WITHDRAWN: Optimizing Treatment for Children with Mild Intellectual Disabilities: Effects of Program Integrity and the Client-Therapist Relationship

Introduction: Youth with mild to borderline intellectual disabilities (MBID – IQ 55-85) and comorbid externalizing behavior are highly at risk for adverse future development. Therefore, reducing these behavioral problems is of great priority in the Dutch healthcare system. Due to specific characteristics of children with MBID (e.g., problems in social information processing), usual family interventions should be adjusted to the specific needs of these children and their parents. Currently, only one family intervention has been implemented in The Netherlands and has found to be effective in the reduction of externalizing behavior in children with MBID. “Standing Strong Together” targets both parenting skills in therapeutic sessions for parents, as well as problem solving skills in sessions for their children.

The current study: In the current study, secondary analyses of the effectiveness study about this intervention are conducted, with special focus on the importance of program integrity and the therapist-client relationship. Whereas there has been an ongoing debate about whether or not to adhere to the protocol, in order to build an effective therapist-client relationship, we take a more nuanced view in this matter. The current study suggests that therapists need to adhere to the protocol, but also show relation-stimulating behavior. We hypothesized that protocol adherence would lead to increased levels of relation-stimulating behavior of the therapist, which in turn positively influenced treatment outcomes.

Method: The current study includes 80 children (age 9-16) and their parents who were randomly assigned to the intervention condition of “Standing Strong Together”. Therapeutic sessions of these families were observed and behaviors were coded and validated. Outcome measures were externalizing behavior in the child with MBID and parenting quality of their parents. These outcome measures were assessed with questionnaires and completed by multiple informants. Data-analyses were performed by specification of a latent path model. Significance tests of direct and indirect effects from protocol adherence and the therapists’ relation-stimulating behavior to the outcome measures were conducted.

Results: As data-analyses are still ongoing, the results will be provided during the poster presentation.

Discussion: In the current study, we aim to reveal a working mechanism within treatment targeted at this highly vulnerable group in order to optimize the treatment. In this way, we aim to shift the focus from the question whether the intervention works, to why the intervention works.