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: Parent Training
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.
This study, one of the first within a European context, focused on a high-risk sample recruited from real-world urban settings and showed significantly improved child and parent outcomes following a parenting intervention delivered by regular, communitybased service staff. The findings reported here support the importance of early childhood intervention and the utility of evidencebased parenting programs in community-based services in different cultural contexts and in settings characterized by high levels of social disadvantage. This work is an important step in the development, evaluation, and delivery of empirically validated interventions for vulnerable young children with conduct problems and their families. These findings should serve to guide future policy and practice decisions for governments and practitioners who are considering investing in and/or delivering the Incredible Years BASIC Parenting program for children with behavioral problems in disadvantaged communities across different geographical and cultural contexts.
Background: Traditional Korean American discipline is characterized by a lack of expression of affection and use of harsh discipline.
Objective: The purpose of this study was to pilot-test the effect of the Incredible Years Parenting Program among Korean American mothers.
There is strong evidence for the effectiveness of IY with diverse parenting populations but this is the first known study of the programme with bereaved families. The findings support its use with such families where child behaviour is a concern.
Parents own grief reactions, coupled with the multitude of practical stressors, may impact their ability to provide emotional care and stability for remaining children (Worden, 1996). Pfeffer et al. (2000) stressed that parents can become so overwhelmed and consumed by their own loss that they become less aware of their children?s emotional state. Alternatively, a parent?s own grief may prevent them from being able to cope with their child?s emotional and psychological needs. A parent?s level of physical and emotional exhaustion following the death of a spouse or significant family member may leave them with few internal resources to handle the new challenges of parenting
Antisocial behaviour and adult criminality.
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.
In 2002, despite recent efforts to curtail the number of children placed in out-of-home care, there were 532,000 children in foster care in the United States (U.S. Department of Health and Human Services, 2004). There is a growing literature demonstrating the extensive mental health problems of foster children, particularly their high risk for externalizing and conduct difficulties, including noncompliance, aggressiveness, and emotional liability. For example, according to the most comprehensive study of children in the child welfare system to date (National Survey of Child & Adolescent Well-Being Research Group, 2002 47%), of foster children between the ages of 2 and 15 show elevated (T score of 64) rates of externalizing problems in the CBCL (Child Behavior Checklist; Leslie, Hurlburt, Landsverk, Barth, & Slymen, 2004). In a study of 426 children (ages 6 to 17) involved in the child welfare system in California, 42% had a psychiatric disorder, mostly attention-deficit/ hyperactivity disorder and/or disruptive behavior (Patterns of Care; Garland et al., 2001).
It has long been known that problematic children have an impact on their parents? behavior in reciprocal ways; children with externalizing problems (i.e., noncompliance, oppositional behavior, aggressiveness) elicit less positive and more negative discipline practices (Forehand, Miller, Dutra, & Chance, 1997). Negative mother-child interactions escalate into coercive cycles that deteriorate over time unless they are altered through effective parenting training (Patterson, DeBaryshe, & Ramsey, 1989). Over the past 2 decades, research has demonstrated that parent training based on social learning principles is one of the most successful interventions in the treatment and prevention of child externalizing problems (e.g., aggression, noncompliance; Horwitz, 1994).
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.?
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.
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.
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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
This article describes a home coaching model for delivering the Incredible Years Baby, Toddler, Preschool and School Age Parenting programs. The IY home-based program holds promise for providing added support for parents attending the IY group-based program. It can be used to provide additional personalized practice for parents.
We have learned that IY can be disseminated with high fidelity and sustained over time. Some of the critical factors include selecting optimal clinicians to deliver the program; providing them with quality training workshops coupled with ongoing supportive mentoring and consultation, on-site peer and administrative support; facilitative supports; and ongoing program evaluation and monitoring of program dissemination fidelity. Certainly it requires a collaborative team to bring about innovative change. Although it may be tempting for convenience sake and short-term resources to ignore the growing dissemination literature, doing so almost certainly will result in weak and unsustainable programs. Given that there are considerable time and costs involved in delivering even ineffective programs, a much wiser choice would be to invest resources in programs known to sustain high quality evidencebased practices.
Abstract – This study examined the program satisfaction of the Incredible Years parenting program, Basic implemented and used in four Danish municipalities: Holstebro, Herning, Ikast-Brande and Aalborg. Since spring 2006 the parenting program has been a preventive service or treatment for parents with a child with conduct problems.
Conclusion – Some of the data are from the first round of the parent programs, starting in spring 2006, at the same time as translation and implementing the program began, and all the data in the study are parent programs lead by non-certificated group leaders. Under these conditions it is even more positive that the data shows a high satisfaction. It is important to have focus on the method integrity of the group leaders to ensure a continuous high quality of the parent program. It is also important to continue looking at the program satisfaction in the future to ensure high quality and to identify possible parts that could need further development or changes either because of error in implementing the program or in the program because of cultural differences in the Danish and American context.
Raising children is one of the hardest jobs facing adults in our society and one for which there is least preparation. Moreover, several aspects of the job of parenting have become more difficult in recent years. Much has been learned about the risk and protective factors associated with different developmental outcomes for children and the important role parents can play in promoting children’s social, emotional and academic capacity and competence. Our current understanding is that many parents are not well prepared to do their best for their children.
In this chapter we consider factors that can make parenting more challenging and describe the growing number of interventions, in statutory and voluntary services, that have been developed to support parents and children within their own communities.
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.
There is now widespread acceptance that evidence-based interventions treat a range of mental health and behavioral problems. Yet these evidence-based practices are often not adopted in applied settings. As a result, strategies need to be developed to overcome potential barriers to the widespread adoption of evidence-based interventions. Group-based interventions frequently rank high on lists of evidence-based practices, with studies demonstrating that well-designed group-based models are often at least as effective as the best alternative one-on-one approaches.
