Few studies have evaluated the effectiveness of empirically supported therapy in applied settings, or typical service in such settings. In this study, parents seeking help at a children’s mental health center for managing their 3- to 8pyear-old children’s behaviors were randomly assigned to one of three conditions: Webster-Stratton’s Parents and Children Series (PACS) parenting groups (146 families), the eclectic approach to treatment typically offered at the center (46 families), or a wait-list control group (18 families). After 15 weeks, mothers in both treatments reported fewer child behavior problems than mothers on the wait list. Mothers in the PACS program reported fewer behavior problems and greater satisfaction with treatment than mothers in the eclectic treatment. These findings support he effectiveness of the PACS program, relative to typical service, for parents seeking help managing their children’s behavior.
Incredible Years: Treatment
Early onset of behavioural problems has lasting negative effects on a broad range of lifetime outcomes, placing large costs on individuals, families and society. A number of researchers and policy makers have argued that early interventions aimed at supporting the family is the most effective way of tackling child behaviour problems. This study forms the economic component of a randomised evaluation of the Incredible Years programme, a programme aimed at improving the skills and parenting strategies of parents of children with conduct problems. Our results show that the programme provides a cost-effective way of reducing behavioural problems. Furthermore, our cost analysis, when combined with a consideration of the potential long-run benefits, suggests that investment in such programmes may generate favourable long-run economic returns.
Background: Parent training is one of the most effective treatments for young children with conduct problems. However, not every family benefits from this approach and approximately onethird of children remain in the clinical range at follow-up assessments. Little is known about factors affecting treatment outcome for young children. Method: Hierarchical linear modeling methods were used to examine the effects of child attentional risk factors (inattention, impulsivity and hyperactivity problems), parental and familial risk factors upon the efficacy of a parent training program to decrease boys? conduct problems. Mothers of 81 boys, four to seven years of age, exhibiting conduct problems attended a parent training program (The Incredible Years) which lasted 22 to 24 weeks. Treatment effectiveness was assessed at one month and one year post treatment by means of independent home observations, parent and teacher reports. Results: Results indicated significant decreases in observations of mothers? negative parenting interactions with their children and decreases in their conduct problems according to mother reports and independent observations at home. Boys with elevated ratings of attentional problems in addition to conduct problems showed similar benefits from the parent training program as the boys who did not have attentional problems.
Abstract: To evaluate the 12-month efficacy of a parentbased intervention programme on children?s and mothers? outcomes in a sample of Portuguese preschoolers displaying early hyperactive and inattentive behaviours (AD/HD behaviours), 52 preschool children whose mothers had received the Incredible Years basic parent training (IY) were followed from baseline to 12 months of follow-up. Reported and observational measures were used. Effects were found in the children?s reported AD/HD behaviours at home and at school after 12 months. Large effect sizes were also found in mothers? variables: a decrease in selfreported dysfunctional parenting practices and an improved sense of competence and observed positive parenting. However, the improvements in coaching skills that have been observed after 6 months of follow-up decreased over time. No other significant differences were found between 6 and 12 months follow-up, with small effect sizes indicating that the significant post-intervention changes in child and parenting measures were maintained. After 12 months of follow-up, there was a clinically important reduction of over 30 % in reported AD/HD behaviours in 59 % of children. The sustained effects observed both for children and their mothers suggest long-term benefits of IY. Therefore, efforts should be made by Portuguese policy makers and professionals to deliver IY as an early preventive intervention for children displaying early AD/HD behaviours.
The Webster-Stratton Incredible Years (IY) Therapeutic Dinosaur School intervention was evaluated in clinically referred children with behavioural disorders. Results suggest that this is an effective intervention.
The diagnosis Conduct Disorder (CD) is used to refer to severely disruptive, aggressive and/or destructive behaviour characterised by a repetitive and persistent pattern of anti-social behaviour in children and adolescents with an estimated prevalence between 1.5 and 3.4% (Woolfenden, Williams, & Peet, 2002).
For conduct-disordered children the need to learn and use effective relationship skills in social situations is paramount. Considerable evidence has demonstrated that programmes which enhance parenting skills result in significant improvements in the behaviour of these children (Kazdin, 1995) and parent training is seen as the intervention of choice for these children. However, there is a place for interventions that teach relevant skills directly to children alongside or, when this is not possible, instead of working with parents.
The IY Dinosaur School programme (Webster-Stratton, Mihalic, Fagan, Arnold, Taylor, & Tingley, 2001) is one of a set of interlocking programmes for parents, children and teachers. It was developed as a clinical child-training intervention for small groups of children aged four to eight years. It teaches children to develop more appropriate social and problem solving skills.
There is lack of research on the importance of including fathers in parent training programs. This study?s? main purpose is to examine the short-term effects of fathers attending an Incredible Years Parent Training (IY) for Portuguese preschoolers with oppositional/defiant symptoms. Thirty-six children (whose fathers were willing to attend a parenting group with their wives or partners) were randomly assigned either to receive the IY Program or to a waiting-list control group. Outcomes for the study included self-reported parenting-related variables and parents? ratings of their children?s behaviors. Data were collected before the intervention and six months after it. Results showed significant effects on fathers? positive parenting practices and ratings of children?s prosocial behaviors, as well as a reduction of the impact of symptoms on family functioning. Findings provided support for the short-term effectiveness of the IY intervention in Portuguese fathers of preschoolers with oppositional symptoms.
These therapies are getting a push because they have been shown in numerous clinical trials over the past decade to be effective on kids with severe behavioral problems, where other approaches have often failed. The techniques take a pragmatic approach, often using a set curriculum to teach new behaviors, rather than ferreting out the underlying emotional problem as with traditional psychotherapy. In another departure from traditional talk therapies, much of the counseling is often directed at parents.
Developed mostly in the past decade at academic centers, the therapies target kids with diagnoses like conduct disorder, oppositional defiant disorder or bipolar disorder, who are at risk of getting kicked out of school or breaking laws. By some
estimates, there are 1.4 million to 4.2 million children who meet the criteria for conduct disorders alone.
In the UK between three and seven percent of children aged five to 15 years meet diagnostic criteria for conduct disorder (CD; National Institute for Health and Clinical Excellence [NICE], 2006); boys are three times more likely than girls to have such problems (Hutchings, Williams, Martin, & Pritchard, 2011; Office for National Statistics, 2007). Children with early onset behavioral problems likely to develop into CD are at high risk for social and emotional problems, poor school attendance, school dropout, academic failure and delinquency (Webster-Stratton, Reid, & Stoolmiller, 2008). Over the last decade, teachers have reported increasing levels of behavioral problems within the classroom (Hutchings et al., 2011). These children are often taught by teachers who are ill prepared to cope with disruptive behavior (Webster-Stratton et al., 2008). They are also likely to receive less support and positive feedback from their teachers and their peers (Arnold et al., 1999). Exposure to a supportive teacher and a positive classroom environment improves the academic achievement of high-risk children (Werner, 1999). High levels of praise for appropriate behavior improve children?s behavioral, social, and emotional adjustment as does the use of proactive teaching and positive discipline strategies (Webster-Stratton et al., 2008). These studies demonstrate that there is a need for effective, evidence-based classroom intervention programs to support teachers.
Clinic mothers of 35 conduct-disordered children were randomly assigned to a waiting list control group, 9 weeks of individual therapy, or 9 weeks of therapist-led group therapy based on a standardized videotape modeling program. Mothers and their children were assessed at baseline, immediately after treatment, and 1 year later by home visits, twice-per-week telephone reports, and questionnaires. One month after treatment, both groups of treated mothers showed significant attitudinal and behavioral improvements compared with untreated controls. Additionally, the children in the two treatment groups showed reductions in child noncompliance compared with control children. At the 1-year follow-up, not only were most of the changes in mothers? behaviors maintained, but both treatment groups of children continued to show significant reductions in noncompliant and deviant behaviors. There were no significant differences on any of the attitudinal or behavioral measures between individual and videotape modeling group discussion therapies at the immediate or 1-year follow-up. Total therapist time was approximately 251 hr for the entire individual group and 48 hr for the entire videotape discussion group. Although both treatments seem to offer equivalent and sustained improvements for parents and conduct-disordered children, the therapeutic efficiency of the videotape modeling group format is more cost-effective.?
Review of the Incredible Years (IY) Parent, Teacher and Child Training Curricula and summarize research on the effectiveness of these three programs for reducing risk factors and strengthening protective factors associated with children?s social emotional development and school success. The chapter will include a focus on the role of home-school partnerships in preventing and treating children?s behavior problems and improving their school readiness as well as practical tips for engaging schools in the prevention and intervention process.
While researchers have long considered intelligence to be a key predictor of success in school, recent studies indicate that the social and emotional adjustment of young children are strong predictors of early academic achievement even after controlling for variations in children?s cognitive abilities and family resources (Grolnick & Slowiaczek, 1994; Raver & Zigler, 1997).
Children of incarcerated mothers are considered at risk for disruptive behavior problems and later delinquency. Parenting may play a key role in this intergenerational transmission of delinquency. The present study aimed to evaluate the effectiveness of the Incredible Years parent training, enhanced with home visits, for (formerly) incarcerated mothers to prevent disruptive behavior problems in their 2- to 10-year-old children, by means of a nationwide randomized controlled trial. Mothers of 133 children
(M age?76.91 months; 48.9% boys) were assigned to an intervention, consisting of group sessions and individual home visits, or a no-intervention control group. The intervention yielded significant effects on parenting and child behavior for maternal report. Marginally significant effects on child behavior were found for teacher report. The
results show short-term effectiveness of parent training for the high-risk and hard-toreach population of (formerly) incarcerated mothers and their children.
