Incredible Years: All

A Pragmatic Approach for Troubled Kids

These therapies are getting a push because they have been shown in numerous clinical trials over the past decade to be effective on kids with severe behavioral problems, where other approaches have often failed. The techniques take a pragmatic approach, often using a set curriculum to teach new behaviors, rather than ferreting out the underlying emotional problem as with traditional psychotherapy. In another departure from traditional talk therapies, much of the counseling is often directed at parents.

Developed mostly in the past decade at academic centers, the therapies target kids with diagnoses like conduct disorder, oppositional defiant disorder or bipolar disorder, who are at risk of getting kicked out of school or breaking laws. By some
estimates, there are 1.4 million to 4.2 million children who meet the criteria for conduct disorders alone.

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A Pragmatic Randomised Controlled Trial of a Parenting Intervention in Sure Start Services for Pre-School Children at Risk of Developing Conduct Disorder: How and why did it work?

Both the government and local service providers in the UK are becoming increasingly aware of the possibility of improving child outcomes through the delivery of parenting programmes. Government initiatives, such as Sure Start, Pathfinders and Flying Start are a positive step forward, yet programmes sometimes fail to work in service settings. This article describes the components necessary to deliver effective interventions, exploring the need to choose an evidence-based parent programme, implement it with fidelity and evaluate the outcome. It describes the steps taken in North and Mid Wales to do this and reports briefly on the successful outcomes achieved by delivering the Incredible Years Basic Parenting Programme to the parents of high-risk children in Sure Start areas.

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A School-Family Partnership: Addressing Multiple Risk Factors to Improve School Readiness and Prevent Conduct Problems in Young Children

Review of the Incredible Years (IY) Parent, Teacher and Child Training Curricula and summarize research on the effectiveness of these three programs for reducing risk factors and strengthening protective factors associated with children?s social emotional development and school success. The chapter will include a focus on the role of home-school partnerships in preventing and treating children?s behavior problems and improving their school readiness as well as practical tips for engaging schools in the prevention and intervention process.

BACKGROUND:
While researchers have long considered intelligence to be a key predictor of success in school, recent studies indicate that the social and emotional adjustment of young children are strong predictors of early academic achievement even after controlling for variations in children?s cognitive abilities and family resources (Grolnick & Slowiaczek, 1994; Raver & Zigler, 1997).

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Adopting and Implementing empirically supported interventions: A recipe for success

Over the past thirty years, hundreds of carefully controlled studies have demonstrated that there exist today a number of effective therapies and services for children and families which can reduce behaviour problems and delinquency, improve mental health, assist abusive parents to improve their child-rearing, and increase family functioning (Weisz and Weiss, 1993). Yet in spite of this evidence, few empirically supported interventions have been widely adopted in applied settings (Kazdin, Bass, Ayers, and Rodgers, 1991). In the paper, we describe an empirically supported parenting intervention developed and evaluated by the first author, including the strategies used to make it easy for clinicians in the field to implement with integrity.

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Affirming diversity: Multi-cultural collaboration to deliver the incredible years parent programs

While cultural adaptations have been made for specific cultural groups, the appeal of the more ?generic? but culturally sensitive EBP is that it is cost effective and allows for more flexibility in program delivery because it can be used with heterogeneous cultural groups rather than single culture groups. Multicultural groups can also foster greater understanding among parents of differing cultural backgrounds and experiences leading to more tolerant and respectful communities. The challenge of this approach is to train therapists to provide the EBPs using culturally sensitive principles that are generalizeable across cultures. The Incredible Years (IY) Parenting program has shown promising effects in many random control group studies with diverse cultures in United States as well as in numerous other countries. This paper reviews the ?principles? embedded deeply in the IY program, which are designed to provide a culturally sensitive structure to the delivery of the program.

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Blueprints Model programs Fact Sheet – The Incredible Years: Parents, Teachers and Children’s Training Series

Incredible Years Training for Parents. The Incredible Years parenting series includes three programs targeting parents of high-risk children and/or those displaying behavior problems. The BASIC program emphasizes parenting skills known to promote children’s social competence and reduce behavior problems such as: how to play with children, helping children learn, effective praise and use of incentives, effective limit-setting and strategies to handle misbehavior. The ADVANCE program emphasizes parent interpersonal skills such as: effective communication skills, anger management, problem-solving between adults, and ways to give and get support. The SUPPORTING YOUR CHILD’S EDUCATION program (known as SCHOOL) emphasizes parenting approaches designed to promote children’s academic skills such as: reading skills, parental involvement in setting up predictable homework routines, and building collaborative relationships with teachers.

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Bringing The Incredible Years Programs to Scale

Abstract only The Incredible Years® (IY) program series is a set of interlocking and comprehensive training programs for parents, teachers, and children. This article briefly reviews the theoretical foundations, goals, and research underlying these programs. The main purpose of the paper is to describe how the IY programs have been.
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Casey Family Programs: Evaluation Shows Parent Training Program Holds Promise for a Child Welfare Population

Casey Family Programs conducted an evaluation that provides some preliminary evidence of effectiveness for a child welfare population of an existing evidence-based program?The Incredible Years Parent Training Program. Information on effective models for this population is lacking.

Evaluating the implementation and outcomes of an evidence-based program in child welfare settings is an initial step toward addressing the gap between research and practice for improving the well-being of children and families involved with child welfare.

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Changes in social competence in young children treated because of conduct problems as viewed by multiple informants

Aggressive children lacking prosocial strategies are often disliked by their peers and they tend to relate to friends in contexts, where there are high levels of aggression in the peer-group, which in turn may increase levels of child of aggression and other conduct problems (15). Interventions that lead to peer acceptance and enhanced social competence in the child with early conduct problems may disrupt the behavioural trajectories leading to lasting psychosocial problems.

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Characteristics of Young Children with Persistent Conduct Problems 1 Year after Treatment with the Incredible Years Program


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

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Combining Parent and Child Training for Young Children with ADHD

One effective means of preventing early-onset conduct disorder (CD) may be to target preschool children with ADHD before more serious conduct problems have escalated. Unfortunately, one limitation of the ADHD treatment-outcome literature is that comparatively little research has been conducted with samples of children under age seven.

Although research indicates that methylphenidate and other psychostimulants are effective in reducing core ADHD symptoms such as inattention and distractibility among preschoolers (see e.g., Connor, 2002), there is little evidence to suggest that these medications prevent the escalation of ADHD to ODD and CD in later childhood or adolescence

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Conduct Disorders (Book Chapter)

Clinicians working with families typically encounter children who exhibit persistent patterns of antisocial behavior-where there is significant impairment in everyday functioning. This chapter deals with features that characterize young children to whom the label of oppositional defiant disorder and/or conduct disorder is frequently applied.

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Conduct Problems and Level of Social Competence in Head Start Children: Prevalence, Pervasiveness, and Associated Risk Factors


We examined the relative contribution of a variety of risk factors, including maternal history and socioeconomic background, current levels of stress and social support, mothers’ emotional state, and parenting competence in relation to “pervasive” (i.e., at home and school) and “nonpervasive” conduct problems and low social competence. Findings indicated similar risk factors for conduct problems and for low social competence, with an ordered increase it eh number of risk factors from normal to “nonpervasive to “pervasive” groups. Harshness of parent style (i.e., slapping, hitting, yelling) significantly distinguished between the three groups for low social competence and conduct problems. Positive affect, praise, and physical warmth from mothers were positively related to social competence but unrelated to conduct problem

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Disseminating Incredible Years Series Early-Intervention Programs: Integration and sustaining services between school and home

A substantial body of research has clearly shown that young children with early-onset behavioral problems are at significantly greater risk of having severe antisocial difficulties, academic underachievement, school drop out, violence, and drug abuse in adolescence and adulthood. More than two decades of research has also identified a number of high-quality programs for parents and teachers which have been shown to reduce childhood conduct problems and strengthen social competence and in trun prevent secondary outcomes involving crime and violence. Rather the greatest challenge for schools is to select, implement, and sustain these programs for parents and teachers.

