Research Article Functional Assessment Based Parent …downloads.hindawi.com/archive/2014/656327.pdf · 2019-12-12 · on parent implemented functional assessment based inter-ventions

Research ArticleFunctional Assessment Based ParentIntervention in Reducing Children’s Challenging Behaviors:Exploratory Study of Group Training

Angel Fettig1 and Michaelene M. Ostrosky2

1Department of Curriculum and Instruction, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA 02125, USA2University of Illinois at Urbana-Champaign, 288 Education Building, 1310 South Sixth Street, Champaign, IL 61820, USA

Correspondence should be addressed to Angel Fettig; [email protected]

Received 20 August 2014; Accepted 6 November 2014; Published 16 December 2014

Academic Editor: Ross Flom

Copyright © 2014 A. Fettig and M. M. Ostrosky.This is an open access article distributed under the Creative CommonsAttributionLicense, which permits unrestricted use, distribution, and reproduction in anymedium, provided the originalwork is properly cited.

This study examined the effects of group parent training on children’s challenging behaviors in home settings. Eight parents of youngchildren with challenging behaviors were trained in a large group setting on using functional assessment to design interventionsthat fit the strengths and needs of individual families. The training included information sharing and collaborating with parentson designing functional-assessment based interventions. An Interrupted Time Series Design was used to examine the effects oflarge group training by comparing parent and child behaviors prior to intervention with behaviors after the intervention. Datawere analyzed using Repeated Measures ANOVA.The results indicated that group training increased parents’ ability to implementfunctional assessment based strategies and these strategies resulted in a significant reduction in children’s challenging behaviors.Furthermore, parent implementation of functional assessment based strategies and children’s decreased levels of challengingbehaviors were maintained after the completion of the intervention.

1. Group Parent Training onFunctional-Assessment BasedIntervention in Reducing Children’sChallenging Behaviors

Challenging behaviors often are a source of confusion andfrustration to teachers, parents, and other caregivers. Chal-lenging behavior has been defined as any behavior that inter-feres with children’s learning and development, is harmful tochildren and to others, and puts a child at high risk for latersocial problems or school failure [1, 2]. Early in life challeng-ing behavior is developmentally appropriate, and all childrencontinue to engage in it periodically as they grow. However,some children rely on challenging behavior as a way to gettheir needs met [2]. Such children may need individualizedinterventions to help reduce their challenging behaviors andincrease positive behaviors.

While teachers have reported that children’s disruptivebehavior is one of the biggest challenges they face, parentsalso report these difficult experiences in home settings.

Children’s challenging behaviors can impact a family’s abilityto participate in community and family activities. Thesechallenges make families ideal candidates for behavior inter-ventions. One of the most important values of working withyoung children is the belief in family-based practices [3].TheDivision for Early Childhood’s (DEC) position statementspecifically emphasizes the critical role that families play indesigning and carrying out effective interventions for chal-lenging behaviors [4].

The treatment of young children’s challenging behaviorhas received considerable attention over the last two decades.Children often participate in behavioral interventions toreduce their challenging behaviors in school or therapysettings [5]. While this form of intervention has been proveneffective, it is important that parents also learn strategiesto interact with their children who may exhibit challengingbehaviors outside of intervention sessions. Campbell [6]examined the prevalence, course, and correlates of behaviorproblems in preschool children, and the results indicated thatserious externalizing problems identified early often persist.

Hindawi Publishing CorporationChild Development ResearchVolume 2014, Article ID 656327, 11 pageshttp://dx.doi.org/10.1155/2014/656327

2 Child Development Research

Negative, inconsistent parental behavior and high levelsof family adversity are associated with the emergence ofproblems in early childhood and predict their persistence toschool age. Stormont [7] stated that negative and controllingparenting places children at risk for developing behaviorproblems. Also, research has shown that parental aggressiontoward children was differentially associated with children’ssociometric ratings in later school years [8]. Parental aggres-sion toward children at home was a significant predictor ofchildren’s social status at school, above and beyond the vari-ance accounted for by children’s aggression at school. Thus,parents’ interaction with their children and their reactionsto children’s challenging behaviors are key components thatrequire further investigation.

The importance of involving parents in designing effec-tive interventions to treat young children’s challenging behav-iors cannot be ignored. The family is a child’s most valuableand durable resource and exerts the most powerful influenceon a child’s development [9]. Parents are experts about theirchildren and about their family’s culture and ecology. Parentshave unique knowledge about family goals and values, dailyandweekly routines, resources, social supports, and stressors.

