Parenting Training for Children With FASD

Study Overview
=================
Brief Summary
-----------------
Prenatal alcohol exposure can lead to a myriad of adverse developmental outcomes in children, and is the leading cause of mental disability in Canada. The term fetal alcohol spectrum disorders (FASD) was established to encompass the full spectrum of teratogenic effects induced by alcohol. FAS is believed to occur in approximately 1 to 3 per 1000 live births in North America, and it is estimated that FASD may occur as frequently as 1 in 100 live births, making this a public health problem of epidemic proportion. Even though considerable efforts have been aimed at identifying children with FASD, the need for access to services and supports for Canadian families affected by FASD remains unfulfilled. Additionally, there is little empirical data available to influence policy change in how these services and supports are delivered. A key recommendation contained in the Public Health Agency of Canada's (PHAC) Fetal Alcohol Spectrum Disorder (FASD): A Framework for Action document was the need to determine the types of supports children with FASD and their families require and to develop appropriate mechanisms to provide these services at the community, provincial/territorial and federal levels. This identified need forms the basis of the current proposal. Although a variety of psychosocial interventions have been developed to treat neurobehavioural disorders, relatively little research has been conducted that is specifically aimed at improving the behavioral challenges identified in children with FASD. Thus, we hypothesize that (i) a FASD-specific parent/guardian training intervention can be developed using input from major stakeholders to meet the current limitations in access for families seeking services and supports; and (ii) this intervention and its evaluation will provide evidence for feasibility and efficacy to support changes in policy by key decision-makers and provide the basis for developing promising practices in the area of interventions for families affected by FASD. This grant will link academic teams with parents/guardians and decision makers to develop and evaluate a training program for the parents/guardians of children with FASD. Participants will be recruited from across Canada. The specific objectives of the proposed research program, which will be addressed in three inter-related studies, are to: Develop an Internet-based intervention program for parents/guardians of children with FASD between the ages of 4-12 years, that is based on information collected from interviews completed by major stakeholders (e.g., parents/guardians, clinicians, decision-makers, community-based organizations); Evaluate the feasibility (usability) of the intervention; and Obtain data on outcomes from the randomized controlled trial This research will adopt an integrated knowledge translation and exchange approach where knowledge production, dissemination, uptake and usage will occur seamlessly throughout the project and researchers and knowledge users are engaged in the project right from its inception. The intervention will be based on the Strongest Families program that is designed to help families learn to deal with common childhood problems in the comfort and privacy of their home, and provide treatment and care via telephone contact with trained coaches, written manuals, videotapes, and audiotapes. This program has been successful in children neurodevelopmental disorders; and will be adapted for use in the FASD population, as children with FASD, share many of the same behavioral characteristics.

Official Title
-----------------
Strongest Families FASD: Parent Training for Challenging Behaviour in Children With Fetal Alcohol Spectrum Disorder (FASD)

Conditions
-----------------
Fetal Alcohol Spectrum Disorder

Intervention / Treatment
-----------------
* Behavioral: Strongest Families FASD intervention
* Other: Psychoeducation


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Have a child between 4-12 years of age with a diagnosis which falls under the umbrella term Fetal Alcohol Spectrum Disorder as reported by parents/caregivers. The child has been experiencing behavioural problems (as defined by the caregiver) for at least 6 months prior to study screening. Have been the primary caregiver for a minimum of 6 months prior to entry into the study. Have a reasonable expectation of being be the primary caregiver for at least 6 months after study enrolment. Read, write, and understand English. Have access to a telephone. Have access to a computer connected to the Internet. Live in Canada. CBCL Externalizing t-Score must be ≥64 (clinical range) The child meets criteria for behaviour suggestive of FASD No suicide attempts within the previous 6 months No current risk of suicide attempts Exclusion Criteria: Child is NOT able to speak in full sentences or understand everyday language and instructions. Parent/caregiver has previously taken part in a Strongest Families Parenting Program. Parent/caregiver OR child has been diagnosed with Psychosis. Child does not have a diagnosis of schizophrenia, bipolar disorder or major depression. Child does not put others as risk of serious harm (i.e., requiring medical attention). Parent/caregiver has not completed any of the following parenting programs in the last 6 months: Triple P, COPE, Incredible Years.

Ages Eligible for Study
-----------------
Minimum Age: 4 Years
Maximum Age: 12 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: The Strongest Families FASD intervention<br>It is a web-based parent training program with a coach. The program is comprised of 11 sessions, each focusing on a different parenting strategy, delivered using easy to read text, instructional videos and audio clips. One Booster Session is conducted 1 month after completion of Session 11. | Behavioral: Strongest Families FASD intervention<br> <br> Other: Psychoeducation<br> <br> |
| Active Comparator: Psychoeducation<br>It is a static webpage on IRIS providing FASD information and resources, including recommended book titles, websites and organizations that may be helpful. | Other: Psychoeducation<br> <br> |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| A change on the Child Behavior Checklist from baseline to 11 months | It is a standardized questionnaire that assesses adaptive functioning and problems. We will use two versions of the CBCL (CBCL/1 ½ -5 and CBCL/6-18) to accommodate the age range of the sample | At baseline, and 5 months and 11 months after randomization | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| A change on the Depression Anxiety & Stress Scale Short Form (DASS-21) from baseline to 11 months | It will be used to evaluate parental distress | At baseline, and 5 months and 11 months after randomization | 
| Client Satisfaction Questionnaire (CSQ-8) |  | Participants will be asked to complete this measure at the end of the intervention, which will probably last on average 5 months | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
FASD, pFAS, ARND, Fetal Alcohol Syndrome, Partial Fetal Alcohol Syndrome, Alcohol Related Neurodevelopmental Disorder, Static Encephalopathy (Alcohol Exposed), Neurobehavioural Disorder (Alcohol Exposed)