Department of Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands.
J Consult Clin Psychol. 2012 Aug;80(4):574-87. doi: 10.1037/a0028482. Epub 2012 May 7.
The present study tested the hypothesis that improvements in parental sense of competence during multisystemic therapy (MST) lead to positive changes in parenting, which in turn lead to a decrease of adolescent externalizing problems. Mediational models were tested separately for 3 dimensions of parenting (positive discipline, inept discipline, and relationship quality) that are targeted in MST. Each model included "3-path mediation," in which 2 mediators (i.e., changes in parental sense of competence and parenting dimension) intervene sequentially between the independent (i.e., intervention status) and dependent variable (i.e., change in externalizing problems).
Participants in this randomized controlled trial were 256 adolescents and their families who received either MST (n = 147) or treatment as usual (n = 109). In addition to pre- and postintervention assessments, 5 monthly within-intervention assessments took place.
Both preintervention-postintervention comparison, through analysis of covariance, and comparison of trajectories during intervention, through latent growth modeling, showed that MST enhanced growth in parental sense of competence and positive discipline, led to no deterioration in relationship quality, and resulted in a decrease in adolescent externalizing problems. The results supported a sequential pattern of change for positive discipline: Changes in parental sense of competence predicted changes in positive discipline, which in turn predicted decrease in adolescent externalizing problems. No support was found for mediated effects of inept discipline and relationship quality.
The results affirm the importance of directly targeting parental sense of competence and positive discipline in future interventions aimed at decreasing adolescent problem behavior.
本研究检验了这样一个假设，即在多系统治疗（MST）期间，父母的能力感得到改善会导致育儿方式的积极变化，进而导致青少年外化问题的减少。分别针对 MST 针对的育儿的 3 个维度（积极纪律、不熟练纪律和关系质量）测试了中介模型。每个模型都包括“3 路径中介”，其中 2 个中介（即父母能力感的变化和育儿维度）在独立（即干预状态）和因变量（即外化问题的变化）之间依次干预。
本随机对照试验的参与者是 256 名青少年及其家庭，他们接受 MST（n=147）或常规治疗（n=109）。除了干预前后的评估外，还进行了 5 次每月的干预内评估。
通过协方差分析进行的干预前-后比较，以及通过潜在增长建模进行的干预期间轨迹比较，都表明 MST 增强了父母能力感和积极纪律的增长，没有导致关系质量恶化，并且导致青少年外化问题减少。结果支持积极纪律变化的顺序模式：父母能力感的变化预测了积极纪律的变化，而积极纪律的变化又预测了青少年外化问题的减少。不熟练纪律和关系质量的中介效应没有得到支持。
这些结果肯定了在未来旨在减少青少年问题行为的干预中直接针对父母能力感和积极纪律的重要性。