While parent training and intervention in the treatmentand prevention of child externalizing problem behaviors haveemerged as an important topic, much remains to be learnedabout the factors that affect the implementation of this typeof intervention. Specifically, many interventions that targetparent intervention are not based on the factors thatmaintainproblem behaviors. Functional assessment (FA) refers toa set of procedures that are used to explicate the relationshipsbetween physiological or environmental events and problembehaviors. Functional assessment uses interviews, observa-tions, and structural analysis to operationally define thetopography, frequency, and duration of problem behaviors.FA is used to identify the antecedent events that occur beforechallenging behaviors and the consequences that maintainthe behaviors [10]. By designing an intervention based onthe function rather than the form of behavior, a number ofbenefits are realized. First, the emphasis is on skill buildingand supporting prosocial behavior, with less emphasis onpunitive strategies that simply seek to reduce behavior prob-lems. Second, by implementing hypothesis-driven strategies,positive outcomes are more likely. Third, function-basedinterventions increase the likelihood that the new behavior(s)will produce meaningful and long-lasting change, which isthe objective of all intervention efforts [11].

A recent review was conducted to analyze the researchon parent implemented functional assessment based inter-ventions in reducing children’s challenging behaviors [12].The review indicated that functional assessment based inter-ventions provide evidence in supporting parents to reducechildren’s challenging behaviors. However, most studies ofthis nature focus on working with parents individually (e.g.,[13–16]). No studies were identified that investigated theeffects of functional assessment based group parent trainings.While effective, the cost effectiveness of individually providedparent training is a concern. A group approach enables aninterventionist to interact with a larger number of partici-pants at one time, which can help relieve the critical shortage

of professionals needed to treat child behavior problems.Additionally, group training has the potential to help familiesfeel less isolated and might provide a context for parent-to-parent networking and support [17]. Finally, hearing otherparents’ concerns and the strategies they use with their chil-dren might broaden the “skill set” or “bag of tricks” availableto any single parent.

There is a large body of research on the implementationof behavioral interventions by families with young children(e.g., [18–20]); however, few researchers have documentedstrong parent and child outcomes as a result of group training.Furthermore, many of the group studies utilized a preexistingparent training program such as the Incredible Years Program[21], Effective Black Parenting Program [22], and BehavioralParent Training [23]. Because of the use of established parenttraining programs, the opportunities for parent-researchercollaboration were minimal. Programs of this nature do notassess individual parent and child behaviors, thus limitingcollaboration with parents and not tailoring interventions toindividual children and their families. When training pro-grams are not individualized to meet families’ unique needs,parents are less likely to take ownership of the interventionsand the results are less likely to maintain.

In general, parent training programs are effectiveapproaches for helping parents reduce aggressive and opposi-tional behaviors in their children [24]. However, manyquestions remain about the ideal format of parent trainingand the rigor of past research studies. Numerous factors couldcontribute to the variable parent and child outcomes realizedacross published studies. While many studies demonstratedthat group training positively results in reductions inchildren’s challenging behaviors (e.g., [21, 25, 26]) severalfactors related to validity and reliability must be addressed.Theuse of preexisting intervention programs versus interven-tions that researchers design in collaboration with parents toaddress individual needsmust be considered. Although somecommercially available parent programs have been shownto be effective in reducing children’s challenging behaviors,these programs are often used for prevention purposes andmight not be as effective for children who exhibit persistentchallenging behaviors. It is important to look at the functionof children’s challenging behaviors and understand that theyare unique to each child, in order to improve the effectivenessand efficiency of any intervention [27]. Also, when assessingthe effectiveness of an intervention, direct observation ismore reliable than parent report [28]. Observing parents andtheir children enables researchers to consider the relationshipbetween adult and child behaviors.

The purpose of this exploratory study was to examinethe effectiveness of group parent training on using functionalassessment based interventions to reduce young children’schallenging behavior. Specific research questions addressedwere as follows: (a) to what extent did group training increaseparents’ use of functional-assessment based strategies toreduce their children’s challenging behaviors?, (b) to whatextent did parent implemented functional-assessment basedstrategies result in a reduction in their children’s challengingbehaviors?, and (c) to what extent did parents’ and children’sbehaviors maintain after the completion of the intervention?.

Child Development Research 3

Table 1: Participant demographics.

Participants Ethnicity Child sex Child agea(year, month) Child diagnosis Parent education level

Child Parent participant(s)A Mother, father Caucasian M 4 y 2m Soto’s Syndrome BA, N/Ad

B Mother AfricanAmerican F 3 y 10m None AA

C Mother, father Asian M 4 y 6m ASDb, sensoryintegration needs MD, PhD

D Grandmother, mother Caucasian M 4 y 8m ASDc HS, HSE Mother Caucasian F 3 y 7m None MAF Mother Caucasian M 5 y 0m Autism MAG Mother Caucasian M 3 y 0m None BAH Mother, father Caucasian F 2 y 10m None BA, MAaAge at the beginning of the study. bAutism spectrum disorder—diagnosis made prior to the release of DSM-V. The child was diagnosed with Asperger’ssyndrome under DSM-IV. cDiagnosis made prior to the release of DSM-V. The child was diagnosed with pervasive developmental disorder not otherwisespecified. dInformation not provided.