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Servicestyrelsen har i perioden 2008-2010 i samarbejde med 13 kommuner afpr?vet to evidensbaserede familiebehandlingsprogrammer, hhv. b?rneprogrammet Dinosaurusskolen (DINO) og for?ldreprogrammet BASIC. Der har v?ret iv?rksat parallelle evalueringer af hvert af de to programmer, som dog afrapporteres samlet, da der er tale om to programmer og to evalueringer med st?rk synergi i form?l og design, som bl.a. giver mulighed for at anvende de forskellige programmer og kombinationer som interne sammenligningsgrupper.
DINO og BASIC er en del af den evidensbaserede programserie ?De Utrolige ?r? (DU?). DINO har til form?l at hj?lpe b?rn med adf?rdsvanskeligheder i alderen 4-8 ?r ved at tr?ne deres sociale f?rdigheder gennem gruppesamlinger. BASIC henvender sig til for?ldre til b?rn i alderen 3-6 ?r og giver dem r?d og vejledning i forhold til deres b?rn i grupper med op til 12 for?ldre.
Der er tidligere i evalueringen udarbejdet to delrapporter: Delrapport 1 indeholder en analyse af kommunernes udgangspunkt for implementeringen af programmerne, heriblandt m?lgruppen og den praktiske implementering. Rapporten beskriver de forskellige m?der, kommunerne organiserede og fortolkede de to DU?-programmer p?. Delrapport 2 har fokus p? effekten af de to DU?-programmer ved efterm?lingen, og med hvilken fidelitet programmet er implementeret. Denne rapport udg?r den afsluttende rapport i evalueringen af DU?. Rapporten belyser den umiddelbare effekt af deltagelsen i programmet samt den mere langsigtede effekt ved opf?lgningen 6-8 m?neder efter afslutningen og belyser s?ledes ogs? effekternes holdbarhed. Ligeledes belyser rapporten forskelle i kommunernes implementeringsmilj?, samt hvordan disse forhold p?virker fideliteten i programmet. Man kan l?se f?lgende i rapportens kapitler.
A key principle of this programme is modelling, a primary way of learning for both children and adults. The importance of nurturing parents and offering appropriate venues, refreshments and cr?che facilities cannot be underestimated. The overall atmosphere is one of support, not judgment. Parents are encouraged and challenged too. They are given the opportunity to think through solutions for themselves and consider the impact of their behaviours. Parents begin to model a similar style with their children, starting to understand how their child may be feeling. This is often the catalyst for an improved relationship and a decrease in undesirable behaviour usually follows.
Growing numbers of children in the UK enter the care system with significant emotional and behavioural problems. The recent.
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>
Early-onset conduct problems predict antisocial and criminal behaviour in adolescence and adulthood, including violent offending, and these problems occur with greater frequency in disadvantaged communities. Parenting is implicated in the development and maintenance of these problems. To address them the government in England and Wales is funding Sure Start services, but so far it has not specified that evidence-based programmes should be delivered. Sure Start areas were targeted to provide services for high-risk families in disadvantaged areas. Certain family characteristics such as low income, low education level, isolation, teenage pregnancy, high stress levels, single parenthood (or high levels of marital discord), depression, parental psychiatric illness or criminal history, and inconsistent, or harsh, parenting practices put children at high risk of developing conduct disorder and perpetuating particular family characteristics. Within disadvantaged areas there is considerable variation in crime levels. The purpose of this paper is to establish whether crime rates predict outcomes from a parenting intervention, the Webster-Stratton Incredible Years (IY) BASIC Parenting Programme, delivered in 11 Sure Start areas across north and mid-Wales. Parent participation in the programme demonstrated significant improvements in both child and parent behaviour. The current paper reports on the analysis of the effect of community crime levels on outcome. Regression analyses showed that crime rates were not predictive of outcome: the BASIC programme is effective in areas with both higher and lower crime levels..
Two long-term follow-up studies of randomized trials show that relative to controls, youth at risk for behavior problems who received family intervention at age 4 had lower BMI and improved health behaviors as they approached adolescence. Efforts to promote effective parenting and prevent behavior problems early in life may contribute to the reduction of obesity and health disparities.
This study provides preliminary data about a parenting intervention for families of preschoolers with early attention deficit hyperactivity disorder/oppositional defiant disorder symptoms carried out in two diverse primary care pediatric offices. Mothers reported improvements in parenting skills and a decrease in stress. Mothers and providers reported high levels of satisfaction. Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.
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.
This study aims to evaluate the effectiveness of a parent training program in improving parenting practices, parents? feeling of self-efficacy and parents? perception of their child?s behavior, implemented in a child
Though the implementation of an evidence-based parent training program by professionals in a child protection service presents specific challenges, results suggest that it can contribute to improvements in parenting practices and in parents? perception of their child?s behavior.
Determining evidence-based interventions for use in practice can be challenging. Efficacy research, which employs strict standardization of a manual or protocol, randomized control trials, and comparisons to other treatments or placebos, reveals how strongly an intervention creates change or improves functioning. However, one criticism of efficacy research is its inability to predict how or if an intervention will work within real-world, less-controlled settings. Many issues surround effective implementation of evidence-based treatments into practice (Chorpita, 2003). Much of existing intervention research in psychology is limited to Stage I: Treatment Efficacy (Chorpita). This project addresses Stage III: Effectiveness: Dissemination by employing an evidence-to-practice
model of research applied to the treatment of attention deficit hyperactivity disorder (ADHD) under highly naturalistic conditions.
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.
Parent engagement (i.e. enrolment, ongoing attendance, participation quality) remains ia major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check-Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific programme, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that support our approach.
Parent engagement (i.e. enrolment, ongoing attendance, participation quality) remains ia major obstacle to fully realizing the benefits of evidence-based preventive parent management training in community settings. We describe an approach to parent engagement that addresses the myriad motivational, cognitive and pragmatic barriers parents face by embedding services in Head Start and applying a parent engagement model, the Family Check-Up, as a pre-intervention to augment parent training. In this article, we present the rationale for applying FCU to advance parent readiness for engagement and describe the process by which we partnered with the community to modify FCU to be most impactful for enhancing parent engagement in one specific programme, the Incredible Years Parenting Series. We conclude with preliminary data from our ongoing pilot trial that support our approach.