Although co-morbid diagnoses often are not the presenting problem for a child with ODD, they convey additional risk in short- and long-term treatment outcomes and may be directly or indirectly contributing to the externalizing behavior problems (C. Webster-Stratton, 1985, 1990). Thus, treatments that target children?s oppositional and aggressive behaviors, such as the Incredible Years (IY) Child Dinosaur Curriculum must be flexible enough to meet the needs of children with complicated profiles. Since young children cannot easily communicate their feelings or worries and the reasons for their misbehavior, it is important for therapists to look beyond the aggressive symptoms to the underlying reasons for the misbehavior.
Families referred to child welfare for maltreatment and neglect are frequently mandated to attend parenting programmes. Evidence-based parenting programmes (EBPs) are underutilized or not delivered with fidelity for this population. The Incredible Years (IY) Parenting programme is an EPB that has been proven to reduce harsh parenting, increase positive discipline and nurturing parenting, reduce conduct problems, and improve children?s social competence. There is also promising preliminary evidence that IY is an effective for families involved in child welfare (Hurlburt, Nguyen, Reid, Webster-Stratton, & Zhang, under review) and for foster parents (Linares, Montalto, MinMin, & S., 2006). The current paper describes how the updated IY parenting basic programme is delivered with fidelity to this population.
Children with intellectual or developmental disabilities (ID/DD) are more likely than typically developing children to experience behaviour problems. Parent training, such as the IncredibleYears Parent Training (IYPT) series, has been a widely used intervention to support families with children with or at-risk for behaviour problems; yet to date, this programme has not been used with parents with young children with developmental delay or disabilities.
This study examines the specific effects of adding a broader based, videotape treatment component (ADVANCE) to a basic videotape parent skills training program (GDVM). ADVANCE treatment trains parents to cope with interpersonal distress through improved communication, problem solving, and sulef-control skills. Seventy-eight families with a child diagnosed as oppositional-defiant or conduct-disordered were randomly assigned to either GDVM alone or GCVM plus ADVANCE..
Childhood aggression is escalating and at younger ages. The developmental progression of aggression in children suggests that the propensity for physical aggression and oppositional behaviour is at its highest at age two. Typically, as children develop, aggression begins to subside in each subsequent year and reaches a relatively low level prior to entering school (ages five to six). However, for some young children, levels of aggressive behaviour remain high and eventually result in the diagnosis of Oppositional Defiant Disorder (ODD) or early onset Conduct Disorder (CD). These labels refer to an aggregate of disruptive and antisocial behaviours that include high rates of oppositionality, defiance, and aggression. Studies indicate that between 7% and 20% of children meet the diagnostic criteria for ODD and/or CD and that these rates may be as high as 35% for children from low-income welfare-dependent families.
Subject Research on the prevention and treatment of aggression is vitally important because the emergence of early onset ODD/CD in preschool children is stable over time and appears to be the single most important behavioural risk factor predictive of antisocial behaviour for boys and girls in adolescence.4,5 In particular, physically aggressive behaviour in children as young as age three has repeatedly been found to predict the development of violent juvenile delinquency and drug abuse in adolescence,6 as well as depression and school dropout rates.7 There is some suggestion that, in the absence of intervention, early starter aggressive tendencies in children may crystallize around age eight.8 At this point in life, learning and behavioural problems may become less amenable to intervention and more likely to develop into a chronic disorder.9 Since treatment of aggression becomes increasingly difficult and more costly as children grow older, it seems both pragmatic and cost effective to offer treatment and prevention efforts during the toddler and preschool years. Unfortunately, recent projections suggest that less than 10% of school-aged children (and even fewer preschool-aged children) who need services for aggressive behaviour actually receive them;10 and less than half of this group receive empirically validated interventions.
Read the article (French version) (PDF)
Agressivité chez les jeunes enfants : services ayant fait leurs preuves dans la r?duction de l?agressivit?
Background: Parenting practices predict early childhood physical aggression. Preventive interventions that alter parenting practices and aggression during early childhood provide the opportunity to test causal models of early childhood psychopathology. Although there have been several informative preventive intervention studies that test mediation models in older children, no such studies have been conducted with younger children at high risk for psychopathology.
Method: Within the context of a randomized controlled trial, we examined whether changes in parenting practices mediate the effects of a family intervention on observed physical aggression among African American and Latino younger siblings of adjudicated youths.
Results: Improved parenting practices partially mediated the intervention effect on physical aggression. Improvements in harsh parenting, responsive parenting, and stimulating parenting explained a significant amount of the intervention effect on child physical aggression observed in the context of parent?child interactions. Parenting practices accounted for 38% of the intervention effect on physical aggression.
Conclusions: There was support for the hypothesized model of the prevention of physical aggression during early childhood. Intervention benefits on parenting practices partially accounted for intervention effects on physical aggression in young high-risk
Estimates have indicated that child conduct disorders encompass from one-third to one-half of all child and adolescent clinic referrals. Moreover the prevalence of these disorders is increasing, creating a need for service that far exceeds available personnel and resources.
Background: This study examined the effectiveness of an evidence-based parent training program in a real-world Scandinavian setting.
Method: Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self-referred to participate in the Incredible Years? Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self-report data with data from a recent efficacy study.
Results: Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months.
Conclusions: The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence-based U.S. protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy-access early intervention to families of children with or at risk of ADHD.
Summary: Parenting programmes that are delivered in group settings have the potential to help parents develop parenting skills that improve the behaviour of their young children. This review provides evidence that group-based parenting programmes improve childhood behaviour problems and the development of positive parenting skills in the short-term, whilst also reducing parental anxiety, stress and depression. Evidence for the longer-term effects of these programmes is unavailable. These group-based parenting programmes achieve good results at a cost of approximately $2500 (?1712 or ?2217) per family. These costs are modest when compared with the long-term social, educational and legal costs associated with childhood conduct problems.
Background: Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.
Objectives: To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.
We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.
We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.
Data collection and analysis:
Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.
This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.
Authors’ conclusions: Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.
Article is available for purchase: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008225.pub2/abstract
Aggressive children lacking prosocial strategies are often disliked by their peers and they tend to relate to friends in contexts, where there are high levels of aggression in the peer-group, which in turn may increase levels of child of aggression and other conduct problems (15). Interventions that lead to peer acceptance and enhanced social competence in the child with early conduct problems may disrupt the behavioural trajectories leading to lasting psychosocial problems.
Abstract: In the present study, predictors of persistent conduct problems among children aged 4?8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program, or combined parent training and child treatment. Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.
One effective means of preventing early-onset conduct disorder (CD) may be to target preschool children with ADHD before more serious conduct problems have escalated. Unfortunately, one limitation of the ADHD treatment-outcome literature is that comparatively little research has been conducted with samples of children under age seven.
Although research indicates that methylphenidate and other psychostimulants are effective in reducing core ADHD symptoms such as inattention and distractibility among preschoolers (see e.g., Connor, 2002), there is little evidence to suggest that these medications prevent the escalation of ADHD to ODD and CD in later childhood or adolescence
High correlations were observed between mothers’ and children’s behaviors in the unstructured clinic observation and the home observations. Results are discussed in relation to the potential of structured clinic observations to provide more relevant and efficient information about mothers and conduct-problem children.
Clinicians working with families typically encounter children who exhibit persistent patterns of antisocial behavior-where there is significant impairment in everyday functioning. This chapter deals with features that characterize young children to whom the label of oppositional defiant disorder and/or conduct disorder is frequently applied.
We examined the relative contribution of a variety of risk factors, including maternal history and socioeconomic background, current levels of stress and social support, mothers’ emotional state, and parenting competence in relation to “pervasive” (i.e., at home and school) and “nonpervasive” conduct problems and low social competence. Findings indicated similar risk factors for conduct problems and for low social competence, with an ordered increase it eh number of risk factors from normal to “nonpervasive to “pervasive” groups. Harshness of parent style (i.e., slapping, hitting, yelling) significantly distinguished between the three groups for low social competence and conduct problems. Positive affect, praise, and physical warmth from mothers were positively related to social competence but unrelated to conduct problem
The results of this study revealed significant correlations between mothers’ reports of depression and stress and Daily Discipline Interviews (DDI) and disciplinary strategies characterized as inflexible, inappropriate, and critical. These promising results suggest that the DDI may be a low-cost effecient way of getting reasonably accurate information about parent disciplinary approaches./p>
Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking.
The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13.
In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group.
Are the correlates for girls with early-onset conduct problems necessarily the same as for boys? It has been shown that externalizing symptoms such as disruptive, impulsive, hyperactive, inattentive, and overtly aggressive behaviors are important risk factors for boys’ continuing development of ODD and CD, whereas internalizing symptoms are not. In the absence of evidence, one cannot assume that this is equally true for girls.
We examined effectiveness of the IYPT as treatment and preventive intervention.
Results of 50 studies showed that the IYPT is effective regarding child behavior.
Effects with regard to distinct outcomes and distinct informants were found.
