Effects of the incredible years parenting program on children's interpersonal conflict: An integrative data analysis.

Behavioral parenting programs, such as Incredible Years (IY), reduce conduct problems in children. However, conduct problems encompass many different behaviors, and little is known about the effects of parenting programs on specific aspects of children's conduct problems, such as children's relationships with others. The aim of this study was to examine, for the first time, the effects of the IY parenting program on children's levels of conflict with their parents, siblings, and peers. We used individual participant-level data pooled across 12 randomized trials in Europe, comprising a total of 1,409 families: child aged 1-11 years (M = 5.53 years, SD = 1.56) and 61% male, 60% low-income families, and 30% from an ethnic minority. Multilevel models were used to explore the effects of IY on children's conflict with parents, siblings, and peers. The IY program reduced children's conflict with their parents (ß = -.21), but there were no main effects of the program on conflict with siblings or peers. Moderation analyses showed that IY reduced conflict in sibling relationships for the 22% of families with the most severe sibling conflict at baseline. This suggests that high-quality behavioral parenting programs, such as IY, can effectively reduce children's conflict within the home (i.e., with parents and siblings), especially when initial levels of sibling conflict are high, but do not have broader benefits on children's interpersonal conflict outside of the home (i.e., with peers). (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Disruptive child behavior severity and parenting program session attendance: Individual participant data meta-analysis.

OBJECTIVE: We tested if baseline disruptive child behavior problem severity predicts parental attendance at sessions of a parenting group program. METHOD: We used a database of randomized trials of the Incredible Years parenting program in Europe and restricted the sample to participants randomized to the intervention arm. Using baseline Eyberg Child Behavior Inventory scores, we distinguished between trial-level problem severity and child-level problem severity, compared linear and quadratic functional forms at both levels, and considered cross-level interactions, all in a multilevel Poisson regression framework. RESULTS: Drawing on 918 participants in 12 trials, we found that within trials, parents of children with the least and most severe problems attended fewer sessions. Between trials, each additional 10-point increase in the Eyberg Child Behavior Inventory trial mean predicted an 11% increase in attendance. Models including child sex, age, or family low-income did not change coefficients or their interpretation. CONCLUSIONS: Our findings suggest that although generally attendance is higher in parents of children with more challenging behavior, it seems difficult for group programs to keep families with the least or most severe problems engaged. Our findings call for the need to better understand the conditions under which lower attendance translates into equivalent or lesser program benefits. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Exploring Parenting Profiles to Understand Who Benefits from the Incredible Years Parenting Program.

Behavioral parenting programs are a theory-driven and evidence-based approach for reducing disruptive child behavior. Although these programs are effective on average, they are not equally effective in all families. Decades of moderation research has yielded very few consistent moderators, and we therefore still have little knowledge of who benefits from these programs and little understanding why some families benefit more than others. This study applied a baseline target moderation model to a parenting program, by (1) identifying parenting profiles at baseline, (2) exploring their correlations with other family characteristics and their stability, and (3) assessing whether they moderate intervention effects on child behavior. Individual participant data from four Dutch studies on the Incredible Years (IY) parenting program were used (N = 785 caregiver-child dyads). Children (58.2% boys) were at risk of disruptive behavior problems and aged between 2 and 11 years of age (M = 5.85 years; SD = 1.59). Latent profile analyses indicated three distinct baseline parenting profiles, which we labeled as follows: Low Involvement (81.4%), High Involvement (8.4%), and Harsh Parenting (10.1%). The profiles caregivers were allocated to were associated with their education, minority status, being a single caregiver, and the severity of disruptive child behavior. We found neither evidence that baseline parenting profiles changed due to participation in IY nor evidence that the profiles predicted program effects on child behavior. Our findings do not support the baseline target moderation hypothesis but raise new questions on how parenting programs may work similarly or differently for different families.

Does Social and Economic Disadvantage Predict Lower Engagement with Parenting Interventions? An Integrative Analysis Using Individual Participant Data.

