Journal of Abnormal Child Psychology, VoL 6, No. 3, 1978, pp. 385~400

Evaluation of Behavioral Group Counseling for Parents of Learning-Disabled Children z Charles Diament 2 Children's Psychiatric Center Gep Colletti State U)ffversity of New York at Binghamton

The present study evaluated the effectiveness o f a behavioral group counseling program for parent members o f the Association .for Children with Learning Disabilities. Twenty-two mothers were assigned to two treatment groups {N = 5 and N = 6) and a controlgroup (N = 11). Treatment-group mothers received a series o f eight weekly 189 sessions in which they were taught basic principles and procedures o f behavior modification which they couM apply to specific child-rearing problems. Multiple-success criteria (maternal reports, direct observation, frequency counts, and attitudinal measures) were employed to provide a broad.based measurement of outcome. Results indicated that treatment ratings of childrens' conduct and disruption and parental postbehavioral observations o f mother-child interactions showed improvement for the behavioral-counseling groups while control-group ratings and behavior observations remained the same. All treatment-group changes were maintained at 3-month follow-up. Consistency of treatment-grou p data across measures and over time suggests the effectiveness o f this approach as a training method. Implications for future research were discussed. In light o f shortages o f t h e r a p e u t i c personnel and m o n e y ( A r n h o f f , Rubinstein, Shriver, & Jones, 1969), there has been a trend on the part o f m e n t a l health Manuscript received in final form February 2, 1978. An earlier version of this manuscript was submitted to Rutgers University. in partial fulfillment of the first author's doctoral research requirement. Our deepest appreciation is extended to the New Jersey Association for Children with Learning Disabilities (A,C.L.D.) of Morris County, who had only the concern of its member parents and children at heart when they decided to sponsor this project. We also wish to express our deepest gratitude to Mrs. Ellie Feeney for her help in typing this manuscript. 2 Address all correspondence to Charles Diament, Children's Psychiatric Center/Community Mental Health Center, 176 Riverside Avenue, Red Bank, New Jersey 07701. 385 0091-0627/78/0900-0385505.00/0 9 1978 Plenum Publishing Corporation

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professionals to develop effective and more economical means for both intervention and prevention of "mental health problems." This trend is reflected in the use of various mediators (Tharp & Wetzel, 1969) (including volunteer workers, teachers, and parents) in diverse therapeutic programs. Parents, however, have been the focal point: of work in this area and several reviews of the literature have already been published (O'Dell, 1974; Tavormina, 1974; Berkowitz & Graziano, 1972; Johnson & Katz, 1973). In order to better implement behavioral procedures in a less costly way, a trend, characterized by the treatment of parents in groups, has developed. The format of the groups is usually some presentation of didactic material or programmed text (e.g., Becket, 1971) that outlines principles of reinforcement theory and child management. However, the mere presentation of such principles will not in itself change the group's behavior (Patterson, 1971). The major task of the group involves the applications of the didactic material to the individual needs of each family. Several early reports in the literature represent attempts at behavioral group counseling (Walder, Breiter, Cohen, Daston, Forbes, & MacIntyre, Note 1; Walder, Cohen, Breiter, Daston, Hirsch, & Leibowitz, Note 2; Hirsch & Walder, Note 3; Salzinger, Feldman, & Portnoy, 1970; Peine & Munro, Note 4; Mira, 1970; MacPherson & Samuels, 1971). However, these early reports do not contain impartial and objective recordings by independent observers as true indices of change. Later reports make use of objective recordings, independent observers, and control groups. Wiltz (1970), for example, attempted to validate the group procedure versus a matched no-treatment control with six boys in each condition. Observers independently recorded objectively defined target behaviors. Results indicated that treated parents significantly decreased the rate of deviant behavior in their children while children in the control group showed an increase in inappropriate behavior. These results must be viewed with caution, however, since at baseline there may have been significant differences between groups in targeted behaviors. Walter and Gilmore (1973) extended the Wiltz study by comparing the group-counseling procedure to a placebo-treatment condition. A no-treatment control group was not provided. The results indicated that there was a 61% decrease in the frequency of targeted behavior for the treatment while the placebo group showed an increase of 37% in the target behavior. These results, although seemingly conclusive, must be also interpreted with some caution since Walter and Gilmore reported only within-group changes and did not provide any between-groups comparisons. Thus, although better controlled than earlier reports, both the Wiltz (1970) and the Walter and Gilmore (1973) studies suffer from methodological difficulties. Nevertheless, they do provide some tentative suppmzt for the notion that group instruction on the systematic and contingent application of behavioral principles to parents is a practical and possibly time-saving method to

