Peters Sarah, Calam Rachel, Harrington Richard
Division of Psychiatry, University of Liverpool, Royal Liverpool University Hospital, UK.
J Child Psychol Psychiatry. 2005 Apr;46(4):436-48. doi: 10.1111/j.1469-7610.2004.00365.x.
The effectiveness of parent management training (PMT) as a treatment for child behaviour problems is reduced by high attrition rates. One difficulty with engaging mothers is that, by definition, PMT is directed at the parent, yet many parents believe the cause of the problem lies within the child. Hence the model of therapy offered contradicts their understanding about the cause and nature of the problem. Moreover, the emotional consequence of holding child-responsibility causal attributions is associated with high expressed emotion (EE), a known predictor of poor compliance with therapy in other child psychiatric disorders.
Seventy-five consecutive referrals of mothers to a PMT programme were recruited. EE was assessed using the Camberwell Family Interview methodology. Spontaneous causal attributions about their child's problem behaviour were collected from the same interview material and independently coded using the Leeds Attributional Coding System. Attendance data at the PMT programme was collected following completion of programmes.
Contrary to expectations, mothers who made child-responsibility attributions and were highly critical about their child's behaviour were no more likely than non-blaming, low EE parents to drop out prematurely from a course of PMT. However, expressing an understanding of their own role in managing their child's behaviour was predictive of attendance. Two factors were, however, more closely associated with greater attrition: having been offered a clinical diagnosis and being from a lower socio-economic family.
Socio-economic factors should be viewed as barriers to uptake of services and successful strategies for increasing engagement of families are likely to be economical rather than psychological. However, although the causal attributions mothers make about their child's behaviour did not predict whether they were likely to attend PMT, an exploratory analysis found evidence to suggest that successful engagement with PMT begins early in the referral process and that referring clinicians should ensure treatment options are aligned with diagnoses provided.
高流失率降低了父母管理培训（PMT）作为治疗儿童行为问题的有效性。让母亲参与其中的一个困难在于，根据定义，PMT针对的是父母，但许多父母认为问题的根源在于孩子。因此，所提供的治疗模式与他们对问题的原因和性质的理解相矛盾。此外，认为孩子负有责任的因果归因所带来的情感后果与高情感表达（EE）相关，高情感表达是其他儿童精神疾病中治疗依从性差的一个已知预测因素。
招募了75名连续被转介到PMT项目的母亲。使用坎伯韦尔家庭访谈方法评估情感表达。从相同的访谈材料中收集关于其孩子问题行为的自发因果归因，并使用利兹归因编码系统进行独立编码。在项目结束后收集PMT项目的出勤数据。
与预期相反，做出孩子负有责任的归因且对孩子行为高度批评的母亲并不比不责备、低情感表达的父母更有可能过早退出PMT课程。然而，表达对自己在管理孩子行为中角色的理解可预测出勤情况。然而，有两个因素与更高的流失率更密切相关：被给予临床诊断以及来自社会经济地位较低的家庭。
社会经济因素应被视为获得服务的障碍，增加家庭参与度的成功策略可能是经济方面的而非心理方面的。然而，尽管母亲对孩子行为的因果归因并不能预测她们是否可能参加PMT，但一项探索性分析发现有证据表明，成功参与PMT始于转介过程的早期，转介的临床医生应确保治疗方案与所提供的诊断一致。
