Index.

      Family Functioning was measured at baseline and posttest using the 27-item, shortened version of the Family Environment Scale.

      Analysis

      The study initially used a series of two-way repeated measures analysis of variance (ANOVA) models to compare the two online intervention groups’ outcomes over time before using a similar set of models to compare both online groups, combined, to the in-person benchmark group. However, this final set of models only used 3 of the 9 total measured outcomes. All models included baseline outcome controls, but no other adjustments were made.

      In violation of intent-to-treat, analyses focused only on families that completed 80% or more of the treatment sessions and all assessments. This resulted in dropping 30% of the initial sample.

      Outcomes

      Implementation Fidelity: All families retained for the analysis completed (at least 80% of) the treatment. Independent raters reviewed sessions and determined mean treatment integrity to be 93%, across online conditions. Furthermore, there were no significant differences between these groups in the amount of telephone communication with therapists, though therapists rated parents as significantly more adherent to treatment in Full Contact PMT than in the Reduced Contact PMT group; however, parent-reported adherence to treatment did not differ. Fidelity for the benchmark in-person PMT intervention was not reported.

      Baseline Equivalence: Despite reporting “no differences between the two intervention groups in demographic variables and pretreatment clinical characteristics,” the online conditions differed significantly in types of parenting techniques (p=.05). Baseline equivalence of outcome measures was not examined between the online interventions and the benchmark condition, though a significant difference in gender (p=.05) was reported.

      Differential Attrition: Attrition did not differ between the two online conditions, though overall dropouts were less likely to identify as European American and had more children living at home than completers. Whether these characteristics differed by condition was not reported. No information about attrition within the benchmark comparison group was given.

      Posttest: Analyses comparing treatment outcomes between the two online interventions revealed a significant difference across only 1 of 9 outcomes. Parent-reported child internalizing symptoms were reduced more in the Full Contact PMT group than in the Reduced Contact PMT group.

      The combined online versions of the program did not differ significantly on any of 3 examined outcomes from the benchmark group, indicating that online treatment was no less effective in this sample than in-person therapy.

      Study 13

      This study involved boys aged 8-12 with Oppositional Defiant Disorder or diagnosed Conduct Problems in the Netherlands.

      Evaluation Methodology

      Design:

      Recruitment: Participants were boys aged 8-12 recruited from clinical health centers, special education schools, and regular elementary schools in the Netherlands. Inclusion criteria included an IQ of above 70 and a diagnosis of either Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD). A total of 65 boys were recruited and consented to participate.

      Assignment: Participants were assigned to either the clinical intervention condition (n=22) or a control group (n=43). The method of treatment assignment was not discussed.

      Attrition: There was only one drop-out, making the total retention rate 98%.

      Sample:

      The sample was exclusively male and predominantly white (62%), averaging approximately 10 years old at intake. Comorbidity of ADHD was approximately 70% and anxiety was approximately 59%, while depression ranged from 9% to 17%, and conduct disorder from 18% in the intervention group to 41% in the control group. Psychostimulant medication usage was approximately 38% for the entire sample.

      Measures:

      Assessments occurred at baseline, post-intervention (6 months after baseline), and a follow-up 12 months after baseline and 6 months after program completion. Primary outcomes include ­aggression, measured by both the Parent Daily Report and the Teacher Report Form (aggressive behavior subscale), and neurobiology, assessed with resting heart rate, cortisol reactivity, and cortisol recovery. Resting heart rate was measured for 3 minutes while participants were seated comfortably and watching a relaxing video. Salivary cortisol was gathered from participants’ saliva using a .5ml tube and was measured during and after a psychosocial stressor, in this case being led to believe they were losing a computer game competition (with a highly coveted prize for winning) against another boy. Negative parenting practices were assessed with the Alabama Parenting Questionnaire, subscales of supervision and monitoring, inconsistent discipline, and corporal punishment. Internal consistency was not directly presented here but was reported to be adequate.

      Analysis:

      Preliminary analyses used repeated measures ANOVAs and paired t-tests to examine differences in reported aggression over time, and stepwise regression was used to examine the relationship between parental factors and neurobiology. Models controlled for baseline aggression scores but not for other baseline characteristics even if they differed between groups at baseline.

      Intent-to-Treat: All available data were used in the analysis.

      Outcomes

      Implementation Fidelity:

      Fidelity was monitored by checking video samples of recorded sessions, though no quantitative measure was presented.

      Baseline Equivalence:

      There were significant baseline differences in IQ and parent-reported frequency of aggression, and a moderately significant difference in comorbidity of conduct disorder.

      Differential Attrition:

      There was only one attritor.

      Posttest:

      There was a significant reduction in the treatment group on parent-reported aggression over time, relative to the control group; however, there was no impact on the independently measured teacher rating of aggression. Group-by-cortisol interactions showed that parent-rated aggression declined significantly more for intervention group participants with high cortisol reactivity than for those with low activity.

      Long-Term:

      Follow-up occurred 6 months after program completion.