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produce successful behavior change. Further support is provided by Patterson and his colleagues (Patterson, 1971, 1974; Patterson & Brodsky, 1966; Patterson, McNeal, Hawkins, & Phelps, 1967), who reported on their training programs for parents at the Oregon Research Institute. The main findings of this research indicated significant decreases in specific deviant behavior of targeted children and siblings. Patterson's program is clearly a sophisticated and complex one, which demonstrated that parents can be taught general behavior principles and their specific application to their own children. However, it is difficult to assess which of the procedures of this multifaceted program contributed most to the reported changes in parent-child interactions. Based on Patterson's results, it would be premature to conclude that short-term parenttraining groups, by themselves, affect parent or child behaviors. In a recent comparative outcome study, Tavormina (1975) provided a rigorous and systematic investigation of the relative effectiveness of behavioral and reflective group counseling. The subjects were 51 mothers of mentally retarded children who were assigned to behavioral, reflective, or waiting-list control groups. Multiple-success criteria, including direct observations, attitudinal scales, maternal reports, and frequency counts, were used to provide a broadbased measurement of outcome. Results indicated that both types of counseling had a beneficial effect as compared to the untreated controls, but that the behavioral method resulted in a significantly greater magnitude of improvement than did the reflective method in four of the five outcome areas. However, some difficulties exist in the interpretation of this study's results. Mothers were assigned to therapy or control groups on the basis of their choice to attend groups early or late in the year rather than on a random basis. This might represent a motivational confound. Secondly, there was a lack of observed behavioral changes during an analogue free-play situation designed to test the generalizability of improved parent and child behavior to the natural environment. Finally, no follow-up data were reported. Despite its limitations, however, this study lends tentative support to the hypothesis that short-term behavioral group counseling in and of itself is an effective treatment method, at least for counseling parents of the retarded. One can conclude, then, that behavioral group counseling when part of a larger, comprehensive treatment package can be an effective method of training parents to modify their children's problematic behaviors (cf. Patterson, 1974). However, more research evidence is necessary, using better controls for threats to internal and external validity, before one can draw the same conclusions about the efficacy of interventions involving only short-term parent-training groups. This is particularly important since in the applied setting these short-term groups tend to be used frequently as opposed to more expensive and time-consuming comprehensive programs. The present study attempts to objectively assess the efficacy of shortterm groups. Care has been taken to assure random assignment of subjects to

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groups to provide a more demand-free test of the generalizability of improved mother-child interaction and to better control for pretreatment, between-groups differences. It was hoped that these procedural refinements over previous studies,' along with the inclusion of sound follow-up, would increase confidence in the conclusions drawn from the results. Parent members of the Association for Children with Learning Disabilities were considered clinically relevant to select for study since they constitute a population for which there is a definite need of counseling. These parents need to learn to cope with the relatively greater than usual amount of child-rearing problems they encounter.