The impact of difficult child behaviour on family functioning has a compounding effect on the physical, emotional, and psychological welfare of the child, the family unit, and the wider community. Additionally, untreated behaviour problems increase the risk of negative outcomes in adulthood (Breen & Barkley, 1998; Reyno & McGrath, 2006).
Indeed, apart from the impact on the child, recent research has confirmed earlier findings that parents of children with ADHD experience elevated stress levels, and have fewer effective parenting practices compared to parents of children without this disorder (Treacy, Tripp, & Barid, 2005). To address parenting issues and these other factors, an effective, low cost intervention strategy would obviously be a useful addition to the range of services available in everyday settings.
Parenting is not usually the primary problem for families. If there is mental health, domestic violence, trauma, addiction, poverty, service overload etc., those problems will prohibit parents from being able to focus on, believe in and follow through with parenting ideas.
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The Early Child Longitudinal Survey, a nationally representative sample of more than 22,000 kindergarten children, suggests that exposure to multiple poverty-related risks increases the odds that children will demonstrate less social and emotional competence and more behavior problems than more economically advantaged children (West, Denton, & Reaney, 2001).
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.
Background Early risk factors for poor child outcomes are well established,.
Using Paired T-Tests, analysis of the 5 subcategories of Negative Parenting revealed that the Intervention group showed changes in the right direction in all five subcategories, 3 of these were significant changes; Critical Statements, Physical Negatives and Negative Commands.
Highlights of this evalutation are in poster format.
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.
Behaviour management problems (BMP) are common among children (4-12%) and the prevalence seems to be rising. Persistent antisocial behaviour often leads to poor long-term psychosocial adjustment. Structured parent-training programmes have proven to be the most effective way of treating BMP in young children. The Incredible Years Series (IYS), which is a manual-based programme, was introduced in Sweden in 2001. Its aim was to evaluate the effectiveness of IYS in diverse clinical settings in Sweden. Parents of 113 children (3-9 years), recruited through the IYS-trained group leaders? ordinary services, participated in the study. The parents answered various questionnaires regarding their children?s symptoms and their own psychological well-being before and after participating in the parent-training groups. The results are very encouraging; significant reduction of BMP in the children was found on all relevant measures. A significant increase in the self-rated well-being of the mothers was also found. The IYS seems to work in Sweden, even when used by group leaders who are in training. The importance of using a well-documented manualized method when implementing new models is accentuated.
The programme is effective in improving child behaviour and parenting competencies with parents of 8+ aged children.
These data provide convincing evidence of the effectiveness of the IY programme with parents of high risk youngsters aged 8 and above. Staff in regular service settings, even when relatively inexperienced, can achieve good outcomes when supported with training, supervision and adequate time and resources.
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.
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.
Children in foster care have social and emotional problems at rates three to ten times higher than those found in the general population. During the elementary school years (i.e. 5?12 years), research indicates that disruptive behavior in children in care can negatively impact social, emotional and academic development, as well as placement stability. Evidenced-based interventions to improve children’s behavior and reduce parenting stress are necessary. This pilot study augmented an existing evidenced-based intervention (i.e. the Incredible Years) developed for birth families for use with foster caregivers. Results from 18 families indicate that foster caregiver-reported conduct symptoms were significantly lower for children whose families participated in the treatment group. A similar trend was found for the overall externalizing behavior. No significant changes were identified in parenting attitudes and stress. Participants reported high levels of satisfaction and acceptability with the program and outcomes. These findings indicate that foster caregiver training should be examined in larger, randomized control trials.
Parent training (PT) is an evidence-based treatment for reducing and preventing child conduct problems and abusive parenting. However, questions have been raised about the dissemination of PT to culturally diverse families who hold different views on childrearing. Group PT was applied in two Chinese immigrant families illustrating strategies for addressing potential cultural barriers. The Incredible Years program builds in therapeutic process elements to address cultural concerns to enhance engagement. In addition, augmenting basic PT with additional skills training can help parents manage stressors common in immigrant families to facilitate uptake of new parenting skills. This implementation experience suggested that high-risk immigrant Chinese parents can be effectively engaged in group PT, even when they are not in treatment voluntarily.
Reference only for this article.
Théo, 3 ans, ne veut pas aller au lit le soir, se lève de nombreuses fois et finit par s?endormir dans le lit des parents ; Mélanie, 7 ans, refuse tous les fruits et les légumes, est très sélective dans les viandes, ne mange pas de poisson?; Victor, 8 ans, se bagarre avec ses 2 frères plus jeunes, casse leurs jouets.
Preventing conduct problems in young children as become a focus of early intervention efforts. Estimates show that 7% to 35% of young children meet the diagnostic criteria for oppositional defiant disorder or conduct disorder. Left untreated, children with early conduct problems face increasted risk of conduct disorders and school difficulties during early schooling and of school dropout, delinquency, and antisocial behaviors.
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 study investigated the influence of therapist skill on the effectiveness of a manualized parenting program for child antisocial behavior. A reliable instrument with 10 scales was developed to measure skill. 15 parenting groups were observed, from a controlled trial involving 90 clinically referred, disadvantaged children aged 3-8 with severe antisocial behavior. Child outcome was assessed by interview. The skill level of therapists running the groups was found to be a significant predictor of effectiveness.
This paper describes the implementation.
