Technology-Enhanced Program for Child Disruptive Behavior Disorders: Development and Pilot Randomized Control Trial

Abstract

Abstract Early onset disruptive behavior disorders are overrepresented in low-income families; yet these families are less likely to engage in behavioral parent training (BPT) than other groups. This project aimed to develop and pilot test a technology-enhanced version of one evidence-based BPT program, Helping the Noncompliant Child (HNC). The aim was to increase engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Low-income families of 3- to 8-year-old children with clinically significant disruptive behaviors were randomized to and completed standard HNC (n = 8) or Technology-Enhanced HNC (TE-HNC; n = 7). On average, caregivers were 37 years old; 87% were female, and 80% worked at least part-time. More than half (53%) of the youth were boys; the average age of the sample was 5.67 years. All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Further evidence for the boost afforded by the technology is revealed in family responses to postassessment interviews. Finally, cost analysis suggests that TE-HNC families also required fewer sessions than HNC families to complete the program, an efficiency that did not compromise family satisfaction. TE-HNC shows promise as an innovative approach to engaging low-income families in BPT with potential cost-savings and, therefore, merits further investigation on a larger scale. Acknowledgments Funding for this project was provided by NIMH 1R34MH082956 (ClinicalTrials.gov Identifier: NCT01367847). We acknowledge the following individuals who were instrumental in our pilot and feasibility study: Joel Sherrill, Program Chief, Child and Adolescent Psychosocial Intervention Program, for his guidance on this project; Our clinician advisory panel, which included April Harris-Britt, Ph.D., AHB Psychological Associates; Kathryn J. Smith, MSW, Center for Child and Family Health; Jennifer Youngstrom, Ph.D., UNC Child and Family Clinic; Sarah Stearns, Ph.D., Dartmouth-Hitchcock Psychiatry Associates; and Timothy Verduin, Ph.D., NYU Child Study Center, for their review and input on all aspects of the TE-HNC program; finally, we thank the therapists and families who participated in this project for their time and contributions. Notes Note. N = 15; TE-HNC n = 7, HNC n = 8. TE-HNC = Technology-Enhanced Helping the Noncompliant Child. Note. Technology-Enhanced Helping the Noncompliant Child (TE-HNC) n = 7; HNC n = 8. ECBI = Eyberg Child Behavior Inventory. a Within group effect size at postassessment controlling for preassessment. b 95% confidence interval (CI) for within-group ES calculations. c Between-group ES comparing TE-HNC versus HNC at postassessment controlling for preassessment. d 95% CI for between-group ES calculations. e Reliable Change Index (RCI) = change attributable to treatment is clinically significant (*RCI ≥1.96). f Normative Comparison = at posttreatment group mean and upper-limit (M + 1 SD) is within normative range. Note. Technology-Enhanced Helping the Noncompliant Child (TE-HNC) n = 7; HNC n = 8. a Includes sessions, midweek calls, session notes, supervision, review of daily surveys (TE-HNC only), watching home practice video (TE-HNC only), and other program-related activities.