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  1. 1. An evaluation of a behavioural parenting intervention for parents of gifted children Alina Morawska*, Matthew Sanders School of Psychology, University of Queensland, St Lucia, QLD, Australia a r t i c l e i n f o Article history: Received 10 December 2008 Received in revised form 11 February 2009 Accepted 17 February 2009 Keywords: Parenting Child behaviour Child emotional adjustment Gifted and talented children Group Triple P a b s t r a c t Parents of gifted children identify a need for tailored parenting support, and gifted children have unique requirements and vulnerabilities. The aim of this study was to assess the efficacy of a tailored behavioural parenting intervention, for enhancing the parenting skills of parents of gifted children and to assess the effect of these changes on the behavioural and emotional adjustment of their gifted child. A randomised controlled trial of tailored Group Triple P – Positive Parenting Program was conducted with 75 parents of children identified as gifted. Results indicated significant intervention effects for the number and frequency of parent reported child behaviour problems, as well as hyperactivity in the intervention group, relative to a waitlist control. Parents also reported significant improvements in their own parenting style, including less permissiveness, harshness, and verbosity when disciplining their child. No intervention effects were evident for teacher reports, except for a trend in relation to hyperactivity. This study demonstrated that a tailored behavioural parenting intervention is effective and acceptable for parents of gifted children, and thus has clinical implications for the delivery of parenting interventions for this population. Ó 2009 Elsevier Ltd. All rights reserved. Introduction There is growing consensus that gifted and talented children on average do not experience more difficulties than all children (Calero, Garcia-Martin, Jimenez, Kazen, & Araque, 2007; Morawska & Sanders, in press; Neihart, Reis, Robinson, & Moon, 2002), however, a number of factors may place individual gifted children at higher risk for developing behavioural or emotional problems. These factors include: asynchronous development (Pfeiffer & Stocking, 2000; Roedell, 1984; Silverman, 1993b; Webb, 1993); unrealistic expectations of parents and teachers, including exces- sive and inappropriate use of praise (Freeman, 1995; Webb, 1993); parent over-involvement (Pfeiffer & Stocking, 2000; Winner, 2000); a mismatch between the child’s ability and the instructional envi- ronment, and; difficulties with peer groups (Neihart et al., 2002; Pfeiffer & Stocking, 2000). There are also a number of daily stressors that are specific to gifted children such as pressure from others to perform, feeling different to others, not being understood by others, and impatience with easy tasks (Preuss & Dubow, 2004). Although there is limited empirical research on the experience of parenting a gifted child, there is some evidence that the role presents additional challenges to those of parenting a typically developing child (Alsop, 1997; Feldman & Piirto, 1995; Karnes, Shwedel, & Steinberg, 1984; Moon, Jurich, & Feldhusen, 1996; Rimm, 1995), and parents of gifted children report that they require assistance with various aspects of parenting (Dangel & Walker, 1991; Huff, Houskamp, Watkins, Stanton, & Tavegia, 2005; Silver- man, 1993a; Strom, Johnson, Strom, & Strom, 1992). Overall, while little is known about the variations in parenting a gifted and non- gifted child, existing research suggests that most parents face similar issues, although there are differences in terms of parent expectations and confidence in their ability to manage and assist their gifted child (Chan, 2005; Dwairy, 2004; Huff et al., 2005; Morawska & Sanders, 2008; Neumeister, 2004; Winner, 2000). Only a handful of programs have been developed addressing parenting needs in this population; however, these have been largely focused on educational needs (Hertzog & Bennett, 2004), have been very brief with little evidence concerning efficacy (e.g., Conroy, 1987; Webb & De Vries, 1998), or have simply presented a list of strategies for parents to employ without any form of evaluation of the efficacy of such strategies (e.g., Shaughnessy & * Corresponding author at: Parenting and Family Support Centre, School of Psychology, University of Queensland, St Lucia, QLD 4072, Australia. Tel.: þ61 7 3365 7304; fax: þ61 7 3365 6724. E-mail address: alina@psy.uq.edu.au (A. Morawska). Contents lists available at ScienceDirect Behaviour Research and Therapy journal homepage: www.elsevier.com/locate/brat 0005-7967/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.brat.2009.02.008 Behaviour Research and Therapy 47 (2009) 463–470