This study examined group leaders? adherence to The Incredible Years Parenting Program?s components and collaborative process during a yearlong dissemination in a large multicultural city and universal prevention context. Mixed methods were used to evaluate adherence and develop an understanding of the barriers and facilitators of therapist fidelity. Results suggest that the protocol and collaborative group processes were implemented with a high degree of adherence with the three exceptions of role plays, videotape modeling dosage, and ?buddy calls.? A number of interconnected barriers with implications for future implementation were identified. Key contributors to adherence included the training and structure of the program, emphasis on accountability and ongoing session monitoring, and important aspects of supervision and group leader qualities.
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.
Depression is a common and debilitating illness and there is a strong association between maternal depression and childhood Conduct Disorder (CD). This paper examines the impact of maternal depression on the outcome of treatment for the prevention of CD. Data from the Hutchings et al. (2007) Randomised Controlled Trial (RCT) of a parenting programme for parents of high-risk three and four year olds are used to explore the potential role of change in maternal depression as a mediator of child behaviour outcome. The role of positive parenting as an additional mediator was also examined due to previous research findings. Improvement in maternal depression was found to be a significant partial mediator of improvement in child behaviour. Maternal depression continued to be a partial mediator when positive parenting was included in the mediation model. Parenting interventions for the prevention of CD are more likely to result in improved child behaviour when they also address the skill deficits known to be associated
with maternal depression.
AbstractAbnormal patterns of sympathetic- and parasympathetic-linked cardiac activity and reactivity are observed among externalizing children and mark.
Aims: To assess the effectiveness of a parenting programme, delivered by health visitors in primary care, in improving the mental health of children and their parents among a representative general practice population.
Methods: Parents of children aged 2-8 years who scored in the upper 50% on a behaviour inventory were randomised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors, or no intervention. Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Questionnaire to measure child behaviour, and the General Health Questionnaire, Abidin?s Parenting Stress Index, and Rosenberg?s Self Esteem Scale to measure parents? mental health. These outcomes were measured before and immediately after the intervention, and at six months follow up.
Results: The intervention was more effective at improving some aspects of the children?s mental health, notably conduct problems, than the no intervention control condition. The Goodman conduct problem score was reduced at immediate and six month follow up, and the Eyberg Child Behaviour Inventory was reduced at six months. The intervention also had a short term impact on social dysfunction among parents. These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non-clinical (normal) range. Conclusion: This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care.
Disruptive behavior disorders such as Attention Deficient/Hyperactivity Disorder and Oppositional Defiant Disorder are common and stable throughout childhood. These disorders cause long-term morbidity but benefit from early intervention. While symptoms are often evident before preschool, few children receive appropriate treatment during this period. Group parent training such as the Incredible Years has been shown to be effective in improving parenting strategies and reducing children?s disruptive behaviors. Because they already monitor young children?s behavior and development, primary care pediatricians are in a good position to intervene early when indicated.
Objective: The aim of the study was to extend research on the potential benefits of adding ongoing feedback, coaching, and consultation to initial therapist training workshops to ensure fidelity of delivery of evidencebased practices, specifically for the Incredible Years parenting program.
Methods: A randomized controlled trial compared two models for training therapists to deliver the parenting program for children at high risk of developing conduct problems. Therapists (N=56) from ten communitybased mental health service organizations in California were trained in either a three-day workshop model (N=25), based on active, experiential, self-reflective, principle-based learning, videomodeling, and manuals, or an enhanced training model (N=31) that included all elements of the workshop model plus ongoing expert coaching, video review of and feedback on group sessions, and consultation for therapists and agency supervisors.
Results: Overall fidelity across both conditions was rated >3 on a 5-point scale in seven of eight domains measured. Therapists in the condition that received ongoing coaching and consultation were significantly stronger in four of the domains: practical support, collaboration, knowledge, and skill at mediating vignettes. Conclusions: Consultation and expert coaching for training therapists beyond the standard three-day training enhanced skills and therapists? adherence to the model. (Psychiatric Services 65:789?795, 2014; doi: 10.1176/ appi.ps.201200177)
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Kevin was very reluctant to participate in a parent group, commenting,
The first night I went I couldn’t wait for it to be over. I couldn’t imagine continuing for 12 weeks listening to these family service workers who were two women I didn’t know tell me how to raise my kids, and then there were so many mothers and only two other dads in the group.
However, Kevin was drawn to the parent group by the prospect of the support he work receive. He reflected,
I’m not sure if I was abused or not, but I know I used to go to school with welts, from being hit. My parents had an ironong cord that they cut off an iron and stripped the rubber so it was bare metal. That is what we used to set spanked with.
This study was conducted by the Clondalkin Partnership; Incredible Years Initiative in Clondalkin, Ireland.
Children in schools within disadvantaged areas have been found to have emotional disorders of a much more severe nature. Emotional and behavioural problems develop in a dynamic social context within the child?s home, school and community and exert a significant toll on children and young people. The research suggests that one of the most effective means of tackling these problems lies in family-based approaches. Generally, these are targeted at pre-school or slightly older children with conduct or emotional and behavioural problems, with the parent(s) or primary carere as the central focus of the intervention.
The Clondalkin Partnership began the implementation of the Incredible Years (IY) programme in 2004 in order to create a community-based solution to a national problem. The IY BASIC Parent Training program was the first to be implemented on a trial basis. The pilot study reported here was designed and implemented by staff at the Clondalkin Partnership in part collaboration with researchers at NUI Maynooth in order to assess the overall effectiveness of the IY BASIC Parent Training Program.
The quantitative findings in this study indicate important positive changes in many different aspects of the children?s behaviour, which were supported and amplified by the qualitative data. The benefits accrued by parents ? both personally and in terms of their improved relationships
with their child ? as well as their overwhelmingly positive views of the IY program itself, were important and recurring themes identified from the qualitative analysis. Thus, the overall results provide convincing evidence for the effectiveness of the IY program, albeit within the context of a small, localised pilot study without the inclusion of a control group. The results also suggest that any future implementation of the entire IY program (with all three of its training components) would be very well received in Clondalkin.
