Journal of Consulting and Clinical Psychology 197S, Vol. 43, No. 5, 683-688
Changes in Sibling Behavior Following Family Intervention J. E. Arnold, A. G. Levine, and G. R. Patterson Oregon Research Institute, Eugene, Oregon Changes in the behavior of the siblings of 27 treated predelinquents are reported. The parents of the referred predelinquents had been trained in social learning techniques of child management. Prior analyses of home observation data showed significantly reduced rates of deviant behaviors for the identified problem children. These reductions were maintained over a 12-month followup. The child management procedures taught to the parents were presumably applied to siblings as well as to the identified problem child. Analyses were conducted for the data from the 55 siblings of these families. The baseline data showed no significant differences between siblings and identified problem children. At termination of treatment, there were significant reductions in rates of deviant behavior for the siblings. The follow-up results showed the effects were maintained over a 6-month period. Some clinical implications of home intervention programs for socially aggressive boys and their siblings are discussed.
Social learning approaches to family intervention emphasize the assumption that parents control many of the contingencies presumed influential in the acquisition and maintenance of child behaviors. In keeping with this assumption, parents are regarded as logical, even preferred, therapists for their own child's problem behavior. During the past decade, numerous attempts by behavior modifiers have been made to help parents manage their children's behavior more effectively (see reviews by Berkowitz & Graziano, 1972; Patterson, 1971). One as yet unsubstantiated advantage of having the parent treat the child is that the effects should maximally generalize and persist. In the present context, this would imply that the behavior of siblings as well as that of the identified problem child would be altered by such parent-training programs. This would seem particularly desirable since prior studies have shown that siblings of aggressive boys also perform aggressive behaviors at high rates (Patterson, 1975; Patterson, This study was supported by ROI MH 15985 from the National Institute of Mental Health section on Crime and Delinquency. Computing assistance was obtained from the Health Sciences Computing Facility, University of California, Los Angeles, sponsored by National Institutes of Health Grant FR-3. The first author is now at the University of California, Santa Barbara. Order of authorship for the first two authors was randomly determined.
Cobb, & Ray, 1973) and often provide the stimuli that "trigger" the problem child's deviant responses (Patterson, 1973; Patterson & Cobb, 1973). The data summarized in Patterson (197S) strongly suggest that aggressive boys are raised in families comprised of aggressive family members. Of these family members, the siblings were the most aggressive. Effective treatment therefore requires changes in the family system particularly in the behavior of the siblings. Undoubtedly the safest means of assuring maximal generalization and persistence of treatment effects would be to program them (Baer, Wolf, & Risley, 1968; Kazdin & Bootzin, 1972; Wahler, 1969). This implies that the parents should be supervised while applying the child management procedures to the siblings. In the present study, two thirds of the families did in fact receive this type of supervision in sibling management. Siblings so treated are referred to as "involved" to distinguish them from the "uninvolved" siblings who were not intentionally supervised by their parents. The present study assessed rates of deviant behavior of the siblings of 27 socially aggressive boys whose parents were trained in social learning techniques of child managment in the Social Learning Project at the Oregon Research Institute. Previous analyses of the training program's effect on the problem chil-
J. E. ARNOLD, A. G. LEVINE, AND G. R. PATTERSON
dren (Patterson, 1974; Patterson et al., 1973; Patterson & Reid, 1973) have detailed the nature of the parent-training procedures and have shown that the problem children's rates of deviant behavior were significantly reduced over intervention and maintained over a 12-month follow-up period. Observation data were collected in the homes prior to, during, and following treatment. These data constituted the primary criteria for evaluating treatment outcome. The baseline observation data were used to test the hypothesis that the identified problem children differ significantly from their siblings. Prior analyses for small samples have shown no significant differences in rates of deviant child behaviors (Patterson, Ray, & Shaw, 1968; Patterson et al., 1973). The observation data collected throughout intervention and follow-up were used to test the hypothesis that at termination there would be significant reductions from baseline levels for the siblings and that these changes would be maintained through follow-up. METHOD Sample This study's data came from 27 families that had been referred to the Social Learning Project at the Oregon Research Institute by community agencies because one or more of the children within each family had been identified as having a severe conduct disorder. The majority were aggressive boys; others engaged in stealing, truancy, or fire setting. The majority of the families were from the lower socioeconomic class; 8 were mother-only families. TABLE 1 DEMOGRAPHIC INFORMATION FOR THE FAMILIES AND SIBLINGS
M age, years
Families Father absent Referred child Siblings Male Female Older Younger
27 8 27 55 21 34 28 27
— 8.7 8.4 9.4 8.1 11.8 5.3
M socioeconomic Range level" —
— 5-13 2-16 3-16 2-16 6-16 2-11
— — — — — — —
a Based on a system developed by Hollingshead and Redlich (1958).