This article is about the successful implementation of the Incredible Years program and sustaining the program with high fidelity.

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Early Elementary School Intervention to Reduce Conduct Problems: A Randomized Trial With Hispanic and Non-Hispanic Children

Children?s aggressive behavior and reading difficulties during early elementary school years are risk factors for adolescent problem behaviors such as delinquency, academic failure, and substance use. This study determined if a comprehensive intervention that was designed to address both of these risk factors could affect teacher, parent, and observer measures of internalizing and externalizing problems.

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Early Intervention: Good Parents, Great Kids, Better Citizens

Two MPs from opposing parties – Iain Duncan-Smith MP and Graham Allen MP – have authored a unique collaboration with a unique answer to many of society’s ills.

Early Intervention, Good Parents, Great Kids, Better Citizens is published by the Smith Institute and the Centre for Social Justice and was launched in September 2008 in the House of Commons.

The authors’ thesis is that a more grown-up, all-party approach is now necessary, after thirty years of failure by governments of all parties, to tackle the fundamental causes of the symptoms of social deprivation including teenage pregnancy, anti-social behaviour, low educational attainment, drug and alcohol abuse and poor parenting.

Their remedy is Early Intervention – which they argue is both cheaper, and more effective, than the current expensive and failed philosophy of Late Intervention. Their long term plan for Early Intervention is designed to break the intergenerational cycle of underachievement, evident in so many of our inner and outer city estates, by helping all 0-18 year olds become good parents, not least to optimise their impact on the 0-3 age group when positive nurturing has its greatest impact.

This is supported not only by a rigorous analysis in the book, but by reference to the practical Early Intervention package being implemented in Nottingham by the Local Strategic Partnership (One Nottingham). For the first time in the UK, this Early Intervention package pulls together a comprehensive “Virtuous Circle” of policies across the 0-18 age group. These include: preconception support, a family/nurse partnership (intensive health visiting for 150 single mums and babies), children’s centres, the teaching of SEAL (Social and Emotional Aspects of Learning) to every primary school child, an anti-crime course for every 10 year old in the city, a drug and alcohol aware programme for every pre-teen child in Nottingham, 11-16 Life Skills,pre-parenting courses for every teenager and many other specific interventions being pioneered by One Nottingham.

Iain and Graham* have met the three party leaders, and in the book detail 7 specific requests they have made of them regarding: the next manifesto, proper research, a national policy centre, action by local government, the comprehensive spending review, a local plan and treasury study.

“We are challenging out dated thinking in all parties. We need to build a social and political consensus if we are to go beyond treating the symptoms, and break once and for all, the inter-generational nature of our social problems. We hope our personal collaboration is the forerunner of something at national level.”

* Graham is member of parliament for the constituency with the highest teenage pregnancy rate in western Europe, and the fewest number of young people going on to university.

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Early-Onset Conduct Problems: Does Gender Make a Difference

Are the correlates for girls with early-onset conduct problems necessarily the same as for boys? It has been shown that externalizing symptoms such as disruptive, impulsive, hyperactive, inattentive, and overtly aggressive behaviors are important risk factors for boys’ continuing development of ODD and CD, whereas internalizing symptoms are not. In the absence of evidence, one cannot assume that this is equally true for girls.

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Evidence-Based Training for Enhancing Psychiatric Nurses’ Child Behavior Management Skills

Management of behavior problems in an inpatient child and adolescent psychiatric unit is largely the responsibility of nurses, yet few evidence-based programs exist that prepare nurses for this role. A pilot study examined the effects of a 3-day standardized parent/teacher training program adapted for inpatient child and adolescent psychiatric unit nurses. Findings indicated that the standardized parent/teacher training program resulted in significant increases in self-reported use of child praise/incentives and working with parents, with accompanying desired changes in observed nurse behaviors during nurse?child play sessions. Participants rated the program positively and highlighted gains of greater empathy and fewer judgments of parents. Findings support evidence-based training programs for nursing staff and suggest further research.

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Executive Functions in Preschool Children with Externalizing Behavior Problems: A Meta-Analysis


Deficits in executive functions (EF) have been found in school-age children and adolescents with externalizing behavior disorders. Present meta-analysis was carried out to determine whether these EF impairments can also be found in preschool children with externalizing behavior problems. Twenty-two studies were included with a total of 4021 children. Four separate meta-analyses were conducted, concerning overall EF, working memory, inhibition and cognitive flexibility. A medium correlation effect size was obtained for overall EF (ESzr00.22) and for inhibition (0.24), whereas a small effect size was found for working memory (0.17) and for cognitive flexibility (0.13). Moderator analyses revealed a stronger effect for older preschoolers compared to younger preschoolers, and for children from referred samples compared to community samples. These results show that EF, especially inhibition, is related to externalizing behavior problems already in preschool years.

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Financial cost of social exclusion: follow up study of antisocial children into adulthood

Few direct studies have looked at the economic costs of conduct disorder or its consequences. Related studies suggest that costs are high. In the United States the cost for crimes committed by a typical juvenile delinquent (under 18) was estimated at $80,000? $325,000 (?56,000??232,000). Between ages 19 and 24 a typical adult criminal costs a further $1.2m. Victim costs were by the far the greatest part of this total. Dropping out early from school added $243,000?$388,000 to age 24, heavy drug use a further $150,000?$360,000. Rescuing a high risk youth from this typical life path was estimated to save $1.7m?$2.3m.

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Follow-Up of Children Who Received the Incredible Years Intervention for Oppositional-Defiant Disorder: Maintenance and Prediction of 2-Year Outcome


This paper presents 2-year follow-up data for a sample of 159, 4- to 7-year-old children with oppositional-defiant disorder (ODD) who were randomly assigned to: parent training (PT), parent plus teacher training (PT + TT), child training (CT), child plus teacher training (CT + TT), parent plus child plus teacher training (PT + CT + TT). At the 2-year follow-up, approximately 75% of children were functioning in the normal
range according to parent and teacher reports. Twenty-five percent of children were classified as treatment nonresponders at home and/or at school. Teacher training added significantly to long-term school outcomes for children who had pervasive behavior problems. Baseline, post, and 1-year follow-up parenting practices distinguished between home treatment responders and nonresponders (parents of nonresponders were more critical and less positive). For children with baseline pervasive home-school problems, baseline maternal parenting and posttreatment marital discord were associated with poor treatment response at home at the 2-year follow-up.
In addition, 80% of pervasive children whose mothers were highly critical immediately posttreatment were classified as school nonresponders at the 2-year follow-up.

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Implementation Research: A Synthesis of the Literature

Over the past decade, the science related to developing and identifying “evidence-based practices and programs” has improved-however the science related to implementing these programs with fidelity and good outcomes for consumers lags far behind. As a field, we have discovered that all the paper in file cabinets plus all the manuals on the shelves do not equal real world transformation of human service systems through innovative practice. While paperwork and manuals do represent what is known about effective interventions, these tools are not being used effectively to achieve behavioral health outcomes for children, families, and adults nationally. Clearly, state and national policies aimed at improving human services require more effective and efficient methods to translate policy mandates for effective programs into the actions that will realize them.

To this end, our intent is to describe the current state of the science of implementation, and identify what it will take to transmit innovative programs and practices to mental health, social services, juvenile justice, education, early childhood education, employment services, and substance abuse prevention and treatment. The content is distilled from a far-reaching review of existing implementation literature that looks beyond the world of human services to organize and synthesize critical lessons from agriculture, business, engineering, medicine, manufacturing, and marketing. As you will find, authors from around the globe share the rigors of attempting to implement practices and programs and agree that the challenges and complexities of implementation far outweigh the efforts of developing the practices and programs themselves.

