Adapting Webster-Stratton's incredible years parent training for children with developmental delay: findings from a treatment group only study.

It has been well documented that individuals with intellectual disability (ID) and other developmental disabilities are at heightened risk for developing a behaviour problem and/or mental health disorder (e.g. Dosen & Day 2001). Recent estimates suggest that more than a third of children and adolescents with ID have diagnosable psychiatric disorders (Einfeld & Tonge 1996; Emerson 2003). Dual diagnosis presents unique diagnostic (Sturmey 1995) and treatment challenges (Fletcher 2000) and leaves children at particular risk for unfavorable long-term outcomes, including, but not limited to, difficulties at home and school (McIntyre et al. 2002; McIntyre et al. 2006). For young children, serious maladaptive behaviour likely influences the adaptation to school in that student-teacher relationships and peer relationships may be disrupted (McIntyre et al. 2006; Peterson et al. 2002). The early adaptation to school, particularly in preschool and kindergarten years, is crucial because this sets the stage for later school-based experiences (Rimm-Kaufman & Pianta 2000). Young children with developmental delay are at greater risk for developing emotional and/or behaviour problems; however, very little is known about the developmental pathways of these problems or the underlying mechanisms of risk. It is likely a combination of biological, environmental, and social factors that place children at risk (Sameroff & Fiese 2000). At a very early age, families are children’s main socializing agents. The home environment serves as the primary context for children’s development of adaptive (as well as maladaptive) strategies. This is consistent with the tenets of developmental psychopathology, emphasizing and understanding multiple pathways to adaptation. Family processes have influenced the emergence of behaviour disorders in young children without disabilities (Baumrind 1989; Bronson 2000; Kumpfer & Alvarado 2003; Martin 1987; Russell & Russell 1996). In parsing the family risk factors, Gerald Patterson and colleagues (Patterson 1982; Patterson 1998; Patterson et al. 1989) suggest that negative, coercive parenting practices place typically developing children at risk for behavioural problems. In a study of family problem-solving with children with disabilities, Floyd et al. (2004) found that child behavior problems were associated with negative parent-child interactions. Baker and colleagues (2003) suggested a bi-directional relationship between parenting stress and child behaviour problems over time in families with young children with developmental problems. Indeed, a transactional relationship between children, their caregivers, and other environmental influences may best describe the inter-relationships among these risk factors (Sameroff & Chandler 1975; Sameroff & Fiese 2000). Proximal variables (e.g. child temperament, developmental/cognitive status, adaptive behaviour) and more distal factors (e.g. family variables, poverty) may help describe risk factors, but still do not explain direct causes of psychopathology in children. Even less is known about psychopathology in individuals with developmental delay or ID. Few studies examine young children at risk for dual diagnosis and even fewer studies examine treatment outcomes for such children. The work of Baker and colleagues (2002, 2003) suggests that young children with developmental delay, as early as 3-years old, are already exhibiting increased behaviour problems and negatively impacting their families. Existing behaviour problems may be exacerbated by parental stress over time (e.g. Baker et al. 2003). What is unknown is whether the presence of parental stress influences the emergence of behaviour problems in young children. Regardless of underlying cause or mechanism of psychopathology, there is a strong need for earlier, preventive efforts with families. Parent training, a promising form of intervention, has been used with families who have children with intellectual disability (ID) as well as families with children with behaviour disorders.