There is a social gradient to the determinants of health; low socioeconomic status (SES) has been linked to reduced educational attainment and employment prospects, which in turn affect physical and mental wellbeing. One goal of preventive interventions, such as parenting programs, is to reduce these health inequalities by supporting families with difficulties that are often patterned by SES. Despite these intentions, a recent individual participant data (IPD) meta-analysis of the Incredible Years (IY) parenting program found no evidence for differential benefit by socioeconomic disadvantage (Gardner et al. in Public Health Resesearch 5, 1-144, 2017). However, it did not examine whether this was influenced by engagement in the intervention. Using intervention arm data from this pooled dataset (13 trials; N = 1078), we examined whether there was an SES gradient to intervention attendance (an indicator of engagement). We ran mixed-effects Poisson regression models to estimate incidence rate ratios (IRRs) for program attendance for each of five (binary) markers of SES: low income; unemployment; low education status; teen parent; and lone parent status. The multilevel structure of the data allowed for comparison of within-trial and between-trial effects, including tests for contextual effects. We found evidence that low SES was associated with reduced attendance at parenting programs-an 8-19% reduction depending on the SES marker. However, there was no evidence that this association is impacted by differences in SES composition between trials or by the attendance levels of higher-SES families. The findings underscore the importance of developing and prioritizing strategies that enable engagement in parenting interventions and encourage program attendance by low-SES families.

Emotion regulation training as a treatment element for externalizing problems in adolescence: A randomized controlled micro-trial.

Improving interventions for externalizing problems in adolescence may require determining which treatment elements actually produce change. In this micro-trial, we tested a treatment element addressing one widely-hypothesized mechanism underlying externalizing problems: emotion regulation. We tested whether emotion regulation could be improved via training, whether adolescents who received such training would subsequently show reduced externalizing problems, and which training approach and sequence was most effective. We randomized 108 adolescents with elevated externalizing problems (71.3% boys, Mage = 13.66, SD = 1.10) to a control condition or an experimental condition teaching emotion regulation through either a cognitive or behavioral approach, in alternated sequences. Effects of the modules were assessed before and after the modules, and with weekly assessments. The results showed a positive effect of the experimental training on self-reported use of adaptive emotion regulation strategies. However, self-reported externalizing problems decreased more in the control condition than in the experimental condition. No mediation, approach (cognitive versus behavioral) or sequence (cognitive-behavioral versus behavioral-cognitive sequence) effects were found. These findings illustrate that change in a proposed mechanism may not be accompanied by change in targeted problems; this highlights the importance of testing the hypothesized impact of specific treatment elements on targeted mental health problems. TRIAL REGISTRATION: This trial was registered in the Dutch Trial Register (NTR7334, July 10th, 2018) and the study protocol was published (te Brinke, Schuiringa, Menting, Dekovic, & de Castro, 2018).

Parenting group composition does not impact program effects on children's conduct problems.

Many established parenting programs for children's conduct problems are delivered in groups. Various, and at times conflicting, beliefs exist about whether families fare better in groups with parents that are more similar to them, or in groups that are more diverse. We set out to test these beliefs empirically. We integrated data from four trials of the Incredible Years parenting program in the Netherlands, including 452 families (children age 2-10 years) participating in 44 parenting groups. We used multilevel regression to test whether families benefit more (or less) when they participate in a group with parents that are more similar to them in terms of ethnic background, educational level, and children's baseline conduct problems, Attention Deficit/Hyperactivity Disorder (ADHD) symptoms, and emotional problems. In addition, we tested whether relative group position effects were stronger for some families than for others (e.g., whether especially ethnic minority families benefit from groups that are more ethnically diverse). Families with more severe conduct problems benefited more, but they did not fare better (or worse) in groups where other families were more similar to them. Regarding the other group characteristics, families' relative group position did not predict parenting program effects on children's conduct problems. Our findings held across families with different sociodemographic backgrounds and different levels of children's ADHD symptoms and emotional problems. We found no evidence that parenting group composition impacts the effectiveness of the Incredible Years parenting program for children's conduct problems. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Co-occurring change in children's conduct problems and maternal depression: Latent class individual participant data meta-analysis of the Incredible Years parenting program.

Children vary in the extent to which they benefit from parenting programs for conduct problems. How does parental mental health change if children benefit less or more? We assessed whether changes in conduct problems and maternal depressive symptoms co-occur following participation in the Incredible Years parenting program. We integrated individual participant data from 10 randomized trials (N = 1280; children aged 2-10 years) and distinguished latent classes based on families' baseline and post-test conduct problems and maternal depressive symptoms, using repeated measures latent class analysis (RMLCA) and latent transition analysis (LTA). Classes differed mainly in severity of conduct problems and depression (RMLCA; 4 classes). Conduct problems reduced in all classes. Depressive symptoms did not change in most classes, except in a class of families where conduct problems and depression were particularly severe. Incredible Years led to a greater likelihood of families with particularly severe conduct problems and depression moving to a class with mild problems (LTA; 3 classes). Our findings suggest that for the majority of families, children's conduct problems reduce, but maternal depressive symptoms do not, suggesting relative independence, with the exception of families with severe depression and severe conduct problems where changes for the better do co-occur.