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Implementing Evidence-Based Practices: Six “Drivers” of Success. Part 3 in a Series on Fostering the Adoption of Evidence-Based Practices in Out-Of-School Time Programs


In most cases, implementation strategies have been limited to paper-based manuals that focus on describing interventions without providing complementary information on necessary implementation resources and activities. Because of this, they do not facilitate the real-world application of innovative, research-based practice.

Recently, researchers have begun to study implementation in an effort to understand the key ingredients for successful program implementation. This brief will define implementation, highlight why the effective implementation of evidence-based practices is critical to achieving outcomes, and outline six core components that drive successful program implementation, referred to as “drivers.”

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Interdisciplinary Training Program
Program Title: Personnel Preparation to Improve Services and Results for Children with Disabilities (CFDA 84.325D)

This interdisciplinary training program prepares 9 Michigan State University doctoral students from school psychology and special education-emotional impairment for leadership roles in the development, implementation, and evaluation of interventions and prevention programs for youth exhibiting disruptive behaviors within the school setting. The objectives of this project include: (a) recruit and admit qualified candidates using effective strategies to recruit students from underrepresented populations including individuals with disabilities, (b) advise, provide financial assistance, and provide graduated and sustained training in areas and contexts that match doctoral leadership training goals, (c) plan, manage, and evaluate the project via involvement of parents of children with disruptive behaviors, interdisciplinary faculty who specialize in this population, and through the involvement of school, community, and administrative personnel (d) evaluate the program repeatedly across time to assure successful student completion and validation of the training methods and procedures, (e) help students assume leadership roles at local, state, or national levels, (f) institutionalize and disseminate our training model to other institutions and constituents across the country.

Our 4 A?s (Affiliate, Apprentice, Active Learner, Action Researcher) training model provides the methodology by which we will prepare doctoral students in a carefully sequenced set of activities within their current doctoral programs in the areas of teaching, research, and service. Comprehensive activity logs, supervisor ratings, and research to practice projects will serve as a means of evaluating our student leaders. Moreover, variables related to leadership in our respective fields (e.g., conference presentations, teacher in-service activities, preservice teacher instruction, journal publications) will be examined. Our participation in the Teacher Training Workshop in Seattle, WA was one example of the types of activities that the students are working on during the second year of the training grant.

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Ireland Goes Boldly on to the Mountain

A decade ago parenting programs were not in fashion. It was commonplace to talk about the effects of family breakdown or the problems of single mothers, but relatively few people were paying much serious attention to what parents did or to how parenting behaviors could be changed with children’s health and development in mind. Not so today: many jurisdictions are awash with programs, most of them of doubtful value.

The Incredible Years is a case apart. It was developed by Carolyn Webster-Stratton twenty years before most of today?s plethora of programs were dreamed up, and it is now among the most successful and widely applied in the world.

The Incredible Years is often represented as a construction of eight building blocks. At the base are five modules designed for children at successive stages of development ? infancy, preschool, early years and the first years of formal education. At the next level are two more that involve children directly and seek to improve their social, emotional and cognitive competencies. The eighth block is focused on teachers, providing skills to manage difficult behavior and a curriculum that encourages emotional self-regulation.

The catalyst for this week?s series of articles on The Incredible Years is a conference today in Dublin when the Minister for Children, Barry Andrews TD, launches the implementation and rigorous evaluation of Carolyn Webster-Stratton’s program in the Republic of Ireland as part of a broader commitment to prevention and early intervention. The initiative is being led by Margaret Maher, Director of a new NGO called Archways that has been set up to shelter The Incredible Years in Ireland.

Keynote speaker Judy Hutchings almost single-handedly showed the UK Government how its flagship prevention program Sure Start ? floundering elsewhere ? could be made successful. She put The Incredible Years, already a proven model, at the heart of Sure Start in Wales. She then led an experimental evaluation that demonstrated impact on children’s health and development.

After covering her contribution tomorrow, on Wednesday we profile the program?s originator Carolyn Webster-Stratton. On Thursday we turn to an experiment led by Stephen Scott, Director of Research at the new National Academy for Parenting Practitioners in London. Before spearheading this new initiative Scott led an experimental evaluation of The Incredible Years in four London mental health services. He found it had clear benefits and that it cost no more than conventional and unproven interventions to run.

The week is rounded off by a conversation between Carolyn Webster-Stratton and Judy Hutchings about the future of The Incredible Years in particular and parenting programs in general. Huge steps forward have been made in the last few years but they have depended on the guile, determination and rigor of pioneers in the handful of countries that take prevention seriously.

The challenge moving forward is twofold. For all the success of The Incredible Years and the only other proven parenting model, Triple-P, most policy makers and practitioners have yet to get to base camp when thinking about improving parenting.

At the the bottom of the mountain is a stony cutter of parenting interventions, all of them unproven. Some are stray fragments The Incredible Years and Triple-P thrown together. In the worst cases they owe nothing at all to the years of work of Webster-Stratton or pioneers in the field such as Albert Bandura and Jerry Patterson.

Base camp is the place for the rigorous implementation and evaluation of proven models like The Incredible Years and Triple-P. It should be possible to share ideas here and openly disseminate the results.

Further up the mountain there is much uncharted territory. How do we make parenting programs as routinely valuable and unobtrusive as ante natal services? How do we help parents encourage desirable behavior while responding sensitively to their children?s needs? Such is the focus of all the stories in Prevention Action this week.

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One-Year Follow-Up of Combined Parent and Child Intervention for Young Children with ADHD


Efficacies of the Incredible Years (IY) interventions are well-established in children with oppositional defiant disorder (ODD) but not among those with a primary diagnosis of attention-deficit/hyperactivity disorder (ADHD). We sought to evaluate 1-year follow-up outcomes among young children with ADHD who were treated with the IY interventions. Four- to 6-year-olds with ADHD (n = 49, 73% male) participated in 6 months of treatment using the IY parent and child interventions. Immediate posttreatment results indicated improvements in parenting, children’s externalizing and attention problems, and social contact at school. At 1-year follow up, 22 of 27 variables that showed significant posttreatment effects demonstrated maintenance to 1-year follow up. Children with higher ODD symptoms at baseline showed more improvement in oppositionality and total behavior problems, and their mothers showed more improvement on harsh discipline scores. Approximately 70 to 75% of children were reported by their parents and teachers to fall below clinical cutoffs on measures of externalizing symptoms at the 1-year follow up (compared to 50% at baseline), and more than 50% fell below clinical cutoffs on measures of hyperactivity and inattentiveness (all were in the clinical range at baseline). Children with ADHD who were treated with the IY parent and child treatment programs showed maintenance of treatment effects 1 year after treatment.

Available on the Journal of Clinical Child and Adolescent Psychology website

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Parenting a young child with conduct problems: New insights using qualitative methods


What is qualitative research: Why should we do it? After all, isn’t quantitative research the only “legitimate” method of scientific research – objective, verifiable, and methodologically rigorous? Does qualitative research have scientific integrity? Is it reliable? Valid? Generalizable? Can it add anything new to the findings of quantitative research? Is it publishable: After all haven’t psychology journals adhered almost exclusively to quantitative models of research?
These are some of the questions the first author of this paper asked herself when the second author suggested that they undertake a qualitative analysis of parents’ experiences living with their conduct-problem children.