2. Design

Using an Interrupted Time Series Design, the effects ofgroup training were analyzed by comparing parent and childbehaviors prior to interventionwith their behaviors followingintervention [29]. In this design, the group of participantswas tested repeatedly before and after the treatment to allowthe researchers to detect any confounding variables such asregression to the mean, history, and maturation.

3. Recruitment and Participants

Parent-child dyads were recruited from the Midwest. Theinclusion criteria for the study were that child participantshad to be between the age of 2 and 5 and their parents musthave expressed concern regarding their children’s challengingbehavior at home. To increase the reliability of the study andreduce variability, child participants with severe intellectualdisabilities whose parents reported that the child was func-tioning under the developmental age of two years old werenot recruited as participants. Parents of children who werereceiving services due to behavior issues also were excludedfrom the study.

Eight families completed all phases of this study. Threeof the eight families had both mother and father participantspresent during the training sessions, while four of the familieshad mothers as participants. One family included a grand-mother, who was the legal guardian of the child participant,and the child’s mother as participants in the study. Whilemore than one family member attended many training ses-sions, not all “trained participants” were present at each of thehome observation sessions. However, it was required that oneparent participant from each family consistently attend alltraining sessions and be present at each of the home obser-vations.

Of the eight children in the study, five were boys andthree were girls. Child participants’ ages ranged from 2 yearsand 10 months old at the start of the study to 5 years old;four of the children had diagnosed special needs. A sum-mary of demographic information on each parent and childparticipant is presented in Table 1.

4. Procedures

4.1. Baseline. Prior to the start of the study, all interestedparents were interviewed to ensure that their children metthe criteria for the study. After all participants were identified,three home observations per family were conducted duringthe home routine which parents identified as the time whentheir child exhibited persistent challenging behavior. Duringthese observations, parents were asked to interact with theirchildren as they normally would during the routine theyselected as being most problematic. The three observationsessions for each family were completed within a 3-weekperiod. Across all eight families it took four weeks tovideotape the 24 sessions.

4.2. Intervention. Immediately following the completion ofall baseline observations, all parents participated in a 4-session training program over a 4-week period. Over thecourse of the 4 weeks, parent participants met in groups withthe first author for 1-hour training sessions. Childcare wasprovided at the training site. Each session followed a similarformat: a question-answer segment about information sharedduring the previous session, introduction and presentation ofthe new topic, and collaboration between the researcherand parents regarding the new topic. Each training ses-sion included lecture, discussion, scenario presentation, andvideotapes. Parents received handouts about each topic andthey were provided with the opportunity to describe theirchildren’s challenging behaviors to the group so other partic-ipants could help them problem solve. Descriptions of eachintervention session are presented in Table 2. (All materi-als used in training were adapted from training materialsdeveloped by the Center on the Social and Emotional Foun-dations for Early Learning (CSEFEL; http://www.vanderbilt.edu/csefel/).)

4.3. Postintervention. Three home observation sessions wereconducted following the completion of all training sessions.All three observations were completed for all families within3 weeks following the last training session.


Table 2: Training session descriptions.

Session Topic Focus

1Understanding young children’s socialand emotional development andchallenging behaviors

(i) Importance of social emotional development and why challengingbehaviors occur(ii) Ways to promote children’s social emotional development(iii) Benefits of descriptive praise(iv) Introduction to functional assessment

2 Functional assessment (FA) and FA-basedstrategies

(i) The purpose and importance of FA(ii) FA interview and FA observation(iii) Identifying forms and functions of children’s challengingbehaviors

3 Designing FA-based parent interventionstrategies

(i) Identifying suitable strategies(ii) Formulating detailed behavior plans based on all informationgathered(iii) Creating materials to support implementation (e.g., picture cuecards, picture schedules)

4 Implementing the strategies andself-monitoring

(i) Implementation strategies(ii) Self-monitoring

4.4. Maintenance. Four weeks after the completion of thelast observation session in the postintervention phase, allparents were observed one more time (within a three-weektime frame) to determine if parent and child behavior changesmaintained. At the end of this observation session, theresearchers debriefed each parent regarding the results ofthe study and ideas for continued implementation of thestrategies. Parents also were provided a parent questionnaire,which focused on parents’ perceptions of the strategies andthe effectiveness of the intervention. Parents were providedwith a stamped envelope that was addressed to a univer-sity graduate student, who had volunteered to compile thequestionnaire data and omit parent names before sharing theresponses with the researchers. Parents were assured of theiranonymity.