Initial severity of child behavior was the strongest predictor of effects.
The IYPT meets criteria for a well-established intervention.
The present meta-analytic review examined effectiveness of the Incredible Years parent training (IYPT) regarding disruptive and prosocial child behavior, and aimed to explain variability in intervention outcomes. Fifty studies, in which an intervention group receiving the IYPT was compared to a comparison group immediately after intervention, were included in the analyses. Results showed that the IYPT is an effective intervention. Positive effects for distinct outcomes and distinct informants were found, including a mean effect size of d = .27 concerning disruptive child behavior across informants. For parental report, treatment studies were associated with larger effects (d = .50) than indicated (d = .20) and selective (d = .13) prevention studies. Furthermore, initial severity of child behavior revealed to be the strongest predictor of intervention effects, with larger effects for studies including more severe cases. Findings indicate that the IYPT is successful in improving child behavior in a diverse range of families, and that the parent program may be considered well-established.
Families with socioeconomically disadvantaged and ethnic minority backgrounds are often hard to reach for the prevention and treatment of disruptive child behavior problems. We
examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority backgrounds in the Netherlands.
Findings from this study indicate that the Incredible Years Parent Training programme is a valuable intervention for many pre-school children displaying early signs of ADHD.
Attention Deficit Hyperactivity Disorder (ADHD; American Psychiatric Association [APA], 1994) is characterised by developmentally inappropriate levels of inattention, impulsivity, and over activity (APA, 1994; Barkley, 1997). These problems typically emerge in early childhood, are relatively persistent, and result in cross-situational impairment (e.g. at home and at school; APA, 1994). The current Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) specifies three subtypes of ADHD: predominantly inattentive subtype; predominantly hyperactive/impulsive subtype; or combined subtype. Problems must be evident in two or more settings (e.g. home and school), and the child must show significant impairment in social, school, or work functioning (APA, 1994; 2000). Prevalence estimates indicate that between 3-6% of school-aged children meet diagnostic criteria for ADHD (APA, 1994; 2000; Szatmari, 1992).
Left untreated, the long-term prognosis for these children is poor. Children with ADHD are at a much greater risk of experiencing problems in the educational, personal and social domains (Daley, 2006). Children with ADHD are also at a heightened risk of developing conduct problems, substance abuse, and interpersonal and occupational difficulties that can persist into adulthood (Manuzza et al., 1991; Taylor et al., 1996).
The IY parenting program has positive impacts for parents with a history of reported child maltreatment. While similar benefits were observed for both groups of parents in this study, results support delivering evidence-based parenting programs of longer duration and higher intensity than often used by agencies in the community serving parents in contact with child welfare. Practice: Agencies serving parents referred for child maltreatment should carefully examine the characteristics of the parenting programs they deliver. Use of a parenting program that has a sound base of empirical support, such as IY, and sufficient intensity and duration are likely necessary to make substantial changes in parents’ child-rearing practices.
Abstract (abstract only) Parents of 43 conduct-problem children, aged 3-8 years, were randomly assigned to one of two treatments: an individually self-administered videotape modeling treatment (IVM) and IVM treatment plus therapist consultation (IVMC). Randomization also included a waiting-list control group (CON). Compared with the control group, both treatment groups of mothers reported significantly fewer child behavior problems, reduced stress levels, and less use of spanking. Home visit data indicated that both treatment groups exhibited significant behavioral changes. There were relatively few differences between the two treatment conditions. However, the IVMC children were significantly less deviant than the IVM children, suggesting that the IVMC (with therapist consultation) treatment was superior to self-administered treatment with no therapist involvement. The added benefits of therapist involvement are discussed.
This study set out to evaluate the use of a video based parent training programme (The Webster?Stratton Programme) in the management of children referred to child mental health services for treatment of behaviour problems. Following diagnostic assessment children were assigned to one of two groups: parents of both groups completed the parenting programme and, in addition, in the second group the child received an intervention appropriate to his/her clinical presentation. The waiting list control group waited 3 months prior to allocation to either treatment group. Standardised rating scales were administered pre-treatment, post-treatment and at 6-month follow-up to both treatment groups, and at an interval of 3 months to the control group. Improvement was significantly greater in both the treatment groups than in the control group. Parenting training programmes are an effective intervention in the management of clinic-referred children with behaviour disorders.
Children with disruptive behavior problems (DBPs) constitute a large group among those cared for by child and adolescent social and psychiatric services. Serious anti-social behaviours, such as truancy,stealing, robbery and drug abuse, are very costly for society. Therefore, from a societal point of view, it is important to identify DBPs and introduce interventions already during the preschool years, aiming to prevent pathways leading from oppositional defiant disorder (ODD) to severe conduct problems in middle childhood and adolescence.
Management of behavior problems in an inpatient child and adolescent psychiatric unit is largely the responsibility of nurses, yet few evidence-based programs exist that prepare nurses for this role. A pilot study examined the effects of a 3-day standardized parent/teacher training program adapted for inpatient child and adolescent psychiatric unit nurses. Findings indicated that the standardized parent/teacher training program resulted in significant increases in self-reported use of child praise/incentives and working with parents, with accompanying desired changes in observed nurse behaviors during nurse?child play sessions. Participants rated the program positively and highlighted gains of greater empathy and fewer judgments of parents. Findings support evidence-based training programs for nursing staff and suggest further research.
Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021 children. Four separate meta-analyses were conducted, concerning overall EF, working memory, inhibition and cognitive flexibility. A medium correlation effect size was obtained for overall EF (ESzr00.22) and for inhibition (0.24), whereas a small effect size was found for working memory (0.17) and for cognitive flexibility (0.13). Moderator analyses revealed a stronger effect for older preschoolers compared to younger preschoolers, and for children from referred samples compared to community samples. These results show that EF, especially inhibition, is related to externalizing behavior problems already in preschool years.
The current paper reports on the feasibility of implementing an existing empirically-based program, The Incredible Years, tailored to parents of young children with Autism Spectrum Disorder (ASD). Parents raising preschool-age children (ages 3 to 6) with ASD (N=17) participated in a 15-week pilot trial of the intervention. Quantitative assessments of the program revealed fidelity was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, play-based child behavior skills, parent stress management, social support, and visual resources. More work is needed to further refine the program to address parent self-care, partner relationships, and the diverse behavioral and communication challenges of children across the autism spectrum. Furthermore, parent access and retention could potentially be increased by providing in-home childcare vouchers and a range of times and locations in which to offer the program. The findings suggest The Incredible Years is a feasible intervention for parents seeking additional support for child- and family-related challenges, and offers guidance to those communities currently using The Incredible Years or other related parenting programs with families of children with ASD.
Few direct studies have looked at the economic costs of conduct disorder or its consequences. Related studies suggest that costs are high. In the United States the cost for crimes committed by a typical juvenile delinquent (under 18) was estimated at $80,000? $325,000 (?56,000??232,000). Between ages 19 and 24 a typical adult criminal costs a further $1.2m. Victim costs were by the far the greatest part of this total. Dropping out early from school added $243,000?$388,000 to age 24, heavy drug use a further $150,000?$360,000. Rescuing a high risk youth from this typical life path was estimated to save $1.7m?$2.3m.
Background: While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. Method: In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5?6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5?6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview.
Results: While all children qualified for a diagnosis of ODD/CD before treatment, 5?6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5?6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems.
Conclusion: The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.
This paper presents 2-year follow-up data for a sample of 159, 4- to 7-year-old children with oppositional-defiant disorder (ODD) who were randomly assigned to: parent training (PT), parent plus teacher training (PT + TT), child training (CT), child plus teacher training (CT + TT), parent plus child plus teacher training (PT + CT + TT). At the 2-year follow-up, approximately 75% of children were functioning in the normal
range according to parent and teacher reports. Twenty-five percent of children were classified as treatment nonresponders at home and/or at school. Teacher training added significantly to long-term school outcomes for children who had pervasive behavior problems. Baseline, post, and 1-year follow-up parenting practices distinguished between home treatment responders and nonresponders (parents of nonresponders were more critical and less positive). For children with baseline pervasive home-school problems, baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home at the 2-year follow-up.
In addition, 80% of pervasive children whose mothers were highly critical immediately posttreatment were classified as school nonresponders at the 2-year follow-up.
Reference only for this article.
Mary and John, well-educated parents, were describing the problems they were having with their three-year-old-son. “He is unable to accept discipline, disobeys, has temper tantrums, demands attention, can’t get along with other children, and acts irritable and unhappy.” They had come to the Parenting Clinic at the University of Washington and were seeking help.
This paper describes the implementation.
Background: Conduct problems in children are common and have attracted considerable interest, not least because of their negative psychological, social and economic consequences. Controlled trials demonstrate that parenting programmes can be effective in reducing childhood behavioural problems, but much less is known about the processes of change or contextual factors that influence trial outcomes.
Objective: This study involved a process evaluation which was nested within a randomised controlled trial (RCT) of the Incredible Years Parenting Programme (IYPP) in Ireland. The study was designed to: (1) identify and examine the key facilitative and inhibitive factors associated with the implementation of the programme in disadvantaged settings; and (2) to assess the level of implementation fidelity (IF) achieved within the RCT evaluation.
