Feasibility study of a family- and school-based intervention for child behavior problems in Nepal

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Abstract

Background

This study evaluates the feasibility, acceptability, and outcomes of a combined school- and family-based intervention, delivered by psychosocial counselors, for children with behavior problems in rural Nepal.

Methods

Forty-one children participated at baseline. Two students moved to another district, meaning 39 children, ages 6–15, participated at both baseline and follow-up. Pre-post evaluation was used to assess behavioral changes over a 4-month follow-up period (n = 39). The primary outcome measure was the Disruptive Behavior International Scale—Nepal version (DBIS-N). The secondary outcome scales included the Child Functional Impairment Scale and the Eyberg Child Behavior Inventory (ECBI). Twelve key informant interviews were conducted with community stakeholders, including teachers, parents, and community members, to assess stakeholders’ perceptions of the intervention.

Results

The study found that children’s behavior problems as assessed on the DBIS-N were significantly lower at follow-up (M = 13.0, SD = 6.4) than at baseline (M = 20.5, SD = 3.8), p < 0.001, CI [5.57, 9.35]. Similarly, children’s ECBI Intensity scores were significantly lower at follow-up (M = 9.9, SD = 8.5) than at baseline (M = 14.8, SD = 7.7), p < 0.005, 95% CI [1.76, 8.14]. The intervention also significantly improved children’s daily functioning. Parents and teachers involved in the intervention found it acceptable and feasible for delivery to their children and students. Parents and teachers reported improved behaviors among children and the implementation of new behavior management techniques both at home and in the classroom.

Conclusions

Significant change in child outcome measures in this uncontrolled evaluation, alongside qualitative findings suggesting feasibility and acceptability, support moving toward a controlled trial to determine effectiveness.

Electronic supplementary material

The online version of this article (10.1186/s13034-018-0226-3) contains supplementary material, which is available to authorized users.

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Most cited references 29

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Suicidal behavior is a leading cause of injury and death worldwide. Information about the epidemiology of such behavior is important for policy-making and prevention. The authors reviewed government data on suicide and suicidal behavior and conducted a systematic review of studies on the epidemiology of suicide published from 1997 to 2007. The authors' aims were to examine the prevalence of, trends in, and risk and protective factors for suicidal behavior in the United States and cross-nationally. The data revealed significant cross-national variability in the prevalence of suicidal behavior but consistency in age of onset, transition probabilities, and key risk factors. Suicide is more prevalent among men, whereas nonfatal suicidal behaviors are more prevalent among women and persons who are young, are unmarried, or have a psychiatric disorder. Despite an increase in the treatment of suicidal persons over the past decade, incidence rates of suicidal behavior have remained largely unchanged. Most epidemiologic research on suicidal behavior has focused on patterns and correlates of prevalence. The next generation of studies must examine synergistic effects among modifiable risk and protective factors. New studies must incorporate recent advances in survey methods and clinical assessment. Results should be used in ongoing efforts to decrease the significant loss of life caused by suicidal behavior.

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The adolescent brain.

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Adolescence is a developmental period characterized by suboptimal decisions and actions that are associated with an increased incidence of unintentional injuries, violence, substance abuse, unintended pregnancy, and sexually transmitted diseases. Traditional neurobiological and cognitive explanations for adolescent behavior have failed to account for the nonlinear changes in behavior observed during adolescence, relative to both childhood and adulthood. This review provides a biologically plausible model of the neural mechanisms underlying these nonlinear changes in behavior. We provide evidence from recent human brain imaging and animal studies that there is a heightened responsiveness to incentives and socioemotional contexts during this time, when impulse control is still relatively immature. These findings suggest differential development of bottom-up limbic systems, implicated in incentive and emotional processing, to top-down control systems during adolescence as compared to childhood and adulthood. This developmental pattern may be exacerbated in those adolescents prone to emotional reactivity, increasing the likelihood of poor outcomes.

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Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood.