5. Dependent Measures and Coding

5.1. Parent. Parent dependent variables were defined asfunctional-assessment indicated strategies (FA-indicatedstrategies). FA-indicated strategies were identified by usinga functional assessment; they were strategies parents wouldimplement to reduce children’s engagement in challengingbehaviors. FA-indicated strategieswere derived by identifyingfunctions of children’s challenging behaviors and thenreviewing the Functional Assessment Interview (FAI), Func-tional Assessment Observation (FAO), and baseline obser-vations to determine which strategies would directly addresschildren’s behavior functions. Together, the first author andthe parents brainstormed and generated strategies suitablefor each family to implement to help reduce the children’schallenging behavior during the targeted routine. An exampleof an FA-indicated strategy was when a parent offered herchild a drink before bedtime to eliminate the need for thechild to ask for water after she had climbed into bed. By doingso, the child would not engage in challenging behavior (e.g.,whining, crying, and refusing to follow directions) in orderto gain access to water once in bed.

Parent behaviors were coded by determining how manyFA-indicated strategies parents used in each session. Theresearcher used a FA-indicated strategies matrix developedfor each parent to document the strategies that the parentsused. Parent data were analyzed by calculating the percentageof FA-indicated strategies implemented in each session. Thiswas calculated by dividing the total FA-indicated strategiesused in each session by the total FA-indicated behaviorspossible during the routine and multiplying this number by100.

5.2. Child. Child dependent variables were challengingbehaviors identified and defined by each parent in collabora-tion with the researcher using the FAI, FAO, and the baselineobservations. Challenging behaviors exhibited by the 8 chil-dren included hitting, kicking, screaming, and refusing to fol-low directions given by parents. Challenging behaviors werenot the same for all child participants.

When gathering data on child behaviors, a 15-secondpartial time sampling interval-recording method was used.For each observation session coders assessed the presence orabsence of the predetermined challenging behaviors withineach 15-second interval. The percentage of intervals thatthe child exhibited challenging behaviors was calculated bydividing the total number of intervals the child exhibitedchallenging behavior by the total number of intervals of thatobservation session and multiplying by 100.

5.2.1. Support during Postintervention. The researcher pro-vided parents with support during the postintervention phaseto facilitate the implementation of FA-indicated strategies.Some of the support strategies used were affirming parentbehavior, modeling a specific strategy, and suggesting the useof a specific strategy. The amount of support provided toeach parent differed based on his or her unique needs. Someparents needed consistent support to prompt the usage of theFA-indicated strategies throughout most of the postinterven-tion phase while other parents did not need any support to


accurately implement FA-indicated strategies. Support wasnot provided to any parent during the maintenance session.Supports provided to parents were coded as the presence orabsence of support during each observation session.

6. Data Analysis

Repeated Measures ANOVAwas used to analyze both parentand child behaviors. Unlike a between-subject design inwhich differences between subjects are not controlled and aretreated as error, in a Repeated-Measures ANOVA the samesubjects are tested in each condition. Therefore, differencesbetween subjects can be measured and separated from error[30]. This type of analysis was selected given different parentand child behaviors targeted for each family.

7. Treatment Fidelity

In order to increase the reliability of drawing causal infer-ences between children’s challenging behavior and the grouptraining, it was essential to ensure that parent training wasimplemented with high fidelity. Treatment fidelity checklistswere developed for each of the training sessions to insure pro-cedural integrity. To assess the fidelity of treatment, the sec-ond author conducted fidelity checks on all training sessionsto ensure that all parent training procedures were followed.The treatment verification data were 100% of 32 items forsession 1, 100% of 10 items for session 2, 90% of 10 items forsession 3, and 100% of 20 items for session 4. The mean forcombined training fidelity was 97.5%.

8. Interrater Reliability

To assess interrater reliability, a graduate student in earlychildhood special education was trained to code parent andchild behaviors captured on the videotapes; she indepen-dently coded 20% of the tapes. The reliability tapes wererandomly selected across phases (12 sessions total; 5 baseline,5 intervention, and 2maintenance) and across 7 families.Thevideotapes for one of the families were not selected for inter-rater reliability coding because the family spoke both Englishand Chinese at home and the reliability coder did not under-stand Chinese. The first author, who is fluent in Chinese, wasable to code these videos. However, due to the second lan-guage used, this family’s video was not selected for interraterreliability coding.

Mean reliability on randomly selected tapes was 93.1%for challenging behavior (range: 75.5%–100%) and 95.8%for parents’ FA-indicated strategies (range: 83.4%–100%).Reliability on the presence or absence of support provided bythe researcher to the families was 100%.

9. Results

The percentages of parent behaviors and child behaviors foreach session were entered into SPSS to calculate significanceof behavior change before and after intervention. Data werethen aggregated across all eight families. Dependent variable

Inte

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s of c

hild

ren’s

chal

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ing

beha

vior

s (%

)

Observation sessions

Baseline Postintervention Maintenance

Parent behaviorChild behavior

100

90

80

70

60

50

40

30

20

10

0

1 2 3 4 5 6 7

Pare

nt im

plem

ente

dst

rate

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(%)

Figure 1: Group parent and child behavior change.

definitions for child measures and parent measures are pre-sented in Table 3. The mean percent of children’s challengingbehaviors andmean percent implementation of FA-indicatedstrategies in each phase per family are presented in Table 4.