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Parenting Programme for Parents of Children at Risk of Developing Conduct Disorder: Cost-Effective Analysis

Conduct disorder (CD) is estimated to affect 5-10% of children aged 5-15 years in the United Kingdom and the United States. For those children with early onset in pre-school years, CD frequently persists into adulthood, and predicts poor employment prospects, marriage breakdown and self-harming and/or anti-social criminal behaviour. The economic implications of severe behavioural problems in childhood are serious. It has been estimated that by age 28 the costs of publicly resourced services for those with conduct disorder in childhood were 10 times higher (?70,019) than for those with no behavioural problems (?7,423). Parenting is a key determinant in child behaviour. Parents who encourage pro-social behaviour have children with fewer behaviour problems. Parenting-training programmes are effective in helping families with children at risk of developing conduct disorders.

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Parenting Programmes: What works?

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Also of related interest: The ?Spokes? Project: Supporting Parents On Kids Education
Department Of Health Project Funded By The Parenting Initiative?
Authors: Stephen Scott, Reader in Child Health and Behaviour, Institute of Psychiatry, King?s College London and the Maudsley Hospital, and Kathy Sylva, Professor of Educational Psychology, University of Oxford

Executive Summary
Background?
The objective of supporting parents is to enable them to develop a nurturing, stimulating relationship with their child, so they develop the child’s emotional and intellectual well-being. The question arises how best to support parents. This project sought to implement and evaluate a programme to support directly improvement of the quality of the parent-child relationship, rather than address the indirect factors that can stress it.

The consequences of inadequate parenting often lead to child behavioural difficulties and school failure. Without effective intervention, the behaviour problems have a high degree of continuity and lead to behaviours such as theft, violence to persons and property, and use of illegal drugs; disorders such as alcoholism, drug dependence, and antisocial personality disorder. The school failure has a high continuity with unemployment and receipt of state benefits. The children grow up into adults with a high rate of marital violence, family break-up, and abuse of the next generation of children.
These difficulties contribute to a greatly increased economic cost – one recent UK study showed that by the time they are 28 years old, individuals who were antisocial as children cost society ten times more than children without it. There is therefore a need for effective intervention to prevent serious, lifetime social exclusion of children, and strain and distress of parents. To address the need for early intervention, this project operated early, when the children were 5 and 6 years old in primary school.

Nature of Project

This project carried out an innovative community-based intervention to support parents in managing the two sets of child difficulties for which they most frequently seek help, namely behaviour and learning. Its aim was to see whether this parenting support package would improve the functioning of the children at risk for social exclusion, by looking at two crucial outcomes: reduction in antisocial behaviour; and their reading ability, a central skill for coping throughout life.
Implementation questions Question one: Could the groups easily be held in an everyday life venue – the local primary school, so that it could be widely replicated? Question two: Would a substantial proportion of parents with children at risk choose to enrol in the courses? Question three: Would the starting population taken as a whole show improvement? Even if there were useful improvements in those parents who attended most of the course, some would drop out.?

Parent support programme

The intervention package was delivered in 8 primary schools over three school terms. In term 1 there was a basic 12 week parenting course addressing the parent-child relationship and how to handle difficult child behaviour, in term 2 there was a 10 week reading programme, and in term 3 a 6 week combined course.

Term one: Personal development programme This was the basic ?Incredible Years? Webster-Stratton videotape parenting programme, backed up by home visits to maximise effectiveness. The scenes show parents and children in a variety of common situations, with the parents sometimes behaving in a way that leads to the child being calm and obedient, and sometimes in a way which leads the child to be miserable and have tantrums. Through careful observation and group discussion, the elements that led to successful child management were drawn out, and then parents role-played how they would apply these with their own children. They were then given homework to put this into practice during the following week.?

Term two: Intervention to support child literacy development. Professor Sylva and the team devised a new intervention with relatively intensive parental involvement and considerable specific instruction in technique. It centred around engaging maximal parental commitment and giving parents detailed training in how to encourage and shape reading skills in their child. The literacy intervention lasted 10 weeks. Term three: Combined programme This addressed communicating and problem solving with your child, and had a top-up element for literacy. It lasted six weeks.

Results

Sample Strengths and Difficulties Questionnaires (SDQs) were completed on 733 reception and year one children by teachers, representing 99.5% of children in their classes. Parents of 433 children returned SDQs, a rate of 61%. 394 were correctly filled in and usable. A cutoff score was applied, giving 134 or 34% of the sample, who were deemed at risk of social exclusion through a high level of antisocial behaviour. 103 took part. The sample was a typical inner-city, multi-ethnic disadvantaged population. Half of the children were allocated to the parent support programme, the control half were offered an advice helpline. All 8 schools approached were extremely cooperative and welcomed the project.

Attendance by parents allocated to the intervention Personal development programme (term 1) mean attendance was 7 out of a maximum 12 sessions. Literacy programme (term 2) the mean was 6 out of a possible 10 sessions. Combined programme (term 3) the mean was 4 out of a possible 6 sessions?

Child Behaviour?

Antisocial behaviour On the primary outcome, the PACS interview score, there was a significant effect in favour of the intervention group. The effect size was 0.51 standard deviations, substantial for a prevention trial. The reduction in antisocial behaviour corresponds to an improvement for the participants from being within the worst 15% of antisocial children to being outside the most antisocial 35%. The effect size for hyperactivity was also significant, 0.43. Hyperactivity is an important independent risk factor for social exclusion.?

Parent defined problems. Problems parents reported included arguing, disobedience, fighting, whining, spitefulness, jealousy etc. The intervention group showed a significant improvement compared to the controls, with an effect size of 0.64.?

Eyberg Child Behaviour Inventory.

The Intensity Score, which is a measure of the frequency of difficult behaviours, reduced significantly more in the intervention group, with an effect size of 0.28.?

Parent Satisfaction 93% of parents said they were well or extremely satisfied with the programme.

Child Literacy?

The intervention group gained seven months in reading skills, an effect size of 0.43. This result held up unchanged after multiple regression correction for age and gender. Race, parent education, parent income, and child age and gender did not affect degree of change in the intervention group compared to the control group, suggesting that the programme is robust and suited to disadvantaged populations.

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Parents, Teachers, and Therapists Using Child-Directed Play Therapy and Coaching Skills to Promote Children’s Social and Emotional Competence and Build Positive Relationships

If left untreated, early-onset conduct problems (e.g., high rates of aggression, noncompliance, oppositional behaviors, emotional dysregulation) place children at high risk of recurring social and emotional problems, underachievement, school dropout, and eventual delinquency. The development of emotional self-regulation and social competence in the early years plays a critical role in shaping the ways in which children think, learn, react to challenges, and develop relationships throughout their lives.

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Pervasive and non-pervasive conduct problems in a clinic sample aged 4-8 years: child, family and day-care/school factors

All children in this sample scored above the 90th percentile on the Eyberg Child Behavior Inventory (ECBI) for home problems, and met the criteria for a possible or a confirmed diagnosis of oppositional defiant behaviours. The proportion of children with pervasive conduct problems was high, 83%. Teachers in day-care and school reported children in the pervasive group to have significantly more attention and internalizing problems as well as lower social competence scores than those in the non-pervasive group. Children in the pervasive group also showed consistently more problems in their relationships both with teachers and peers than those in the non-pervasive group. The implications for assessment and treatment of children with conduct problems in these age-groups are discussed.

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Preventing Aggression and Violence

With the occurrence of multiple homicides on school campuses during the 1997-1998 and 1998-1999 academic years-such as in Springfield, Oregon and Littleton, Colorado-there has been a growing public perception that an increasing number of students may “go Off” at any time and cause serious harm to themselves and/or others. In response to this perception, school administrators, lawmakers, and prosecutors have recently “cracked-down” on juvenile violence. Metal detectors, security guards and police, crisis drills, “zero tolerance” discipline policies, and alternative programs for aggressive children are now found in many schools that previously saw little need for such measures. Several stats now require that children who commit violent crimes be tried as adults. Lawmakers have also proposed school prayer, mandatory student uniforms, mandatory use of “ma’am” or “sir” when responding t teachers, and the school-wide posting of the Ten Commandments as partial solutions to the widely perceived rising tide of school violence. Although well intended, too often such “solutions” have been misguided, based on little, if any, empirical research supporting their effectiveness in preventing school violence and promoting children’s mental health.

