Dokument

Zusammenfassung:
Die Prävalenz psychischer Störungen bei Kindern liegt weltweit bei ca. 13 %. Es lässt sich eine Unterteilung in internalisierende und externalisierende Störungen vornehmen, die jeweils mit ernsthaften Beeinträchtigungen einhergehen. Bisher konnten sowohl biologische und psychologische sowie umweltbezogene Ursachen psychischer Störungen gefunden werden. Eine rechtzeitige und wirkungsvolle Behandlung ist wichtig, um den Verlauf dieser Störungen und die kindliche Entwicklung positiv zu beeinflussen. Dabei spielt der Einbezug der Eltern in die Behandlung der Kinder eine wichtige Rolle. Im vorliegenden Kumulus werden drei Publikationen vorgestellt, die sich mit der Wirksamkeit elternzentrierter Interventionen in der Behandlung von Kindern mit internalisierenden und externalisierenden Störungen beschäftigen. Da die Eltern eine wichtige Rolle für die gesamte kindliche Entwicklung spielen, werden ebenso die Auswirkungen von Elterntrainings auf spezifische Elternvariablen dargestellt. In Publikation 1 wurde mittels eines systematischen Reviews die vorhandene Literatur zur Wirksamkeit elternzentrierter Interventionen in der Behandlung von internalisierenden und externalisierenden Störungen überblicksartig zusammengefasst. Insgesamt konnten Belege für die Wirksamkeit gefunden werden, wobei sich die Forschungsbasis für externalisierende Störungen deutlich breiter präsentierte als für internalisierende Störungen. Die vorliegenden meta-analytischen Befunde zur Wirksamkeit von Elterntrainings bei externalisierenden Störungen weisen dabei jedoch heterogene Effekte sowohl für bestimmte Elternvariablen als auch für die Veränderung des kindlichen Verhaltens auf. Deshalb wurden in Publikation 2 und 3 mittels Meta-Meta-Analysen diese Befunde zusammengefasst, um einen genaueren Eindruck über die Höhe der Effekte auf spezifische Elternvariablen (Erziehungsverhalten, elterliche Wahrnehmung, elterliche psychische Gesundheit, elterliche Beziehungsqualität) bzw. auf das kindliche Verhalten (allgemeines kindliches Verhalten, externalisierendes Verhalten) zu erhalten. Um einer möglichen Verzerrung der Ergebnisse durch Überlappungen von Primärstudien vorzubeugen, wurden diese in den Berechnungen berücksichtigt. Bezüglich der Elternvariablen konnten für das Erziehungsverhalten sowie für die elterliche Wahrnehmung moderate, stabile Effekte gefunden werden. Allerdings konnte die Wirksamkeit auf das Erziehungsverhalten durch Daten zur Verhaltensbeobachtung nicht bestätigt werden. Für die elterliche psychische Gesundheit und die Beziehungsqualität zeigte sich hingegen jeweils nur ein kleiner Effekt, der sich im Follow-Up nur für die elterliche Beziehungsqualität als stabil erwies. Bezüglich der Wirksamkeit von Elterntrainings auf das kindliche Verhalten konnten für alle untersuchten Variablen (allgemeines kindliches Verhalten, externalisierendes Verhalten) über alle Messzeitpunkte hinweg (Post-Intervention, Follow-Up) moderate Effekte gefunden werden. Dabei konnte die Wirksamkeit auf das kindliche Verhalten auch anhand von Verhaltensbeobachtungen bestätigt werden. Insgesamt wurde eine deutliche Heterogenität in den Analysen festgestellt, auf die in der Diskussion hinsichtlich möglicher Ursachen eingegangen wird. Zusammenfassend lässt sich feststellen, dass Elterntrainings eine evidenzbasierte Intervention für die Behandlung von Kindern mit psychischen Störungen darstellen und aus diesem Grund in der klinischen Praxis eingesetzt werden sollten.

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