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)