Transcript No Slide Title

Emotion Coaching Predicts Change in Family Functioning Across
Treatment for Children with Oppositional Defiant Disorder
Julie C. Dunsmore, Jordan A. Booker, Na’ama Atzaba-Poria, Sarah Ryan,
Ross W. Greene, & Thomas H. Ollendick
Introduction
Oppositional Defiant Disorder (ODD) includes symptoms
such as temper tantrums and argumentative and defiant
behavior (DSM, American Psychiatric Association, APA 2013).
ODD is associated with children’s conflict with parents even
after accounting for parents’ own antisocial behavior
(Bornovalova et al., 2013). It is important to better understand
processes of change in treatment for children with ODD
because of the deleterious effects of ODD on children’s longterm outcomes as well as family functioning (Greene et al.,
2002; Kazdin, 2005, 2009). The primary purpose of this study
was to examine emotion-related processes of change in families
receiving treatment for children with ODD.
Specifically, we investigated whether parental emotion
coaching predicted changes in families’ effective problemsolving and overall cohesion from pre- to post-treatment.
Emotion coaching, a socialization style validating children’s
negative emotions and instructing about appropriate emotional
expression (Gottman, Katz, & Hooven, 1997), is associated with
emotional competence in both typically-developing and at-risk
samples (Katz, Maliken, & Stettler, 2012). Because emotion
coaching involves acceptance of and effective engagement with
children’s negative emotion, families with a parent high in
emotion coaching might be more effective at resolving conflicts
and maintaining relationships. This might enhance increases
in family emotional functioning across treatment.
Participants and Procedures
One hundred two mothers with children meeting diagnostic
criteria for ODD (mean age = 9.57 years; range 7 – 14 years; 65
boys, 37 girls) participated as part of a larger NIMH-funded
clinical trial. Pre-treatment assessments included clinical
diagnostic interviews with trained assessors, questionnaires,
and parent-child interaction tasks.
Families were randomly assigned to one of two treatment
groups. Parent Management Training (PMT) is an empirically
supported treatment for ODD that teaches parents to use
contingency management procedures (Ollendick & King,
2012). Collaborative & Proactive Solutions (CPS; Greene,
1998) emphasizes active involvement of parents in
collaboratively solving problems that contribute to oppositional
episodes. Each treatment was designed for 12 weekly 75minute sessions. Mid-treatment assessment took place after the
6th treatment session, and two weeks after the completion of
treatment, families participated in a post-treatment assessment.
Social Development Lab ([email protected])
Measures
Maternal emotion coaching (pre-treatment). Composite of:
•Belief that positive emotions are valuable (α = .77)
•Belief that negative emotions are valuable (α = .93)
•Belief that parents need to guide children’s emotions (α = .77; these
three scales from the short form of the Parents’ Beliefs about Children’s
Emotions scale, Halberstadt et al., 2008)
•Observed encouragement of children’s positive emotion
•Observed encouragement of children’s negative emotion (ICCs > .80;
both observed during conversation about family memories)
Effects of Maternal Emotion Coaching on
Improvement in Child Positive Involvement in
Problem-Solving and in Family Cohesion
Family Environment Scale (Moos & Moos, 1981; pre- & post-treatment)
•Family cohesion (αs > .79)
•Family conflict (αs > .68)
Problem Solving Task (Conduct Problems Prevention Research Group
(1992; pre-, mid-, & post-treatment). Parents were asked to select a single
problem to discuss with children for 7 minutes. Conversations coded for:
•Maternal positive involvement
•Child positive involvement
•Extent to which family reached a realistic solution (all ICCs > .73)
Analyses
Hierarchical Linear Modeling (HLM) was used to examine change
over time in families’ problem-solving behavior (mother and child
positive involvement, realistic solutions), cohesion, and conflict.
Emotion coaching and treatment placement was included in models.
Effect of Treatment Placement on Improvement in
Child Positive Involvement in Problem-Solving
Conditional Growth Models for Level-2 Treatment
Placement and Emotion Coaching Effects on ProblemSolving and Family Functioning
Outcome
Maternal Positive
Involvement
Child Positive
Involvement
Family Realistic
Solutions
Family Cohesion
Family Conflict
Random
Effects
Time
Intercept
β10
.03 (.05)
Fixed Effects
Time, π1
PMT/CPS
β11
.12 (.06)†
Coaching
β12
.02 (.01)†
r1
.03†
.00 (.05)
.18 (.06)**
.04 (.02)*
.01
.22 (.08)**
-.12 (.10)
.01 (.02)
.00
.28 (.12)*
-.50 (.15)**
.00 (.18)
-.26 (.23)
.07 (.03)*
.01 (.04)
.07†
.05
Note. † p < .10, * p < .05. ** p < .01. The level-2 effect of CPS is a dummy variable for treatment placement, 0 = PMT, 1 = CPS. The level-2 effect of emotion
coaching is grand centered around the mean. Given primary interest in the Level-1 effect of Time and Level-2 effects of Treatment Placement and Coaching, the
Overall Intercept effects (β00, r0) are not included in this table. Model estimation used full maximum likelihood estimation.
Conclusions
Overall, families showed improvement over the course of
treatment, in family realistic solutions, cohesion and lower
conflict. Furthermore, emotion coaching was related to greater
increases in child positive involvement when discussing conflict,
and in family cohesion. Assignment to CPS rather than PMT
was related to greater increases in child positive involvement
when discussing conflict. It is important to further study
emotion-related family processes in treatment outcome studies.
We acknowledge support from the National Institute of Mental Health
(NIMH 5R01MH076141) and the Institute for Society, Culture, and
Environment at Virginia Tech
Presented at the biennial meeting of the Society for Research in Child Development, Philadelphia, PA , March 2015