METHOD

Subjects Subjects were 22 mothers who responded to a newsletter advertisement by the Association for Children with Learning Disabilities (A.C.L.D.)of Morris County, New Jersey. They were selected on a first come, first served basis. Although fathers were encouraged to attend lecture sessions, mothers and their children served as the primary data source since data-collection sessions were conducted during normal working hours when the fathers were usually unavailable. All mothers were members of or had applied for membership to the A.C.L.D. and had become aware of the program by reading the organization's newsletter or by speaking to mothers who had previously participated in the program. The mother's average age was 35.7 years (range = 24-50 years); their treated children averaged 7.1 years of age (range = 4.0-12.6 years). Eleven of the mothers had previously received some form of psychological counseling in relation to their children. The sample's socioeconomic status ranged from middle to upper midd!e class; no minority-group families participated. Testing indicated that the children's average IQ as measured by the Peabody Picture Vocabulary Test was 99. Ten of the children were on medication and one had been involved with a behavior-modification project at school. Twelve of the children were enrolled in grade school; their average grade level was 3.9 years (range -- 1-7 grade). Five of the remaining 10 children were in kindergarten while 4 were enrolled in preschool. Only 1 of the children had not yet received any kind of formal education. Despite the fact that all parents were members of the A.C.L.D., many of the children had never been officially diagnosed as learning disabled. In fact, the children would be more appropriately described as manifesting moderate to severe behavioral and learning deficits. Their behavioral repertoires included tantrums, aggression, disobedience, and highly inappropriate verbalizations. Some of the children manifested typical learning disabilities (i.e., short attention

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span and perceptual deficits) with only moderate behavioral problems, while others manifested more generalized learning difficulties related to severe emotional or developmental disorders.

Experim enters The two experimenters (group leaders) were advanced clinical psychology graduate students at Rutgers University. Both had previous experience in conducting behavior-modification workshops and had extensive training and exposure to children with the learning-disability diagnostic label. The first experimenter, the author, had a minimum of 1,500 hours of supervised clinical internship experience, while the second experimenter was completing his clinical internship and already had 750 hours of supervised clinical experience at the time of the study.

Procedure All subjects were evaluated on all measures at the beginning of the study. They were then matched on the basis of age and randomly assigned to a treatment (N = 11) or control (N = 11) condition. The treatment subjects were then further randomly divided into two subgroups (N = 6 and N = 5), each of which was assigned an experimenter. There were no differences between these two treatment subgroups on any of the demographic variables. During October and November the treatment groups received a series of eight weekly 189 sessions of behavior-modification lectures while the control group received no treatment. Immediately following this period, all subjects were retested on all measures to determine posttreatment scores. After this evaluation session, all subjects waited until the beginning of March when all the measures were readministered so that follow-up scores could be ascertained. After this third evaluation session, mothers in the control group were exposed to the same treatment sessions that the other group had received. All mothers attended an initial introductory session during which they met the experimenters and were informed about the nature and purpose of the study. All the details of the study were disclosed, including the fact that only half of the mothers would be receiving treatment at the time. Those parents who had to await treatment were willing to do so because of the lack of services in the geographical area. The objective measures that were part of the program were briefly explained, and all of the mothers were asked to pay a $34 nonrefundable fee to the A.C.L.D., which covered that organization's costs in offering the lectures and providing the textbook. In addition, they were asked to sign a consent form and contract. Subsequently, they received the Bipolar Ad-

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jective Checklist and Target Behavior Rating Form to complete at home and return at the first lecture session. Several alternative times during which behavioral observations would be conducted were presented and mothers chose the time most convenient for them.

Treatment Mothers in the treatment groups were taught the principles of behavior modification and shown how to apply operant techniques to their specific child-rearing problems. The programmed text, Parents Are Teachers: A Child Management Program (Becker, 1971), was used as a general outline with reading assignments taken from the book. The group leaders followed a prearranged lecture manual and encouraged group discussion. The lectures spent 11A-2 hours preparing for the lectures, thinking of illustrations of the material and "troubleshooting" questions. Additionally, parents were encouraged to select target behaviors for their children and maintain graphs on those target behaviors before and after interventions. The lectures primarily focused on the use of praise, emphasis on positive rather than negative consequences, and the need to specify and observe behaviors targeted for change. The major group task was the application of these principles to each mother's specific problems. Group discussion, modeling, and role playing were used to enable each mother to devise and implement behavior change programs for her child.