The treatment that the families received is described in Patterson et al. (1973). The effects of treatment on the behavior of the referred children are summarized in Patterson (1975). The sample for the present study consisted of the 55 siblings of the 2,7 referred children who were 3 years of age or older. The families had been screened at intake to include at least 1 sibling. The mean number of siblings averaged 2.44 per family, with a range of 1-5. Additional demographic information can be found in Table 1.
Therapists Five staff members, each having spent 2 or more years on the project, carried the bulk of the treatment load. During that time, five trainees, supervised by the staff, also worked with one or more families. The families received an average of 31.5 hours of professional time during intervention and an additional 1.9 hours during follow-up.
Observational Procedures The time sampling observation procedures described in Patterson, Ray, Shaw, and Cobb 1 were used in this study and were designed to describe 14 noxious and 15 prosocial behaviors displayed among family members. An earlier series of methodological studies on the problem associated with use of the code was summarized in Patterson et al. (1973, pp. 156-165). A more complete discussion of observer reliability, observer bias, reactivity to observer presence, observer drift, code complexity, and stability of event estimation can be found in Jones, Reid, and Patterson (1975). To conserve space, no attempt was made to summarize these materials here. Six to 10 baseline observations were made in each home prior to intervention. For each session the observer went to the home at about dinner time and made two 5-min observations on each family member in a prearranged random order. This produced a sequential account of each target subject's behavior and the reaction of other family members to him. A portable interval timing device signaled the observer every 30 sec, at which time she shifted to the next line on the protocol sheet. A trained observer could record five reactions of the target subject and five reactions of the family members on each line. In the discussions to follow, many of the variables are expressed as a "rate per minute." It should be understood that the upper limit for such rates is approximately 10 responses per minute for any given subject. Periodic observation probes were conducted at 4week intervals throughout intervention. Each probe 1 Patterson, G. R., Ray, R. S., Shaw, D. A., & Cobb, J. A. Manual for coding of family interactions, 1969 revision. See NAPS Document #01234. Order from ASIS/NAPS, c/o Microfiche Publications, 305 E. 46th Street, New York, New York 10017. Remit in advance $5.45 for photocopies and $1.50 for microfiche. Make checks payable to Microfiche Publications.
CHANGES IN SIBLING BEHAVIOR FOLLOWING FAMILY INTERVENTION consisted Of two consecutive observation sessions during which the referred child was observed for 20 minutes and each of the other family members for S minutes. Probes were introduced immediately following the parents' reading of the programmed text, after 4 and 8 weeks of intervention, and at termination. During follow-up, two probe sessions were carried out monthly for the first 6 months. Additional probe sessions were conducted in the 8th, 10th, and 12th months.
Reliability The same five observers collected the data for the entire study. Biweekly observer training sessions were conducted, and biweekly reliability checks were carried out in the homes in order to guard against decay in observer reliability (Reid, 1970). Agreement between pairs of observers was calculated by dividing total agreements by total agreements plus disagreements for each 30-sec segment. The event-by-event analysis required agreement on behavior, family member, and sequence. The analysis for the data in the present article showed an average agreement of 74.2%.
Dependent Variable The observation data provide average rates per minute for 14 noxious responses. Their sum is labeled total deviant and consists of the following behaviors: command negative, cry, destructive, dependency, disapproval, high rate, humiliate, ignore, noncomply, negativism, tease, whine, yell, and physical negative. Definitions for all behavior categories can be found in Patterson et al. (see footnote 2). Data reviewed by Patterson (1974) suggest a rate of .450 responses per minute as the most efficient cutting score for differentiating between samples of aggressive and nonaggressive boys. Estimates of the total deviant score based on 3-5 observation sessions were correlated with estimates made a week later using a comparable number of sessions. The test-retest reliability correlation (uncorrected) was .78 (df = 26, />1). The validity data summarized in Jones et al. (1975) showed that the total deviant score correlated significantly with parents' ratings of aggressiveness for their boys.
