A family-centred intervention to reduce challenging behaviours in children with acquired brain injury (ABI)

© 2010 Dr. Damith T. WoodsOf significant concern for parents following childhood acquired brain injury (ABI) is the often reported sequelae of challenging behaviours. Of equal concern are the often reported bi-directional influences between family-parental burden and stress and long-term behaviour problems. Less is known, however, about the nature and influence of parenting factors such as disciplinary practices and its relationship with children’s behaviour following ABI. Additionally, with recent research indicating that better child outcomes are commonly associated with greater family unity and cohesion, lower levels of parental stress, and increased social support, a family-centred approach to behavioural intervention may prove most effective. Thus, the two main aims of this thesis were to: (1) examine parental disciplinary use and its association with child behaviour following ABI; and (2) investigate the clinical utility and efficacy for a family-centred behavioural intervention programme delivered directly to the parents of children with ABI, in either telephone or face-to-face formats. The results of Study 1 revealed that overreactive and lax disciplinary strategies were endorsed most by parents following childhood ABI. Clinically dysfunctional levels of disciplinary use were associated with children who displayed more challenging behaviour, parents with elevated levels of stress, anxiety and depression, and families experiencing significant dysfunction and social adversity. Study 2 demonstrated that following the delivery of the Signposts for Building Better Behaviour programme, parents reported feeling less stressed and more confident in managing the challenging behaviours of their child following ABI. All parents approved of the strategies taught and a majority felt the materials were helpful in teaching new skills. In its two service delivery modes, the programme was able to reduce the number of challenging behaviours in brain injured children as well as lower dysfunctional parenting practices, stress and family burden. Study 3 revealed that parents continued to report subclinical child behaviour problems and reduced levels of family burden at 6 and 18 months follow-up indicating the long-term treatment effects of the Signposts programme. Further, parents also reported high levels of parenting self-efficacy and satisfaction that was inversely related to dysfunctional disciplinary use. With more children surviving brain injury there is a growing need for rehabilitation services and in particular a greater need for well researched evidence-based intervention approaches. The findings suggest that behavioural interventions that utilise a family-centred approach are both clinically useful and efficacious in ameliorating negative sequelae for family, parent, and brain injured child