Method: The process evaluation employed a longitudinal, mixed-methods approach, and consisted of two separate but related stages. In Stage One, the experiences of stakeholders (parents, practitioners and organisational managers) were assessed and explored using semi-structured interviews and focus groups. A series of in-depth interviews (N=81) was conducted with parents at pre-intervention (n=20), and at three follow-up time points, including 6- (n=33), 12- (n=20), and 18-months later (n=8). A further 16 interviews were conducted with group facilitators (n=11) and service managers (n=5) following delivery of the IYPP. Interview data were analysed using constructivist grounded theory. Stage Two was based on a mix of parent reports (N=103) and facilitator reports (N=11) designed to investigate aspects of fidelity within the RCT. Data were examined using a series of ANOVAs and correlational analyses.
Results: Three overarching themes were identified from Stage One, including: (1) ?Experiences of learned helplessness? (e.g. the association between child conduct problems and family conflict and social isolation); (2) ?Perceived benefits and mechanisms of change? (e.g. the links between positive outcomes and a number of factors, including key parenting skills, social support, longer-term resilience and commitment, and facilitative organisational practices); and (3) ‘Challenges in programme implementation’ (e.g. cultural discomfort with praise and positive attention,conflict with partners; and organisational difficulties with fidelity, attrition and sustainability). The findings from Stage Two indicated that IF was high in relation to therapist adherence (M=90%, SD=4%) and parental satisfaction (M=6.69, SD=0.14), but lower with regard to the retention of parents (M=8.23 sessions, SD=4.79). There were no statistically significant relationships between IF and the primary child behaviour outcome.
Conclusion: This process evaluation is one of the first studies to investigate the key short- and long-term factors associated with implementing the IYPP within disadvantaged settings. The findings underline the many benefits gained from participating in the IYPP whilst also indicating that extra supports may be required to enhance outcomes for the most vulnerable families, particularly in the longer term. Overall, the study highlights the feasibility of implementing the IYPP within the existing infrastructure of mainstream health and social service settings in Ireland. These findings represent a valuable addition to current evidence on the effectiveness of the programme, whilst also informing its routine implementation both within Ireland and elsewhere.
As part of the Drivers of Crime work programme the Ministries of Education, Health and Social Development established a pilot study of the Incredible Years Parent (IYP) programme to assess its effectiveness in reducing conduct problems in a New Zealand context. ?? The New Zealand Incredible Years Pilot Study provided evidence to suggest that IYP, a programme developed overseas, can be successfully implemented in New Zealand and retain its general level of effectiveness for both M?ori and non-M?ori families. The Follow-up Study investigated the longterm outcomes for 136 (82%) of the 166 children and parents who were in the original sample. The key finding of the Follow-up Study is that the IYP programme outcomes were maintained over the 30-month follow-up with no diminution in the size of effects for almost all of the outcome measures.
Several aspects of the evidence-based IY BASIC parenting series make it particularly effective for families involved with child welfare due to maltreatment. The programs make extensive use of video modeling methods, showing a vignettes of families from different cultural and socioeconomic backgrounds with a variety of parenting styles and child temperament and development. The observational modeling and practice training approach is more effective learning for some of these families than the more cognitive, verbal training approaches.
The prevalence of children with conduct problems is increasing and far exceeds personnel and resources available for dealing with them. One method of training parents that is potentially both efficient and cost-effective is to use videotape parent training materials.
The current investigation puts forth the authors? conceptualization of a cultural approach to implementing evidence-based practices with American Indian (AI) families. Their approach involves two phases, the motivational phase, which sets an historical context for current difficulties; and the intervention phase, which links evidence-based skills with cultural traditions, beliefs, and values. Herein, they present preliminary evidence for the efficacy of the intervention phase, overlaid onto the Incredible Years parenting program.
This study takes an in-depth look at parental acceptability (i.e., the ability to meet parent needs) of an intervention that has shown strong empirical support for treating and preventing childhood conduct disorder. The authors obtained acceptability data from 30 parents of children ages 5 to 12 years presenting externalizing behavior problems through completion of the Treatment Evaluation Questionnaire-Parent Form and the Incredible Years Parent Program Video Evaluation Form. The Incredible Years Self-Administered Parent Training Program was implemented over 8 weeks with the majority of participants showing improvement. Study results indicated that the Incredible Years Self-Administered Parent Training Program was found to be acceptable with a significant difference in level of acceptability between Video Series 2 and 3. Given the ease of dissemination and acceptable nature of this parent training program, future research on this evidence-based intervention is warranted within a school-based mental health service delivery model.
Children who are looked after experience significantly higher levels of social, emotional and behavioural difficulties than children who live with their family of origin. Such difficulties tend to be pervasive and can have detrimental consequences for placement stability, and ultimately for the child?s ability to reach their potential. Government documents such as Care matters highlight the importance of providing ongoing training and support to foster carers to equip them with the necessary skills to manage the complex needs presented by children who are looked after. The nature of this training and support is often debated. With this in mind, Barnardo?s Professional Fostering Service piloted the Incredible Years Basic Parenting Programme with 13 foster carers. The 12-week programme was evaluated using the Eyberg Child Behaviour Inventory pre and post intervention. Results provide a promising insight into the potential of the Incredible Years Basic Parenting Programme as a method of training and supporting foster carers.
Research demonstrates that interventions targeting multiple settings within a child’s life are more effective in treating or preventing conduct disorder. One such program is the Incredible Years Series, which comprises three treatment components, each focused on a different context and type of daily social interaction that a child encounters. This article
explores the cost-effectiveness of stacking multiple intervention components versus delivering single intervention components.
Economic data may be used to compare competing intervention formats. In the case of this program, providing multiple intervention components was cost-effective.
Long-term follow-up of 83 mothers and 51 fathers who had received one of three parent training programs 3 years earlier for their preschoolers’ conduct problems. Follow-up results indicated overall improvements in parent reports of the children’s behaviors compared to baseline reports. However, only treatment that combined videotape modeling with therapist-led group discussion achieved stable improvements. Evaluation of the “clinical significance” of the treatment programs indicated that, after e years, 25% to 46% of parents and 26% of teachers reported significant child behavior problems. The families whose children were maladjusted were characterized by single-parent status, increased maternal depression, lower social class status, and family history of alcoholism and drug abuse.
Background and Methods: Fifty-eight boys and twenty girls with early onset conduct problems whose parents received the Incredible Years (IY) parent treatment program when they were 3?8 years (mean 58.7 months) were contacted and reassessed regarding their social and emotional adjustment 8?12 years later. Assessments included home interviews with parents and teenagers separately.
Results and conclusion: Adolescent reports indicated that 10% were in the clinical range on internalizing behaviors, 23% had engaged in major delinquent acts, and 46% reported some substance use. Eighteen percent of children had criminal justice system involvement and 42% had elevated levels of externalizing behaviors (mother report). Post-treatment factors predicting negative outcomes (delinquent acts) were maternal reports of behavior problems and observed mother?child coercion.
This study examined whether the link between marital con?ict management style and child conduct problems with peers and parents is direct or mediated by mothers’ and fathers’ parenting style (critical parenting and low emotional responsivity). One hundred and twenty
children, aged 4 to 7 years, were observed interacting in our laboratory playroom solving a problem with their best friend as well as at home with their parents. In addition, all the children’s parents were observed in our laboratory trying to solve two family problems as
well as at home interacting under more natural conditions with each other and with their children. Mothers and fathers completed questionnaires assessing marital problem solving as well as reports of their children’s behavior problems. Results indicated that a negative
marital con?ict management style had direct links with children’s conduct problems. In addition, the linkage between negative marital con?ict management and children’s interactions with parents and peers was found to be mediated by both mothers’ and fathers’ critical parenting and low emotional responsivity, thereby supporting the indirect as well as the direct model of negative family interactions. The ?ndings are discussed in relation to the implications for treatment.
This study examined the relationship of reported maternal depression to prior and current life stressors, and to mother perceptions of child adjustment, parent behaviors, and child conduct problems. Maternal reports of stress related to mother characteristics and to negative life events were the most potent variables discriminating depressed from nondepressed mother families.
Several child conduct problem interventions have been classified as either efficacious or well established. Nevertheless, much remains to be learned about predictors of treatment response and mechanisms of behavioral change. This study combines data from six randomized clinical trials and 514 children, ages 3.0-8.5, to evaluate moderators, mediators, and predictors of outcome. Among other findings, latent growth curve models of mother-report and observational measures of child externalizing behaviors suggested that marital adjustment, maternal depression, paternal substance abuse, and child comorbid anxiety/depression each moderated treatment response. Moreover, critical, harsh, and ineffective parenting predicted and mediated outcome, with the most favorable responses observed when parents scored relatively low on each construct at intake yet improved during treatment. Implications for treatment non-responders are discussed.
It is important to determine in what ways families with conduct problem children who seek out clinic services differ from families with “normal” children in order to design successful treatment programs. More recently research has attempted to discern if parental behavior and reports are more potent than child behavior for differentiating between clinic and nonclinic families.
Before young children with behavior problems can receive treatment, they must be identified by at least one of their parents as having severe enough problems to warrant professional attention. However, a number of researchers have cautioned clinicians against overreliance on mothers’ perceptions of their children’s deviant behaviors and have suggested that mothers may inaccurately label their children as deviant.
see whether a behaviourally based group parenting programme, delivered in regular clinical practice, is an effective treatment for antisocial behaviour in children.