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This paper seeks to extend research into the adult sequelae of childhood conduct problems by investigating the associations between conduct problems in middle childhood and psychosocial outcomes in adulthood. Data were gathered during the course of a 25-year longitudinal study of a birth cohort of New Zealand young people. Information was collected on: a) parent and teacher reports of child conduct problems at ages 7, 8 and 9 years; b) measures of crime, substance use, mental health, sexual/partner relationships, education/employment; c) confounding factors, including childhood, family and educational characteristics. There were statistically significant associations between childhood conduct problems from 7-9 years and risks of adverse outcomes across all domains of functioning. After control for confounding factors the associations between conduct problems and education/employment outcomes became statistically non-significant. Associations persisted for other outcomes (crime, substance dependence, mental health and sexual/partner relationships). Children in the most disturbed 5% of the cohort had rates of these outcomes that were between 1.5 and 19 times higher than rates for the least disturbed 50% of the cohort. The associations between conduct problems and adult outcomes were similar for males and females. Childhood conduct problems were associated with a wide range of adverse psychosocial outcomes (crime, substance use, mental health, sexual/partner relationships) even after control for confounding factors. The results reinforce the need for greater investment into interventions to address these problems.

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Author and article information

Contributors

Ramesh P. Adhikari:

ORCID: http://orcid.org/0000-0002-0896-2074

rameshadhikaria@gmail.com

Nawaraj Upadhaya: navarajtpo@gmail.com

Emily N. Satinsky: ens48@cornell.edu

Matthew D. Burkey: matthewburkey@gmail.com

Brandon A. Kohrt: bkohrt@gwu.edu

Mark J. D. Jordans: mark.jordans@kcl.ac.uk

Journal

Journal ID (nlm-ta): Child Adolesc Psychiatry Ment Health

Journal ID (iso-abbrev): Child Adolesc Psychiatry Ment Health

Title: Child and Adolescent Psychiatry and Mental Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1753-2000

Publication date (Electronic): 23 March 2018

Publication date PMC-release: 23 March 2018

Publication date Collection: 2018

Volume: 12

Electronic Location Identifier: 20

Affiliations

[1 ]ISNI 0000 0001 2114 6728, GRID grid.80817.36, Padma Kanya Multiple Campus, , Tribhuvan University Kathmandu, ; Bagbazar, Kathmandu, Nepal

[2 ]Research Department, Transcultural Psychosocial Organization (TPO), Baluwatar, Kathmandu, Nepal

[3 ]ISNI 0000 0001 0941 7177, GRID grid.164295.d, Global Mental Health and Addiction Program, , University of Maryland College Park, ; College Park, USA

[4 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Johns Hopkins University, ; Baltimore, MD USA

[5 ]ISNI 0000 0004 1936 9510, GRID grid.253615.6, Department of Psychiatry and Behavioral Sciences, , George Washington University, ; Washington, DC USA

[6 ]ISNI 0000 0001 2322 6764, GRID grid.13097.3c, Centre for Global Mental Health, Institute of Psychiatry, Psychology & Neuroscience, , King’s College London, ; London, UK

Author information

Ramesh P. Adhikari http://orcid.org/0000-0002-0896-2074

Article

Publisher ID: 226

DOI: 10.1186/s13034-018-0226-3

PMC ID: 5865299

PubMed ID: 29588657

SO-VID: f2dea0ff-9e7a-4a47-addb-fd0c8f0ba94a

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 February 2018

Date accepted : 14 March 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;

Award ID: U19MH095687

Award ID: K01MH104310

Award Recipient : Ramesh P. Adhikari Brandon A. Kohrt

Custom metadata

ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: children,behavior problems,school and family based intervention,feasibility study,psychosocial support,nepal

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ScienceOpen disciplines: Clinical Psychology & Psychiatry

Keywords: children, behavior problems, school and family based intervention, feasibility study, psychosocial support, nepal

Feasibility study of a family- and school-based intervention for child behavior problems in Nepal

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Chinese Journal of School Health

Most cited references 29

Suicide and suicidal behavior.

The adolescent brain.

Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood.

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