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 programme developed by Professor Carolyn Webster-Stratton had produced a significant level of research to suggest that it is the best way to treat early onset conduct disorders by teaching parents to change their behaviour which in turn changes their child’s behaviour (social learning theory). In Essex 296 parents have taken part in groups and self completed questionnaires have shown an improvement in all the following areas; family life, parent-child relationship, level child problem behaviours, frequency of child problem behaviours, strengths and difficulties, parental stress and general health. This shows that the Incredible Years Parent Training Program is a success.
Analyses showed a significant reduction in child problem behaviour and improvement in carers? depression levels for intervention families at follow-up, compared with control. Unexpectedly, there was a significant improvement in control carers’ self-reported ‘parenting’ strategies.Initial foster carer training could incorporate the IY programme to support carers in establishing positive relationships and managing difficult child behaviour. Programme participation may lead to reduced service use and improved placement stability.
The strategies used to manage children?s behaviour contribute significantly to the development, establishment and maintenance of conduct problems, and there is substantial evidence in the literature suggesting that parenting programmes are the most effective interventions for preventing or treating conduct problems, in the short
and long term, especially if delivered early, before the child encounters secondary risk factors following the transition to school. There is strong evidence for the effectiveness of the IY
Basic Parenting Programme in enhancing parenting skills and reducing child conduct problems, as well as improving parent child relationships with children aged three to eight years old.
Increasing numbers of high-risk children now spend time in out-of-home care during their pre-school years. Government, at national and local level, is increasingly recognising the importance of delivering evidence-based parenting programmes, to parents of children living in disadvantaged areas at risk of developing CD, but this has not been reflected in similar support to childcare staff working in nurseries in these areas.
A growing body of research provides evidence of the prevalence of childhood conduct problems and the long-term negative consequences that result. It also identifies parent management training such as the Incredible Years Parenting (IYP) programme as an effective evidence-based treatment. ?? As part of the Drivers of Crime work programme the Ministries of Education, Health and Social Development established a pilot study of the IYP programme to assess the effectiveness of this programme in reducing conduct problems in a New Zealand context. ?? The project was influenced by the recommendations of the Government Advisory Group on Conduct Problems, the Ministry of Education Positive Behaviour for Learning strategy and the desire to develop a new collaborative model to evaluate government-funded programmes. The benefits of the IYP training were broadly similar for M?ori and non-M?ori families. Both M?ori and non-M?ori parents expressed high to moderate satisfaction with the programme. These results suggest the IYP programme can be successfully implemented in New Zealand and retain its general level of effectiveness.
[spacer]The use of Time Out as a self-regulation calm down strategy for children between the ages of 3 and 9 years old is part of a.
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.
Which programme to choose? How to deliver it so as to achieve comparable outcomes to those reported in the research trials? These two issues, choice of programme and how to take interventions to scale and deliver them effectively in service settings, are the subject of the growing field of “implementation science” that has been informed by the Society for Prevention Research and set out in their guidance to service providers on how to ensure that evidence based programmes work in service settings (Flay et al. 2004) and by the work at the University of Colorado Center for Violence Prevention in identifying strongly evidence- based ?blueprint? programmes (Mihalic et al. 2002).
This paper provides a case study in the implementation and dissemination of the strongly evidence-based Incredible Years parent, child and teacher programmes across Wales. It describes the author?s work in delivering, researching and supporting the dissemination of the parent programme, and subsequently the child and teacher programmes, with the support of the Welsh government. It sets out the reasons for choosing the programmes, the steps taken to test their effectiveness in service settings across Wales, the dissemination process and lessons learned.
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.
Most of the parenting programs in the U.S. are originally developed for Americans who understand American culture and common parenting practices. Therefore, when pilot-testing these programs with minority populations, it is important to examine not only the effectiveness of the program but also the cultural and linguistic appropriateness and usefulness of program content and delivery.
The goal of this study was to evaluate the delivery of a parenting program to 17 Korean immigrants for cultural and linguistic appropriateness and usefulness regarding recruitment, retention, program content, and delivery methods. Focus group interview data were audiotaped, transcribed, and analyzed. Themes identified included fit between the parents? desire and what the program offered, effective recruitment and retention strategies, program content and videotapes: based on western cultural background but useful, helpful role-play and homework, and recommendations (Korean language videotapes, longer classes, extended learning). The findings can be used in adopting the program to increase cultural and linguistic
This long-term study has demonstrated the stability of positive intervention outcome for families within this disadvantaged, at-risk, population, using both self-report and objective observational data. The relatively low drop-out rate and high mean attendance reflects the effectiveness of the intervention in engaging typically hard-to-reach-families. Positive effects of the Incredible Years programme are maintained over time for many children and families who are in greatest need. Up to 40% of untreated children diagnosed with conduct disorders develop later problem behaviours including drug misuse, criminal and violent behaviour.
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.
Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multi-agency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children?s conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multi-agency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial set-up costs were ?3305.73; recurrent delivery costs for the program based on eight parents attending a group were ?752.63 per child, falling to ?633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were ?1509.28 per child based on eight parents, falling to ?1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively.
A diversity of parent training methods have emerged. Parents have been trained individually and in groups, both in the home and in the laboratory, by means of didactic lectures, sddigned readings, programmed materials, group discussions, and videotape. Specific goals of the study were:
1. To examine the effect of the program on the mothers’ attitudes of confidence, acceptance, trust, understanding, and causation.
2. to examine the effect of the program in changing the mothers’ behaviors.
3. to examine the effect of the program six-to-eight weeks after termination of the program.
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.
NICE technology appraisal guidance 102. Parent-training/education programmes in the management of children with conduct disorders.
The full guidance and quick reference guide are also available at http://www.scie.org.uk/publications/children.asp
For printed copies of the quick reference guide or ?Understanding NICE guidance?, phone the NHS Response Line on 0870 1555 455.