Design Controlled trial with permuted block design with allocation by
date of referral.
Setting Four local child and adolescent mental health services.
Participants 141 children aged 3.8 years referred with antisocial behaviour and allocated to parenting groups (90) or waiting list control (51).
Intervention Webster.Stratton basic videotape programme administered to parents of six to eight children over 13.16 weeks. This programme emphasises engagement with parental emotions, rehearsal of behavioural strategies, and parental understanding of its scientific rationale.
Main outcome measures Semistructured parent interview and questionnaires about antisocial behaviour in children administered 5.7 months after entering trial; direct observation of parent.child interaction.
Results Referred children were highly antisocial (above the 97th centile on interview measure). Children in the intervention group showed a large reduction in antisocial behaviour; those in the waiting list group did not change (effect size between groups 1.06 SD (95% confidence interval 0.71 to 1.41), P < 0.001). Parents in the intervention group increased the
proportion of praise to ineffective commands they gave their children threefold, while control parents reduced it by a third (effect size between groups 0.76 (0.16 to 1.36), P = 0.018). If the 31 children lost to follow up were included in an intention to treat analysis the effect size on antisocial behaviour was reduced by 16%.
Conclusions Parenting groups effectively reduce serious antisocial behaviour in children in real life conditions. Follow up is needed to see if the children’s poor prognosis is improved and criminality prevented.
Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children’s externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.
A randomized controlled trial was used to evaluate a parent training intervention for caregivers with preschool-age children with developmental disabilities. Results suggest that this parent training intervention was superior to usual care for young children with developmental delays or disabilities in reducing negative parent?child interactions and child behavior problems. Participants in the experimental group indicated high satisfaction with treatment.
Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empiricallyvalidated parent training curriculum. CM provided incentives for daily monitoring of parenting and child behavior, completion of home practice assignments, and session attendance.
All parents of ADHD children who participated in the PTP were less likely to use harsh and inconsistent discipline at post test compared to parents in the control group. This result is coherent with previous findings on the relevance of PTP for parents of ADHD children. The emphasis of Incredible Years on positive parenting is observed in parents using less harsh and inconsistent discipline as a result of their participation in the PTP.
Parents of young children often seek the support of professionals when experiencing difficulties in managing their child?s behaviour. Parents of children with complex neurodevelopmental disorders, including autism spectrum disorder (ASD), are no exception.
Following the Wanless Report, a new service was set up across the county of Conwy in North Wales to promote the psychological wellbeing of children and young people. This followed the Wanless principles of managing demand and remodelling services in order to provide an accessible and equitable non-stigmatising service for children and families, and the post of specialist behaviour practitioner was created. The aim was to support the parents of children aged five to 11 years who had mild to moderate behavioural difficulties, and also the staff working with these families.
The most thoroughly tested video modeling approach has been developed by Webster-Stratton and her colleagues. In the parent component of their Incredible years Training Series, a therapist shows brief videos of parent-child interactions to groups of mothers and fathers and leads discussions on themes illustrated in the videos. This chapter describes some of the videos.
Discourse on the application of PT with ethnic minority families has enumerated potential cultural barriers to engagement among parents whose own socialization experiences fall outside middle-class European American heritage. Given that parent?child relations and discipline practices are the proximal targets of change, many have cautioned that cultural barriers may threaten the generalizability of PT. Wide cultural variation in parenting practices and values across ethnic groups may influence receptivity to proscribed changes in parent?child interaction patterns, perhaps accounting for increased attrition or lowered participation among ethnic minorities. As such, PT interventions targeting ethnic minority families have been enhanced by attending to cultural barriers to engagement.
Incredible Years equally benefitted children with CD with and without family psychiatric histories of externalizing behavior. Family psychiatric history of externalizing behavior and parental depressive symptomatology predicted greater severity of CD symptomatology at baseline.
If left untreated, early-onset conduct problems (e.g., high rates of aggression, noncompliance, oppositional behaviors, emotional dysregulation) place children at high risk of recurring social and emotional problems, underachievement, school dropout, and eventual delinquency. The development of emotional self-regulation and social competence in the early years plays a critical role in shaping the ways in which children think, learn, react to challenges, and develop relationships throughout their lives.
All children in this sample scored above the 90th percentile on the Eyberg Child Behavior Inventory (ECBI) for home problems, and met the criteria for a possible or a confirmed diagnosis of oppositional defiant behaviours. The proportion of children with pervasive conduct problems was high, 83%. Teachers in day-care and school reported children in the pervasive group to have significantly more attention and internalizing problems as well as lower social competence scores than those in the non-pervasive group. Children in the pervasive group also showed consistently more problems in their relationships both with teachers and peers than those in the non-pervasive group. The implications for assessment and treatment of children with conduct problems in these age-groups are discussed.
Parents raising young children with Autism Spectrum Disorder (ASD) experience disproportionately high levels of stress and burden, which are associated with a plethora of other negative child and family outcomes. Yet, few interventions address parent mental health or related outcomes in this population.
Chapter 1 describes a comprehensive review of randomized controlled trials which included parents of preschool-age children with ASD. Seven interventions met the review criteria. The studies were strengthened by the use of fidelity measures and developmentally-appropriate interventions. However, while all of the studies collected parent measures, none reported significant posttest improvements in parent mental health or other outcomes. Furthermore, numerous issues, such as unclear randomization strategies, small sample sizes, and poor external validity further limited the ability to draw significant conclusions regarding the promise of the interventions. The chapter concludes with a call to develop and rigorously test family-centered interventions aimed at improving both child and parent outcomes.
Chapter 2 highlights the feasibility of implementing an existing evidence-based practice, The Incredible Years, tailored to parents of children with ASD. Two groups of parents raising preschool-age children (ages 3 to 6) with ASD (N =17) participated in a 15-week pilot trial of the intervention. The fidelity of the program was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, parent stress management, social support, and visual resources.
Chapter 3 reports on a mixed method test of the acceptability and results from the trial described in Chapter 2. Attendance was high (88% to 100% weekly) and attrition was modest (18%). Participants reported high acceptability of all aspects of the program (mean 3.3 out of 4). Parent stress decreased significantly after program completion, as compared to baseline. Parents highlighted several barriers to their success in the program, including trouble finding time to focus on their own needs and difficulty applying some program content (e.g., time-out for noncompliance) to children with sensory or self-regulation challenges. However, parents reportedly enjoyed the strengths-based, play-based approach of the program, as well as opportunities for social support and peer learning.
The findings point toward the overall utility and cost-effectiveness of the IY TCM programme in an Irish context. The programme led to improvements in the classroom environment, including a reduction in teacher reported stress and negative classroom management strategies, as well as fewer incidences of disruptive behaviour amongst pupils in the classroom. Some improvements were also seen in teacher reports of social, emotional and behavioural difficulties in the intervention group children when compared to their control group counterparts including, in particular, a significant reduction in emotional symptoms. Teacher reports also underline the acceptability and benefits of the programme to teachers and possibly other staff within the Irish education system.
Methods – Parents of 117 children with ODD, ages 3-6 years, seen in primary care received either a minimal intervention bibliotherapy treatment (MIT), or a 12-session parenting program led by a nurse or psychologist.
Results – More initial total life stress, parenting distress, internalizing problems, functional impairment, and difficult temperament were associated with more improvement, but families scoring lower on those variables had fewer behavior problems at posttreatment and follow-up. Gender was a significant moderator, with more improvement for girls than boys in the nurse-led group but more improvement for boys than girls in the MIT group. Less well-educated mothers treated by psychologists showed the greatest change. Conclusions Predictors and moderators may play a role in deciding, which families receive a particular form of treatment for ODD in primary care.
Several investigations have revealed that parent psychological and cognitive factors may be responsible for success or failure in parent training. Pretreatment levels of parental depression and anxiety were found to be significantly related to treatment failure and dropout during therapy and during followup.
There is a need to bolster the impact of parent training programs both by lengthening their treatment programs and by providing ongoing expanded therapy which focuses on families’ specific needs such as life crisis management, depression, problem-solving, budget planning, marital therapy, and so forth. Only by addressing the broader ecological needs of families can we begin to reach those 30-50% of families who fail to benefit from the traditional parent training approaches.
With the occurrence of multiple homicides on school campuses during the 1997-1998 and 1998-1999 academic years-such as in Springfield, Oregon and Littleton, Colorado-there has been a growing public perception that an increasing number of students may “go Off” at any time and cause serious harm to themselves and/or others. In response to this perception, school administrators, lawmakers, and prosecutors have recently “cracked-down” on juvenile violence. Metal detectors, security guards and police, crisis drills, “zero tolerance” discipline policies, and alternative programs for aggressive children are now found in many schools that previously saw little need for such measures. Several stats now require that children who commit violent crimes be tried as adults. Lawmakers have also proposed school prayer, mandatory student uniforms, mandatory use of “ma’am” or “sir” when responding t teachers, and the school-wide posting of the Ten Commandments as partial solutions to the widely perceived rising tide of school violence. Although well intended, too often such “solutions” have been misguided, based on little, if any, empirical research supporting their effectiveness in preventing school violence and promoting children’s mental health.