  2. 2. Neely, 1987). This is in the context of surveys suggesting that parenting and educational services for parents are identified as key required services, as differentiated from standard services for parents, with a particular focus on understanding the emotional and social needs of the gifted child (Alsop, 1997; Moon, Kelly, & Feldhusen, 1997). There is a recognised need for family interven- tions for parents of gifted children, focused on both intervention with children exhibiting problems, and prevention for children identified as gifted but not currently exhibiting problems (Fornia & Frame, 2001). Parenting programs derived from social-learning, functional analysis, and cognitive–behavioural principles, are considered the interventions of choice for behavioural difficulties in children (Lundahl, Risser, & Lovejoy, 2006), and have also proven efficacious in prevention studies (Prinz & Dumas, 2004). Positive effects have been replicated many times across different studies, investigators, and countries, and with a diverse range of client populations, and have been identified as exemplary on multiple best-practice lists (Sanders, 1999). Parents are typically taught to increase positive interactions with children and to reduce coercive and inconsistent parenting practices. Parents who have completed a behavioural parenting intervention praise their child more, set clearer, calmer limits, criticise less often, and smack their child less frequently (e.g., Patterson, Chamberlin, & Reid, 1982). To the authors’ knowledge behavioural parenting programs have not been specifically evaluated in the context of parenting a gifted child. However, there is evidence to suggest that such interventions are efficacious across a range of child difficulties and contexts (Barlow & Stewart-Brown, 2000). The aim of this study was to assess the efficacy of a tailored behavioural parenting intervention (Morawska & Sanders, in press), on the parenting skills of parents of gifted children and to assess the effect of these changes on the behavioural and emotional adjustment of the gifted child. The intervention used in this study was Triple P – Positive Parenting Program which is an extensively evaluated program for parents of children with behavioural and emotional problems, within the framework of a population health approach to enhancing parenting competence (de Graaf, Speetjens, Smit, de Wolff, & Tavecchio, 2008; Nowak & Heinrichs, 2008). A randomised controlled trial of tailored Group Triple P was conducted for parents of children identified as gifted. It was predicted that compared to waitlist control, parents in the intervention group would report more effective parenting styles, less child behavioural and emotional problems, and better overall family adjustment following intervention. It was also predicted that these effects would be maintained at 6-month follow-up, and that improve- ments in children’s behaviour would also generalise to the classroom. Method Participants Participants were recruited through the Queensland Gifted and Talented Association (a parent led organisation), as well as school newsletter notices emailed to all Brisbane elementary schools with a publicly listed email address. In addition, media releases and school presentations were utilised in order to gain as wide a participant pool as possible. Recruitment was conducted over a period of 14-months. Overall, 204 families contacted the program, and completed a 10-min telephone screening interview, designed to assess the family’s suitability for the program, as well as inform the parent of program requirements. The major criterion for eligibility was the presence in the family of child between the ages of 3 and 10 years, and that the family lived within the Brisbane metropolitan area. Furthermore, in order to be eligible to participate the child had to have received a formal cognitive assessment or have been identified at school as gifted by placement in a gifted class or accelerated in their schooling. Parents also had to report concerns about their child’s behaviour or their parenting (Are you concerned about your child’s behaviour or emotional adjustment or your parenting?). In addition, families were excluded if the parents were currently seeing a professional for the child’s behaviour difficulties. Eighty-four families (41.2%) were eligible to participate and the main reason for non-eligibility was that the child had not received a formal assessment of their ability, and/or the parent was not concerned about the child’s behaviour or their own parenting. Of these 84 families, 75 (89.3%) families returned the initial assessment package and were randomly assigned to one of two conditions. Thirty-seven families were assigned to Group Triple P, while 38 families were assigned to the waitlist control group. Sixty- eight (90.7%) of the participating parents were mothers and seven (9.3%) were fathers. There were 45 (60%) male and 30 female children, with an average age of 7.81 (SD ¼ 1.89). The mothers of these children were on average aged 39.28 (SD ¼ 5.50), ranging from 27 to 54. Fathers were on average aged 41.77 (SD ¼ 6.01), ranging from 30 to 56. Most children lived in their original family (86.7%) with a minority living in a single parent (8%) or step (4%) family. The majority of parents were married (85.3%), with the remainder single or separated. Family size ranged from one to four children, with a mean of 2.23 (SD ¼ .73). The majority of families identified themselves as Australian (85.3%), while 5.3% were Asian, 1.3% were Maori, and a further 8% indicated ‘Other’ ethnicity. In general, both parents were well educated, with 77.3% of mothers and 65.3% of fathers holding a university degree. Sixty percent of mothers were employed, working an average of 23.21 h (SD ¼ 12.50). The majority (86.7%) of fathers were employed, working an average of 46.53 h (SD ¼ 11.19). Most (72%) households had an annual income over AUD$70,000; with 10.7% having an annual income of AUD$50,000–70,000; 12% an income of AUD$25,000–50,000, and; 2.7% an income of less than $25,000 annually. Parents