Letters to the Editor
Reply: Evaluation of a Children’s Temper-Taming Program
Dear Editor: We wish to thank Ms Augimeri and colleagues for their letter in response to Williams and others (1).
We are aware of the SNAPTM program used at the Child Development Institute; we agree that many of the strategies used to make children aware of the link between thoughts (cognitions), feelings, physiologic sensations, and behaviour, together with strategies to further help them use this knowledge to make better choices about their behaviour, are similar between programs. Several researchers have shown that these cognitive-behavioural strategies help to decrease aggressive behaviours (2–4). Both programs are also manualized, which allows consistent training of others and replication of the intervention with integrity across sites and time.
There are several notable differences between the programs as well, as Ms Augimeri points out. We did not run the clinic-based groups described in our paper as sex-specific groups. Within our clinic, the referral rate to these temper-taming groups is greater for boys than for girls, as evidenced by the enrolment in the groups reported in our article (46 boys and 10 girls). It would be easy to run boys-only groups; however, the lower referral rate for girls makes it impossible to assemble all-girl groups and still offer timely service. As we continue to learn more about the similarities and differences in the development of aggression in girls and boys, clinical services may also move toward adopting sex-specific groups.
The other notable difference is in the process of program referral. The groups described in the paper were run through our outpatient children’s mental health service and only included clinician referrals for children and families being seen within the clinic. The Earlscourt Under 12 Outreach Program accepts referrals more broadly. Only about 1 of every 6 children with emotional-behavioural problems reaches an outpatient mental health service for assessment and treatment (5), owing to limited availability and inaccessibility of services and high opportunity costs to families (6–8). Many children and families who might benefit from specialized services remain in the community. It is important to provide clinical services that have been evaluated and have shown positive effects, such as the clinical Temper-Taming Program, to clinical children and their families. Community-based services such as the Under 12 Outreach Program, which allow participation without accessing clinical services, have the opportunity to serve a greater number of children and families in need.
Recognizing the importance of this issue, we have adapted and expanded the clinical Temper-Taming Program and have been providing it as a community-based program in Hamilton. It is part of a research study with rigorous evaluation methods—a randomized controlled trial (RCT) funded by the Ontario Mental Health Foundation. Our preliminary results are based on 99/123 pregroup–postgroup evaluations of children and families enrolled in the RCT (that is, 80.5% of the total sample). These preliminary results show that group participation has positive effects on parent-rated child aggression, parent–child relationships, and parenting stress, with small effect sizes. These results suggest that the adaptation of the clinical temper-taming groups provides an effective community-based intervention program.
We agree with Augimeri and colleagues that well-defined, manualized group programs with evidence for effectiveness and with potential to be replicated in other sites are critical to providing a clear, evidence-based intervention for the population of children with aggressive behaviours.
References
1. Williams S, Waymouth M, Lipman E, Mills B, Evans P. Evaluation of a children’s temper-taming program. Can J Psychiatry 2004;49:607–12.
2. Kazdin AE, Esveldt-Dawson K, French NH, Unis AS. Effects of parent management training and problem-solving skills training combined in the treatment of antisocial child behaviour. J Am Acad Child Adolesc Psychiatry 1987;26:416–24.
3. Kazdin AE, Esveldt-Dawson K, French NH, Unis AS. Problem-solving skills training and relationship therapy in the treatment of child antisocial behaviour. J Consult Clin Psychol 1987;55:76–85.
4. Kazdin AE, Siegel TC, Bass D. Cognitive problem-solving skills training and parent management training in the treatment of antisocial behaviour in children. J Consult Clin Psychol 1992;60:733–47.
5. Offord DR, Boyle MH, Fleming JE, Munroe Blum H, Rae-Grant NI. Ontario Child Health Study: summary of selected results. Can J Psychiatry 1989;34:483–91.
6. Lipman EL, Boyle MH. Barriers to services promoting child emotional, behavioural and social health. In: Encyclopedia on early child development. Centre for Excellence for Early Childhood Development Web site. Available: http://www.excellence-earlychildhood.ca/documents/Lipman-BoyleANGxp.pdf. Accessed 2005 May 3.
7. Canadian Academy of Child Psychiatry. Physician Resource Committee. Child psychiatry in Canada. Position statement. Ottawa (ON): Canadian Psychiatric Association; 2002. Available: http://www.cpa-apc.org/Publications/Position_Papers/child.asp. Accessed 2005 Mar 4.
8. Owens PL, Hoagwood K, Horwitz SM, Leaf PJ, Poduska JM, Kellam SG, and others. Barriers to children’s mental health services. J Am Acad Child Adolesc Psychiatry 2002;41:731–8.
Ellen Lipman, MD
Susan Williams, PhD
Marjorie Waymouth, BSW
Brenda Mills, CYW
Peter Evans, MA
Meghan Kenny, MA
Carrie Sniderman, MSc
Hamilton, Ontario
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