This article presents long-term effects of a preventive intervention for young children at high risk for antisocial behavior. Ninety-two children (M age ? 4 years) were randomly assigned to an 8-month family intervention or no-intervention control condition and assessed 4 times over a 24-month period. Intent-to-treat analyses revealed significant intervention effects on observed child physical aggression, and significant intervention effects found at the end of the program were maintained at follow-up for responsive parenting, harsh parenting and stimulation for learning. Parent ratings of child aggression did not show significant effects of intervention.
IYS has also been evaluated as a preventive intervention with low-income preschoolers and toddlers (Gross et al., 2003; Webster-Stratton, 1998; Webster-Stratton, Reid, & Hammond, 2001). As a preventive intervention, the program has been found to have short-term benefits on parenting practices, child social competence, and conduct problems in Head Start children (Webster-Stratton, 1998; Webster-Stratton et al., 2001). The program was found to be effective for a higher risk subgroup of the Head Start sample, defined as children of mothers with mental health problems and children with elevated behavior problems (Baydar, Reid, & Webster-Stratton, 2003; Reid, Webster-Stratton, & Baydar, 2004). However, long-term effects on parenting practices and child physical aggression are not known. The study presented here extends this work by testing the long-term effects of an adapted version of the IYS on parenting practices and physical aggression in children at especially high risk for antisocial behavior because of their family history of delinquency. Specifically, our study included children with delinquent siblings, a group that has proven to be at significant risk for antisocial behavior (Bank et al., 2004; Compton, Snyder, Schrepferman, Bank, & Shortt, 2003; Conger & Rueter, 1996; Patterson, 1984; Reid, Patterson, & Snyder, 2002; Reiss, Neiderhiser, Hetherington, & Plomin, 2000; Rodgers et al., 2001; Rowe, Almeida, & Jacobson, 1999; Rowe, Rodgers, & Meseck-Bushey, 1992; Slomkowski et al., 2001; Wasserman, Miller, Pinner, & Jaramillo, 1996).
Identification and selection of an ‘evidence-based,’ ’empirically validated,’ or ‘best practices’ mental health program is only the first step in service delivery. In order to obtain similar results to those published by the developer of a program, attention must be given to supervising the quality of the implementation of that program. It is important to assure that the program is delivered with the highest degree of fidelity possible. Fidelity means that the program is delivered in its entirety, using all the components and therapeutic processes recommended by the developer. The Incredible Years Parent, Teacher, and Child Training Programs have been proven in numerous randomized control group studies to be effective for promoting positive parent and teacher interactions with children, strengthening children?s emotional, social, and self-regulation competence and reducing behavior problems in both prevention and clinic populations. A number of training processes are recommended to ensure that replication of the Incredible Years programs can be achieved with fidelity: standardized training, detailed treatment manuals, standardized session protocols, peer review, mentoring and supervision, and leader certification. This chapter will provide a description of these training methods and supervision processes to deliver the Incredible Years training programs with a high degree of fidelity.
Background: to test effectiveness of a parenting intervention (The Incredible Years), delivered in a community-based voluntary-sector organisation, for reducing conduct problems in clinically-referred children.
Methods: Randomised controlled trial, follow-up at 6, 18 months, assessors blind to treatment status. Participants – 76 children referred for conduct problems, aged 2-9, primarily low-income families, randomised to treatment vs. 6-month wait-list group. Retention was 93% at 6 months, 90% at 18 months. Interventions – Webster-Stratton Incredible Years video-based 14-week group programme. Intervention teaches cognitive-behavioural principles for managing behaviour, using a collaborative, practical, problem-solving approach. Primary outcomes – child problem behaviour by parent-report (Eyberg) and home-based direct observation; Secondary outcomes – observed positive and negative parenting; parent-reported parenting skill, confidence and depression. All measures standardised and well-validated.
Results: Group differences were tested using ANCOVA, controlling for baseline levels. Post-treatment improvements were found in child problem behaviour, by parent-report (effect size (ES) .48, p=.05) and direct observation (ES .78, p=.02); child independent play (ES .77, p=.003); observed negative (ES .74, p=.003) and positive (ES .38, p=.04) parenting; parent-reported confidence (ES .40, p=.03) and skill (ES .65, p=.01). Maternal depression did not change. Consumer satisfaction was high. At 18-month follow-up, no randomised comparison was possible. However, changes appeared to maintain at 18-month follow-up, with no significant change toward baseline level on any measure. Change in observed positive parenting appeared to mediate change in child problem behaviour.
Conclusions: Findings suggest that a group-based cognitive-behavioural parenting programme, delivered by well-trained and supervised staff can be effective in a community voluntary-sector setting, for reducing conduct problems and enhancing parenting skills. Change in parenting skill appears to be a key mechanism for change in child behaviour. Findings have implications for feasibility of translating evidence-based programmes, even for clinically-referred conduct problems, into less specialised community settings, likely to have lower costs and be more accessible for families.
There is a pressing need for cost-effective population-based interventions to tackle early-onset antisocial behaviour. As this is determined by many factors, it would seem logical to devise interventions that address several influences while using an efficient means of delivery. The aim of this trial was to change four risk factors that predict poor outcome: ineffective parenting, conduct problems, attention deficit/hyperactivity disorder (ADHD) symptoms, and low reading ability.
This study is the first in a middle-income country to show that training teachers in classroom behaviour management and social skill promotion can lead to significant and clinically important reductions in child conduct problems and increases in social skills among pre-school children with antisocial behaviour. Benefits were demonstrated by direct observation as well as by teacher and parent report.
The benefits of this school-based intervention support its implementation for disruptive behavior in schools. This model of intervention also provides effective ways to meet the needs of an underserved population. Children with significant needs for behavioral and social/emotional intervention can be treated in the same environment where the need is greatest: the community school.
Parents of 114 conduct-problem children, aged 3-8 years, were randomly assigned to one of our groups: an individually administered videotape modeling treatment (IVM), a group discussion videotape modeling treatment (GDVM), a group discussion treatment (GD), and a waiting-list control group. Compared with the control group, all three treatment groups of mothers reported significantly fewer child behavior problems, more prosocial behaviors, and less spanking. Fathers in the GDVM and IVM conditions and teachers of children whose parents were in the GDVM and GD conditions also reported significant reductions in behavior problems compared with control subjects. Home visit data indicated that all treatment groups of mothers, fathers, and children exhibited significant behavioral changes. There were relatively few differences between treatment groups on most outcome measures, although the differences found consistently favored the GDVM treatment. However, cost effectiveness was the major advantage of the IVM treatment.
Results suggest that young children with conduct problems have deficits in their social information processing awareness or interpretation of social cues – they overestimate their own social competence and misattribute hostile intent to others. Tests of cognitive prolem solving and observations of peer play interactions indicated that the children with conduct problems and significantly fewer postitive problem-solving strategies and positive social skills, more negative conflict management strategies and delayed play skills with peers.
Parenting programs for school-aged children are typically based on behavioral principles as applied in social learning theory. It is not yet clear if the benefits of these interventions extend beyond aspects of the parent-child relationship quality conceptualized by social learning theory. The current study examined the extent to which a social learning theory-based treatment promoted change in qualities of parent-child relationship derived from attachment theory.
Families of 99 children with early-onset conduct problems, aged 4-8 years, were randomly assigned to a child training treatment group (CT) utilizing the Incredible Years Dinosaur Social Skills and Problem Solving Curriculum or a waiting-list control group (CON). Post-treatment CT children had significantly fewer externalizing problems at home, less aggression at school, more prosocial behavior with peers, and more positive conflict management strategies than CON children. Significantly more CT than CON children showed clinically significantly improvements on reports and independent observations of aggressive and noncompliant behavior. The differential treatment response was evaluated according to child comorbidity with attention deficit hyperactivity disorder (ADHD), parenting discipline practices, and family risk factors. The only risk factor related to failure to make improvements in child conduct problems after treatment was negative parenting (i.e., maternal critical statements and physical force). The long-term follow-up 1 year later indicated that most of the significant post-treatment changes were maintained.?
In the present study, generalisation effects from home to day-care/school settings were examined in a clinic sample of children aged 4-8 years treated because of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) with The Incredible Years Parent Training programme or Parent Training combined with Classroom Training.
A striking characteristic of the sample was that 83% of the children exhibited clinical levels of conduct problems both at home and in day-care or school settings before treatment. Overall, the combined Parent Training + Classroom Training treatment produced more positive generalisation effects than the Parent Training only group, in particular after treatment. Analyses of differences between group means between pre- and posttreatment were conducted by means of ANCOVAs using pretreatment scores as covariate and treatment condition.
Objective: To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). Method: Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4?6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. Results: Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. Conclusions: We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.
This study compares consumer satisfaction of three cost-effective methods for training parents of conduct problem children. Seventy-nine mothers and 52 fathers completed weekly evaluations and extensive one-month post treatment evaluations. One year later 84 percent of the mothers and 75 percent of the father completed the consumer follow-up evaluation.
Behavioral treatment research for preschoolers (ages 4 to 6 years) with ADHD is not extensive; however, parent training for young children diagnosed with ADHD has shown some preliminary promising outcomes. One of the core methods for the IY parent program is that therapists work collaboratively with parents to develop individual goals for each parent and child. IY therapists collaborate with parents to tailor the program content to each parent and child?s particular situation. For parents of children with ADHD, this tailoring process often involves helping parents understand ADHD and how it aff ects children?s social, emotional, and academic development, setting developmentally appropriate goals around increasing children?s att ention and focus and reducing misbehavior, strengthening children?s emotion regulation skills, and also changing the environment to support children?s need for movement, structure, predictable routines, scaffolding, and immediate feedback.