provided details of their child’s cognitive assessments1 ; however, these were not available in 12% of cases (e.g., in order to be eligible for the study children may have been accelerated at school, without a formal assessment). A full scale IQ was available for 54 children, ranging from 119 to 160, with a mean of 132.98 (SD ¼ 7.80). A verbal IQ was available for 38 children, ranging from 106 to 151, with a mean of 133.08 (SD ¼ 10.59). However, a verbal IQ percentile score was available for 53 children, with a mean of 95.66 (SD ¼ 8.05). A non-verbal IQ was available for 37 children, ranging from 106 to 155, with a mean of 127.08 (SD ¼ 9.34). A non- verbal IQ percentile score was available for 50 children, with a mean of 94.31 (SD ¼ 6.26). Thirty six percent of children were receiving extension work (e.g., completing work in mathematics a year above their current academic year); 24% of children were accelerated by one academic year (based on their age); 1.3% of children were accelerated by more than one academic year, and; 6.7% of children were in a gifted class. Measures A Family Background Questionnaire was used to assess socio- economic status (including income, occupational status, and parent 1 A verbal or non-verbal or full-scale IQ score of 130 was used as the cut-off for determining eligibility. Some children had wide discrepancies between their verbal and non-verbal scores, but in all cases at least one score was above 130. A. Morawska, M. Sanders / Behaviour Research and Therapy 47 (2009) 463–470464
  3. 3. education), ethnic background, single parenting, and parent age, as well as child age, gender and health. An additional series of ques- tions asked for details of the child’s cognitive assessments, and schooling arrangements. Child behaviour was assessed using the Eyberg Child Behavior Inventory (ECBI; Eyberg & Pincus, 1999), a 36 item measure of parental perceptions of disruptive behaviour in children between the ages of 2 and 16. It consists of a measure of the frequency of disruptive behaviours (intensity) rated on a 7-point scale, ranging from never (1) to always (7) and a measure of the number of behaviours that are a problem for parents (problem), using a yes–no format. In this sample there was good internal consistency (a ¼ .91 and .93, respectively), and the ECBI has good test–retest reliability (r ¼ .86 and .88, respectively). Scores greater than 131 on the intensity scale and greater than 15 on the problem scale are indicative of difficulties in the clinical range, and were used as clinical cut-offs in this study. Child adjustment was assessed using the Strengths and Diffi- culties Questionnaire (SDQ; Goodman, 1997), a screening measure that is used to identify children’s emotional and behavioural problems over the previous 6-months. The measure consists of 25 items that address five factors; hyperactivity, conduct problems, emotional symptoms, pro-social behaviour and peer problems, and five items that assess the impact of the problems on various aspects of the child’s life. Five items measure each of the five subscales and responses are assessed using a 3-point scale. Parents respond according to how correct they feel each state- ment is for their child and options are (0) not true, (1) somewhat true and (2) certainly true. A total difficulties score is produced by summing all of the deficit scores together excluding pro-social behaviour, giving a total score ranging from 0 to 40. A total impact score is generated by the scores on the five impact questions, measured on a 4-point scale. The SDQ has been shown to reliably discriminate between clinic and non-clinic children with a total score cut-off for the normal range of 13 out of 40. Scores of 14–16 are considered borderline and a score of 17 or more indicates clinically elevated difficulty. The SDQ has well established reliability and validity, and Australian data shows moderate to good internal consistency for each subscale (ranging from a ¼ .67 to a ¼ .80) and total difficulties scores (a ¼ .73) (Mellor, 2005). The scale displayed moderate internal consistency in the present sample (a ¼ .74) for parents. Teachers completed the teacher version of the SDQ, and the internal consistency for this sample was moderate (a ¼ .76). The Parenting Tasks Checklist (PTC; Sanders & Woolley, 2005) is a 28 item tool used to assess task-specific self-efficacy. For each item parents are asked to indicate on a scale of 0 (Certain I can’t do it) to 100 (Certain I can do it) how confident they feel in managing each child behaviour. The PTC consists of two subscales, behav- ioural and setting self-efficacy both with excellent internal consistency (a ¼ .95 and .87, respectively) in this sample. The Parenting Scale (PS; Arnold, O’Leary, Wolff, & Acker, 1993) is a 30 item questionnaire measuring three dysfunctional discipline styles: laxness (permissive discipline), over-reactivity (authori- tarian discipline, displays of anger), and verbosity (overly long reprimands or reliance on talking). Each item has a more effective and a less effective anchor, and parents indicate on a 7-point scale, which end better represents their behaviour. The scales had good internal consistency in this sample (a ¼ .82, .82, and .63, respec- tively) and the scale has good test–retest reliability (r ¼ .83, .82, and .79, respectively). The Parent Problem Checklist (PPC; Dadds & Powell, 1991) is a 16 item questionnaire measuring conflict between parents specifically