Measures3 Bipolar Adjective Checklist (BAC) (Patterson & Fagot, 1967). Parental ratings of their children's behavior were obtained by having mothers complete the BAC at the first, last, and follow-up meetings. This form, which has been previously used to detect changes in parents' perception of their children following treatment (Eyberg & Johnson, 1974; Patterson, Cobb, & Ray, 1972), is a 47-item, scaled checklist that yields scores on the following five factors: tense disposition, withdrawn-hostile, aggression, intellectual deficiency, and conduct problems. Ratings of Target Behaviors. These were obtained at the first, last, and follow-up session by asking mothers in each condition to list the three most troublesome problems that they were having with their child. They were then asked to rate these problems on two dimensions (Patterson & Reid, 1973). The first dimension was a rating of the amount of disruption each problem causes at home. The second was the intensity of mother's emotional reaction to that 3Information regarding all measures employed in this study is available from the first author upon request.

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behavior. Five-point scales ranging from "no disruption" (1) to "significant disruption" (5), and "no emotional reaction" (1) to "considerable emotional reaction" (5) were provided. This form has been previously used to detect changes in parents' perception of their children's target behaviors following treatment (Tavormina, 1975). Behavioral Observations. Mothers and their children were observed in a school playroom on three occasions during the course of the study: at baseline (2 weeks before the beginning of the lectures), posttreatment (1 week after the last lecture), and follow-up (3 months after the last lecture). Behavioral observations were made as the mother-child interaction was observed for two 50-minute sessions at baseline and posttreatment and one 50-minute session at follow-up. At each observation session, data were collected on each mother and child for a total of 20 minutes. Accordingly, each mother-child pair was observed for 40 minutes at baseline and posttreatment and 20 minutes at followup. A maximum of five parent-child pairs and a minimum of four parent-child pairs were present at any particular observation session. To preclude the possibility of any bias at the baseline observation sessions, neither subjects nor observers knew which parents were assigned to either the treatment or control group. During the observation sessions, mothers were instructed to interact with their children in an unstructured, free-play situation. An assortment of games and other toys were provided and mothers were informed before the sessions that they would be permitted to bring their own toys if desired. Mothers were instructed to keep their children occupied, keep them in the playroom, and not allow their children to play or interact with the other children or parents. The behavioral Coding system employed was a slightly modified version of that developed by Cobb (Note 5) and has been used to differentiate between normal and deviant behavior (Gordon & Keefe, Note 6). Behavior interactions between mother and child were coded by means of a 12-category coding system. Four categories of appropriate behavior were recorded: approval, compliance, appropriate verbal interaction, and attending. Seven categories of inappropriate behavior were recorded: physical negative, destructiveness, disapproval, noisy, inappropriate verbal interaction, self-stimulation, and nonattending. The observers, equipped with stopwatches, clipboards, and observation sheets, sat as unobtrusively as possible in a corner of the room. They observed behavior for 10 seconds and recorded for 5 seconds continuously for a period of 10 minutes. One observer was a senior undergraduate student majoring in psychology with an extensive background in behavior modification, while the other was an advanced graduate student in clinical psychology. The author served as reliability checker. During training, the observers first studied and memorized a manual that described the behavioral categories in detail. They then practiced using the coding system while viewing videotapes of families interacting in an analogue home situation. They observed the tapes until their reliability with the

