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Promoting Anger Management Skills with the Coping Power Program: Adaptation and Dissemination

Promoting Anger Management Skills with the Coping Power Program: Adaptation and Dissemination. John E. Lochman, PhD, ABPP The University of Alabama Penn State TIES Summer Institute ---- 5/19/11. Topics. Coping Power program Intervention research Efficacy and effectiveness studies

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Promoting Anger Management Skills with the Coping Power Program: Adaptation and Dissemination

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  1. Promoting Anger Management Skills with the Coping Power Program: Adaptation and Dissemination John E. Lochman, PhD, ABPP The University of Alabama Penn State TIES Summer Institute ---- 5/19/11

  2. Topics Coping Power program Intervention research Efficacy and effectiveness studies Adaptations of program: With diagnosed DBD children Shorter version and boosters individual vs group format Dissemination issues: parent engagement training intensity Counselor and school characteristics

  3. Contextual Social Cognitive ModelBackground Mediating Outcomes

  4. Coping Power Child and Parent Components

  5. Coping Power Child Component: Derived from the Anger Coping Program • Group format, 5 to 6 children per group • 34 sessions • Implemented with children ages 8-14 • Also includes periodic 1-to-1 sessions (reinforce generalization, extend problem-solving, enhance relationship to adult co-leaders) • Case-centered teacher consultation

  6. Behavioral and personal goal setting Organizational and study skills Accurate awareness of feelings related to anger and vulnerability Anger management training, including methods for self-instruction, distraction, and relaxation Perspective-taking and attribution retraining Social problem-solving in a variety of situations (peer, teacher, family) Resistance to peer pressure and focus on involvement with non-deviant peer groups Foci for Coping Power Child Component

  7. Coping Power Parent Component • Group format with two co-leaders. • 6 to 12 sets of parents in each parent group. • 16 sessions. • Periodic home visits and phone check-ins.

  8. Positive attention and rewards for appropriate child behavior. Ignoring minor disruptive behavior. Provision of clear commands, rules, and expectations. Use of consistent consequences for negative child behavior (response cost, time-out, withdrawal of privileges). Monitoring of children’s behavior in the community. Improvement of family communication and increasing family activities. Improvement of parents’ own stress management. Informing parents of children’s current work on social-cognitive skills (e.g., problem-solving skills) in their group, so parents can reinforce children’s use of these new skills. Academic support at home. Foci for Coping Power Parent Component

  9. Coping Power Intervention: Efficacy and Effectiveness

  10. NIDA-funded study of Child Component onlyvs. Child and Parent ComponentsLochman & Wells (2004), Journal of Consulting and Clinical Psychology, 72, 571-578

  11. Sample • 183 high risk boys, in the top 22% of teacher-rated aggression on a screening measure administered in the 4th and 5th grades of 11 schools, randomly assigned to 3 conditions: Child Component Only, Child + Parent Component, Control [73% assessed at the follow-up] • 61% African American, mean income of $25,000 • No baseline differences across conditions in ethnic status, cognitive ability, or aggression screen score • Normative Comparison: 63 non-risk boys: 47% African-American, mean income of $35,000 [87% assessed at follow-up]

  12. Effect Sizes of Contrasts with Control Cell: Outcomes at 1 Year Follow-up

  13. Contextual Social-Cognitive Mediators and Child Outcome at a One Year Follow-up: Mediation of Coping Power EffectsLochman & Wells (2002), Development and Psychopathology, 14, 945-967

  14. CSAP-funded Effectiveness StudyLochman & Wells (2002) Psychology of Addictive Behaviors, 16, S40-S54 Lochman, J.E. & Wells, K.C. (2003), Behavior Therapy, 34, 493-515

  15. Sample • 245 moderate to high risk children , in the top 30% of teacher-rated aggression on a screening measure administered in the 4th grades of 17 schools • 66% male • 78% African American • No baseline differences across conditions in sex, ethnic status, cognitive ability, or aggression screen score • 84% assessed at one-year follow-up, 83% assessed at two-year follow-up

  16. Post-Test: Parent-Rated Proactive Aggressive BehaviorTime X Indicated: F(2,416)=2.68

  17. Post-Test: Teacher-Rated Proactive Aggressive BehaviorTime X Indicated: F(1,183)=3.02

  18. Substance Use(youth self report of use of Tobacco, Alcohol, and Marijuana in the past month)Coping Power vs Control: F(1,120)=10.8, p=.001

