Wähnke Laura, Dose Christina, Klemp Marie-Theres, Mühlenmeister Judith, Plück Julia, Döpfner Manfred
School for Child and Adolescent Cognitive Behavior Therapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany.
JMIR Pediatr Parent. 2024 Sep 4;7:e54051. doi: 10.2196/54051.
Web-based self-help (WASH) has been found to be effective in the treatment of child externalizing behavior disorders. However, research on the associations of caregivers' use of WASH and symptom changes of child externalizing behaviors is lacking.
This study examined the longitudinal and reciprocal associations between the use of WASH by caregivers of children with externalizing behavior disorders and their children's externalizing behavior symptoms.
Longitudinal data of 276 families from 2 intervention conditions of a randomized controlled trial (either unguided or supported by a therapist over the phone) were analyzed. Caregiver- and clinician-rated child externalizing behavior symptoms were assessed before (T1), in the middle (T2), and after the 6-month WASH intervention (T3). Additionally, 2 indicators of the caregivers' use of the WASH intervention were considered: number of log-ins (frequency) and the percentage of completed material (intensity). Associations of caregivers' use during early (T1-T2) and late (T2-T3) treatment with child externalizing behavior symptoms were analyzed using path analyses (structural equation modeling).
Frequency and intensity of use were higher during the first 3 months than during the next 3 months of the intervention period. The number of log-ins at early treatment was significantly but weakly associated with caregiver-reported child externalizing behavior symptoms in the long term (T3). Moreover, caregiver-reported child externalizing severity at T2 predicted the number of log-ins in the late treatment. The results were not replicated when considering the percentage of completed material as a measure of use or when considering clinician ratings of child externalizing behavior symptoms.
The findings provide the first, albeit weak, evidence for longitudinal associations between caregivers' use of WASH and improvements in caregiver-rated child externalizing behavior symptoms. However, as the associations were rather weak and could not be replicated across different rater perspectives and operationalizations of use, further research is needed to better understand these relations and their interplay with other putative influence factors (eg, quality of the implementation of the interventions, changes in parenting behaviors).
German Clinical Trials Register DRKS00013456; https://www.drks.de/DRKS00013456.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s12888-020-2481-0.
基于网络的自助干预（WASH）已被证明在治疗儿童外化行为障碍方面有效。然而，关于照顾者使用WASH与儿童外化行为症状变化之间关联的研究尚缺。
本研究探讨了患有外化行为障碍儿童的照顾者使用WASH与他们孩子的外化行为症状之间的纵向和相互关联。
分析了来自一项随机对照试验2种干预条件（无指导或由治疗师通过电话支持）的276个家庭的纵向数据。在6个月的WASH干预之前（T1）、中期（T2）和之后（T3），评估了照顾者和临床医生评定的儿童外化行为症状。此外，考虑了照顾者使用WASH干预的2个指标：登录次数（频率）和完成材料的百分比（强度）。使用路径分析（结构方程模型）分析了早期（T1-T2）和晚期（T2-T3）治疗期间照顾者的使用与儿童外化行为症状之间的关联。
在干预期的前3个月，使用频率和强度高于后3个月。早期治疗时的登录次数与长期（T3）照顾者报告的儿童外化行为症状显著但微弱相关。此外，T2时照顾者报告的儿童外化严重程度预测了晚期治疗时的登录次数。当将完成材料的百分比作为使用量度或考虑临床医生对儿童外化行为症状的评定时，结果未得到重复验证。
研究结果首次提供了证据，尽管证据较弱，表明照顾者使用WASH与照顾者评定的儿童外化行为症状改善之间存在纵向关联。然而，由于这种关联相当微弱，且无法在不同评分者视角和使用操作化方法中得到重复验证，因此需要进一步研究以更好地理解这些关系及其与其他假定影响因素（如干预实施质量、养育行为变化）的相互作用。
德国临床试验注册中心DRKS00013456；https://www.drks.de/DRKS00013456。
国际注册报告识别码（IRRID）：RR2-10.118
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