Equity effects of parenting interventions for child conduct problems: a pan-European individual participant data meta-analysis.

BACKGROUND: Childhood conduct problems are a costly public health problem and are five times more common in socially disadvantaged groups than they are in advantaged groups. Untreated, conduct problems have a poor prognosis, with increasing gaps between socioeconomic groups, and high rates of subsequent criminality. Incredible Years is a high quality parenting programme for reducing conduct problems and is widely disseminated in Europe. Many trials have shown Incredible Years to be effective but the potential effects of parenting interventions on social inequality are unknown. Some behavioural interventions (eg, smoking cessation programmes), although beneficial overall, can widen inequality gaps. Because single trials and aggregate-level meta-analyses are ill equipped for examining differential intervention (moderator) effects, we pooled individual-level trial data to assess the effects of Incredible Years on social equity. METHODS: We did a systematic review and individual participant data meta-analysis by searching CINAHL, Embase, Global Health, Medline, and PsycINFO, for studies published from inception to March 15, 2019. We also searched the Incredible Years website library and consulted with experts, including the European Incredible Years mentors' network. We included data from all completed randomised trials of the Incredible Years parenting intervention in Europe that included children aged 1-12 years, including unpublished trials, without restriction on publication year or outcome measures. We included prevention (selective or universal) and treatment or indicated prevention trials (for children diagnosed or above the clinical cutoff for conduct problems). We excluded trials or conditions within trials that were not randomised, included additional non-parenting material (eg, child-focused interventions), or were abbreviated, non-standard versions of the usual Incredible Years intervention of 12-14 weekly sessions. We requested individual participant data from the study authors. The primary outcome was child conduct problems, assessed using the Eyberg Child Behavior Inventory Intensity (ECBI-I) scale. Moderators were analysed using multilevel modelling with multiple imputation. FINDINGS: Of 15 European trials of Incredible Years parenting programmes (n=1696 children), individual participant data were unavailable for one trial and one trial did not assess the primary outcome. Children were aged 2-10 years (median 5·1), 492 (30%) of 1651 children were from an ethnic minority and 931 (58%) of 1614 were from low-income families. Families who received the Incredible Years intervention reported an overall reduction in child conduct problems (13·5 points on the ECBI-I scale, 95% CI 10·9-16·1). There were no differential effects by family disadvantage (indicated by poverty, lone parenthood, teenage parenthood, household joblessness, or low education), or ethnic minority status. INTERPRETATION: We found no evidence for differential effects by social disadvantage, suggesting that Incredible Years is unlikely to widen socioeconomic inequalities in conduct problems. Furthermore, the programme might be an important tool for reducing social disparities and improving poor long-term outcomes in disadvantaged families because follow-up studies indicate that benefits persist. Clinicians and commissioners can be reassured that the programme is similarly effective for families from different backgrounds. FUNDING: UK National Institute for Health Research.

Understanding Who Benefits from Parenting Interventions for Children's Conduct Problems: an Integrative Data Analysis.

Parenting interventions are an effective strategy to reduce children's conduct problems. For some families, that is, not all families benefit equally. Individual trials tend to be underpowered and often lack variability to differentiate between families how benefit less or more. Integrating individual family level data across trials, we aimed to provide more conclusive results about often presumed key family (parental education and ethnic background) and child characteristics (problem severity, ADHD symptoms and emotional problems) as putative moderators of parenting intervention effects. We included data from 786 families (452 intervention; 334 control) from all four trials on the Incredible Years parenting intervention in The Netherlands (three randomized; one matched control). Children ranged between 2 and 10 years (M = 5.79; SD = 1.66). Of the families, 31% had a lower educational level and 29% had an ethnic minority background. Using multilevel regression, we tested whether each of the putative moderators affected intervention effects. Incredible Years reduced children's conduct problems (d = - .34). There were no differential effects by families' educational or ethnic background, or by children's level of ADHD symptoms. Children with more severe conduct problems and those with more emotional problems benefited more. Post hoc sensitivity analyses showed that for the two trials with longer-term data, moderation effects disappeared at 4 or 12 months follow-up. Often assumed moderators have some, but limited abilities to explain who benefits from parenting interventions. This suggests the need for studying theoretically more precise moderators in prevention research, other than relatively static family characteristics alone.

A trial of parent training for mothers being released from incarceration and their children.

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-to-reach population of (formerly) incarcerated mothers and their children.

Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: a meta-analytic review.

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.