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checker was 85% or better. To determine reliability, sets of observer's protocols were compared event by event for each 10-second interval. The percentage agreement or reliability coefficient was the number of agreements divided by the total number of agreements plus disagreements. Training of observers took a total of approximately 8 hours. To preclude observer shift, drift, or drop (Romanczyk, Kent, Diament, & O'Leary, 1973), observers were not told whom the checker was watching. Additionally, observers were never told immediately after the observation sessions how well their individual category-observation sessions compared with those of the reliability checker. At least one of the observer's observations was checked for reliability at every 10-minute observation. Paper-and-Pencil Test. At the last lecture, a surprise test on the content of the course was administered to parents. The test included short-answertype questions on child management and related issues. This test provided a measure of how well the parents had learned the material that was presented in the lectures and in the homework assignments. Workshop and Leader Evaluation. A questionnaire assessing the parents' opinions of the lectures and their satisfaction with them was administered at the end of the lecture series. This questionnaire also provided the parents with an opportunity to provide feedback as to the likability of the leaders, the content and process of the course, and subjective appraisals of whether the course had worked for them.

RESULTS

Three subjects, one from the treatment group and two from the control group, missed one or more observation sessions for a total of five observations. This resulted in unequal cell frequencies for all measures, so missing values were calculated using means, and error terms were reduced by five degrees of freedom (one for each calculated missing value) (Bliss, 1967). None of the parents dropped out of the treatment. However, some parents were not able to attend all sessions. No more than two sessions were missed by any one mother and cassette-tape recordings were provided in those instances. All baseline measure (i.e., BAC, Target Behavior Rating, and Behavioral Observation Data) were subjected to a one-way analysis of variance to test for differences across treatment conditions and across the two treatment subgroups. These analyses showed no initial significant differences between groups on any measures, thereby indicating that no systematic differences on criterion measures existed among groups at the commencement of the study. Changes in outcome measures between baseline, posttreatment and followup were evaluated by a 2 X 3 analysis of variance with repeated measures for each of the dependent variables. Data for the two treatment subgroups were collapsed.

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Means for Bipolar Adjective Checklist: Conduct and tense disposition scales Conduct

Treat Control

Tense disposition

Pre

Post

F.U.

Pre

Post

F.U.

37.8 39.4

31.2 41.3

28.0 40.2

24.0 24.5

21.4 21.0

21.2 21.3

Means for behavior observations: Maternal praise, child nonattending, child attending, child noncompliance, and child negatives Pre Post F.U. Pre Post F.U. Child nonattending

Maternal praise Treat Control

1.5

2.1

8.6 1.8

10.0 2.2

Child attending Treat Control

56.4 50.6

71.6 65.1

7.3 9.5

.5 12.4

.0 12.2

Child noncompliance

74.0 62.2

.9 3.6

.3 .4

.5 .1

Child negatives Treat Control

.8 1.5

.0 .0

.1 .0

Also, an orthogonal set o f planned comparisons was chosen to evaluate at which time changes occurred. 4 To ensure that there was no differential change in the two treatment subgroups, posttreatment measures were subjected to a one-way analysis o f variance that revealed no differential improvement.

Bipolar Adjective Checklist There were no significant changes over pre, post, and follow-up on the Total scale or the Withdrawn-Hostile, Aggression, or Intellectual Deficiency scales o f the BAC. However, there was a significant treatment X time interaction on the Conduct scale ( F = 15.58, df = 2/35, p < .005), indicating differential improvement among groups. Planned comparisons indicated that this significant interaction was a function o f an improvement in the treatment group from baseline to posttreatment ( F = 30.08, df = 1/35, p < .005). Both groups remained relatively stable from posttreatment to follow-up. Additionally, parents in both groups rated their children as more relaxed on the BAC at posttreatment and follow-up than at baseline ( F = 3.55, dr= 2/35, p < .05). For means, see Table 2. 4 The problem of planned comparisons is not a simple one and statisticians who have worked upon the problem are not themselves in complete agreement as to procedures. For example, Hayes (1963) insists that planned comparisons be used instead of the ordinary F test. Bliss (1967), however, feels that planned comparisons can be used in addition to the F test. In the present investigation, Bliss's recommendations were followed.