relating to child-rearing practices and their abilities to co-operate as parents, including disagreement over household rules, discipline and inconsistency between parents. For each of the items, parents report whether or not the issue has been a problem over the last 4 weeks by answering either yes or no. This generates a score on the problem scale, which indicates the number of areas in which the parents are experiencing conflict. The problem scale ranges from 0 to 16, with a clinical cut-off of 5. Dadds and Powell reported the problem scale to have good internal consistency (a ¼ .70) and high test–retest reliability (r ¼ .90). The internal consistency for the current sample was high (a ¼ .84). For each issue that parents identify as problematic they are also asked to rate the extent to which each issue has caused difficulty. Extent is measured on a 7- point scale ranging from (1) not at all to (7) very much, with scores on the extent scale ranging from 16 to 112. In the present sample, the extent scale displayed high internal consistency (a ¼ .89). The PPC also has concurrent validity with the DAS (Bayer, Sanson, & Hemphill, 2006). The Relationship Quality Index (RQI; Norton, 1983) is comprised of six items that measure global relationship satisfaction that can discriminate between clinic and non-clinic couples. In the present sample, the scale was found to have a high level of internal consistency (a ¼ .96). The first five items assesses relationship strength, stability and satisfaction on a 7-point scale ranging from (1) very strongly disagree to (7) very strongly agree. The final item assesses overall happiness of the relationship on a 10-point scale ranging from unhappy (1) to perfectly happy (10). The measure generates a total score from 6 to 45, with a cut-off of 29 or less indicating a clinically elevated level of dissatisfaction in the rela- tionship. The index is correlated with the Dyadic Adjustment Scale (Spanier, 1976). The Depression Anxiety Stress Scale-21 (DASS; Lovibond & Lovi- bond, 1995) is a 21 item questionnaire assessing symptoms of depression, anxiety and stress in adults, with adequate internal consistency for each scale in this sample (a ¼ .84, .54 and .86, respectively). It has good convergent and discriminant validity. Parents indicate the extent to which each item applies to them on a scale from 0 (Did not apply to me at all) to 3 (Applied to me very much, or most of the time). Scores on each scale can range from 0 to 42. Following the intervention parents completed a Client Satis- faction Questionnaire (CSQ; Sanders, Markie-Dadds, & Turner, 2001), which addresses the quality of the service provided; how well the program met the parent’s needs and decreased the child’s problem behaviours; and whether the parent would recommend the program to others. Scores range from 13 to 91, with higher scores indicating greater satisfaction with the program. Design The design of the study is a fully randomised, repeated measures design employing a group comparison methodology involving two conditions (group Triple P versus waitlist control (WLC)) by three time periods (pre-, post- and 6-month follow-up). Procedure Ethical clearance for the study was sought and received in accordance with the ethical review processes of the University of Queensland and within the guidelines of the National Health and Medical Research Council. Written informed consent was obtained from all participating families. Families were randomly assigned after initial assessment to one of two conditions (intervention or waitlist). Randomisation was implemented using a list of computer generated random numbers, and families were assigned sequen- tially to condition. A. Morawska, M. Sanders / Behaviour Research and Therapy 47 (2009) 463–470 465
  4. 4. Intervention Gifted and Talented Group Triple P is based on Group Triple P which is described extensively (Turner, Markie-Dadds, & Sanders, 2000), consisting of five weekly, 2 h group sessions, followed by three weekly, 15-min telephone consultations and a final 2 h group session. Gifted and Talented Group Triple P is specifically tailored for the need of parents of gifted and talented children based on pilot work and parent surveys (Morawska & Sanders, 2008; Morawska & Sanders, in press). Each family receives both the Every Parent’s Workbook (Markie- Dadds, Turner, & Sanders, 1997), and the Parenting Gifted and Talented Children Group Workbook (Morawska & Sanders, 2006), while the Every Parent’s Survival Guide video (Sanders, Markie- Dadds, & Turner,1996) is used to supplement written materials. The program involves teaching parents core child management skills falling into three areas: (1) promoting children’s development; (2) managing misbehaviour; and (3) planned activities and routines. This tailored program involves teaching parents 17 core child management strategies. Ten of the strategies are designed to promote children’s competence and development (quality time; talking with children; physical affection; praise; attention; engaging activities; setting a good example; ask, say, do; incidental teaching; and behaviour charts), and seven strategies are designed to help parents manage misbehaviour (setting rules; directed discussion; planned ignoring; clear, direct instructions; logical consequences; quiet time; and time-out). A number of specific parenting issues are emphasised in the tailored version of the program including: having clear expectations of