This bulletin describes state-of-the-art universal and selective prevention programs designed to promote parent and teacher competencies and to prevent conduct problems. In addition, it describes indicated interventions designed for children who already have been diagnosed with oppositional defiant disorder and/or conduct disorder. Emphasis is placed on empirically supported programs that have identified key malleable risk factors in children, families, and schools, which have been shown in longitudinal research to be related to later development of substance abuse, delinquency, and violence. We have targeted preschool and primary grade chi ldren, ages 0-8 years, in this review because research suggests that the most effective interventions can nip in the bud risk behaviors in the early years, before antisocial behaviors become crystallized. Guidelines for selecting effective interventions are provided.
This paper reports on a quantitative evaluation of a group-based programme designed to promote parent infant attachment and child.
New IY programmes for parents of toddlers and babies were recently developed in Seattle by Carolyn Webster-Stratton, Ph.D. The 12-week toddler parenting programme has been the subject of a Welsh Government funded separate evaluation. The eight-week programme discusses appropriate stimulation and aims to increase parental sensitivity to their babies’ cues, encourage the development of parent support networks and highlight safety issues. Parents and their babies meet weekly with two trained leaders for twohour sessions. Updates on their infants’ activities and development are shared in a safe and supportive environment. Parents are encouraged to implement the programme strategies in their daily activities at home.
Assessed the effectiveness of ?The Incredible Years Parent Training Program? on the functioning of families of children with ADHD within a community clinic setting. A multiple baseline across participants design was employed with four research participants in a group of nine parents attending a 2-hour treatment session weekly for twenty weeks, with planned booster sessions at 2 and 4 months following treatment. Participants were all solo mothers with sons between 6 and 9 years of age who met the DSM IV criteria for ADHD. Family functioning was assessed from the pre-treatment interview schedule, measures of child behavior (Conners, Strengths and Difficulties Questionnaire, daily ratings of child behavior) and parental functioning (BDI-II, Parental Stress Index, weekly ratings on specific areas of family functioning, group goals). Participants also completed program satisfaction and evaluation measures. Results overall showed (a) some improvement in teacher and parent reports of child behavior, including targeted child behavior goals, (b) improved targeted family functioning problems, (c) increased parental confidence, (d) reduced stress and depression levels for most parent participants, and (e) reports of better parent-child relationships. Additionally, participants all reported being highly satisfied with the program. Findings support the use of the Incredible Years Parent Training Program and planned booster sessions as an effective low cost intervention to improve the functioning of solo mothers and of children with ADHD. Discussion considers the use of this intervention in an overall multiple gating, stepped care approach, particularly in light of a need for continuing services for one of the mothers.
Executive Summary – Aims of the Study?
In the present study we assess the preventive effects of the IY BASIC and ADVANCE parent programs in preschool children at risk for disruptive behavior disorders. We are studying the moderating effects of psychophysiological and neuropsychological variables on intervention outcome. We also study whether positive outcomes are caused by favorable changes in parenting skills. Finally, costs and cost-effectiveness are studied. One hundred and forty children, aged four and a half years are selected for the study on the basis of high aggression scores on the Child Behavior Checklist. The parents of half of these children are randomly assigned to the IY BASIC and ADVANCE programs; the other children serve as ‘care as usual’ controls. Assessments are conducted 00at pre-treatment, post-treatment, one year follow-up, and two year follow-up. Measures consist of parent questionnaires (e.g., Child Behavior Checklist, Eyberg Children?s Behavior Inventory), parent interviews (e.g., Daily Discipline Interview, NIMH Diagnostic Interview Schedule for Children IV), teacher questionnaires (e.g., Child Behavior Checklist – Teacher Rating Form, Parent-teacher Involvement Questionnaire), and observations of parent-child interactions at home (Dyadic Parent-Child Interaction Coding System). Detailed information on the costs of the intervention and on the costs generated by the conduct problems (e.g., medical consumption, education) are monitored.
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.
The effectiveness of the Incredible Years Parenting program was evaluated in a low-income sample of Caucasian, African American, Hispanic, and Asian mothers whose children were enrolled in Head Start. Data from two prior interventions studies [Webster-Stratton (1998) Journal of Consulting and Clinical Psychology, 66(5), 715-730; Webster-Stratton et al. (in press) Journal of Clinical Child Psychology] were combined, yielding a sample of 634 families (370 Caucasian, 120 African American, 73 Asian, 71 Hispanic) across 23 Head Start centers. Centers were matched and assigned randomly t either an experimental condition (8-12 weeks of weekly 2-hr parenting classes), or a control condition (the regular Head Start Program without parenting groups).
There is substantial evidence that improving parenting skills through parent training programs can significantly reduce the development and persistence of conduct problems and improve the quality of parent-child relationships (Kazdin, 1997; McMahon, 1999; Serketich & Dumas, 1996; Tucker & Gross, 1997). Specifically, when parents limit their use of coercive child management strategies (e.g., yelling, hitting, and verbal aggression) and increase their use of positive, supportive responses (e.g., encouragement, praise, and physically positive behaviors), child conduct problems and parenting self-efficacy significantly improve. These positive outcomes have mostly been achieved with early schoolaged children and adolescents. However, those findings have led to increasing interest in providing training for parents when their children are toddlers and preschoolers, before child conduct problems become firmly entrenched and more difficult to treat (Wakschlag & Keenan, 2001; Yoshikawa, 1994).
The authors tested a 12-week parent training program with parents (n=208) and teachers (n=77) of 2-3 year olds in day care centers serving low-income families of color in Chicago. Eleven centers were randomly assigned to one of four conditions: (a) parent and teacher training (PT + TT), (b) parent training (PT), (c) teacher training (TT), and (d) waiting-list control (C). After controlling for parent stress, PT and PT + TT parents reported higher self-efficacy and less coercive discipline and were observed to have more positive behaviors than C and TT parents. Among toddlers in high-risk behavior problem groups, toddlers in the experimental conditions showed greater improvement than controls. Most effects were retained one year later. Benefits were greatest when parents directly received training.?
