School of Psychology, Faculty of Science, University of Sydney, Sydney, New South Wales, Australia.
Department of Psychology, Faculty of Humanities and Social Sciences, The University of Bath, Bath, United Kingdom.
JAMA Netw Open. 2022 Sep 1;5(9):e2229726. doi: 10.1001/jamanetworkopen.2022.29726.
Exposure to adverse childhood experiences substantially increases the risk of chronic health problems. Originally designed to treat child conduct problems, parent management training programs have been shown to be effective in preventing children from being exposed to further adversity and supporting children's recovery from adversity; however, there are increasing concerns that a core component of these programs, the discipline strategy time-out, may be harmful for children with a history of exposure to adversity.
To investigate the comparative benefits and potential harms to children exposed to adversity that are associated with parenting programs that include time-out.
DESIGN, SETTING, AND PARTICIPANTS: This nonrandomized waiting list-controlled clinical study was conducted at a specialist clinic for the treatment of conduct problems in Sydney, Australia. The self-referred sample included children with conduct problems and their caregivers. Eligibility was confirmed through clinician-administered interviews. Data were collected between February 14, 2018, and February 1, 2021.
Caregivers participated in a 10-session, social learning-based parent management training program. Caregivers were provided with parenting strategies aimed at encouraging desired behaviors through effective reinforcement and managing misbehavior through consistent limit setting, including the use of time-outs.
The primary outcome was the parent-reported Strengths and Difficulties Questionnaire score, and secondary outcomes included subscale scores from the clinician-administered Diagnostic Interview Schedule for Children, Adolescents, and Parents. Multi-informant measures of child adversity were collected using the parent-reported Adverse Life Experiences Scale and the clinician-rated Maltreatment Index.
A total of 205 children were included in analysis (156 in the full intervention and 49 in the control condition; 158 boys [77.1%]; mean [SD] age, 5.6 [1.8] years [range, 2-9 years]). Compared with children with low adversity exposure, children with high adversity exposure showed greater reductions in the Strengths and Difficulties Questionnaire score from baseline (mean difference, 3.46 [95% CI, 1.51-5.41]; P < .001) to after treatment (mean difference, 1.49 [95% CI, -0.46 to 3.44]; P = .13) and in the internalizing symptom subscale score (baseline mean difference, 1.00 [95% CI, -2,00 to 0.00]; P = .50; posttreatment mean difference, 0.06 [95% CI, -0.82 to 0.94]; P = .90). No significant differences in the externalizing symptom subscale score were found.
In this nonrandomized clinical study, children with high exposure to adversity experienced equivalent, if not greater, benefits associated with parenting programs that include time-out compared with children with low exposure to adversity. Results suggest that time-out was an effective component of parenting programs for children exposed to adversity.
anzctr.org.au Identifier: ACTRN12617001472369.
儿童期逆境经历会大大增加患慢性健康问题的风险。最初旨在治疗儿童行为问题的父母管理培训计划已被证明能有效防止儿童遭受更多逆境，并支持儿童从逆境中恢复；然而，人们越来越担心这些项目的一个核心组成部分，即纪律策略暂停，可能对曾经历过逆境的儿童有害。
研究与包括暂停在内的育儿项目相关的、对经历过逆境的儿童的比较益处和潜在危害。
设计、设置和参与者：这是一项非随机等待名单对照临床研究，在澳大利亚悉尼的一家专门治疗行为问题的诊所进行。自我推荐的样本包括有行为问题的儿童及其照顾者。通过临床医生管理的访谈确认合格。数据收集于 2018 年 2 月 14 日至 2021 年 2 月 1 日。
照顾者参加了一个 10 节、基于社会学习的父母管理培训计划。照顾者获得了育儿策略，旨在通过有效的强化鼓励期望的行为，并通过一致的限制设定来管理不良行为，包括使用暂停。
主要结果是父母报告的困难问题问卷评分，次要结果包括临床医生管理的儿童、青少年和父母诊断访谈时间表的子量表评分。使用父母报告的不良生活经历量表和临床医生评定的虐待指数多信息源测量儿童逆境。
共有 205 名儿童纳入分析（156 名在全干预组，49 名在对照组；158 名男孩[77.1%]；平均[SD]年龄，5.6[1.8]岁[范围，2-9 岁]）。与低逆境暴露的儿童相比，高逆境暴露的儿童从基线到治疗后的困难问题问卷评分（平均差异，3.46[95%CI，1.51-5.41]；P<0.001）和内化症状子量表评分（基线平均差异，1.00[95%CI，-2.00 至 0.00]；P=0.50；治疗后平均差异，0.06[95%CI，-0.82 至 0.94]；P=0.90）都有更大的降低。在外化症状子量表评分方面没有发现显著差异。
在这项非随机临床研究中，与低逆境暴露的儿童相比，高逆境暴露的儿童经历了相同的、甚至更大的益处，与包括暂停在内的育儿项目相关。结果表明，暂停是针对经历过逆境的儿童的育儿项目的有效组成部分。
anzctr.org.au 标识符：ACTRN12617001472369。