children; problem solving skills; promoting children’s self-esteem; encouraging persistence and perseverance; having effective rules and bound- aries; helping children to establish good sibling and peer rela- tionships; managing anxiety and other emotions; and building a good school–home partnership. In addition, parents are taught a six-step planned activities routine to enhance the generalisation and maintenance of parenting skills (plan ahead, decide on rules, select engaging activities, decide on rewards and consequences, and hold a follow-up discussion with child). Consequently, parents are taught to apply parenting skills to a broad range of target behaviours in both home and community settings with the target child and all relevant siblings. Active skills training methods include modelling, role-plays, feedback, and the use of specific homework tasks. Protocol adherence Each practitioner delivering Triple P receives training using a nationally coordinated system of training and accreditation, designed to promote program use and program fidelity. Practi- tioners deliver Triple P according to a standardised manual and follow treatment delivery protocols. Each practitioner completed protocol adherence checklists for each session conducted, which were reviewed and coded for adherence. Session 1 consists of 24 topics, and on average group facilitators reported delivering 22.8 topics. Session 2 consists of 23 topics, and on average group facil- itators reported delivering 22.2 topics. Session 3 consists of 26 topics and on average group facilitators reported delivering 24.2 topics. Session 4 consists of 20 topics, and on average group facil- itators reported delivering 17.8 topics. Session 5 consists of 21 topics, and on average group facilitators reported delivering 19.9 topics. Practitioners also received regular supervision. In addition, group sessions were videotaped and independently coded by a research assistant for protocol adherence. The inter-rater reli- ability (kappa) between the coder and facilitator ratings was moderate (.464). Statistical analyses Preliminary analyses were conducted to check for deviations from statistical assumptions. As most of the outcome measures are continuous scale scores, short-term intervention effects were analysed by a series of MANCOVAs with post-intervention scores as dependent variables. The main dependent variables for these analyses included: parent-reported child adjustment (ECBI, SDQ), parenting style and confidence (PS, PTC), parent relationship and adjustment (DASS, PPC, RQI). The level of significance for these analyses was established by using a family-wise modified Bonfer- roni correction in which a p-value of .05 is divided by the number of measures in the group of measures. Follow-up effects were ana- lysed using repeated-measures MANOVAs. Intent-to-treat analyses. Treatment outcome were measured via the typical method of including only completers of treatment, thus excluding those who drop out of the trial before the post-intervention or follow-up assessment phases. The second, more conservative method of measuring treatment efficacy, is to include all participants who were randomised at the commencement of the trial (Kendall, Butcher, & Holmbeck, 1999). That is provided there was intent-to- treat the participant at the commencement of the project, then that participant was included in the analyses. In employing the intent- to-treat analyses, dropouts were contacted at the post-intervention and follow-up phases (where possible) and assessed according to the protocol established for the project. If this was not possible, then a participant’s pre-intervention scores were used as their post-intervention scores. The impact of the intervention was assessed using reliable change indices, to test whether statistically significant intervention effects are clinically meaningful (Jacobson & Truax, 1991). Results No between-group differences on demographic variables were found on preliminary analysis. There were also no significant differences across the majority of outcome variables, indicating that the randomisation process resulted in two groups that were not significantly different prior to intervention. Nevertheless, pre- intervention scores were used as covariates in subsequent analyses in order to control for any differences. There was minimal missing data, and analyses were conducted with pairwise exclusion of missing data. The only exception was the teacher SDQ data, where missing values were replaced with item means. Attrition Overall, a very high retention rate at post-intervention was accomplished, with 70 of the original 75 (93.3%) parents completing post-assessment. Of the five parents who did not complete the post-assessment, four were from the intervention condition and one from the waitlist condition. One participant moved inter-state, one was undergoing chemotherapy, one had a new baby, and for one the child had just received a diagnosis of learning disability. The final participant who withdrew did not have sufficient time to attend the groups. There were no significant differences in the rates of attrition across the two groups, c2 (1, 75) ¼ 2.02, p ¼ .200. Thirty-one of the original 37 parents (83.8%) in the intervention condition participated in the follow-up assess- ment. To examine any significant differential attrition across groups, a series of one-way ANOVAs was used to compare completers versus non-completers across all dependent variables at pre-intervention. There were no significant differences on any outcome measure between parents who completed post-assess- ment versus those who did not. A. Morawska, M. Sanders / Behaviour Research and Therapy 47 (2009) 463–470466