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.
Early-onset behavioural problems such as aggression and non-compliance are the best predictors of antisocial and criminal behaviour in adolescence and Randomised controlled trial of a parenting intervention. Untreated, up to 40% of children with early difficulties develop subsequent conduct disorder, including drug misuse, criminal and violent behaviour. Early behavioural difficulties predicting long-term problems are easily identifiable and effective interventions prevent progression into more severe difficulties. There are severe financial costs if conduct disorder is not prevented. Utilisation of health, social, education and legal services is ten times higher for this population, mostly borne by publicly funded services, especially in areas of social exclusion. Parenting behaviour contributes to the establishment of conduct disorder and many children learn, develop, or establish problem behaviours because parents lack, or inconsistently use, key parenting skills9. When ineffective parenting is the problem, cognitive-behaviourally based parenting programmes can provide an effective solution but are more effective with younger children. When both child problems and parenting patterns are less well-established parents can more easily influence their children?s behaviour. One UK government strategy is Sure Start early preventive parenting support for families of pre-school children living in identified high-risk, disadvantaged areas. Since its launch in 2001 ?3.1 billion has been invested in the scheme11. This funding was provided without direction from government about which services should be delivered. As a result, widely varying services were provided, many lacking evidence of effectiveness from randomised trials.
A recent and compelling study entitled ‘Neurons to Neighborhoods’, conducted by the Board on Children, Youth, and Families of the Institute of Medicine (USA) calls attention to the importance of early emotional development in young children. Based on a careful review of neuroscience and developmental science, it highlights compelling evidence that a child?s earliest experiences and relationships set the stage for how he or she manages feelings and impulses, and relates to others (Raver & Knitzer, 2002). This paper discusses data from studies of behavioural and emotional problems and prosocial behaviour in a community sample of 362 Portuguese preschool children (age 3 to 6 years) and examine how these problems vary, as hypothesized, with parental practices. Each mother/father completed the Portuguese translation of two measures: Parenting Practices Questionnaire (adapted from the Oregon Social Learning Centre?s discipline questionnaire and revised for young children by Webster-Stratton, Reid and Hammond, 2001); Strengths and Difficulties Questionnaire (Goodman, 1997). Implications for prevention and intervention, in terms of parenting education and support, and for the development of social policies are discussed. Key words: parental practices; emotional and behavioural problems; prosocial behaviour; preschool; parenting training; parental education; SDQ.
School-based social-emotional learning programs are cost saving for the public sector, with education services likely to recoup the cost of the intervention in five years. Lack of investment in well-being (mental health) promotion in schools is likely to lead to significant costs for society. The Incredible Years is a good example of an evidence-based intervention that can “go to scale”, and help parents and teachers work together to achieve common goals.
Conduct problems are the most common reason for referral for psychological and psychiatric treatment in childhood. The prevalence rate of conduct disorder is 5?10%. It can lead to negative life outcomes including criminal behaviour and psychiatric disorders, with increased costs to the education, health, social and criminal justice services. The study involved an evaluation of an universal school-based approach ? the Incredible Years Teacher Classroom Management programme ? which was developed in the US and implemented in Jamaica to help reduce conduct problems in young children.
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.
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.
While there is now compelling evidence for the efficacy of parent management training programmes in reducing rates of childhood conduct problems, installing these programmes into a new social context such as New Zealand raises a number of issues. In particular, before such programmes can be accepted as part of established practice in a new context there is a requirement to show (i) that these programmes can be delivered effectively within that context; (ii) that programme efficacy in the new context is established; and (iii) that the cultural appropriateness of the programme is assessed.
Against this background, the present research note summarizes the findings of a preliminary examination of the effectiveness and cultural acceptability of the Incredible Years Basic Parent Programme delivered in New Zealand.
Young children with aggressive and oppositional behavior are at risk for serious antisocial behavior that may persist into adolescence and adulthood. Most parents wish to discuss parenting difficulties and their child?s social and emotional development during well-child visits. Parent training programs are an effective option to promote positive parenting and discipline strategies and enhance a child?s social skills, emotional self-regulatory skills, and problem-solving ability. Key parenting principles can be incorporated into developmental surveillance and anticipatory guidance during periodic well-child visits to prevent disruptive behavior problems, address parenting concerns, and nurture the optimal development of children?s social-emotional competency.
Responding to serious behaviour problems requires new practice answers and emphases. Best practice principles and a developmental perspective indicate that the family should be the focus of preventative work. The Incredible years parent training series is described as an important example of an empirically-supported programme that is presently being used in Tauranga and elsewhere in New Zealand.
The early childhood period is associated with profound development across cognitive, social, emotional, behavioral, and physical domains. Early childhood mental health is characterized by social-emotional competence and behavior regulation within healthy and supportive relationship contexts. However, children may demonstrate significant disruptions in social, emotional and behavioral functioning from early on, with approximately 12% of preschoolers in the general population and up to 30% in high-risk, low income samples identified as having serious behavioral difficulties. These challenges are associated with an elevated risk of future emotional, academic, and relationship problems. Specifically, children exhibiting early-onset behavioral problems are at especially high risk for life-course delinquency, substance use, violent behavior, academic failure, and depression. Although conduct problems are the most frequent reason children are referred for mental health services, young children’s mental health problems remain underrecognized and undertreated.
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).
As pediatric mental health problems have become more prevalent, pediatricians face the need to hone their skills in identifying and managing these issues in practice. The American Academy of Pediatrics has advocated for competency in mental health care for all pediatricians. Despite these recommended changes, ongoing deficiencies and barriers to developmental?behavioral pediatrics (DBP) training in residency persist, including inadequate faculty development, gaps in training, and funding. Graduates report feeling inadequately prepared to handle DBP issues.