RESULTS Comparison of Siblings and Identified Problem Children at Baseline As can be seen in Figure 1, sizable baseline rate differences existed between siblings and the identified problem children. The mean total deviant scores were .563 and .759, respectively. A t test for related measures compared the baseline scores for these two samples. Expecting that the deviancy rates of referred children would exceed that of their siblings, a one-tailed test seemed appropriate;
• PROBIEM CHItO
N = 76
FIGTTRE 1. Mean rates of total deviant behaviors for the problem child and his siblings. (N refers to the number of families contributing to the mean rates.)
t(26) = 1.678, p > .10. The problem child/ sibling correlation for these scores was .74 ( d f - 2 ( > , p< .001). Changes in sibling behavior at termination. Table 2 presents the mean sibling values at baseline, the fourth week of intervention, and at termination for each family. Complete intervention data were available for 26 of the 27 treated families. The one-way repeated-measures analysis of variance produced a significant F value of 3.785 (df = 2, SO, p < .029). Across the 26 families the average sibling showed an average reduction of 36% from baseline level. In 11 families the average sibling's rate of deviant behavior had dropped by more than 30% by termination. Twenty-seven of the 55 siblings in the study (or 49%) evidenced a reduction of at least 30% in deviant behavior rates over intervention. Across-family means of sibling and identified problem-child
J. E. ARNOLD, A. G. LEVINE, AND G. R. PATTERSON TABLE 2 WITHIN-FAMILY MEAN SIBLING RATES OF TOTAL DEVIANT BEHAVIOR (RESPONSES PER MINUTE) FOR INTERVENTION AND FOLLOW-UP Intervention
% change from baseline
B B A A A A A A B A A A A B A B B B B B A A A A A A A
.492 .277 1.150 .345 .540 .073 .790 .980 .360 .280 1.450 .460 .900 .280 .105 .561 .375 .267 .529 .133 .167 .367 .133 .284 .750 1.625 1.411
.125 .650 .450 .100 .000 .850 .200 .000 .267 .200 .125 1.400 .700 .350 .400 .250 .250 .375 .000 .100 .600 .000 .700 .100 .550 .600
1.089 .100 .325 .275 .034 .000 .250 .900 .000 .733 .200 .500 .200 .200 .100 .100 .350 .625 .325 .200 .500 .400 .100 .450 .900 1.200 .400
+ 121.3 -63.9 -71.7 -20.3 -93.7 -100.0 -68.4 -8.2 -100.0 + 161.8 -86.2 +8.7 -77.8 -28.6 -4.8 -82.2 -6.7 + 134.1 -38.6 +50.4 + 199.4 +9.0 -24.8 +58.5 +20.0 -26.2 -71.7
11 12 14
15 16 17 18 21 22 24 25 26 27 28 29 31 32 33 35 36 38 39 40 42 43 44 45 Mean
Follow-up M M follow-up, % change follow-up, % change months from months from 1-6 baseline 8-12 baseline .294 .129 .635 .475 .367
-40.2 -53.4 -44.8 +37.7 -32.0
.383 .108 .329 .450 .217
-22.2 -61.0 -71.4 +30.4 -59.8
.350 .050 .456 .592
-64.3 -86.1 +62.9 -59.2
+25.0 + 166.1
+ 11.1 +96.4
.373 .521 .275 .362 .288 .058 .125
+39.7 -1.5 + 106.8 + 116.8 -21.5 -56.4 -56.0
.258 .692 .267 .317 .475 .133
-3.4 +30.8 + 100.8 +89.8 +29.4 0
Note. "A" status signifies "involved"; "B" status signifies "uninvolved."
