Interventions to reduce behavioral problems in children with cerebral palsy: an RCT.
OBJECTIVE
To test Stepping Stones Triple P (SSTP) and Acceptance and Commitment Therapy (ACT) in a trial targeting behavioral problems in children with cerebral palsy (CP).


METHODS
Sixty-seven parents (97.0% mothers; mean age 38.7 ± 7.1 years) of children (64.2% boys; mean age 5.3 ± 3.0 years) with CP (Gross Motor Function Classification System = 15, 22%; II = 18, 27%; III =12, 18%; IV = 18, 27%; V = 4, 6%) participated and were randomly assigned to SSTP, SSTP + ACT, or waitlist. Primary outcomes were behavioral and emotional problems (Eyberg Child Behavior Inventory [ECBI], Strengths and Difficulties Questionnaire [SDQ]) and parenting style (Parenting Scale [PS]) at postintervention and 6-month follow-up.


RESULTS
SSTP with ACT was associated with decreased behavioral problems (ECBI Intensity mean difference [MD] = 24.12, confidence interval [CI] 10.22 to 38.03, P = .003; ECBI problem MD = 8.30, CI 4.63 to 11.97, P < .0001) including hyperactivity (SDQ MD = 1.66, CI 0.55 to 2.77, P = .004), as well as decreased parental overreactivity (PS MD = 0.60, CI 0.16 to 1.04, P = .008) and verbosity (PS MD = 0.68, CI 0.17 to 1.20, P = .01). SSTP alone was associated with decreased behavioral problems (ECBI problems MD = 6.04, CI 2.20 to 9.89, P = .003) and emotional symptoms (SDQ MD = 1.33, CI 0.45 to 2.21, P = .004). Decreases in behavioral and emotional problems were maintained at follow-up.


CONCLUSIONS
SSTP is an effective intervention for behavioral problems in children with CP. ACT delivers additive benefits.
Queensland Cerebral Palsy and Rehabilitation Research Centre School of Medicine, and Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia; and koawhittingham@uq.edu.au.
Koa
K
Whittingham
Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, Australia; and.
Matthew
M
Sanders
Queensland Paediatric Rehabilitation Service, Royal Children's Hospital, Brisbane, Australia.
Lynne
L
McKinlay
Queensland Cerebral Palsy and Rehabilitation Research Centre School of Medicine, and.
Roslyn N
RN
Boyd
D064869:Acceptance and Commitment Therapy; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology / Q000628:therapy; D001521:Behavior Therapy / Q000379:methods*; D002547:Cerebral Palsy / Q000523:psychology*; D002648:Child; D002653:Child Behavior Disorders / Q000523:psychology* / Q000628:therapy*; D002675:Child, Preschool; D004505:Education, Nonprofessional / Q000379:methods*; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D064866:Mindfulness
acceptance and commitment therapy; behavioral family intervention; cerebral palsy; mindfulness; parenting