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Preventing Conduct Problems, Promoting Social Competence: A Parent and Teacher Training Partnership in Head Start


The authors studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the ‘highest risk’ at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.

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Promoting Early Childhood Mental Health through Evidence-based Practice


In 2004, the Amherst H. Wilder Foundation introduced the Incredible Years programs to the community. This set of evidence-based programs is designed to teach positive interaction skills, social problem-solving strategies, anger management, and appropriate school behaviors to young children. The programs also strengthen parent-child relationships and help parents develop positive behavior guidance strategies.


Wilder introduced the Incredible Years programs as part of their 100-year history of combining direct services, research, and community development to address the needs of the most vulnerable people in Ramsey County, Minnesota. At Wilder, three of the Incredible Years programs have been implemented and two additional programs were added in November 2009.

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Quality Training, Supervision, Ongoing Monitoring, and Agency Support: Key Ingredients to Implementing The Incredible Years Programs with Fidelity


Identification and selection of an ‘evidence-based,’ ’empirically validated,’ or ‘best practices’ mental health program is only the first step in service delivery. In order to obtain similar results to those published by the developer of a program, attention must be given to supervising the quality of the implementation of that program. It is important to assure that the program is delivered with the highest degree of fidelity possible. Fidelity means that the program is delivered in its entirety, using all the components and therapeutic processes recommended by the developer. The Incredible Years Parent, Teacher, and Child Training Programs have been proven in numerous randomized control group studies to be effective for promoting positive parent and teacher interactions with children, strengthening children?s emotional, social, and self-regulation competence and reducing behavior problems in both prevention and clinic populations. A number of training processes are recommended to ensure that replication of the Incredible Years programs can be achieved with fidelity: standardized training, detailed treatment manuals, standardized session protocols, peer review, mentoring and supervision, and leader certification. This chapter will provide a description of these training methods and supervision processes to deliver the Incredible Years training programs with a high degree of fidelity.

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Rand Report: Promising Practices Network – Programs that Work: The Incredible Years

The Incredible Years series is a set of comprehensive curricula targeting children age 2 to 10 years old and their parents and teachers. The curricula are designed to work jointly to promote emotional and social competence and to prevent, reduce, and treat children?s behavioral and emotional problems.

Parent-Training Programs

The Incredible Years Parent-Training program includes four separate components targeting parents of high-risk children or children displaying behavior problems. In all four training components, facilitators use videotaped scenes to encourage group discussion, problem-solving, and sharing of ideas. The “BASIC Parent-Training Program?Early Childhood” (BASIC?Early Childhood) is a core component of the Incredible Years series and includes 12 to 14 two-hour weekly sessions targeting children age 2 to 7 years old. The BASIC?Early Childhood curriculum emphasizes parenting skills to promote children?s social competence and to reduce behavior problems, and it teaches parents how to play with children, help children to learn, give effective praise and incentives, use limit-setting, and handle misbehavior.

The four add-on parent-training components, “Advance Parent Training Program?School Age (ADVANCE),” “BASIC Parent Training Program?School-Age (BASIC-School Age),” “Supporting Your Child?s Education?School Age”, and the school readiness supplements “Child-directed Play” and “Interactive Reading” may be offered as supplements to the early childhood BASIC component. ADVANCE targets school-age children 4 to 10 years old and includes eight to ten two-hour sessions that emphasize parents? interpersonal skills, such as effective communication, anger management, problem-solving between adults, and ways to give and receive support. The BASIC?School Age program is similar to the early childhood program but emphasizes strategies for older children, including logical consequences, monitoring, helping children learn to problem solve with children, and family problem-solving. The Supporting Your Child?s Education?School Age component for children age 5 to 10 involves four two-hour sessions and highlights approaches to parenting to promote children?s academic skills, including nurturing reading skills, setting up homework routines, and building collaborative relationships with teachers. The school readiness supplements may be used with parents of 3- to 5-year-olds, and includes an emphasis on building children?s social, emotional and academic skills, as well as fostering pre-reading and reading skills using the interactive reading approach.

Child Training Programs

There are two separate child-training components in the Incredible Years series. The first is the classroom program for children age 4 to 8 years. The Classroom Child-Training program uses the “Dina Dinosaur” curriculum which has more than 60 lesson plans (with preschool, kindergarten and grade one and two curricula), and may be offered over multiple years from preschool to grade two. The program seeks to improve peer relationships and reduce aggression both at home and at school. The curriculum is delivered to the entire classroom by regular teachers, two to three times a week through 20 – 30 minute group discussions followed by small-group practice activities. Home activity manuals encourage parents? involvement in teaching their children school rules, social skills, and problem-solving.

The second child-focused program is the “Dinosaur Child-Training” curriculum, a treatment program for small groups of children age 4 to 8 years who are exhibiting “conduct” problems (defined as high rates of aggression, defiance, and oppositional and impulsive behaviors). The curriculum emphasizes communicating feelings, empathy for others, friendship development, anger management, interpersonal problem-solving, and obeying school rules. The Dinosaur Child-Training program is offered to groups of five to six children in two-hour sessions held weekly for 20 to 22 weeks. The program can be delivered by counselors or therapists to treat conduct-disordered children in small groups, or can be used by schools as a “pullout” program for children with special behavioral and emotional needs.

Teacher Training Program

The training program for teachers emphasizes classroom management skills, such as the effective use of praise and encouragement, proactive teaching strategies, and ways to manage inappropriate classroom behavior and build positive relationships with students. Training can be provided through either four to six full-day workshops or 14 to 20 two-hour sessions.

The BASIC Parent-Training Program?Early Childhood component and the small-group Dinosaur Child-Training program have been rigorously evaluated, and the remainder of this description of the Incredible Years series focuses on these two components. The ADVANCE, BASIC?School Age, Supporting Your Child?s Education, and school readiness parent-training components, the Teacher-Training program, and the Dina Dinosaur classroom curriculum currently do not have sufficiently rigorous research evidence that clearly assesses impacts on child outcomes.

View the report on the Promising Practices Network website

The Promising Practices Network (www.promisingpractices.net) is a Rand Corporation website

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She understands the kids who bring their parents to their knees – Early intervention is key in stopping aggressive behavior

Carolyn Webster-Stratton adores and understands kids who throw things, bite, kick, refuse to obey every request or command and who rarely get invited to birthday parties. Kids who are asked to leave preschools and, if they are invited to a play date, are never asked again.

And through every encounter Webster-Stratton appears as a woman wrapped in calm, a calm that puts visitors at ease the minute she enters a room.

Carolyn Webster-Stratton, whose work focuses on helping children ages 3 to 8, uses the puppets shown in her University District office to interact during therapy sessions. Her office is a dinosaur haven and her windowsills overflow with stuffed animals and a multiracial classroom of puppets, some of them in sizes and shapes similar to her clients. Children talk to the puppets, and this clinical psychologist listens.

Webster-Stratton is an ally of children who bring parents to their knees — children with conduct problems, a generic term for children who are highly oppositional, defiant, aggressive. These disruptive disorders affect about 8 percent of the population.

“That’s a lot of kids, and services for these children are few and far between,” she said. “Aggressive behavior is an important risk factor related to later violence.”

That’s why she’s focused on children ages 3 to 8, a key time to break the trajectory. Without early intervention, these children are at risk of getting kicked out of schools, living with anti-social behaviors, abusing drugs and alcohol and eventually facing criminal charges as they age.