Results show that all parent participants increased theirimplementation of FA-indicated strategies from baseline tothe postintervention andmaintenance phases. All 8 children’schallenging behaviors decreased from baseline to postin-tervention and maintenance. Group means and ranges ofparent and child behaviors for each observational session arepresented in Table 5.

A one-wayRepeatedMeasuresANOVAwas conducted tocompare scores on the parents’ use of FA-indicated strategiesand children’s behavior change at baseline, postintervention,and maintenance. The means and standard deviations forparent and child behaviors are presented in Table 6. Therewas a significant effect for the three different phases forparents’ use of FA-indicated strategies (with the SphericityAssumption intact,𝐹(2, 6) = 128.54,𝑃 < 0.0005,multivariatepartial eta squared = 0.948) as well as for children’s behaviorchange (with the Sphericity Assumption intact, 𝐹(2, 6) =120.73, 𝑃 < 0.0005, multivariate partial eta squared = 0.945).The statistical test revealed that parent training was effective,and behavior changes were observed across all 8 parentand child participants. Parents increased their use of FA-indicated strategies following group parent trainingwhich ledto decreases in children’s challenging behaviors. Parent andchild data are represented graphically in Figure 1.

Overall, the results indicate that group training resultedin increased parent ability to implement FA based strate-gies. Subsequently, these strategies resulted in a significantreduction in children’s challenging behaviors. Furthermore,parents’ implementation of FA based strategies and children’slow level of challenging behaviors maintained after thecompletion of the intervention.

10. Discussion

Results of the current study show that parents were able toeffectively implement a functional assessment based inter-vention, which effectively reduced children’s challenging


Table 3: Dependent variable definitions for child measures and parent measures.

Family Targetroutine Child’s challenging behaviors FA

hypothesisFA-indicated strategies performed byparents

A Dinner time

(i) Cries, whines, yells, and screams(ii) Hits/pushes adults hand away whenbeing fed(iii) Throws food on the floor and playswith toys at dinner table duringdinnertime(iv) Leaves seat and refuses to eat byyelling “no” and turning head away fromfood(v) Plays with food

Escape

(i) Provide Tripp Trapp chair for child tosit on(ii) Use first/then picture schedule tofacilitate dinner routine and describeexpectations(iii) Use descriptive praise(iv) Engage child in conversation(v) Do not provide toys at dinnertime(vi) Redirect child’s challenging behaviorby referring to first/then picture scheduleor by asking the child if he is all donewith dinner

B Dinnerpreparation

(i) Cries and whines(ii) Screams for attention(iii) Engages in off task (e.g., playing withwater instead of washing hands)behaviours(iv) Continues action when adult requeststhat child stop(v) Refuses to follow adult directions(vi) Runs around the house

Attentionseeking

(i) Use descriptive praise(ii) Use a picture schedule to facilitatechore selection(iii) Allow child to help with chores(iv) Redirect child to select chores whenchallenging behaviors occur

C Bedtimeroutine

(i) Cries(ii) Engages in off task behaviors(iii) Refuses to cooperate with adultswhen directions are given(iv) Jumps on the bed/couch(v) Hits, pushes, or takes toys away fromsibling(vi) Destroys property(vii) Laughs uncontrollably(viii) Leaves bedroom after book readingroutine has started

Escape andattentionseeking

(i) Provide calm activity prior to bedtimeroutine (e.g., drawing, writing, andreading books)(ii) Use picture schedule to facilitatebedtime routine(iii) Use descriptive praise(iv) Do not provide child with free playtime once bedtime routine has started(v) Redirect child’s challenging behaviorby referring to the picture schedule or bysetting the timer

D Dinner time

(i) Cries, yells, and screams(ii) Moves/swirls chair all the way around(iii) Gets out of seat(iv) Hits, kicks, pinches, bites, pushes,and throws objects at or attempts to hurtan adult in any way

Escape

(i) Provide child with dinnertimewarning by directing him to wash hishands(ii) State dinnertime expectations at thestart of dinner(iii) Use descriptive praise(iv) Engage child in conversation duringdinnertime(v) Redirect child’s challenging behaviorby referring to dinnertime expectationsor ask child if he is all done with dinner

E Bedtimeroutine

(i) Cries, whines, yells, and screams(ii) Whines about completing routine(iii) Throws objects(iv) Hits, pushes, or grabs toys fromsiblings(v) Leaves bedroom to play in the livingroom once bedtime routine has started(vi) Hides or tries to escape from an adultduring bedtime routine(vii) Plays with toys in the bedroom oncebedtime routine has started(viii) Plays and talks in the bedroom oncebedtime routine has started

Escape andattentionseeking

(i) Use picture schedule to facilitatebedtime routine(ii) Use descriptive praise(iii) Make sure child completes allroutines before bedtime(iv) Redirect child’s challenging behaviorby referring to her picture schedule(v) State bedtime expectations(vi) Put on quiet/bedtime music


Table 3: Continued.