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Ratings of Target Behaviors There were no significant changes over data-collection periods in the mothers' ratings of intensity of their emotional reactions to troublesome behaviors. No significant treatment • time interaction was evident for the mothers' ratings of the amount of disruption that troublesome behaviors caused at home, although planned comparisons revealed that the treatment group's ratings reflected significant improvements from baseline to posttreatment (F = 4.59, df = 1/35, p < .05). Both groups remained relatively stable from posttreatment to follow-up.

Behavior Observations The mean interrater reliability for parent and child behavior was 2.5% (range = 77.3-100%). The behavioral code was broken down into 12 categories for mother and child; resulting in a total of 24 categories. Each of these categories was treated as an individual dependent variable. The data indicated that when treatment mothers were compared to controls, they praised a mean of 1.5 as opposed to 2.1 times at baseline, 8.6 as opposed to 1.8 times at posttreatment, and 10 as opposed to 2.2 times at follow-up. Every mother in the experimental group increased her quantity of praise. An analysis of variance revealed a significant main effect for praise (F = 10.59, df = 1/15, p < .01). There was also a significant treatment • time interaction (F = 22.57, df = 2/35, p < .005), which, planned comparisons indicated, was a reflection of significant treatment-group increases from baseline to posttreatment (F = 44.59, df = 1/35, p < .005). Both groups remained relatively stable from posttreatment to foUow-up. For means, see Table I. When treatment children were compared to controls they failed to attend a mean of 7.3 as opposed to 9.5 times at baseline, .5 as opposed to 12.3 times at posttreatment, and 0 as opposed to 12.2 times at follow-up. An analysis of variance revealed a significant treatment X time interaction (F = 4.99, dr= 2/35, p < .025), which, planned comparisons indicated, was a reflection of significant treatment-group reductions from baseline to posttreatment (F = 9.99, dr= 1/35, p < .005). Both groups remained relatively stable from posttreatment to follow-up. Children in both groups attended significantly more at posttreatment and follow-up than they did at baseline (F = 3.88, df = 2/35,p < .05). Additionally, all children failed to comply significantly less at posttreatment and follow-up than at baseline (F = 3.46, df = 2/35, p < .05) and uttered significantly fewer negative statements at posttreatment and follow-up than at baseline (F = 3.72, df -- 2/35, p < .05). None of the other categories changed significantly as a function of either treatment or time.

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Paper-and-Pencil Test The mean grade on the test was 89.5% (range = 78-100%), indicating that parents had learned the material presented in the lectures and in the homework assignments.

Workshop and Leader Evaluation The treatment subgroups expressed satisfaction with the treatment sessions they participated in on the posttreatment program evaluation. Their mean ratings on a 5-point scale ranging from 1 = "very dissatisfied" to 5 = "very satisfied" were 4.0 and 4.4, respectively. Subjects' mean scores on a 5.point scale o f therapist likability, with 5 = "very likable," were 4.3 and 4.6, respectively.

Quasi-Replication After follow-up, when the control group mothers were exposed to treatment, they also significantly increased their use o f praise statements (t -- 4.50, df = 7, p < .005) while their children reduced nonattending behavior (t = 2.50, df = 7, p < .025). s These data strongly suggest replicability of the results.

DISCUSSION

These results indicate that the present training course equipped mothers with skills in behavior modification that they were able to apply in an analogue free-play situation. As demonstrated by the observation measure, every mother in the treatment group began to use more praise as a consequence for her child's behavior. Concomitantly, there are changes in the behavior of the treated children, who reduced significantly their nonattending behavior. The observation data suggest that as the children in both the treatment and control groups acclimated to the observation sessions, they attended more and showed less noncompliance. s Nine of the 11 control-group mothers were observed at pre- and posttreatment for maternal praise. One of those 9 mothers, however, was observed at posttreatment only. Therefore, the group mean was substituted for the missing observation and the degrees of freedom reduced from eight to seven. While all 11 control-group mothers were observed for child nonattending, one post- and two pretreatment observations were missed. Again, the group mean was substituted for the three missing observations and the degrees of freedom reduced from 10 to 7 accordingly.