  19. Delinquent Behavior(Youth self report of theft, assault, property destruction, fraud, and drug selling in the past month) Coping Power vs Control: F(1,129)=4.30, p=.04

  20. Teacher-rated Peer Aggressive Behavior(fighting and harming others from the TOCA-R) Coping Power vs Control: F(1,80)=4.18, p=.04

  21. Longer – Term 3 Year Follow-up:TOCA Aggression: Coping Power vs Control

  22. Coping Power Intervention: Adaptations

  23. Coping Power Study with ODD/CD Dutch Children van de Wiel, N.M.H., Matthys, W., Cohen-Kettenis, P.T., Maassen, G.H., Lochman, J.E., & van Engeland, H. (2007). The effectiveness of an experimental treatment when compared with care as usual depends on the type of care as usual. Behavior Modification.Zonnevylle-Bender, M.J.S., Matthys, W., van de Wiel, N.M.H., & Lochman, J. (2007). Preventive effects of treatment of DBD in middle childhood on substance use and delinquent behavior.Journal of the American Academy of Child and Adolescent Psychiatry, 46, 33-39. van de Wiel, NMH, Matthys, W, Cohen-Kettenis, P, & van Engeland, H (2003), Behavior Therapy, 34, 421-436.

  24. Sample and Program • 77 children with ODD or CD were randomly assigned to Utrecht Coping Power (UCPP; N=38) or to Care-As-Usual (N=39) in child psychiatry clinics • 8-13 years of age • UCPP was 23 session child program and 15 session parent program adapted from full Coping Power program • UCPP implemented with new trainees (0.5 years experience); CAU given by experienced clinicians (10.0 years experience) • Primary therapy types in CAU were CBT and Family Therapy • CAU continued to receive services in the period between Post and Follow-Up (26/39 cases; vs 4/38 for UCPP)

  25. Results at 4 Year Follow-Up: Substance Use

  26. Booster Intervention with Briefer Version of Coping Power • A remarkably understudied assumption, with few randomized tests of whether boosters promote long-term maintenance or produce long-term preventive effects, as assumed • Have been positive effects of a brief booster to the Anger Coping program in maintaining observed classroom disruptive off-task behaviors at a 3 year follow-up (Lochman, 1992), and of a booster for a family-focused prevention program on child aggression at a 1 year follow-up (Tolan et al, 2009) • However, boosters have not produced additional effects in a treatment for adults with impulse-control problems (Hodgins et al, 2009) nor for a classroom social problem solving program to reduce aggression (Daunic et al, 2006)

  27. Sample and Design (Lochman, Boxmeyer, Powell, Roth & Windle, 2006, New Directions for Evaluation) • 240 children in 7 schools screened for aggressive behavior by teacher ratings (top 30%), randomly assigned to CP versus control • 64% boys; 69% African-American • CP intervention delivered during 5th grade • CP children randomly assigned to Booster in 6th grade • 5 assessment points: T1 (pre), T2 (post-intervention), T3 (post-Booster), T4 FU1, T5 FU2

  28. HLM Growth Curve Analyses Time 1-5 • Level 1 – time • Level 2 – individuals and intervention condition • Level 3 – nested within schools • Quadratic effects not significant

  29. Brief Coping Power – Growth Curve Analyses Time 1-5 – on Teachers’ APSD Impulsive-Conduct Problems Coping Power delivered during 5th grade (24 child sessions, 10 parent sessions) CP Booster – monthly individual sessions in grade 6 CP-Only:60: CP-Booster:60; Control:120

  30. Impulsive-Conduct Teacher APSD Impulsive-Conduct Problem Ratings by Condition Teacher Rated APSD Impulsive-Conduct Problem 5.83 Control CP Only Booster CP 5.37 4.92 4.47 4.02 0 0.97 1.93 2.90 3.87 Year

  31. Brief Coping Power – Growth Curve Analyses Time 1-5 – on Teachers’ APSD Ratings of CU Traits Coping Power delivered during 5th grade (24 child sessions, 10 parent sessions) CP Booster – monthly individual sessions in grade 6 CP-Only:60: CP-Booster:60; Control:120

  32. Teacher APSD Callous-Unemotional Ratings by Condition Teacher Rated APSD Callous-Unemotional Trail CU Trail 6.00 Control CP Only Booster CP 5.72 5.44 5.16 4.87 0 0.97 1.93 2.90 3.87 Year