Family Targetroutine Child’s challenging behaviors FA

hypothesisFA-indicated strategies performed byparents

F Post-schoolactivity time

(i) Yells(ii) Pulls or takes objects away from theadult(iii) Takes turn out of sequence(iv) Escapes from adult or an activity(v) Engages in off task behaviors(vi) Stands on couch or table(vii) Hits, pushes, or kicks the adult

Escape andseekingsensoryneeds

(i) Use picture schedule to facilitateactivity time(ii) Use picture schedule to facilitatetransition from one activity to the next(iii) Use descriptive praise(iv) Use turn taking card to facilitategames that require child to take turns(v) Have “break” card available for childto request a break(vi) Provide a break when child requestsone(vii) Provide sensory input during breaks(viii) Redirect child by using pictureschedule/turn taking card/break cardwhen challenging behaviors occur

G After nap(i) Cries, whines, yells, and screams(ii) Hits and kicks adult or sibling(iii) Takes toys away from sibling

Escape andseekingsensoryneeds

(i) Use picture schedule to facilitateactivities after waking up from a nap(ii) Read a social story(iii) Use descriptive praise(iv) Facilitate child using toilet beforesnack(v) Redirect child by using the pictureschedule or the social stories whenchallenging behaviors occur

H Dinner time

(i) Cries and whines(ii) Leaves seat(iii) Completely turns away from thedinner table(iv) Put her legs on adult or leans againstadult when sitting next to the adult

Escape

(i) Provide dinnertime expectations priorto start of dinner(ii) Provide child with the “break” cardand the “all done” card(iii) Use descriptive praise(iv) Provide child with a booster seat atdinnertime(v) Provide child with a break whenneeded/requested(vi) Redirect child to use the “break” cardor the “all done” card(vii) Engage child in conversation duringdinnertime

behaviors. For all child participants, their challenging behav-iors were inversely related to their parents’ implementation ofFA-indicated strategies. These results provide strong supportfor a causal relationship between parent implemented FA-indicated strategies and a reduction in children’s challengingbehaviors. Also, the group parent training format extendsprevious research (e.g., [21, 31]) by highlighting the effective-ness and efficiency of training parents in small groups.

The current study extends previous research throughthe use of a behavioral approach that provided parentswith strategies to meet their individual family needs. Unlikestudies that used established parent training programs andfocused on prevention (e.g., [21, 32]), the current studyutilized a training program that included collaboration witheach family in identifying strategies that would effectivelyreduce their children’s persistent challenging behaviors. Thisstudy provides support for the idea that individualized behav-ior support plans yield positive effects across families. Thepositive outcomes realized in this studymight be attributed to

the process of collaborating with parents who were involvedin the design and implementation of interventions thatresulted in decreases in children’s challenging behaviors.Thisextends previous research (e.g., [31, 33]) and supports collab-oration with parents in designing interventions that fit familyneeds and child rearing philosophies.

The current study demonstrates that parents are ableto implement FA-indicated strategies at high levels. Unlikeprevious research that used self-report measures of parentalstress and self-efficacy as measures of parent behavior change(e.g., [34, 35]), observational data were utilized in the currentstudy to document parents’ use of intervention strategies.Data reveal that parents increased their implementation ofFA-indicated strategies from a baseline mean of 12.2% to amean of 97.8% postintervention; all parents implemented allstrategies during at least one of the postintervention sessions.

Previous studies of this nature also used parent reportas the primary measure to evaluate child behavior change.Although other researchers have reported positive outcomes


Table 4:Mean percent of children’s challenging behaviors andmeanpercent implementation of FA-indicated strategies by family andphase.

Family Phase

ImplementedFA-indicated

parent strategies(% strategiesperformed)

Childchallengingbehavior

(% intervals)

ABaseline 22.1 64.2

Postintervention 88.8 24.6Maintenance 100.0 18.3

BBaseline 16.6 51.1


CBaseline 0.0 52.6


DBaseline 26.6 51.2


EBaseline 0.0 54.4


FBaseline 4.1 44.8


GBaseline 13.3 25.4


HBaseline 14.2 49.5


Table 5: Means and ranges for parent and child behaviors.

Session% FA-indicated

strategies parentsperformed

% Intervals ofchildren’s challenging

behaviorsMean Range Mean Range

Baseline #1 18.5 0–60 42.3 4.2–79.7Baseline #2 11.6 0–33.3 51.5 24.4–87.2Baseline #3 6.4 0–20 51.3 27.7–67Postintervention #1 97.9 83.3–100 16.4 0–40Postintervention #2 97.9 83.3–100 13.6 0–31.3Postintervention #3 97.5 80–100 8.5 0–20.4Maintenance 88 60–100 5.1 0–18.3

for children as a result of intervention provided the parents(e.g., [25, 26]), parent report as the primary source of dataraises questions of reliability. In the current study, children’schallenging behaviors were systematically observed and theresults showed significantly fewer challenging behaviors

(amean of 48.4% at baseline and amean of 12.8% at postinter-vention) as parents’ implementation of FA-indicated strate-gies increased. This study extends previous research of thisnature by including observation data to document childbehavior changes [25, 35].