She’s shown that these children can be helped, and dreams of the day when parents and educators are as attuned to developing emotional skills as academic skills.

“All kids yell, hit, bite, scream,” Webster-Stratton said of her subjects. “These kids do it at a greater frequency and intensity.” Most children are aggressive at 2 and 3, but that aggression decelerates at 4 or 5.

“A typical 5-year-old will disobey about one-third of the time, but do what is asked two-thirds of the time,” she said. “Children with defiance or conduct disorders refuse most of the time. Unless they obey, they can’t be socialized or taught.

“Highly aggressive children tend to stay that way throughout life unless they are helped. Both parents and teachers need to be involved in promoting social skills and replacing aggressive behavior.”

That means learning how to share, follow directions and use words to ask for what they want, for example.

Webster-Stratton said society, unfairly, tends to blame parents for kids with misbehavior issues: “The biology a child gets isn’t something they can do anything about.”

She cites three factors affecting a child with conduct problems: biology, family and school.

Biologically, a child’s “wiring” could be off, making him difficult to deal with. He might have additional issues such as an attention deficit disorder.

Family factors include neglect, high stress, poverty, harsh punishments and abuse.

Schools can add a high student-to-teacher ratio, not enough help, a teacher who isn’t tuned in to these disorders.

A combination of these risk factors can be overwhelming for an affected child.

Webster-Stratton has spent more than 30 years working to break that cycle. She’s worked with children, their families and teachers. She’s researched, developed and published curricula, books and videotapes — programs that are now used in countries throughout the world.

And she’s been at it long enough to track the results, which are impressive. On a three-year follow-up, more than two-thirds of the children were in the normal range on standardized measures completed by teachers and parents.

In the late 1970s this UW psychologist and professor began a parenting program with middle-class families, teaching them how to bring out the best in their kids and to deal with common behavior problems. But when she tried to publish it, editors said, “Who cares about the middle class?”

“It led me to take the program to lower-income families, often single-parent families with a child,” Webster-Stratton said. “That’s what hooked me on this population.”

She taught classes at Children’s Hospital and Regional Medical Center to highly motivated parents who made huge efforts (as in several bus transfers) to learn ways to deal with their children.

Those classes led to programs for children, parents and teachers — prevention programs usually focused on schools with high rates of children in free-lunch programs. Teachers have been trained to deal with behavior and to offer a social and emotional curriculum. Parents are often offered classes in the schools their children attend, parenting classes open to all.

Webster-Stratton’s years in the field and follow-up studies have proved that an increase in social competence decreases aggressive behavior.

John Bancroft, director of Head Start for Puget Sound, has known Webster-Stratton and her work for a long time. She worked with him in a Head Start program for three years in the early 1990s.

“I liked her involvement of parents,” Bancroft said. “She was willing and eager to train parents to train other parents. There’s no professional aloofness. I would say it was one of the most successful parent education programs we’ve done in Head Start.”

Another mark of her success was having 70 percent to 80 percent of parents participate. “That was unheard of,” Bancroft said.

It was information to help all parents, not just parents of challenging children.

Webster-Stratton’s dream is for social and emotional curriculums to be regarded as being as important as reading or math. “You can’t separate them,” she said. “Better social/emotional skills (lead to) better academic outcomes.”

She also noted that we can take courses in almost any subject, but courses in parenting are rare. “We should ‘immunize’ parents to be the best parents they can be,” Webster-Stratton said.

She speaks from professional and personal experiences. A native of Canada, she has a nursing degree from University of Toronto, two master’s degrees from Yale — one in public health and another as pediatric nurse practitioner, and a doctorate in educational psychology from the UW.

After working with children for years, she had two sons, now 20 and 22. Did motherhood cause her to rethink any of her programs?

The question made her laugh. She said that’s when she developed her Advanced Parenting Program focusing on anger and depression management, problem solving, communication skills and giving and getting support.

PARENTING TIPS

Social skills are as important as numbers and the alphabet for preschoolers.

If parents feel they’ve lost control with their child, they should seek help.

Teachers are good at spotting problems because they have more perspective.

Parents can get away with some “slop” in their parenting skills with typical kids, but not with those with conduct problems.

Children with conduct disorders can be so inattentive they miss both praise and commands.

Attention is a powerful reward. It works when teachers ignore kids who are out of their seats and praise those who stay seated, for example.

Don’t reinforce misbehavior.

Develop a meaningful relationship with your child and partner with your child’s teacher.
— Source: Carolyn Webster-Stratton

TO LEARN MORE

To learn more about Webster-Stratton, her programs and books, go to incredibleyears.com

Children’s Hospital and Regional Medical Center in Seattle offers parenting classes and other programs. Call the hot line: 206-987-2500.

The University of Washington Parenting Clinic is accepting families of children 4 to 6 years of age with attention deficit hyperactivity disorders. For information, call 206-543-6010

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Show, Not Tell

A decade ago parenting programs were not in fashion. It was commonplace to talk about the effects of family breakdown or the problems of single mothers, but relatively few people were paying much serious attention to what parents did or to how parenting behaviors could be changed with children’s health and development in mind. Not so today: many jurisdictions are awash with programs, most of them of doubtful value.

After spending two years practicing among the Haida and Tlingit Indians of Alaska, Carolyn Webster-Stratton came to the conclusion that showing parents how to play with their children was more effective than telling them how to do it. When sl1e arrived at the University of Washington in 1976 to teach in the nurse practitioner program, she began the process of videotaping families to show them what worked with their children and what didn’t. Today, Webster-Stratton is a professor of nursing at the University of Washington where, in 1980, she con1pleted her doctoral dissertation in educational psychology on the effectiveness of videotape modeling parental education as a therapeutic tool.

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Strategies for Helping Early School-Aged Children with Oppositional Defiant and Conduct Disorders: The Importance of Home-School Partnerships

Year: 1993 Bibliography: Webster-Stratton, C. (1993). Strategies for helping early school-aged children with oppositional defiant and conduct disorders: The importance of home-school partnerships. School Psychology Review, 22(3), 437-457. [spacer] Abstract This article provides a brief review of the diagnosis, developmental progression, and etiology of oppositional defiant and early-onset conduct disorders (ODD/CD) in children..
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Study of generalisation effects from home to day-care/school settings were examined in a clinic sample of children aged 4-8 years

In the present study, generalisation effects from home to day-care/school settings were examined in a clinic sample of children aged 4-8 years treated because of Oppositional Defiant Disorder (ODD) or Conduct Disorder (CD) with The Incredible Years Parent Training programme or Parent Training combined with Classroom Training.

A striking characteristic of the sample was that 83% of the children exhibited clinical levels of conduct problems both at home and in day-care or school settings before treatment. Overall, the combined Parent Training + Classroom Training treatment produced more positive generalisation effects than the Parent Training only group, in particular after treatment. Analyses of differences between group means between pre- and posttreatment were conducted by means of ANCOVAs using pretreatment scores as covariate and treatment condition.

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Tailoring the Incredible Years Parent, Teacher, and Child Interventions for Young Children with ADHD

Behavioral treatment research for preschoolers (ages 4 to 6 years) with ADHD is not extensive; however, parent training for young children diagnosed with ADHD has shown some preliminary promising outcomes. One of the core methods for the IY parent program is that therapists work collaboratively with parents to develop individual goals for each parent and child. IY therapists collaborate with parents to tailor the program content to each parent and child?s particular situation. For parents of children with ADHD, this tailoring process often involves helping parents understand ADHD and how it aff ects children?s social, emotional, and academic development, setting developmentally appropriate goals around increasing children?s att ention and focus and reducing misbehavior, strengthening children?s emotion regulation skills, and also changing the environment to support children?s need for movement, structure, predictable routines, scaffolding, and immediate feedback.