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Also, they issued fewer negative statements. The changes in the mothers and children of the treatment group were maintained for a 3-month follow-up period. Furthermore, these same changes were evidenced by the mothers and children of the control group after treatment was administered subsequent to follow-up. This strongly suggests replicability of the.results. The alternations in behavior are particularly significant for several reasons. First, neither mothers nor their children were directly instructed to change specific aspects of their behavior. Rather, the mothers had been taught the principles of behavior modification in a lecture format, and they were able to apply what they had learned in an analogue to the natural environment. Second, previous studies failed to accomplish changes in free play (Tavormina, 1975). The present investigation controlled for baseline differences and demonstrated that changes in free play were possible. Finally, the free-play situation in which mothers applied their newly acquired skills was under relatively less experimenter demand. Every treatment mother increased her quantity of praise while neither mothers nor their children were aware of the specific behaviors that were recorded by observers. This facet of the observation sessions, in conjunction with the lack of experimenter prompting of specific behaviors, suggests that the observed improvements had a substantial probability of occurring in the natural environment. It is not surprising that there were no changes on the other dependent measures on the behavioral code. Careful examination of those categories shows that for the most part they occurred at either extremely high or low baseline frequencies. There may have been "ceiling" or "floor" effects that reduced the likelihood of any further observable increases or decreases. However, the change in praise is particularly relevant since an increase in positive statements can, in and of itself, improve a child's behavior (Madsen, Becker, & Thomas, 1968). The value of a reduction in a child's failure to attend is self-evident. In addition to these objective changes, mothers in the treatment group tended to evaluate their children's conduct more favorably following treatment. Mothers also felt that those troublesome behaviors that persisted after treatment caused less disruption at home. Although the validity and reliability of subjective data are questionable, the data are important because they provide an indirect measure of consumer satisfaction. Also, it is typically the subjective opinions, rather than objective data, which prompt parents to seek treatment for their children at child guidance clinics and community mental health centers (Wiggins, 1973). It also appears that when parents feel subjectively that there has been improvement they terminate treatment. The present data suggest that at the very least, mothers viewed their children's behavior as improved following treatment. The high scores on the paper-and-pencil test indicate that mothers had apparently learned the lecture material and ~that the lectures had provided them with sufficient skills to cope with specific problems encountered at home. The ability to cope probably made mothers feel that there was a reduction in behavior problem frequency.

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Consistent with previous reports (Tavormina, 1975; Wiltz & Patterson, 1974), all mothers in treatment felt that the lectures were extremely worthwhile, and that the leaders were both competent and likable. Since the posttreatment evaluations remained anonymous, it is less likely that mothers would have deliberately concealed their feelings on the forms for fear of offending the lecturers. Nevertheless, it is difficult to distinguish the mothers' real feelings from their need to justify the time and effort spent on the group. The present results are clinically significant since the subjects represented a random sample of mothers with varied behavioral- and learning-disordered children. In addition, nearly half of the children were receiving prescribed medications as a means of controlling their disruptive behavior. In all likelihood, these mothers would have sought psychological counseling at mental health centers and child guidance clinics and with private practitioners. The present results imply that a less time-consuming and more economical way of providing services to such families is available. The data indicate that behavioral groups may offer relief for overburdened clinicians, particularly those who practice in community mental health centers with large catchment-area populations and relatively small staff. For instance, a reduction of waiting-list size might be accomplished by providing all families on waiting lists with an initial screening interview designed to assess whether they could benefit from a group similar to the one investigated in the present study. If so, they could be enrolled in such a group, which the present data suggest would accomplish objective and subjective behavioral improvements. It is feasible that at least some of these families' needs would be satisfied and that either they would not require further treatment or their length of treatment would be shortened since they had already been provided with basic parenting skills. Alternatively, parents already in therapy could be referred to behavior-modification groups if their therapist's assessment was that the parents lacked such skills. Rather than having many individual therapists training individual families in behavior-modification principles, one therapist could conduct the group and treat several families at once. Since the present study did not employ a placebo control group, it is very difficult to determine the differential contributing effects of nonspecific factors such as attention, demand characteristics, etc. The consistency of results across individual behavioral subgroups strongly suggests that' this method could be applied with similar results across different leaders and with different groups of parents. The contribution of placebo effects should be analyzed in future research along with an analysis of the generalizability of these results to the home. This might be accomplished through the use of home observations. In addition, the effects of booster sessions, which may be helpful in maintaining the effects of the group process, should be examined before the workshops are offered on a wide-scale basis to the community. The effects of parental motivation are also important to consider in light of the high motivation that these parents exhibited. They were of a relatively high S.E.S., were willing to pay a $34 nonrefundable fee, and were willing to wait a long period of time to