The level of children’s behavior change from baseline topostintervention is noteworthy. While all children’s challeng-ing behaviors significantly decreased from baseline to postin-tervention, the magnitude of behavior change differed foreach child.Thedifferences of each child’s behavior change canbe seen on Table 4. For example, E and H’s level of behaviorchange was larger (a mean of 54.4% at baseline to a meanof 5.2% postintervention and a mean of 49.5% at baseline toa mean of 3.4% postintervention, resp.) than G’s (a mean of25.4% at baseline to a mean of 6.8% postintervention). Thiscould be attributed to the fact that G’s challenging behaviorwas lower than the other children at the start of intervention.

The maintenance data in this study are consistent withresearch conducted by Briggs et al. [34], Gross et al. [25], andMyers et al. [26]. It is impressive that the results of the currentstudy were maintained one month following completion ofthe intervention. Low rates of challenging behaviors coin-cided with parents’ continuous use of FA-indicated strategies.Parents continued to implement FA-indicated strategies athigh levels following completion of the intervention. It isimportant to note that some parents showed a decrease inimplementing FA-indicated strategies at maintenance whencompared to postintervention because some strategies wereno longer necessary. For example, C’s parents and G’s motherno longer needed to use visual schedules with their childrenbecause both C and G had learned the routines and were ableto complete the steps of the routines without many prompts.Additionally, D’s mother and grandmother and H’s parentsdid not have to review dinnertime expectations prior tothe start of mealtime because both D and H had learnedthe expectations and were able to participate in the routinewithout reminders.

Positive outcomes observed in this study also might beattributed to the characteristics of the families who partic-ipated. All parent participants were recruited through theAutism Network and parenting listservs in the community.These families already belonged to local parent supportgroups and might have been more committed to findingresources and opportunities that would increase the qualityof their lives, thus, making parent collaboration more easilyachieved. Four of the 8 participating families who lived morethan 20 minutes from the training site were willing to travelto attend the weekly trainings, and although parents wererequired to commit to an intensive training and observationschedule, attrition was low. Only one family dropped out ofthe study for they relocated to a city more than 2 hours away.

In addition to the observational data that were gathered,parent questionnaires distributed at the end of the studyrevealed some insights regarding the effects of the interven-tion. Overall, parents were very satisfied with the outcomesof the study. Parents were pleased that they were able to learnpractical strategies (e.g., descriptive praise, visual charts, andcue cards) that effectively reduced their children’s challengingbehaviors. One parent reported that she learned strategies for


Table 6: Descriptive statistics and Repeated Measures ANOVA values for parent and children’s dependent measures.

Behaviors Time period 𝑁 M SD 𝐹 𝑃 value 𝜂2

Parents’ use of FA-indicated strategiesBaseline 8 12.1 10

128.54∗ 0.000 0.948Postintervention 8 97.8 4.3Maintenance 8 88 14.9

Children’s challenging behaviorsBaseline 8 49.2 11.1

120.73∗ 0.000 0.945Postintervention 8 12.8 8.5Maintenance 8 5.1 5.6

∗𝑃 < 0.000.

interacting positively with her daughter throughout the day.Several parents shared examples of their children being betterlisteners and following directions since they began makingtheir expectations clearer.

Several parents also reported that their own behavior out-side of the targeted routine had changed, which had positivelyaffected their children’s behavior. For example, one parentstated the following.

Much of what we learned from the study has beenapplicable for her other routines. Bedtime routine hasgotten a lot easier now. My child has shown muchbetter listening skills and she feels empowered thatshe knows what to do to get ready for bed. I ammuchless stressed and am able to spend more quality timewith her.

Another parent reported the following.

We have implemented a morning routine, which hasworked just as marvelously as the bedtime routinechart. She nowhas fewer tantrums in themorning andis willing to get dressed and eat breakfast with all ofus. She is now able to use the chart on her own andcomplete her tasks without much adult prompts.

Parents also noted on the questionnaire that they woulddefinitely recommend a training of this nature to othersparents. All parents felt that the experience was positive andthe individual observations, strategies, and support providedwere helpful. One parent stated that this type of training couldhelp parents becomemore aware of ways to address children’sbehaviors rather than using typical punitive responses suchas timeout, negative consequences, and removal of desiredmaterials. Another parent stated the following.

This study forced us to think about our routines andhow important it is to be organized and prepared. Weare now more ready and prepared for fits/tantrums.We think through things better on outings with morevisuals, staying calmer, getting out of themayhem andgoing to a bathroom to regroup, and so forth.