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The Impact of the Incredible Years Parent, Child, and Teacher Training Programs on Children’s Co-Occurring Internalizing Symptoms

Theoretical and empirical evidence suggests that two of the most common childhood syndromes, disruptive behaviors and depression, have similar developmental antecedents and may respond to similar interventions. Recent evidence suggests that parenting interventions that target more nurturing and less harsh parenting risk factors lead to reduced internalizing symptoms in children (Webster-Stratton & Herman, 2008) in addition to the well-established effects on child conduct problems. For instance, Webster-Stratton and Herman (2008) found that children whose parents participated in the IY Parent Training (PT) program had reduced depressive symptoms at post-treatment compared to children in a wait-list control condition. Effects were mediated by changes in parenting effectiveness.

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The Importance Of Implementation Fidelity


Over the past several years, a large amount of information has been collected on the risk and protective factors for violence. Research has also identified prevention programs that can modify these risk and protective factors. The Blueprints initiative has been in the forefront in identifying exemplary programs that have been evaluated in rigorous, controlled trials, and much attention has been focused nationally on selecting and implementing quality programs. However, identification of effective programs is only the first step in the efforts to prevent and control violence. Widespread implementation of effective programs is unlikely to affect the incidence of violent crime unless there is careful attention given to the quality of implementation, the degree to which a program is delivered as intended (American Youth Policy Forum, 1999; Biglan & Taylor, 2000; Lipsey, 1999). Research demonstrates that successful implementation is not guaranteed by a site?s decision to adopt a best practices program. Many science-based programs have been adopted in different settings with widely varying outcomes. In fact, a high quality implementation of a poor program may be more effective than a low quality implementation of a best practice program (Gottfredson, Gottfredson, & Czeh, 2000). Until recently, little emphasis has been given to implementing programs with fidelity in both the science and practice of prevention. As a result, most people do not recognize the importance of implementation fidelity and feel that implementation of at least some program components will be better than doing nothing. However, this may be an erroneous belief, since we typically do not know which components of a program may be responsible for the reductions in violence. Programs must be implemented with fidelity to the original model to preserve the behavior change mechanisms that made the original model effective (Arthur & Blitz, 2000).

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The Incredible Years – The Norwegian Webster-Stratton Programme 1998-2004 (In Norwegian)

This report has been prepared to provide an account of the Norwegian The Incredible Years programme, in accessible form. Beside a description of the programme, it concentrates on the results of clinical trials carried out in Trondheim and Troms? in 2001-2003, and presents material from a user evaluation carried out in 2003-2004. A brief examination of implementation issues is also included. Important project components in the programme seen as a whole have had to be omitted here, either because they are not yet complete or because space did not allow their inclusion. The treatment trial material presented here is based on work carried out by Bo Larsson, Willy-Tore M?rch, May Britt Drugli and Sturla Fossum. The user evaluation material is based on work carried out by Jim Lurie and the undersigned. Charlotte Reedtz, Jim Lurie and the undersigned have worked on collection of material to standardise instruments used in the research.

Background: Controlled evaluations of psychosocial interventions for young children with behavioural problems are sparse. However, in a series of experimental studies, professor Webster- Stratton and her collaborators in Seattle have examined the effects of various forms of parent and child therapy for 4-8 year-old children with aggressive and noncompliant behaviours. In the studies various forms of basic parent and child training have been compared to waiting-list controls, a more comprehensive parent training program, and in addition to a school-based (teacher) intervention. No previous replications have been made in Scandinavia, but two such studies have been conducted in Canada and one recently in England, both with positive outcomes.?

Aims and study design: To replicate one of Webster-Stratton’s studies comparing the basic training program for parents (12 sessions) with parent training and child therapy (“The Dinosaur School”)(18 sessions) and waiting-list controls in an experimental study including a total of 150 Norwegian children aged 4-8 years; 60 families will be randomized into each of the active treatment groups and 30 families to the waiting-list. To examine the maintenance of treatment effects one year after treatment, in addition to generalisation of treatment effects from home to school settings.?

Measures: After screening for children’ s noncompliant and aggressive behaviours as rated by parents and teachers (Eyberg Child Behavior Inventory-EBCI), parents of children with high scores are interviewed to obtain psychiatric diagnoses of either oppositional defiant disorder (ODD) or conduct disorder (CD). Parents rate their practices, involvement in child care and rearing disagreement, in addition to their own anger, depression and stress. Observations of child and parent interaction are made at home and in the clinic. In the school and preschool the children’s behavioural problems are observed and compared with children with no such problems. The child reports on its feelings of loneliness and takes a problem-solving test. School and day care teachers assess the children’ s behaviour and social competence, in addition to their own home involvement.?

Implementation and intervention: The planning of the project started 1998 and has been subjected to an evaluation by the Norwegian Research Council before implementation. Extensive contacts were established with professor Carolyn Webster-Stratton, who helped training of therapists and the mentor. Because no normative data existed for the screening measure (EBCI), it was first standardised in a survey including about 640 children aged 4-8 years from Trondheim and Troms?. Many of the assessment instruments and the video vignettes were translated into Norwegian.?

Since the fall of 200l recruitment of children and families has taken place. Today, about half of the final sample (N=78) has been recruited in the project, which will continue unti1 summer 2003. Treatment is administered to parents and children in groups over a 3-4 month period. Two therapists conduct the group treatment, which is highly structured and manual.?

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The Incredible Years Ireland Study, Parents, Teachers and Early Childhood Intervention: Long-term outcomes of the Incredible Years Parent and Teacher Classroom Management training programs (Combined 12-month Report)


Background: Early childhood behavioural difficulties are becoming more prevalent (Collishaw et al., 2004) and increase the risk of poorer outcomes later in life, including academic difficulties, antisocial behaviour, criminality, and poor social adjustment. A growing body of literature highlights the importance of early intervention and prevention programmes, such as parent-training or school-based programmes, for the prevention and treatment of early childhood behavioural problems and promotion of child well-being. The Webster-Stratton Incredible Years (IY) Parent, Teacher and Child Training Series was designed for the early treatment and prevention of conduct disorders in childhood (Webster-Stratton & Hancock, 1998). The IY series comprises a suite of comprehensive, specially designed programmes, which target children aged 0-12 yrs, and their parents and teachers, with a view to improving social and emotional functioning and reducing or preventing emotional and behavioural problems. The implementation of the IY programme in several community-based agencies and schools in Ireland began in 2004 – spearheaded by Archways, the national co-ordinator of the IY programme in Ireland – as a means of preventing and treating emotional and behavioural difficulties in children.

Study 1 (Section 1): Examining the longer-term benefits of the Incredible Years BASIC parent training programme in Ireland
Study 2 (Section 2): Examining the longer-term utility and implementation of the Incredible Years Teacher Classroom Management Programme in Ireland

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The Incredible Years Parent Programs: Methods and Principles that Support Fidelity of Program Delivery

Year: 2015 Bibliography: Webster-Stratton, C., The Incredible Years Parent Programs: Methods and Principles that Support Fidelity of Program Delivery. in Evidence-Based Parenting Education: A Global Perspective. J. Ponzetti, Editor, 2015. Routledge. Author: Webster-Stratton [spacer] Abstract Social, emotional, and behavioral problems in young children are the most com­mon reason parents seek help from mental health professionals..
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The Incredible Years Parent, Teacher, and Child Intervention: Targeting Multiple Areas of Risk for a Young Child With Pervasive Conduct Problems Using a Flexible, Manualized Treatment Program


Young children who present for treatment with oppositional-defiant disorder (ODD) and conduct disorder (CD) frequently exhibit these symptoms across settings and often show comorbid symptoms of attention-deficit/hyperactivity disorder (ADHD) and/or internalizing symptoms such as anxiety or depression. Parent training programs to treat these children must be flexible and comprehensive enough to address these issues. This article outlines a case in which the Incredible Years Parent, Teacher, and Child Training programs were used to treat a young boy, John, with ODD. His problems were pervasive and occurred at home, at school, and with peers. This case study outlines how a multimodal, manualized treatment can be applied flexibly to attend to individual family needs and address issues of comorbidity.