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receive treatment. Additionally, they were selected on a first come, first served basis and therefore can be said to have been more eager to lear about their children's behavior than parents who were slow to respond. However, the purpose of the present investigation was to first ascertain whether short-term parent training groups can be effective. Future research should more clearly examine the relationship between motivational variables and success. The type of group studied in the present investigation should not be confused with the short-term workshops that Stein (1975) criticizes. He addresses himself to weekend/1-day workshops and cautions against attempts to disseminate a large quantity of information in a brief period of time. Stein feels that such attempts will result in the nonsystematic application of behavioral principles by workshop receipients and that this misapplication suggests a lack of understanding of the conditions under which the principles operate. Unlike those short-term workshops, participants in the present groups were given the opportunity, every week, to go home and practice what they had learned. Then, at subsequent sessions, they would be provided with feedback about their applications of behavioral principles. This feedback, usually lacking in shortterm workshops, is probably essential for the development of appropriate usage of behavioral techniques. It is not surprising, therefore, that the mothers in the present investigation, who had been provided with appropriate feedback, did not misapply behavioral principles and seemed to understand the conditions under which the principles work. It would be extremely unfortunate if the negative side effects of those short-term workshops, which would be more appropriately used as a means of "turning on" people to behavior modification, should be attributed to relatively long-term workshops such as the one investigated in the present study. The type of group treatment suggested in the present investigation is not a panacea for all parents and all children nor will it offer relief for all types of behavioral and emotional disorders. The treatment is designed solely as a means of acquainting parents with the basic principles of behavior modification and would probably be best used as an adjunct to traditional forms of counseling. The group should be considered as one facet of a more broadly based treatment program and should not be indiscriminately offered to all parents.

REFERENCE NOTES

1. Walder, L. O., Breiter, D. E., Cohen, S. I., Daston, P. G., Forbes, J. A., & Maclntyre, R. W. Teaching parents to modify the behaviors o f their autistic children. Paper presented at the 74th annual convention of the American Psychological Association, New York, 1966.

2. Walder, O. O., Cohen, S. I., Breiter, D. E., Daston, P. G., Hirseh, I. S., & Leibowitz, J. M. Teaching behavioral principles to parents o f disturbed children. Paper presented at the meetings of the Eastern Psychological Association, Boston, 1967.

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3. Hirsch, I., & Walder, L. Training mothers in groups as reinforcement therapists for their own children. Proceedings of the 77th Annual Convention of the American Psychological Association, 1969, 4, 561-562. 4. Peine, H., & Munro, B. Training parents using lecture demonstration procedures and a contingency managed program. Unpublished manuscript, University of Utah, Salt Lake City, Utah, 1970. 5. Cobb, J. A. Manual for coding academic survival skill behaviors and teacher/peer responses (Report No. 3). Eugene, Oregon: University of Oregon, Center for Research and Demonstration in the Early Education of Handicapped Children, 1971. 6. Gordon, S. B., & Keefe, F. J. Naturalistic observations of classroom behavior of normal and deviant children. Unpublished manuscript, Rutgers Medical School, 1976.

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