Cerebral Palsy: Parenting Support Lowers Behavioral Problems

Lara C. Pullen, PhD

April 08, 2014

Parenting interventions reduced behavioral problems in children with cerebral palsy and improved parenting skills, according to a recent randomized controlled trial (RCT).

Stepping Stones Triple P (SSTP) is a readily available parenting intervention used to target behavioral and emotional problems. It is effective at improving behavioral problems in children with cerebral palsy (CP). The addition of Acceptance and Commitment Therapy (ACT) to a SSTP program may provide added benefits for children with CP.

Koa Whittingham, PhD, from the Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, and the Parenting and Family Support Centre, School of Psychology, University of Queensland, Brisbane, Australia, and colleagues present their results in an article published online April 7 in Pediatrics.

The investigators intended to enroll 98 families but were only able to include 67. The vast majority (97.0%) of the parents were mothers (mean age, 38.7 ± 7.1 years), and they enrolled in the study with their child, 64.2% of whom were boys (mean age, 5.3 ± 3.0 years).

Parents were randomly assigned to SSTP, SSTP + ACT, or waitlist (WL). After the postintervention assessment, parents assigned to WL were offered an opportunity to receive SSTP and were followed-up in the same manner as the other groups.

Families who received SSTP alone showed decreased child emotional symptoms compared with children on the WL (Strengths and Difficulties Questionnaire mean difference, 1.33; confidence interval, 0.45 - 2.21; P = .004). These results are consistent with previous studies.

As expected, SSTP + ACT was also associated with decreased behavioral problems relative to WL (Eyber Child Behavior Inventory intensity mean difference, 24.12; confidence interval, 10.22 - 38.03; P = .003). SSTP + ACT reduced dysfunctional parenting styles when compared with WL, but not when compared with SSTP alone. Specifically, SSTP + ACT was associated with decreased parental overreactivity compared with WL (Parenting Scale mean difference, 0.60; confidence interval, 0.16 - 1.04; P = .008).

The study enrollment was not large enough to form solid conclusions about the effects of SSTP alone in comparison with the effects of SSTP + ACT. The investigators were able to identify some patterns, however.

"To our knowledge, this was the first RCT to test the additive benefit of ACT, above and beyond an established behavioral parenting intervention. The results suggest that ACT provides an additional contribution, with particular benefits shown for parenting style and child hyperactivity. The combined SSTP and ACT intervention, but not SSTP alone was associated with reductions in child hyperactivity, parental overreactivity, parental verbosity, and child behavioral problems on the ECBI Intensity scale," the authors write.

Approximately 1 in 4 children with CP develop a behavioral disorder. These behavioral problems are often overlooked by physicians, according to Nancy Murphy, MD, from the University of Utah Department of Pediatrics in Salt Lake City, who was not involved in the study.

"The emphasis is so often on spasms, seizures, feeding/nutrition, hips and spines...that we run out of time and skip the behavioral issues, which clearly are at least as important to the child and the family in the context of their homes, schools, and communities. Kids with CP do not become socially isolated because they can't walk; they become isolated because of limitations in social and behavioral skills. Let's teach them!" Dr. Murphy told Medscape Medical News.

This work was supported by a National Health and Medical Research Council postdoctoral fellowship, a National Health and Medical Research Council career development fellowship, and a Smart State Fellowship. Stepping Stones Triple P is owned by the University of Queensland and sublicensed to Uniquest, the University of Queensland’s Technology Transfer Company. One coauthor is also a coauthor of the Stepping Stones Triple P program and receives royalty payments from the publisher, Triple P International, in accordance with the University of Queensland Intellectual Property Policy. The other authors and Dr. Murphy have disclosed no relevant financial relationships.

Pediatrics. Published online April 7, 2014. Abstract


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.