  5. 5. Short-term intervention effects A significant multivariate intervention effect was found for child behaviour problems for parents’ ECBI scores, F(2, 61) ¼ 11.68, p < .001, indicating that there were significant intervention effects across groups. Univariate ANCOVAs indicated significant interven- tion effects for both intensity and number of child behaviour problems, as indicated in Table 1. There was also a significant multivariate effect for children’s adjustment assessed using the SDQ, F(4, 61) ¼ 3.74, p ¼ .009, however, univariately there was an intervention effect for the hyperactivity scale only, as seen in Table 1. A significant intervention effect was found for parenting style, and parental confidence, F(4, 51) ¼ 6.62, p < .001. Univariate ANCOVAs indicated significant intervention effects for laxness, verbosity and over-reactivity, but not parental confidence as shown in Table 2. No significant intervention effect was found for parental reports of personal and marital adjustment, F(3, 53) ¼ 1.86, p ¼ .147. Table 2 provides details of the means and standard deviations, for the DASS total score, PPC problem and RQI. As indicated in the table all scores, with the exception of PPC problem at pre-intervention for the WL group are within the normal range, thus making it likely that floor effects obscure intervention effects Table 3. Reliable change As shown in Table 3, the intervention group improved reliably compared to the waitlist group for ECBI intensity, c2 (1, 69) ¼ 12.76, p < .001. The only reliable change in the waitlist condition was one participant who became reliably worse, while none in the intervention group became reliably worse. Similarly, the intervention group improved reliably compared to the waitlist group for ECBI problem, c2 (1, 62) ¼ 10.33, p ¼ .003. Four partici- pants in the waitlist condition changed reliably, with three of these becoming reliably worse. One participant in the interven- tion condition also became reliably worse. Interestingly, this same participant, also reported a reliable improvement on ECBI intensity. For PS laxness, there was no difference between intervention and waitlist conditions, c2 (1, 69) ¼ 2.24, p ¼ .186. However, one participant in the waitlist condition became reliably worse, while none became worse in the intervention condition. The intervention group improved reliably compared to the waitlist group for PS over- reactivity c2 (1, 69) ¼ 4.85, p ¼ .040. One participant in the waitlist condition became reliably worse, while none became worse in the intervention condition. Similarly, the intervention group improved reliably compared to the waitlist group for PS verbosity c2 (1, 69) ¼ 6.23, p ¼ .018. Intent-to-treat analyses Intent-to-treat analyses were conducted including all clients present at the time of randomisation. Where post-intervention scores were not available (drop-outs), original pre-intervention scores were substituted. Intent-to-treat analyses were conducted only when the original analyses on completers were significant, that is for child behaviour and parenting style. A significant intervention effect was found for child behaviour problems, F(2, 66) ¼ 9.47, p < .001. Univariate ANCOVAs indicated significant intervention effects for both intensity and number of child behaviour problems, F(1, 67) ¼ 15.62, p < .001 and F(1, 67) ¼ 14.57, p < .001, respectively. A significant intervention effect was found for parenting style, F(3, 67) ¼ 7.57, p < .001, with signif- icant univariate intervention effects for laxness, F(1, 69) ¼ 4.80, p ¼ .032, verbosity, F(1, 69) ¼ 19.90, p < .001, and over-reactivity, F(1, 69) ¼ 15.93, p < .001. Intervention acceptability A total satisfaction score was obtained by summing all Likert- type items (on a 7-point scale with 7 being very satisfied). The maximum reported score was 88, while the minimum was 49, with a mean satisfaction rating of 69.29 (SD ¼ 10.53), indicating that on average parents were satisfied with the program. Long-term intervention effects Long-term intervention effects were assessed using repeated- measures MANOVAs, comparing pre-intervention to follow-up effects only for the intervention group across child behaviour and parenting variables, followed by univariate ANOVAs. There was a significant multivariate time effect for child behaviour, F(2, 26) ¼ 19.58, p < .001, with univariate effects significant for both ECBI intensity, F(1, 27) ¼ 26.05, p < .001, and ECBI problem, F(1, 27) ¼ 26.60, p < .001. There was also a significant multivariate time effect for parenting style, F(3, 26) ¼ 6.25, p ¼ .002, with univariate effects significant for laxness F(1, 28) ¼ 4.66, p ¼ .040, verbosity, F(1, 28) ¼ 15.37, p ¼ .001, and over-reactivity, F(1, 28) ¼ 16.33, p < .001. The results indicate a maintenance effect over the 6- month period for child behaviour and parenting style. Teacher data No significant multivariate intervention effect was found for child behaviour and adjustment problems for teachers’ SDQ scores, F(4, 35) ¼ 2.42, p ¼ .067 at post-intervention, and only the univariate effect for SDQ hyperactivity was significant, F(1, 38) ¼ 8.48, p ¼ .006. There was also no multivariate time effect for pre-intervention to Table 1 Short-term