  33. Teacher APSD CU: CP-Only X Sex Teacher Rated APSD Callous-Unemotional Trail CU Trail 6.39 Girl, Control Girl, CP Only Boy, Control Boy, CP Only 5.88 5.37 4.86 4.35 0 0.97 1.93 2.90 3.87 Year

  34. Individual vs Group Formats • Although overall Coping Power program effects have significantly reduced children’s problem behavior, it is plausible that the degree of positive effects may be reduced or truncated to some degree by deviant peer effects and other behavioral management problems with groups of children. • The steepest growth of substance use occurs among adolescents with drug-using peers (Chassin et al., 1996; Curran et al., 1997). • Similarly, aggressive children within classrooms with high rates of other aggressive children are more likely to increase their aggression during that academic year (Barth et al., 2004).

  35. Intervention Research on Deviant Group Effects • By a 1-year follow-up, Dishion and Andrews (1995) found that youth who had received youth ATP sessions had higher rates of tobacco use and of teacher-rated delinquent behaviors than did the control children, and these iatrogenic effects were evident even if the parents had also received intervention in the combined condition. • At a 3-year follow-up, the teen intervention conditions continued to have more tobacco use and delinquency (Poulin et al., 2001). • Analyses of the iatrogenic group conditions revealed that subtle dynamics of deviancy training during unstructured transitions in the groups predicted growth in self reported smoking and teacher ratings of delinquency (Dishion et al., 2001).

  36. Pilot Study of Individual vs Group format for Coping Power 11 schools randomly assigned to either the ICP (individually delivered Coping Power) or GCP (group delivered Coping Power) condition (ICP: 30; GCP: 30) abbreviated CP intervention: 24 child sessions and 10 parent sessions during the 4th grade year Assessments: T1, T2 (after 5 sessions), T3 (post; 98% retention)

  37. Baseline-Post (T1-T3)parent-rated BASC Conduct Problems – ICP vs GCP contrastRepeated Measures Anova: Time X Cond: p=.008*

  38. Baseline-Post (T1-T3)Dominance/Revenge Social Goals – ICP vs GCP contrastRepeated Measures Anova: Time X Cond: p= 01**

  39. Baseline-Post (T1-T3)Self-Dysregulation– ICP vs GCP contrastRepeated Measures Anova: Time X Cond: p=.03*

  40. Pilot: Individual vs Group Effects Individual format (ICP) is more effective than Group Format (GCP) in reducing parent-rated children’s conduct problems; no difference for teacher-rated externalizing at post GCP was more effective than ICP in reducing children’s dominance/revenge-oriented social goals and in improving their self-regulation Thus, group and individual delivery of programs may affect different types of outcomes; unclear how format will affect longer term followups

  41. Other adaptations in progress

  42. Other adaptations/moderator studies in progress….. • Use of “Adventures of Captain Judgment” to augment intervention and to make a briefer, more efficient intervention • Coping Power for early adolescents (repair of damaged relationships, etc) – w/ Bradshaw & Ialongo - Hopkins • Coping Power with Family Check-Up – adaptive parent intervention – w/ Bradshaw & Ialongo - Hopkins • Cultural adaptations in Ireland, Italy and Pakistan • Neurodevelopmental predictors (Prefrontal cortex; limbic system) of CP response – w/ Drabick, Steinberg

  43. Dissemination Issues

  44. Parent engagement in preventive intervention is only a function of parent characteristics ?

  45. Parental Monitoring Positive Parenting Parent Involvement Dominant Social Goals Maternal Depression Child Social Goals Community Support Revenge Social Goals Contextual Factors Parenting Community Problems Attendance Parent Attendance SES/Parent Education Parenting Practices Mediate Effect of Family Context on Parent Attendance at CP Parent SessionsRyan, Boxmeyer & Lochman, Behavioral Disorders, 2009

  46. Feedback Form: Tool to communicate and connect family strength and areas of concerns.

  47. Enhancing parent engagement: through children • Lag effects of child engagement and parent engagement during Coping Power sessions

  48. Parent engagement: attendance Child engagement: attendance, goal points earned, group points earned Parent and Child Engagement Across early, Middle and Late InterventionEllis, Lindsey, Barker, Boxmeyer & Lochman, under review

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