For example, parents of children who are impulsive, hyperactive, and inattentive learn about temperament and how their children?s biological make-up makes it more difficult for their children to listen, follow directions, and play appropriately with other children. They learn the importance of clear limit setting and consistent follow through and ways to help coach their children?s academic and social skills during play with other children. On the other hand, adoptive or foster parents are more likely to be focused on helping their children develop trusting relationships with them. This means they will spend more time on child-directed play, emotional coaching and building the relationship or attachment building components of the curriculum.
Read the book chapter (PDF)
(Note: This is a large PDF so will take 30 seconds to display)
There has been recent increased emphasis in the use of performance-training methods to increase the effectiveness of parent-training programs. Once such method has been the use of live modeling, a technique whereby the experimenter or another parent demonstrates the behaviors the parents are to acquire. This method has been shown to be a powerful agent to enhance the effectiveness of parent-training programs.
This article describes a pilot project whose objective was to explore whether the Webster-Stratton Parenting Programme may be effective for hearing parents and their deaf children who present with conduct disorders and other emotional, behavioural and developmental problems. Outcome measures aimed at overall impact in decreasing behavioural problems and improving overall family function were used. Participants were hearing parents of deaf children referred to our specialist service whose assessment had recommended a parenting skills group as treatment of choice. The children had been diagnosed with behavioural problems with or without additional comorbidity. This pilot phase focused deliberately on one participant, in order to explore whether the approach justified further, more comprehensive evaluative research. Outcome was positive, suggesting that modified Webster-Stratton approaches may well be of use in deaf children of hearing parents.
Thirty families who received parent training for conduct-disorder children were divided into two groups, father-involved families and father-absent families. Immediately post-treatment both groups reported significant improvements in their children’s behaviors. Behavioral data showed significant increases in mother praises and reductions in mother negative behaviors, child non-compliance and deviancy.
Reference only for this article.
Theoretical and empirical evidence suggests that two of the most common childhood syndromes, disruptive behaviors and depression, have similar developmental antecedents and may respond to similar interventions. Recent evidence suggests that parenting interventions that target more nurturing and less harsh parenting risk factors lead to reduced internalizing symptoms in children (Webster-Stratton & Herman, 2008) in addition to the well-established effects on child conduct problems. For instance, Webster-Stratton and Herman (2008) found that children whose parents participated in the IY Parent Training (PT) program had reduced depressive symptoms at post-treatment compared to children in a wait-list control condition. Effects were mediated by changes in parenting effectiveness.
Evidence-based psychosocial interventions such as parent training programs are strongly recommended as first-line treatment for preschool-age children with or at-risk of attention deficit/hyperactivity disorder (AD/HD).
Evaluate the effectiveness of the Incredible Years Basic Parent Training (IY) in hyperactive and inattentive behaviors of Portuguese preschoolers.
One hundred children, between three and six years-old, with AD/HD behaviors, who were part of a larger randomized controlled trial in which participants were allocated to either an intervention or control group. In this subsample analysis, there were 52 participants in the intervention condition (IYC) and 48 in the waiting-list control condition (WLC). Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 14-week intervention.
Medium-to-large intervention effects were found in primary caregivers? reported measures of children?s AD/HD behaviors and on self-reported parenting practices. Independent observations indicated significant short-term effects on positive parenting and coaching. Primary caregivers had a high attendance rate and reported high satisfaction with the program. Additionally, 43 % of children in the IYC clinically improved in the primary AD/HD outcome measure, compared with 11 % in the WLC.
Preliminary results suggest that IY parent training seems to be an effective tool, making the difference in the behavior of Portuguese preschoolers with early signs of AD/HD and their mothers.
The Clinical Problem :
The incidence of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in children is alarmingly high, with reported cases of early-onset conduct problems in young preschool children 4-6% (Egger & Angold, 2006) and as high as 35% for low-income families (Webster-Stratton & Hammond, 1998). Developmental theorists have suggested that, compared to typical children, ‘early starter’ delinquents, that is, those who first exhibit ODD symptoms in the preschool years, have a two- to threefold risk of becoming tomorrow’s serious violent and chronic juvenile offenders (Loeber et al., 1993; Patterson, Capaldi, & Bank, 1991; Snyder, 2001; Tremblay et al., 2000). These children with early-onset CD also account for a disproportionate share of delinquent acts in adulthood, including interpersonal violence, substance abuse, and property crimes. Indeed, the primary developmental pathway for serious conduct disorders in adolescence and adulthood appears to be established during the preschool period.
To address the parenting, family, child, and school risk factors, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (ages 2-8 years). This chapter reviews these training programs and their associated research.
Although our programs were first designed and evaluated to be used as clinic-based treatments for diagnosed children, our recent work has tended our clinic-based treatment model to school settings and has targeted high-risk populations. As more is known about the type, timing, and dosage of interventions needed to prevent and treat children?s conduct problems, we can further target children and families to offer treatment and support at strategic points. By providing a continuum of prevention and treatment services, we believe we will be able to prevent the further development of conduct disorders, delinquency, and violence.
Article not available
Effective interventions for children with conduct problems ideally target multiple risk factors and are best offered as early as possible. Conduct disorder becomes increasingly resistant to change over time, so early intervention is a crucial strategy for the prevention or reduction of conduct problems, violence, substance abuse, and delinquency. Children with ODD and CD are clearly identifiable as early as 3-4 years of age, and there is evidence that the younger the child is at the time of intervention, the more positive the behavioral adjustment at home and at school following treatment. Intervention that is delivered prior to school entry and during the early school years can strategically target risk factors across multiple domains; home and school, and through multiple change agents; parent, teacher, and child. Unfortunately, less than 20% of young children meeting DSM-IV criteria for ODD are referred for mental health services (Horwitz, Leaf, Jeventhal, Forsyth, & Speechley, 1992). Even fewer of those referred obtain evidence-based interventions.
To address the parenting, family, child, and school risk factors for children or adolescents with conduct problems, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (from birth to 12 years). This chapter reviews these training programs and their associated research findings.
The aim of this paper is to present the research protocol for the randomised controlled trial (RCT) designed to primarily establish whether the IY Therapeutic Dinosaur School Programme, when delivered as a school-based targeted intervention, improves ?at risk? children?s social, emotional and behavioural competencies compared with a waiting list control condition.
The Incredible Years Parents, Teachers, and Children Training Series, described in this Bulletin published by the Office of Juvenile Justice and Delinquency Prevention, is designed to prevent, reduce, and treat conduct problems among children ages 2 to 10 and to increase their social competence.
OJJDP?s Family Strengthening Project has designated the Incredible Years Training Series as an exemplary best practices program. As such, the series has been subject to a quality evaluation, evidenced excellent effectiveness, and attained high overall ratings.
The Bulletin provides an overview of the Incredible Years Training Series, describes its methodologies, and summarizes program effectiveness, noting pertinent evaluations.
Because Conduct Disorder becomes increasingly resistant to change over time, intervention that begins in the early school years is clearly a strategic way to prevent or reduce aggressive behavior problems. Our decision to focus our interventions o n the period consisting for preschool and early school years was based on several considerations. First, evidence suggests that children with ODD and CD are clearly identifiable at this age. Second, evidence suggests that the younger the child at the time of intervention, the more positive the child’s behavioral adjustment at home and at school. Third, the move to school – from preschool through the first years of elementary school – is a major transition and a period of great stress for many children and their parents. The child’s early success or failure in adapting to school sets the stage not only for the child’s future behavior at school and his or her relationships with teachers and peers but also for parents’ future attitudes toward their child’s schools and their own relationships with teachers and administrators.
This artcle summarizes the Incredible Years Series. The training series consists of three empirically validated and integrated programs for parents, teachers and children that are designed to promote social competence and prevent, reduce and treat conduct problems in young children. The training methods, content and processes are explained.
A recent UK government-commissioned report on early intervention stated that ?what parents do is more important than who they are? (Allen, 2011, p. xiv). The report emphasised the importance of support for families at disadvantage at an early age before behavioural and social problems become entrenched and more expensive to tackle. Children classified as securely attached in the first 12 to 18 months develop better peer relationships at pre-school (Sroufre, Fox, & Pankake, 1983) and achieve better academic outcomes (Pearson et al., 2011).
The increased emphasis on investing support for families before children enter school has increased the need for assessment tools that support and encourage positive parenting. Identifying the positive parental behaviours that promote healthy child development is challenging as many of the current observational codes have been designed for parents? interactions with older children. This article describes the development of a new observational code to analyse the behaviour of mothers playing with their baby in the first 18 months. The six predetermined positive parenting behaviours are analysed using video recordings from the home. Practitioners can be trained to use the code and a manual facilitates future researchers and clinicians to evaluate parent behaviour with their infant in a natural environment and with minimal disturbance to the family.