intervention effects for parental reports of child behaviour and adjustment. Measure Intervention Waitlist ANCOVA p Pre Post Pre Post M (SD) M (SD) M (SD) M (SD) (N ¼ 32) (N ¼ 34) F(1, 66) ECBI intensity 124.06 (26.99) 103.38 (25.67) 112.57 (28.81) 111.71 (28.80) 19.84 <.001 ECBI problem 13.61 (6.68) 8.38 (6.87) 10.68 (6.68) 11.35 (7.32) 16.69 <.001 (N ¼ 33) (N ¼ 37) F(1, 64) SDQ emotional symptoms 2.61 (2.46) 2.85 (2.40) 3.59 (2.27) 3.68 (2.77) .01 .925 SDQ conduct problems 2.82 (1.99) 2.18 (1.53) 1.95 (1.78) 1.84 (1.57) 1.20 .278 SDQ hyperactivity 4.30 (2.07) 3.39 (1.97) 3.62 (2.62) 4.00 (2.44) 11.26 .001 SDQ peer problems 2.79 (2.32) 3.24 (2.44) 2.70 (2.26) 2.97 (2.55) .223 .638 Note. Pre ¼ pre-intervention; Post ¼ post-intervention for Group Triple P and second assessment for WL; F ¼ ANCOVA univariate effect for condition; ECBI ¼ Eyberg Child Behavior Inventory; SDQ ¼ Strengths and Difficulties Questionnaire A. Morawska, M. Sanders / Behaviour Research and Therapy 47 (2009) 463–470 467
  6. 6. follow-up repeated MANOVA for teachers’ SDQ scores, F(4, 16) ¼ .684, p ¼ .613, however data for only 20 participants were available at follow-up. Pre-, and post-intervention, and follow-up means and standard deviations are provided in Table 4, showing that pre-intervention scores were in the normal range. This indicates that a floor effect may have obscured any significant changes in the classroom environment. Discussion The results of the present study provide support for the efficacy of tailored Group Triple P for parents of gifted children. There were significant short-term effects of intervention in terms of parent reported child behaviour problems, hyperactivity, and parenting style providing partial support for hypothesis one. The participants in the intervention condition showed not only statistically signifi- cant improvements, but also changes that were clinically reliable compared to the waitlist condition. Parents reported fewer prob- lematic child behaviours, and less frequent difficult behaviour following intervention, and there was also indication that they perceived their child to be less hyperactive. However, there was no effect on the child’s emotional symptoms or peer difficulties. Furthermore, the effects reported in this study were confirmed by more conservative intent-to-treat analyses, which control for the effects of attrition. These effects were maintained over the 6-month follow-up period, providing support for hypothesis two. The effect sizes for intervention effects range from low to moderate for child behaviour outcomes and moderate to high for parenting outcomes, consistent with the initial sub-clinical nature of the study sample. Given that parents were reporting low to moderate levels of diffi- cult behaviour at pre-intervention, leaving limited room for change, these effects indicate the strength of the intervention in leading to behavioural change. The results of this study are consistent with previous research, which has supported the use of behavioural parenting programs and Triple P in particular, in reducing child behaviour problems and improving parenting skills (de Graaf et al., 2008; Nowak & Hein- richs, 2008; Zubrick et al., 2005). Consistent with previous research, this study has provided support for changes in both parents and children immediately following parenting intervention (e.g., Webster-Stratton, Reid, & Hammond, 2004), and for maintenance of treatment gains (e.g., Sanders, Bor, & Morawska, 2007). Impor- tantly, this research also extends the available evidence on the efficacy of parenting intervention for parents of gifted children, pointing the generalisability of program content and strategies to parents of varying needs. Contrary to previous findings (e.g., Connell, Sanders, & Markie- Dadds, 1997; Forehand, Wells, & Griest, 1980) there were no significant effects of parenting intervention on parents’ personal adjustment or their marital relationships. However, all parent personal and martial adjustment scores were well within the normal range at pre-intervention, indicating that floor and ceiling effects most likely account for a lack of significant findings. Simi- larly, there were no effects for teacher reports of child behaviour problems within the school setting, except for a trend in relation to hyperactivity. There are three reasons which may account for this finding. The first is that using the same measure (SDQ), there were also no significant effects reported by parents, except for hyperac- tivity. This may reflect the fact that the SDQ has a 3-point response format, which may not be sensitive to change, particularly when teachers report mild to moderate levels of difficulty. The second reason for the lack of significant findings for teacher reports, is that on average teachers reported low levels of problems, and all the pre-intervention scores were well within the normal range, sug- gesting that floor effects may have obscured any changes. Finally, the number of teachers providing data on children was also low, reducing the power to detect an effect. The study demonstrated that behavioural parenting interven- tions can provide benefits in terms of improved child behaviour and parenting skill for parents of gifted children, however, there are a number of limitations of this study that need to be consid- ered in interpreting the findings. Firstly, the sample is drawn from the general population and thus consists of families who have some