deviant behavior rates during intervention are presented in Figure 1. In general, the magnitude of the treatment was less for the siblings than it had been for the identified problem child (Patterson, 1974b). Maintenance of Changes in Sibling Behavior through Follow-up Whereas relatively complete data (at least 3 months) were collected for 74% of the families in the first 6 months of follow-up, home observation data were available for only 59% of the families during Months 8-12 of follow-up. The 16 families for whom relatively complete, 1-year sibling follow-up data were obtained appear, as a group, to be unrepresentative of the sample as a whole. That
is, the average sibling in the subsample that completed follow-up was less deviant at baseline than the subsample that failed to participate in or finish follow-up. The mean rates were .478 and .755, respectively. Additionally, the average sibling who completed follow-up evidenced less reduction in deviant behavior during intervention than did the average sibling who dropped out of follow-up (mean percentage of reduction during intervention of siblings not completing follow-up was 36.8%; ./V = 11) as compared to a percentage reduction of 23.3% (N = 16) for those families for whom relatively complete 1-year follow-up was available). Therefore, emphasis is placed on observation data collected in the first 6 months of follow-up.
CHANGES IN SIBLING BEHAVIOR FOLLOWING FAMILY INTERVENTION From Table 2 the mean deviancy rate for the average siblings in the 20 families who participated in the first 6 months of follow-up was .392. Comparing this to the termination mean of .398 for this group indicates that, on the whole, the siblings' treatment effects were maintained over the first 6 months 'following intervention. This conclusion is supported by the / test for related measures that compared rate changes between termination and the average of Months 1-6 of the follow-up, t (19) = .067, us. There were 42 siblings in the 20 families that completed the first 6 months of follow-up. For 21 of them, their mean follow-up rate was at least 30% below their base rate level. In 18 of the 27 families, one or more of the siblings were actively included in the parents' treatment program. The mean baseline rates for the involved subset of siblings were higher than those for the remainder of the sample (.658 vs. .365), thus indirectly supporting the clinical judgment to include those siblings in treatment. However, a two-tailed t test comparing baseline rates for the involved and noninvolved groups yielded nonsignificant results, t (25) = 1.718, p < .10, two-tailed. The magnitude of the treatment effect also appeared larger for the involved subset of siblings; however, the appropriate two-way repeated-measures analysis of variance comparing involved and uninvolved sibling rates from baseline to termination yielded a nonsignificant F value. Similar nonsignificant results were obtained when male/female sibling behavior was examined using a twoway repeated-measures analysis of variance. DISCUSSION The initial hypothesis of this study was that the children referred for treatment to the Oregon Research Institute were not significantly more deviant than their siblings. Analyses performed on the baseline home observation data supported this hypothesis; nonsignificant results were found when comparing the rates of total deviant behavior of the referred child to the total deviant behavior of his siblings. This tends to support the results from earlier analyses for small samples (Patterson et al., 1968, 1973).
The fact that there were no significant differences between siblings and problem children in their rates of deviant behavior at baseline raises a question about the process by which a family comes to label one of its members as deviant. The data presented here emphasize the often capricious quality of the deviancy labeling process. The high baseline deviant behavior rates of siblings also raise a question about the appropriateness of solely treating the referred child in home intervention programs. In many instances a family may contain more than one "deviant" child, although only one child may be so labeled by the parents. In such cases, failure to treat all deviant children within the family may portend ill for the long-term treatment outcome of the referred child, since as has already been mentioned, there is some evidence to implicate siblings as "triggers" for considerable portions of the "problem child's" deviant behavior (Patterson, 1973; Patterson & Cobb, 1973). Thus, effective treatment seems to require changes in the family system, particularly in the behavior of the siblings. In addressing the generalization issue of whether intervention did have an impact on the observed rates of deviant behavior of the siblings of the referred children, we hypothesized that the repeated-measures analysis of variance on the observation data from baseline to termination would demonstrate a significant decrease in the siblings' rates of deviant behavior and that the treatment effects would maintain through follow-up. The results clearly support the hypothesis that the family intervention aimed primarily at the referred child did, in fact, generalize to the siblings as well. Whether the sibling data are looked at across families, within families, or individually without reference to family, the data analyses consistently reveal that sibling rates of deviant behavior were greatly reduced by the end of treatment and that, as a group, these reductions were maintained during the first 6 months of follow-up. It would appear that the parents are learning a set of skills that they are then applying to the siblings as well as the referred children. This is in keeping with the findings of Taplin (1974), who showed changes in the con-