This study examined qualitative aspects of the peer relationships of children with conduct problems in a laboratory assessment procedure. The sample consisted of 101 children aged 4 to 7 years identified by parents as having oppositional behavior problems. Positive social skills and negative conflict tactics were coded. Additionally, two categories assessing the reciprocal nature of the relationship were also coded, including behavioral “escalation” and “failure” to use social skills successfully with peers. Relations between observed peer interactions, child self-reports of peer relationships, observed and parent reports of home behavior interactions, and teacher reports of school behaviors were examined. Positive skills and failure to use skills with peers were related to loneliness and teacher reports of social competence, whereas negative behavior and escalation with peers were associated with school problems and home problems, respectively. Results are discussed in a developmental framework that highlights the potential importance of social behaviors within the peer context to later adjustment.
Findings suggest that there is an important need to develop multifaceted parent training programs that not only teach more positive parent skills but also incorporate stress management and interpersonal relationship skills, as well as a need for social support, especially for single and martially distressed parents.
This study examines the role of several components of parental stress in physically abusive and nonabusive families with conduct-disordered children. The 123 families studied were seen in a parenting clinic aimed at improving parent-child interactions in families with a highly oppositional child. Parent stress was found to play in important role in abusive families. Physically abusive families were significantly more often low income, had younger mothers with less education, more frequently reported a family history of child abuse, and were more likely to be abusing alcohol or drugs.
This What Works Brief is part of a continuing series of short, easy-to-read, ‘how to’ information packets on a variety of evidence-based practices, strategies, and intervention procedures. The Briefs are designed to help teachers and other caregivers support young children?s social and emotional development. In-service providers and others who conduct staff development activities should find them especially useful in sharing information with professionals and parents. The Briefs include examples and vignettes that illustrate how practical strategies might be used in a variety of early childhood settings and home environments.
La funci?n del ?tiempo de descanso? como uno de los m?todos para tratar los comportamientos desafiantes de ni?os preescolares
Read the article (Spanish) (PDF)
There has never been a time in the history of education and psychology when there has been a stronger emphasis on the use of evidence-based interventions (EBIs) in mental health and educational settings (Chambers, Ringeisen, & Hickman, 2005; Kratochwill & Stoiber, 2002). EBIs are well-developed interventions in which highly regarded scientific methods have established a program as effective. In the field of education, federal, state, and local governments reportedly spend over $330 billion per year on public education, including significant investments in educational interventions and professional development activities (Slavin & Fashola, 1998). Despite these expenditures, many school-based interventions have been inadequately researched or found to be ineffective (Kavale & Forness, 1999). Teacher training was specifically identified by the Coalition for Evidence-Based Policy (2002) as a domain in which existing practices have rarely been tested using rigorous scientific methods. Today, however, rising standards, accountability requirements, and national education legislation require that educational policies and practices are based on strong research evidence.
La incidencia del trastorno oposicionista desafiante (TOD) y el trastorno disocial (TD) (conduct disorder) en ni?os es alarmantemente alta, con informes de inicio temprano de problemas de conducta en ni?os preescolares en tasas que van del 4-6% y tanto como un 35% para las familias de bajos ingresos.
Families of 97 children with early-onset conduct problems, 4 to 8 years old, were randomly assigned to 1 of 4 conditions: a parent training treatment group (PT), a child training group (CT), a combined child and parent training group (CT + PT), or a waiting-list control group (CON). Post treatment assessments indicated that all 3 treatment conditions had resulted in significant improvements in comparison with controls. Comparisons of the 3 treatment conditions indicated that CT and CT + PT children showed significant improvements in problem solving as well as conflict management skills, as measured by observations of their interactions with a best friend; differences among treatment conditions on these measures consistently favored the CT condition over the PT condition. As for parent and child behavior at home, PT and CT + PT parents and children had significantly more positive interactions, compared with CT parents and children. One-year follow-up assessments indicated that all the significant changes noted immediately post treatment had been maintained over time. Moreover, child conduct problems at home had significantly lessened over time. Analyses of the clinical significance of the results suggested that the combined CT + PT conditions produced the most significant improvements in child behavior at 1-year follow-up.
As has become all too evident to researchers in the field as well as to the general public, the incidence of conduct problems in young children is increasing. Current estimates are that 7% to 25% of children are affected. This trend is disturbing, both in itself and in its social implications, for research has shown that the emergence of early-onset conduct problems in young children (in the form of high rates of oppositional defiant, aggressive, and noncompliant behaviors) is related to a variety of health and behavioral problems in adolescence – peer rejection, drug abuse, depression, juvenile delinquency, and school dropout (Campbell, 1991; Loeber, 1991).
In response to this growing social problem, a variety of innovative parent training interventions have been designed with the aim of reducing children’s conduct problems. The rationale for targeting parenting behavior as the primary focus of intervention arises from the considerable body of research indicating that parents of children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) lack certain fundamental parenting skills.
Families of 159, 4- to 8-year-old children with oppositional defiant disorder (ODD) were randomly assigned to parent training (PT); parent plus teacher training (PT + TT); child training (CT); child plus teacher training (CT + TT); parent, child, plus teacher training (PT + CT + TT); or a waiting list control. Reports and independent observations were collected at home and school. Following the 6-month intervention, all treatments resulted in significantly fewer conduct problems with mothers, teachers, and peers compared to controls. Children?s negative behavior with fathers was lower in the 3 PT conditions than in control. Children showed more prosocial skills with peers in the CT conditions than in control. All PT conditions resulted in less negative and more positive parenting for mothers and less negative parenting for fathers than in control. Mothers and teachers were also less negative than controls when children received CT. Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems./p>
It is essential that sound theory and research support new treatment and that procedures are described elearly and are followed closely. This chapter describes the training, supervisory and organizational requirements to implement the Incredible Years (IY) Training Series to prevent and to treat early onset of conduct problems in children. Five key elements are identified and descussed.
Young preschool and early school-age children with early onset conduct problems are at high risk for developing school drop out, substance abuse, violence and delinquency in later years. Consequently, developing treatment strategies for reducing conduct problems when aggression in its more malleable form prior to age 8, and thus interrupting its progression, is of considerable benefit to families and society. This article describes a treatment program, known as the Dina Dinosaur Social Skills and Problem Solving Child Training Program, specifically designed with developmentally appropriate teaching methods for young children (ages 4 to 8 years) and based on theory related to the types of social, emotional, and cognitive deficits or excesses exhibited by children with conduct problems. The treatment emphasizes training children in skills such as emotional literacy, empathy or perspective taking, friendship and communication skills, anger management, interpersonal problem solving, school rules, and how to be successful at school. Emphasis is placed on ways to promote cross setting generalization of behaviors taught by involving parents and teachers in the treatment. A review of two randomized trials with this treatment approach and long term results are provided. ?
This chapter describes a treatment program ? Dina Dinosaur’s social, emotional, and problem-solving child training program- that was designed specifically with developmentally appropriate teaching methods for young children (ages 4-8 years) and based on theory related to the types of social, emotional, and cognitive deficits or excesses exhibited by children with conduct problems.
Objective – To determine if a nurse-led or psychologist-led parent-training program was more successful than a minimal intervention in treating early childhood Oppositional Defiant Disorder (ODD) in pediatric primary care.
The present study compared three models of intervention: an office model, with primary care nurses providing a moderately intensive parent training program; a referral model, with clinical child psychologists providing the same parent training, and a minimal intervention treatment without therapist contact. The Webster-Stratton parent training program we used has considerable empirical support and its videotape-based program seemed suitable for use by nonmental health professionals.
Abstract – The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4?8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon ountries.
Impulsivity, hyperactivity, oppositionality, and aggression are behaviors that most three-and fouryear-old children display to some degree with up to 10 to 20% of preschoolers exhibiting these behaviors at significant levels at home or at preschool/day care.
This study provides an important first step in providing evidence to support the adaptation of empirically-supported interventions for use in mental health consultation when providing services to preschoolers with disruptive behavior problems. This study suggests that these interventions can be effectively exported from controlled clinical settings into community settings. These results will need to be replicated by training professionals already providing mental health consultation within the preschool setting to incorporate the use of the empirically-supported strategies into their everyday work with teachers and children. Having mental health consultation that includes empirically-supported interventions delivered within this collaborative framework available as part of the array of services will likely reduce the need for more costly treatments in the future.
This paper has three general aims. The first is to review briefly some of the current research on performance-training methods so as to provide evidence of the benefit of using videotape modeling for parent training. The second aim is to describe the guidelines for developing and using a videotape modeling program. The third aim is to describe the content of one such program which was developed and researched by the author at the University of Washington.
AbstractThe aim of the present study was to investigate residential child care staff satisfaction with.
The need to help families with conduct-disordered children is particularly urgent, for these “aggressive” children are at increased risk for being abused by their parents, as well as for school dropout, alcoholism, drug abuse, juvenile delinquency, adult crime, antisocial personality, marital disruption, interpersonal problems, and poor physical health. Thus in the absence of treatment, the long-term outlook for conduct-problem children is poor.
There is a modest but growing literature in the parenting field, based on secondary analysis of randomized trials suggesting that change in observed positive parenting skill may be an important predictor of change in child outcome. Furthermore, several studies suggest that, at least in early childhood, positive rather than negative parenting may be a developmentally more important predictor of child problem behavior outcome, based on converging evidence from both randomized intervention trials and longitudinal studies of natural development. We chose to focus on overt parenting skill as a postulated intervention mechanism, because this is consistent with the theoretical underpinnings of cognitive-behavioral parenting interventions, which assume that parenting skill is the primary mechanism underlying both development and change in children?s conduct problems.