1. family and parenting

Neurocognitive Rehab Lab
School of OT
Faculty of Medicine
Hadassah and Hebrew University
What is Parenting Self-Efficacy?
Change in Parenting SelfEfficacy after CognitiveFunctional (Cog-Fun)
treatment in OT for
children with ADHD
Jeri Hahn-Markowitz, Dana Zeides Taubin, Adina Maeir
Neurocognitive Rehabilitation Laboratory
School of Occupational Therapy, Hebrew University in
Jerusalem
Background
Subjective belief in ability to enlist motivation,
cognitive resources and skills necessary to
successfully encourage & nurture child.
High PSE = high involvement, satisfaction &
enjoyment from parental role; security in ability to
acquire & use parenting strategies that increase the
probability that their children will display high
social, emotional and academic abilities.
Low PSE = experience difficulty in parenting skills
in challenging situations and may avoid coping with
them.
(Bandura, 1995; Jones & Prinz, 2005).
What is Cog-Fun?
Literature on parents of children with
ADHD shows that their PSE is low
Cognitive-Functional treatment aims to
promote:
(Finzi-Dottan, et al, 2011; Whalen, et al, 2011; van den
Hoofdakker et al, 2010; Jones & Prinz, 2005).
• Executive Functions
Can this be changed by participation in
Cog-Fun treatment in OT?
• Child and parent self-efficacy
• Quality of life (QOL)
among children with ADHD and their
families (Maeir, et al., 2014a; Maeir, et al., 2014b;
Hahn-Markowitz, et al., 2011).
Cog-Fun change agents: based on
OT models
• Child and family-centered occupation-based intervention
• Enabling therapeutic relationship (Intentional Relationship
Model, Taylor, 2008)
• Identify, strengthen & connect occupations to child’s
volition (MOHO, Kielhofner, 2008)
• Executive strategy acquisition and self awareness (MCT,
Toglia, 2011)
Methods: Tools
• Tool to Measure Parenting Self-Efficacy
(TOPSE) (Kendall & Bloomfield, 2005)
• Behavioral Rating Inventory of Executive
Functions (BRIEF) (Gioia, et al, 2000)
• Pediatric Quality of Life 4.0 Generic Cores
Scales (PedsQL) (Varni, Seid & Kurtin, 2001)
• Canadian Occupational Performance
Measure (COPM) (Law, et al, 2005)
• Environmental supports and functional training
(Neurofunctional approach to Cog Rehab, Giles, 2011)
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Neurocognitive Rehab Lab
School of OT
Faculty of Medicine
Hadassah and Hebrew University
RCT – Cog-Fun Effectiveness
(N=99)
Methods: Study Population
• Children (7-10 y.o., in 2nd-4th grade
at first assessment) diagnosed with
ADHD, referred by MDs
• Regular schools
• No serious neurological or psychiatric
co-morbidities
RCT – Crossover Study
(3 mo. between assessments)
Time1
Research Pre-tx
Group
Assess
Control
Group
Assess1
Intervent’
Time2
Crossover
Time3
Cog-Fun
Post-tx
Assess
No tx
Followup
Wait
period
Pre-tx
Assess
Cog-Fun
Post-tx
Assess
Tool to Measure Parenting SelfEfficacy (TOPSE) (Kendall & Bloomfield, 2005)
8 Scales (6 items per scale)
•
•
•
•
•
•
•
•
Emotion and affection
Play and enjoyment
Empathy and understanding
Control
Discipline and limit-setting
Pressures
Self-acceptance
Learning and knowledge
RCT – Cog-Fun Effectiveness
(N=99)
Study Population
Blocked Randomization
Research gr Control gr
Boys 7-8
24
26
Girls 7-8
11
7
Boys 9-10
9
10
Girls 9-10
6
6
Total
50
49
Tool to Measure Parenting SelfEfficacy (TOPSE) (Kendall & Bloomfield, 2005)
• 48 items (Likert rating 0 -10)
• 8 scales
• Lower scores reflect lower PSE.