The aim of the present study was to evaluate whether a short parent-training program (PT) reduces risk factors related to development of childhood socio-emotional and behavior problems in a non-clinical community sample. Data were obtained from parents in a randomized controlled trial (RCT) on PT for children aged 2 to 8 years (N = 186) at pre-intervention, post-intervention and one-year-follow up. There were significant differences in the changes in the two groups, with reductions in harsh parenting and child behavior problems, an enhancement of positive parenting and of the parents? sense of competence in the intervention group. The effects on parenting and parents? satisfaction all lasted through one-year follow up. Our findings suggests that a shortened version of a well-structured parenting intervention, The Incredible Years program, implemented in primary care at community level, reduces harsh parenting and strengthens positive parenting and parents? sense of competence, as reported by the parents. Issues related to a public health approach to promote positive parenting are discussed.
The programme is one of Webster-Stratton?s Incredible Years (IY) programmes developed and researched for parents, children and teachers. The programme is being offered to parents of pre-school children at risk of developing conduct disorder and who are living in identified Sure Start areas across North Wales. The programme is being delivered by certified group leaders through seven participating Sure Start centres across North Wales.
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.
What can we do better with our programme delivery to ensure a higher rate of retention among participants of the Incredible Years Parent Programmes (IYP) we offer in the Central North Region? In particular, is there anything we can be doing more effectively that will enable Māori participants to complete the course?
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.
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.
The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time.
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.
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.
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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.
Child depression is a serious public health burden without any currently accepted empirically supported treatments. Given the dire consequences of life-course persistent depression and the developmental roots of depression in childhood, effective treatments and prevention strategies are urgently needed. The parent behavior-management intervention used in the present study is a widely used and accepted treatment. Given mounting pressures toward time-limited therapy and the widely accepted high rates of co-occurring behavior problems in children, clinicians and researchers welcome any evidence that single interventions can promote change in multiple problem areas. Current evidence suggests that the parent behavior-management program tested in this study offers a viable treatment for reducing depressive symptoms in young children.
The Birmingham Brighter Futures strategy was informed by epidemiological data on child well-being and evidence on “what works,” and included the implementation and evaluation of three evidence-based programmes in regular children’s services systems, as well as an integrated prospective cost-effectiveness analysis (reported elsewhere). A randomised controlled trial (RCT) of the Incredible Years BASIC parenting programme involved 161 children aged three and four at risk of a social-emotional or behavioural disorder. An RCT of the universal PATHS social-emotional learning curriculum involved children aged four?six years in 56 primary schools. An RCT of the Level 4 Group Triple-P parenting programme involved parents of 146 children aged four?nine years with potential social-emotional or behavioural disorders. All three studies used validated standardised measures. Both parenting programme trials used parentcompleted measures of child and parenting behaviour. The school-based trial used teacher reports of children’s behaviour, emotions, and social competence. Incredible Years yielded reductions in negative parenting behaviours among parents, reductions in child behaviour problems, and improvements in children?s relationships. In the PATHS trial, modest improvements in emotional health and behavioural development after one year disappeared by the end of year two. There were no effects for Triple-P. Much can be learned from the strengths and limitations of the Birmingham experience
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.
This article describes an evidence-based preventive group intervention, Incredible Years Parent Training Program (IY). Decades of research have shown that IY strengthens parent and child competencies and in turn reduces child risks for developing conduct problems and other negative life outcomes. The purpose of this article is to examine IY through a resilience lens and highlight how it capitalizes on group process mechanisms to serve as a model preventive group intervention. Future directions and implications for research, practice, and training are discussed.
For this paper the researcher took the unusual approach of interviewing the deliverers of the parent training programme in Tauranga, rather than the recipients. The perspective taken was that the programme facilitators are usually highly qualified psychologists and social workers who collectively have an enormous amount of knowledge, experience and insights. The Incredible Years parent training programme has been found to be highly successful in Tauranga as it provides a supportive group environment in which parents can share concerns and ideas, and it is adaptable to different cultural and individual needs.
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The Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over.
This book chapter summerizes the Incredible Years Parent and Child Training Series: how to deliver IY parent and child core program principles and adapt the program with fidelity to meet the needs of intact families referred by child welfare as well as families where the children have been removed from the home. These evidence-based interventions have demonstrated ability to improve parent-child relationships and to build parents? own sense of competence and self-control as well as strengthen their supportive family and community networks. While it is not uncommon for child welfare agencies to seek briefer interventions than the Incredible Years, these families are complex and in the highest risk category for re-abuse and maltreatment if not adequately trained and supported. Data in the parenting literature support the notion that parenting curricula need to be substantial to produce sustainable effects with challenging populations (Kazdin & Mazurick, 1994). Data from the IY programs have shown that the dosage of the intervention received and fidelity with which it is delivered are directly linked to changes in parenting and child behaviors (Baydar, Reid, & Webster-Stratton, 2003; Eames et al., 2009). Our standard treatment recommendation for child welfare families referred because of abuse and neglect is a minimum of 18 2-hour parent and child group sessions delivered by accredited IY group leaders who have high levels of support and consultation.
Parent participation in the full IY program is expected to accomplish the following: improve the parent-child relationship; increase parents? sense of competence and self-control; increase the use of positive discipline strategies, predictable schedules and monitoring; and reduce the rates of harsh and physical discipline. Child participation in the full IY child program is expected to improve children?s emotional regulation, social skills and to strengthen problem-solving skills as well as attachment and trust with parents. In the long term, we expect that these improvements in parenting and parent-child relationships will lead to lower rates of re-abuse, fewer re-reports to Child Welfare Services and more academically, emotionally, and socially competent children. In order to break the intergenerational cycle of parent-child violence and neglect and child conduct problems, it is also necessary to provide enough training and support to therapists to assure program fidelity with the goal of these children getting the best parenting possible.
BACKGROUND: Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process.
AIM: To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. Methods An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder.
RESULTS: The Leader Observation Tool (LOT) achieved high internal reliability and good code?recode and inter-rater reliability. Evidence of concurrent validity was also obtained. Conclusions Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome.