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.

Comparison of mother, father, and teacher reports of ADHD core symptoms in a sample of child psychiatric outpatients.

OBJECTIVE: To explore the significance of adding father ratings to mother and teacher ratings in the assessment of ADHD symptoms in children. METHOD: The ADHD Rating Scale-IV, the Child Behavior Checklist, and the Teacher Report Form were filled out by all three informants for a sample of 48 clinically referred children (79% boys) aged 6 to 15 (M = 10.1) years. RESULTS: Correspondence between father and teacher reports on ADHD-specific symptoms (intraclass correlation coefficient [ICC] = .38) exceeded that between mothers and teachers (ICC = .23). Fathers rated their children as having fewer problems than did mothers and teachers on Total scale scores and the Inattention subscale of the ADHD Rating Scale-IV. Mother ratings were more sensitive to an ADHD diagnosis, whereas father ratings better predicted an ADHD diagnosis requiring the two-setting criterion. CONCLUSION: The choice of parent informant and informant combination had a considerable impact on parent-teacher concordance and estimates of ADHD symptoms and subtypes in the child.

Associations between high levels of conduct problems and co-occurring problems among the youngest boys and girls in schools: a cross-sectional study.

BACKGROUND: Few studies have focused on conduct problems and co-occurring problems among the youngest children in schools, such as social, internalizing and attention problems. In particular, there is a lack of studies that differentiate between boys and girls in terms of such problems. AIM: The aim of the current study was to test associations between conduct problems and social, internalizing and attention problems, as well as adaptive school functioning, which was rated by the teachers of boys and girls in grades 1-3. METHODS: In a cross-sectional study, 103 boys and 108 girls in grades 1-3 at six schools participated in a national Norwegian study of child conduct problems in the normal population. Linear regression analysis was used to test the associations between conduct problems, social skills, problems of internalization, attention problems and adaptation to school among boys and girls. RESULTS: There were significant associations between high levels of conduct problems and social skills problems, attention problems and low adaptive school functioning scores among boys and girls. Attention problems had the most powerful associations with conduct problems for both genders. CONCLUSIONS: Young schoolchildren with high levels of conduct problems also had co-occurring problems. Schools and teachers need to adopt a comprehensive approach to help these children during their first years in school.

Promoting positive parenting practices in primary pare: outcomes and mechanisms of change in a randomized controlled risk reduction trial.

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.

Characteristics of young children with persistent conduct problems 1 year after treatment with the Incredible Years program.

In the present study, predictors of persistent conduct problems among children aged 4-8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program (PT), or combined parent training and child treatment (PT + CT). Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.

Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training.

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.

Parent training for young Norwegian children with ODD and CD problems: predictors and mediators of treatment outcome.

Participants were 121 children, aged 4-8 years referred for conduct problems, and their mothers. A parent training intervention was implemented in two outpatient clinics in Norway. Treatment responders were defined as children scoring below a cut-off on the Eyberg Child Behavior Inventory, a score below an optimal cut-off for children in day-care and school as reported by teachers, in addition to a 30% reduction or greater in observed negative parenting. Self-reported parenting practices were explored as potential mediators. The results of logistic regression analyses showed that high levels of maternal stress, clinical levels of ADHD, and being a girl predicted a poorer outcome in conduct problems at home, while pretreatment clinical levels of ADHD predicted a poorer outcome as perceived by the teachers. Harsh and inconsistent parental disciplining emerged as significant partial mediators of changes in conduct problems, highlighting the importance of altering parenting practices to modify young children's conduct problems.

Treatment of oppositional defiant and conduct problems in young Norwegian children : results of a randomized controlled trial.

The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4-8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries.

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents: a meta-analysis.

BACKGROUND: The effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated. METHOD: Sixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated. RESULTS: The mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively. CONCLUSION: Psychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.

Eyberg Child Behavior Inventory (ECBI): Norwegian norms to identify conduct problems in children.

This article presents the first Norwegian standardization of an assessment tool specifically designed to measure childhood conduct problems. Norwegian norms for the Eyberg Child Behavior Inventory (ECBI) based on data obtained from a random population sample (N= 4063) of children in the age range of 4 to 12 years are presented. The sample was drawn from rural and urban areas within three Norwegian town districts. Clinical and research advantages of having a properly standardized assessment tool for this specific subclass of childhood psychiatric problems in Norway are discussed.

Childhood disruptive behaviors and family functioning in clinically referred children: are girls different from boys?

Baseline assessments of 4 to 8-year-old children, 26 girls and 101 boys, referred to outpatient treatment for disruptive behaviors, were examined, focusing on possible differences between the functioning of boys and girls and their families. Child variables included diagnostic information, measures of disruptive behaviors, social competence, and independent observations of child behaviors. A variety of family variables, such as information regarding parenting practices, parental stress, and depression were included. Teacher reports of disruptive behaviors and social competence at school were included. Teacher ratings of child functioning indicated that boys displayed significantly more externalizing behaviors and they were less socially competent than girls. Parents perceived both girls and boys as highly oppositional and aggressive, and generally speaking, differences were few. Nevertheless, the level of stress was higher in girls' than in boys' families, and mothers of girls reported of higher levels of depressive symptoms. Girls and boys did not differ regarding diagnostic status.

The Strengths and Difficulties Self-Report Questionnaire as a screening instrument in Norwegian community samples.

This study reports on the application of the Norwegian self-report version of the Strengths and Difficulties Questionnaire (SDQ-S). The application of the SDQ-S was not motivated by a wish to reveal the prevalence of psychiatric disorders, but rather to set the stage for routine screening as part of schools' efforts to inform themselves about the life of adolescents at school. The survey included 4167 young people aged 11 to 16 years, attending 66 primary and secondary schools in Northern Norway. The respondents comprised 80.2% of the total population in these grades in the target area. Structural analysis of the instrument, including confirmatory factor analysis, internal consistency and intra- and cross-scale correlations revealed somewhat variable psychometric properties. Model modification suggested several ways of improving the structural psychometric properties of the SDQ-S. Norwegian cut-off points were similar to those found in other Scandinavian studies. About one third of the subjects reported at least minor perceived difficulties, while about 5% reported definite or severe difficulties. These difficulties were strongly associated with all symptom scales. Girls reported a significantly higher level of emotional problems and better prosocial functioning. Boys reported significantly higher scores on the externalising scales and on peer problems. The SDQ-S may be judged as an efficient and economical screening instrument for preventive research on large community samples. However, efforts should be made to improve its psychometric structure.