11. Limitations

First, the number of participants poses a concern in thisgroup design study. Previous research involving group parenttraining showed a high effect size of 0.83 [36]. With an

ideal power of 0.80 suggested by Cohen [37], involving 20parent-child dyads is ideal. However, despite several attemptsto recruit additional participants, it was not possible tosecure consent from 20 families. While the results indicatesignificant behavioral changes for the 8 parent participantsand their 8 children, a larger sample size might provide morevariation in family characteristics (e.g., level of commitment,resources available) that could provide further insights intothe complexity of parent collaboration and behavior change.Moreover, in the current study an analysis of behavior basedon specific demographic factors (e.g., family socioeconomicstatus, child diagnosis) was not conducted. Further analysismight provide a deeper understanding of the impact of grouptraining on families from different backgrounds. Lastly, thecomplexity of dependent measures and coding cannot beignored. For example, parent behaviors were coded by deter-mining the percent of FA-indicated strategies parents used ineach session. Due to the different number of FA-indicatedstrategies targeted for each parent participant, using percent-age as the primary means of comparison might not representan accurate picture of parent behaviors implemented.

Several factors need to be considered when conductinghome-based parent implemented intervention research in thefuture. Researchers must take into consideration the com-plexity of family values and routines in home-based interven-tions [38]. While a specific strategy may have much researchand evidence to support its effectiveness, parents might beunwilling to implement the strategy due to their child rearingvalues and philosophy.

Furthermore, the complexities of identifying FA-indicated strategies that match the function of children’schallenging behaviors merit further investigation. While theFA-indicated strategies selected for each family effectivelyreduced children’s challenging behaviors, it is unknownwhether other strategies would have resulted in decreasedlevels of challenging behaviors quicker or more thoroughly.

Conducting maintenance checks after a longer timeperiod also is worth investigating. While the current studydemonstrated that all parents were able to continue imple-menting FA-indicated strategies and children’s challengingbehaviors remained low at the 4-week maintenance check,maintenance checks at later points in time would provideinformation on whether parents continued to use the FA-indicated strategies and whether children’s low levels of chal-lenging behaviors remained several months after interven-tion.


Generalization data also can provide insight into par-ents’ ability to utilize training information in settings otherthan the target routine. Postintervention questionnaire datarevealed that several parents noticed positive changes intheir children’s behaviors in settings other than the targetedroutine. Systematic data collection during these nontargetroutines could provide information on the generalizability ofthe FA-indicated strategies.

The complexity of defining and coding target behaviorsalso needs to be addressed in future studies. While challeng-ing behaviors have been studied for many years, targetingparent behaviors as themain dependent variable has not beensystematically evaluated. Identifying FA-indicated strategiesprior to intervention can be challenging. Until a child’s chal-lenging behavior has been carefully observed and defined, itis impossible to identify parent behaviors that might supportchildren’s behavior change. Also, designing an observationalcoding scheme for parent behaviors that are linked with childoutcomes is worthy of further investigation.

12. Implications for Practice

The results of this study provide promising implicationsfor parents, practitioners, and other service providers whowork with young children with challenging behaviors. Parentinvolvement with their children with challenging behaviors iscritical. Since parents spend a significant amount of timewiththeir children, collaborating with them to design interven-tions is a promising approach to help reduce children’schallenging behaviors. Additionally, the importance of link-ing functional assessment data to interventions is critical.Functional assessment, which focuses on the identification ofvariables that influence the occurrence of problem behaviors,is needed to guide parents and practitioners in determiningwhat strategies might be most effective and efficient inaddressing children’s challenging behaviors. At the presenttime, functional assessment is not consistently used whendesigning interventions to reduce young children’s challeng-ing behaviors [13]. Results from the current study successfullydemonstrated that positive effects could be realized whenfunctional assessment data are linked with parent imple-mented strategies.

Finally, the positive results of group parent training inreducing children’s challenging behaviors provide practition-ers with insight into a cost effective approach to collabo-rating with parents. While several studies have documentedsuccess in decreasing children’s challenging behavior whenparents were trained individually (e.g., [15, 16]), the costeffectiveness and efficiency of these interventions have beenquestioned.The current study provides a promising approachto addressing young children’s challenging behaviors throughgroup training. Practitioners and service providers shouldconsider how trainings of this nature could be designed andimplemented by professionals who work with families.

13. Conclusion

The results of the current study provide important informa-tion about the effects of group training in reducing children’s

challenging behaviors. Results demonstrate that parentsare capable of effectively applying FA-indicated strategiesacquired through a group training format. Changes in parentbehaviors resulted in reductions in their children’s challeng-ing behaviors, and both parents’ and children’s behaviorsweremaintained after the completion of intervention. Additionalresearch on group training to reduce children’s challengingbehaviors needs to be completed with larger groups of diverseparents to better understand this approach.

Conflict of Interests

The authors declare that there is no conflict of interestsregarding the publication of this paper.

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