concerns about their child’s behaviour or their own parenting. This was a sub-clinical sample, and some pre-inter- vention scores were in the normal range, particularly more general Table 2 Short-term intervention effects for parenting style and confidence, as well as parental adjustment and inter-parent relationship. Measure Intervention Waitlist ANCOVA p Pre Post Pre Post M (SD) M (SD) M (SD) M (SD) (N ¼ 29) (N ¼ 31) F(1, 54) PS laxness 2.43 (.58) 2.06 (.69) 2.46 (.76) 2.56 (.74) 7.73 .007 PS verbosity 3.59 (.82) 2.70 (.86) 3.67 (.89) 3.74 (.93) 22.71 <.001 PS over-reactivity 3.32 (.61) 2.61 (.70) 2.96 (.99) 3.04 (.97) 18.89 <.001 PTC 228.91 (29.49) 246.77 (32.64) 227.00 (37.25) 235.01 (34.86) 3.63 .062 (N ¼ 29) (N ¼ 31) F(1, 55) DASS 15.15 (12.08) 11.72 (10.63) 18.00 (16.51) 17.29 (15.73) 2.49 .121 PPC problem 4.73 (3.37) 3.76 (3.30) 5.16 (4.22) 4.55 (3.18) .893 .349 RQI 35.58 (7.37) 36.41 (5.64) 37.11 (6.88) 35.16 (7.53) 4.83 .032 Note. Pre ¼ pre-intervention; Post ¼ post-intervention for Group Triple P and second assessment for WL; F ¼ ANCOVA univariate effect for condition; PS ¼ Parenting Scale; PTC ¼ Parenting Tasks Checklist; DASS ¼ Depression Anxiety Stress Scale; PPC ¼ Parent Problem Checklist; RQI ¼ Relationship Quality Index. Table 3 Reliable change and effect sizes at post-intervention. Measure Condition % Reliable change (n1/n2) Effect size (d) ECBI intensity Intervention 30.3 (10/33) .30 Waitlist .0 (0/37) ECBI problem Intervention 34.4 (11/32) .42 Waitlist 2.9 (1/34) PS laxness Intervention 12.1 (4/33) .70 Waitlist 2.7 (1/37) PS verbosity Intervention 15.6 (5/32) 1.16 Waitlist .0 (0/37) PS over-reactivity Intervention 24.2 (8/33) .51 Waitlist 5.4 (2/37) Note. ECBI ¼ Eyberg Child Behavior Inventory; PS ¼ Parenting Scale; n1 ¼ participants reliably improved; n2 ¼ all participants with available post-inter- vention data. A. Morawska, M. Sanders / Behaviour Research and Therapy 47 (2009) 463–470468
  7. 7. family adjustment variables. Further research is needed with a more severe clinical sample to address the issue of how effica- cious the program is as a treatment intervention for high-risk children. Secondly, the lack of significant findings for teacher data and for parent reported emotional symptoms points to the importance of further examination of the efficacy of the inter- vention for these aspects with children with varying behavioural and emotional difficulties. It may be that the intervention is effective for addressing emotional or peer problems, however, parents and teachers in this sample did not report significant concerns in these types of problems at pre-intervention. While the eligibility criteria included the parent being concerned about their child’s behaviour, clearly these concerns were not evident within the school context for most children. A sample with behavioural and emotional difficulties at home and at school would be required to provide evidence for the generalisability of interven- tion outcomes to the school setting. Finally, the sample size was relatively small, and reflected the difficulty of recruiting a sample of parents of gifted children, where the child had been objectively identified as gifted, and where the parent was concerned about the child’s behaviour. Anecdotally, many parents who contacted the program requested referral information for assessments, in cases where their child had not been previously assessed. When followed up many of these parents had sought an assessment, but in approximately half of the cases, the child was assessed as not within the gifted range. As a result of the small sample size, it was not feasible to conduct analyses comparing clinically elevated versus non-elevated children, however, it is noteworthy that intervention effects were demonstrated despite initially mild to moderate levels of difficulty. The results of this study provide support for the efficacy of Triple P for parents of gifted children, a unique population which has to date received minimal attention in the research literature. Given the paucity of methodologically sound research in the literature on parenting gifted children, these results provide a significant contribution with the potential to inform delivery of parenting support to this population. Many parents of gifted children identify a need for tailored parenting support, however, to date no empir- ically supported interventions have been evaluated for this pop- ulation. In addition, parents of gifted children are often concerned about whether strategies used for typically developing children will work for their child, a concern that was frequently aired by parents attending groups in this study. For example, many parents voiced the opinion that their gifted child could ‘see through praise’ and that this was not an effective intervention. The results of this study support the utility of behavioural parenting intervention for parents of gifted children, and demonstrate that with minimal tailoring and modification, parents are able to implement the strategies at home, and find the intervention acceptable and helpful. Furthermore, the intervention was relatively brief, con- sisting of six group sessions and three telephone consultations, however, potentially shorter interventions may also be appropriate for parents with mild to moderate difficulties. Acknowledgment This research was supported by a research grant from the Telstra Foundation. 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