title: Improving child and parenting outcomes following paediatric acquired brain injury: a randomised controlled trial of Stepping Stones Triple P plus Acceptance and Commitment Therapy.
abstract: BACKGROUND
  Persistent behavioural difficulties are common following paediatric acquired brain injury (ABI). Parents and families also experience heightened stress, psychological symptoms and burden, and there is evidence of a reciprocal relationship between parent and child functioning, which may be mediated by the adoption of maladaptive parenting practices. Despite this, there is currently a paucity of research in family interventions in this population. The aim of this study was to determine the efficacy of Stepping Stones Triple P: Positive Parenting Program (SSTP), with an Acceptance and Commitment Therapy (ACT) workshop, in improving child outcomes and parenting practices following paediatric ABI.
  
  
  METHODS
  Fifty-nine parents of children (mean age 7 years, SD 3 years, 1 month; 35 males, 24 females) with ABI (Traumatic injuries 58%, Tumour 17%, Encephalitis or meningitis 15%, Cardiovascular accident 7%, Hypoxia 3%) who were evidencing at least mild behaviour problems were randomly assigned to treatment or care-as-usual conditions over 10 weeks. Mixed-model repeated-measures linear regression analyses were conducted to compare conditions from pre- to postintervention on child behavioural and emotional functioning (Eyberg Child Behavior Inventory, Strengths and Difficulties Questionnaire) and dysfunctional parenting style (Parenting Scale). Assessment of maintenance of change was conducted at a 6-month follow-up. The trial was registered on Australian New Zealand Clinical Trials Registry (ID: ACTRN12610001051033, www.anzctr.org.au).
  
  
  RESULTS
  Significant time-by-condition interactions were identified on number and intensity of child behaviour problems, child emotional symptoms and parenting laxness and overreactivity, indicating significant improvements in the treatment condition, with medium-to-large effect sizes. Most improvements were maintained at 6 months.
  
  
  CONCLUSIONS
  Group parenting interventions incorporating Triple P and ACT may be efficacious in improving child and parenting outcomes following paediatric ABI.
authors.affiliation: Faculty of Health and Behavioural Sciences, The School of Psychology, The University of Queensland, Brisbane, Queensland, Australia; Faculty of Medicine and Biomedical Sciences, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Faculty of Medicine and Biomedical Sciences, Queensland Children's Medical Research Institute, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Felicity L
authors.initials: FL
authors.lastname: Brown
authors.forename: Koa
authors.initials: K
authors.lastname: Whittingham
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
authors.forename: Lynne
authors.initials: L
authors.lastname: McKinlay
authors.forename: Kate
authors.initials: K
authors.lastname: Sofronoff
mesh_terms: D000328:Adult; D001930:Brain Injuries / Q000523:psychology*; D002648:Child; D002652:Child Behavior / Q000523:psychology; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D016896:Treatment Outcome
keywords: Acquired brain injury; Stepping Stones Triple P: Positive Parenting Program; acceptance and commitment therapy; behavioural and emotional functioning; parenting style; randomised controlled trial