• High internal reliability on each scale
(0.80-0.89) and for all items
(Cronbach’s alpha=0.94)
Tool to Measure Parenting SelfEfficacy (TOPSE) (Kendall & Bloomfield, 2005)
Examples of scale statements:
“I am able to show affection towards my child.”
“I am able to have fun with my child.”
“I am able to explain things patiently to my child.”
“As a parent I feel I am in control.”
“Setting limits and boundaries is easy for me.”
“I do not feel a need to compare myself to other
parents.”
“I know I am a good enough parent.”
“I am able to recognize developmental changes in
my child.”
2
Neurocognitive Rehab Lab
School of OT
Faculty of Medicine
Hadassah and Hebrew University
TOPSE Data analysis
RCT – Cog-Fun Effectiveness
(N=99)
Hypotheses
• MANOVA repeated measures by
group to examine the interaction
effect (Time X Group)on TOPSE
scales.
• MANOVA repeated measure to
examine improvement in TOPSE
scales after Cog-Fun tx.
1. A time effect will be found on the Tool to
Measure Parenting Self-Efficacy (TOPSE)
after Cog-Fun tx.
2. An interaction effect will be found between
the research and control (waitlist) groups
on the TOPSE.
3. Significant correlations will be found
between PSE, EF, QOL and occupational
performance.
Interaction Effect:
Group (Research vs Control) by Time
(time1, Time2) on TOPSE total scores
Treatment effect in both groups
(pre-post treatment)
Topse Scales:
Discipline*
Play*
Control*
Empathy*
Time effect F= 8.43; p=.005
Group *Time F= 5.612; p=.02
TOPSE correlations with other
measures after treatment (N=88)
TOPSE/
BRIEF/
COPM/
QOL
Emotional
Control
Inhibit
QOL
COPM
Play
Control
TOPSE Scales:
Discipline*
Play*
Control*
Empathy*
Discipline
Empathy
-.248*
-.258*
-.251*
-.111
-.130
-.230*
-.240*
-.290**
.450**
.372**
.380**
.440**
NS
.221*
NS
NS
Results
• Significant improvements in parenting
self-efficacy after tx and a significant
interaction effect were found between
group and time.
• Correlations with measures of EF, QOL
and occupational performance
• Supporting evidence for the effectiveness
of Cog-Fun tx for improving self-efficacy
among parents of children with ADHD
* <.05; **<.01
3
Neurocognitive Rehab Lab
School of OT
Faculty of Medicine
Hadassah and Hebrew University
Cog-Fun change agents
Ramifications
• Child and family-centered occupation-based
intervention
Improved parenting self-efficacy of
• Enabling therapeutic relationship
parents who participate in Cog-Fun tx
(Intentional Relationship
Model, Taylor, 2008)
• Identify, strengthen & connect occupations to child’s
volition (MOHO, Kielhofner, 2008)
• Executive strategy acquisition and self awareness
(MCT, Toglia, 2011)
with their child can help them to
continue helping their child after
therapy is finished.
• Environmental supports and functional training
(Neurofunctional approach to Cog Rehab, Giles, 2011)
Limitations
• Longer treatment periods and/or
more support for parents after CogFun would increase the tx effect.
• Future studies should include a
longer follow-up period.
Cog-Fun
References
Maeir A, Hahn-Markowitz J, Fisher O, & Traub Bar-Ilan R.
(2014). Cognitive Functional (Cog-Fun) intervention for
children with ADHD: Theory and practice. In I Berger & A
Maeir (Eds.), ADHD - A transparent impairment, clinical, dailylife and research aspects in diverse populations. New York:
Nova Science Publishers.
Maeir A, Fisher O, Traub Bar-Ilan R, Boas N, Berger I, &
Landau YE. (2014). Effectiveness of Cognitive-Functional
(Cog-Fun) Occupational Therapy Intervention for Young
Children with Attention Deficit Hyperactivity Disorder: A
Controlled Study. AJOT, 68(3): 260-267.
Hahn-Markowitz J, Manor I, & Maeir A. (2011). Effectiveness of
Cognitive-Functional (Cog-Fun) Intervention with Children with
Attention Deficit Hyperactivity Disorder. AJOT 65(4): 384-392.
Thank you!
jerihahnmarkowitz@gmail.com
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