Family Drawings before and after Treatment for Child Conduct Problems: Fluidity of Family Dysfunction

Journal of Child and Family Studies, Jul 2017

Children’s drawings have previously been found to reflect their representations of family relationships. The present study examined whether evidence-based parent training for child conduct problems impacts on representations of family functioning using the Family Drawing Paradigm (FDP). N = 53 clinic-referred children (aged 3–15) with conduct problems and their families were assessed pre-treatment and at 6-month follow-up on a modified version of the FDP. Analyses of changes in the FDP revealed improvements in family functioning but not tone of language (as indicated by written descriptors) following treatment. Higher family dysfunction scores were associated with increased levels of callous-unemotional (CU) traits in the children pre-treatment. Children with high levels of CU, however, demonstrated greater change in FDP dysfunction than a low CU group, resulting in similar levels at follow-up. CU traits also moderated the association between change in family warmth and conduct problem severity, with increased FDP warmth more strongly related to improved conduct problems in the high vs. the low CU group. FDP drawings are sensitive to changes in family functioning arising from parent training, accounting for unique variance in child outcomes independent of verbal reports.

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Family Drawings before and after Treatment for Child Conduct Problems: Fluidity of Family Dysfunction

Family Drawings before and after Treatment for Child Conduct Problems: Fluidity of Family Dysfunction Lilian Kloft 0 1 ● David Hawes 0 1 ● Caroline Moul 0 1 ● Sonia Sultan 0 1 ● Mark Dadds 0 1 0 School of Psychology, University of Sydney , Sydney , Australia 1 Faculty of Psychology and Neuroscience, Maastricht University , Maastricht , The Netherlands 2 Lilian Kloft Children's drawings have previously been found to reflect their representations of family relationships. The present study examined whether evidence-based parent training for child conduct problems impacts on representations of family functioning using the Family Drawing Paradigm (FDP). N = 53 clinic-referred children (aged 3-15) with conduct problems and their families were assessed pre-treatment and at 6-month follow-up on a modified version of the FDP. Analyses of changes in the FDP revealed improvements in family functioning but not tone of language (as indicated by written descriptors) following treatment. Higher family dysfunction scores were associated with increased levels of callous-unemotional (CU) traits in the children pre-treatment. Children with high levels of CU, however, demonstrated greater change in FDP dysfunction than a low CU group, resulting in similar levels at follow-up. CU traits also moderated the association between change in family warmth and conduct problem severity, with increased FDP warmth more strongly related to improved conduct problems in the high vs. the low CU group. FDP drawings are sensitive to changes in family functioning arising from parent training, accounting for unique variance in child outcomes independent of verbal reports. Parent training ● Conduct problems ● Callous- unemotional traits ● Family functioning ● Family drawings - Children with early-onset conduct problems (CPs) are at high risk for chronic antisocial and aggressive behaviour, and a variety of social and mental health problems in adolescence and adulthood (e.g. delinquency, psychiatric disorders, substance use, school dropout; Fergusson et al. 2005; Kratzer and Hodgins 1997) . Research conducted over the past four decades has, however, shown that conduct problems can be treated successfully (Beauchaine et al. 2005). Among the various treatment models currently available, parent training interventions based on social learning theory are regarded as particularly well-established and efficacious. In these programs parents are coached in behavioural strategies for increasing reinforcement of adaptive child behaviour and setting consistent limits on disruptive behaviour, thereby replacing escalating cycles of parent-child coercion with positive, relationship-enhancing interactions (Hawes and Allen 2016) . The intervention’s large evidence base demonstrates clinically significant improvements for typically about two thirds of participant children, including short- and long-term benefits such as reduced disruptive behaviour and improved parental mental health (e.g. Beauchaine et al. 2005; Webster-Stratton et al. 1989) . Despite their well-established effectiveness, there remains a need to examine how parenting interventions produce change, that is, identify the mechanism(s) through which treatments operate (Kazdin and Nock 2003) . Traditionally, parent training programs target parenting practices in order to improve the effectiveness of discipline and the quality of parent-child relationships. Accordingly, there is considerable evidence that improvements in parenting skills are key mechanisms of change in these interventions, with outcomes accounted for by both increased positive parenting (e.g., warmth, contingent positive reinforcement) and decreased negative parenting (e.g., harsh/inconsistent discipline; Beauchaine et al. 2005; Gardner et al. 2006) . Some intervention programs also include components targeting broader family functioning (e.g., marital relationship, behaviour of siblings and other family members), and research has supported that these broader family dynamics change in response to treatment. For example, Adams (2001) found that parents who participated in a parent training program reported healthier family functioning in the areas of problem solving, communication, affective responsiveness, and behaviour control, compared to families who received regular mental health services. In observational research examining changes in parent-child interaction from pre- to post-treatment it has also been found that the families of children who benefit from such treatment show increased emotional flexibility in problemsolving discussions (Granic et al. 2007) . Although an improvement in parenting practices appears to be the key mechanism of change, research to date into treatment mechanisms has been limited by a reliance on parent-report and observational methods, and has neglected data on the child- and family process-levels. There are, however, various methods available that can reliably measure children’s represe (...truncated)


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Lilian Kloft, David Hawes, Caroline Moul, Sonia Sultan, Mark Dadds. Family Drawings before and after Treatment for Child Conduct Problems: Fluidity of Family Dysfunction, Journal of Child and Family Studies, 2017, pp. 1-14, DOI: 10.1007/s10826-017-0841-2