Shapiro Cheri J, Kilburn Janice, Hardin James W
University of South Carolina, United States.
South Carolina First Steps to School Readiness, United States.
Res Dev Disabil. 2014 Nov;35(11):2958-75. doi: 10.1016/j.ridd.2014.07.036. Epub 2014 Aug 12.
Because young children with disabilities are at elevated risk for development of challenging behaviors, and caregivers of these children typically lack access to evidence-based parenting interventions, two randomized trials were conducted to examine the impact of an evidence-based parenting intervention, Stepping Stones Triple P (SSTP), as a selective preventive intervention. Both studies targeted parents of children under two with a variety of disabilities who were enrolled in the IDEA Part C Early Intervention (EI) system in one state. SSTP was delivered in family homes. In Study One, 49 families were randomly assigned to EI services as usual, with or without SSTP; a 52% attrition rate from treatment was seen. No significant between-group differences were seen aside from a trend toward reduced symptoms of parental depression at follow-up. Intervention group children demonstrated significant decline in behavior problems from post treatment to follow-up, and there was a trend toward improved parenting style in the intervention group during this same time frame. Study Two incorporated a separate workforce intervention for EI service coordinators; 40 families on their caseloads were then randomly assigned to receive EI services as usual with or without SSTP. Attrition from treatment was limited to 20%. No differential impact was seen on child behavior; a trend was noted post-treatment on parent symptoms of depression and on the observed parent-child relationship. At 12-month follow-up, there was a trend favoring improvement in the intervention group in parenting style; statistically significant impact was also seen on the observed quality of the parent-child relationship. SSTP shows promise as a selective preventive intervention for an early intervention population. Reasons for the differential findings between the two studies are explored and suggestions for future research are provided.
由于残疾幼儿出现具有挑战性的行为的风险较高，且这些孩子的照顾者通常无法获得循证育儿干预措施，因此开展了两项随机试验，以检验一种循证育儿干预措施——“步步为营正面管教法”（SSTP）作为选择性预防干预措施的效果。两项研究的目标对象均为一个州内参加《残疾人教育法》C部分早期干预（EI）系统的两岁以下患有各种残疾的儿童的家长。SSTP在家庭中实施。在研究一中，49个家庭被随机分配接受常规EI服务，有或没有SSTP；治疗的损耗率为52%。除了随访时父母抑郁症状有减轻趋势外，未观察到显著的组间差异。干预组儿童从治疗后到随访时行为问题显著减少，且在同一时间段内干预组的育儿方式有改善趋势。研究二为EI服务协调员纳入了一项单独的员工干预措施；然后将其案头上的40个家庭随机分配接受常规EI服务，有或没有SSTP。治疗的损耗率限制在20%。未观察到对儿童行为的差异影响；治疗后注意到父母抑郁症状和观察到的亲子关系有趋势变化。在12个月随访时，干预组在育儿方式上有改善趋势；观察到的亲子关系质量也有统计学上的显著影响。SSTP显示出作为早期干预人群选择性预防干预措施的前景。探讨了两项研究结果差异的原因，并提供了未来研究的建议。