J. E. ARNOLD, A. G. LEVINE, AND G. R. PATTERSON
sequences provided by the parents for deviant child behaviors. Even though some of the changes in sibling deviant behavior may be attributable directly to the changes in the behavior of the referred child (it would be logical to assume that referred children act as triggers for their siblings' deviant behavior), the series of studies suggests that changes may occur within the entire family system, lending further support to the growing body of evidence that families function as an interactive system (Patterson & Reid, 1970; Patterson & Cobb, 1973) and also suggests that in home intervention programs closer attention should be paid to sibling behavior during and following treatment of the referred child. It is interesting to note, however, that while the magnitude of the treatment effect appeared larger for those siblings who were actively involved in treatment, the appropriate analysis comparing involved and uninvolved siblings from baseline to termination yielded nonsignificant results. Apparently, treatment generalized to the siblings of the referred children whether or not the siblings were specifically involved in the intervention, yielding further credence to the notion that the parents have learned a general set of child management skills rather than a specific method of dealing with a specific child. Additional studies involving more random assignment of siblings to involved and uninvolved groups are indicated to further test this notion. REFERENCES Baer, B. M., Wolf, M. M., & Risky, T. R. Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1968, 1, 91-97. Berkowitz, B. P., & Graziano, A. M. Training parents as behavior therapists: A review. Behaviour Research and Therapy, 1972, 10, 297-317. Hollingshead, A. B., & Redlich, F. C. Social class and mental illness. New York: Wiley, 1958, Jones, R. R., Reid, J. B., & Patterson, G. R. Naturalistic observations in clinical assessment. In P. McReynolds (Ed.), Advances in psychological assessment (Vol. 3). San Francisco: Jossey-Bass, 1975. Kazdin, A. E., & Bootzin, R. R. The token economy: An evaluative review. Journal of Applied Behavior Analysis, 1972, 5, 343-372.
McCall, R. B., & Appelbaum, M. I. Bias in the analysis of repeated-measures designs: Some alternative approaches. Child Development, 1973, 44, 401-415. Patterson, G. R. Behavioral intervention procedures in the classroom and in the home. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change. New York: Wiley, 1971. Patterson, G. R. Changes in the status of family members as controlling stimuli: A basis for describing treatment process. In L. A. Hamerlynck, L. C. Handy, & E. J. Mash (Eds.), Behavior change: Methodology concepts and practice. Champaign, 111.: Research Press, 1973. Patterson, G. R. Intervention for boys with conduct problems: Multiple settings, treatments and criteria. Journal of Consulting and Clinical Psychology, 1974, 42, 471-481. Patterson, G. R. The aggressive child: Victim or architect of a coercive system. In L. A. Hamerlynck, L. C. Handy, & E. J. Mash (Eds.), Behavior modification and families. I. Theory and research. New York: Brunner/Mayell, 1975, in press. Patterson, G. R., & Cobb, J. A. Stimulus control for classes of noxious behavior. In J. F. Knutson (Ed.), The control of aggression: Implications from basic research. Chicago: Aldine, 1973. Patterson, G. R., Cobb, J. A., & Ray, R. S. A social engineering technology for retraining the families of aggressive boys. In H. Adams & I. Unikel (Eds.), Issues and trends in behavior therapy. Springfield, 111.: Charles C Thomas, 1973. Patterson, G. R., Ray, R. S., & Shaw, D. A. Direct intervention in families of deviant children. Oregon Research Institute Research Bulletin, 1968, 8, No. 9. Patterson, G. R., & Reid, J. B. Reciprocity and coercion: Two facets of social systems. In C. Neuringer & J. Michael (Eds.), Behavior modification in clinical psychology. New York: AppletonCentury-Crofts, 1970. Patterson, G. R., & Reid, J. B. Intervention for families of aggressive boys: A replication study. Behaviour Research and Therapy, 1973, 11, 383394. Reid, J. B. Reliability assessment of observation data: A possible methodological problem. Child Development, 1970, 41, 1143-1150. Taplin, P. S. Changes in parent consequating behavior as an outcome measure in the evaluation of a social reprogramming approach to the treatment of aggressive boys. Unpublished doctoral dissertation, University of Wisconsin-Madison, 1974. Wahler, R. G. Setting generality: Some specific and general effects of child behavior therapy. Journal of Applied Behavior Analysis, 1969, 2, 239-246. (Received January 23, 1975)