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The Incredible Years Parents, Teachers, and Children Training Series: A multifaceted treatment approach for young children

The Clinical Problem :

The incidence of Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) in children is alarmingly high, with reported cases of early-onset conduct problems in young preschool children 4-6% (Egger & Angold, 2006) and as high as 35% for low-income families (Webster-Stratton & Hammond, 1998). Developmental theorists have suggested that, compared to typical children, ‘early starter’ delinquents, that is, those who first exhibit ODD symptoms in the preschool years, have a two- to threefold risk of becoming tomorrow’s serious violent and chronic juvenile offenders (Loeber et al., 1993; Patterson, Capaldi, & Bank, 1991; Snyder, 2001; Tremblay et al., 2000). These children with early-onset CD also account for a disproportionate share of delinquent acts in adulthood, including interpersonal violence, substance abuse, and property crimes. Indeed, the primary developmental pathway for serious conduct disorders in adolescence and adulthood appears to be established during the preschool period.

To address the parenting, family, child, and school risk factors, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (ages 2-8 years). This chapter reviews these training programs and their associated research.

Although our programs were first designed and evaluated to be used as clinic-based treatments for diagnosed children, our recent work has tended our clinic-based treatment model to school settings and has targeted high-risk populations. As more is known about the type, timing, and dosage of interventions needed to prevent and treat children?s conduct problems, we can further target children and families to offer treatment and support at strategic points. By providing a continuum of prevention and treatment services, we believe we will be able to prevent the further development of conduct disorders, delinquency, and violence.

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The Incredible Years Program for Children from Infancy to Pre-adolescence: Prevention and Treatment of Behavior Problems

Effective interventions for children with conduct problems ideally target multiple risk factors and are best offered as early as possible. Conduct disorder becomes increasingly resistant to change over time, so early intervention is a crucial strategy for the prevention or reduction of conduct problems, violence, substance abuse, and delinquency. Children with ODD and CD are clearly identifiable as early as 3-4 years of age, and there is evidence that the younger the child is at the time of intervention, the more positive the behavioral adjustment at home and at school following treatment. Intervention that is delivered prior to school entry and during the early school years can strategically target risk factors across multiple domains; home and school, and through multiple change agents; parent, teacher, and child. Unfortunately, less than 20% of young children meeting DSM-IV criteria for ODD are referred for mental health services (Horwitz, Leaf, Jeventhal, Forsyth, & Speechley, 1992). Even fewer of those referred obtain evidence-based interventions.

To address the parenting, family, child, and school risk factors for children or adolescents with conduct problems, we have developed three complementary training curricula, known as the Incredible Years Training Series, targeted at parents, teachers, and children (from birth to 12 years). This chapter reviews these training programs and their associated research findings.

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The Incredible Years Programmes in Scotland

The Hospital Education Service provides education for children and young people attending or admitted to hospital. One of the main roles of this service is to ensure minimal disruption to children’s education during these difficult times.

This service is provided by Glasgow City Council and serves children and young people from 3 to 18 years of age from all local authorities in Scotland and, on occasion, from other areas in the United Kingdom. The service offers a range of interventions to support children and their families in addressing the additional support needs of children and young people with medical conditions and/or social, emotional and behavioural difficulties.

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The Incredible Years Series: A Review of the Independent Research Base

Year: 2014
Bibliography: Pidano, A. & Allen, A. (2014). The Incredible Years Series: A Review of the Independent Research Base. Journal of Child and Family Studies, 24, 1898-1916.
DOI: 10.1007/s10826-014-9991-7
Authors: Pidano, Allen

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Abstract The Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over.

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The Incredible Years Series: A Review of the Independent Research Base

Year: 2015 Bibliography: Pidano, A.E. and A.R. Allen, The Incredible Years Series: A review of the independent research base. Journal of Child Family Studies, 2015. 24: p. 1898-1916. Authors: Pidano, Allen DOI: 10.1007/s10826-014-9991-7

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Abstract

The Incredible Years (IY) parent, teacher, and child training series, developed by Carolyn Webster-Stratton, has been studied extensively over.

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The Incredible Years Training Series

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The Incredible Years Parents, Teachers, and Children Training Series, described in this Bulletin published by the Office of Juvenile Justice and Delinquency Prevention, is designed to prevent, reduce, and treat conduct problems among children ages 2 to 10 and to increase their social competence.

OJJDP?s Family Strengthening Project has designated the Incredible Years Training Series as an exemplary best practices program. As such, the series has been subject to a quality evaluation, evidenced excellent effectiveness, and attained high overall ratings.

The Bulletin provides an overview of the Incredible Years Training Series, describes its methodologies, and summarizes program effectiveness, noting pertinent evaluations.

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The Incredible Years: A Training Series for the Prevention and Treatment of Conduct Problems in Young Children (Book Chapter)

Because Conduct Disorder becomes increasingly resistant to change over time, intervention that begins in the early school years is clearly a strategic way to prevent or reduce aggressive behavior problems. Our decision to focus our interventions o n the period consisting for preschool and early school years was based on several considerations. First, evidence suggests that children with ODD and CD are clearly identifiable at this age. Second, evidence suggests that the younger the child at the time of intervention, the more positive the child’s behavioral adjustment at home and at school. Third, the move to school – from preschool through the first years of elementary school – is a major transition and a period of great stress for many children and their parents. The child’s early success or failure in adapting to school sets the stage not only for the child’s future behavior at school and his or her relationships with teachers and peers but also for parents’ future attitudes toward their child’s schools and their own relationships with teachers and administrators.

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The National Registry of Evidence-based Programs and Practices (NREPP) Intervention Summary: Incredible Years Program

Incredible Years has been used in hundreds of sites in at least 15 States (Arkansas, California, Colorado, Delaware, Florida, Kansas, Ohio, Oregon, Maine, Massachusetts, Minnesota, New York, North Carolina, Pennsylvania, and Washington). The program has also been implemented in Australia, Canada, Denmark, England, Germany, Ireland, the Netherlands, New Zealand, Norway, Portugal, Russia, Scotland, Sweden, and Wales. Incredible Years research staff have trained more than 10,000 professionals worldwide. Research articles for both U.S. and non-U.S. evaluation studies are available.

The parent training intervention focuses on strengthening parenting competencies and fostering parents’ involvement in children’s school experiences to promote children’s academic and social skills and reduce delinquent behaviors. The Dinosaur child training curriculum aims to strengthen children’s social and emotional competencies, such as understanding and communicating feelings, using effective problem-solving strategies, managing anger, practicing friendship and conventional skills, and behaving appropriately in the classroom. The teacher training intervention focuses on strengthening teachers’ classroom management strategies, promoting children’s prosocial behavior and school readiness, and reducing children’s classroom aggression and noncooperation with peers and teachers. The intervention also helps teachers work with parents to support their school involvement and promote consistency between home and school. In all three training interventions, trained facilitators use videotaped scenes to structure the content and stimulate group discussions and problem solving.

Costs
The cost of implementing Incredible Years depends on the amount of training needed and the components to be implemented. One-time start-up costs include $400-$500 per leader for leader training and $1,500 per series for program materials (the cost for the child program is slightly higher due to the price of puppets). Ongoing costs include $500 annually for each leader to receive consultation, $476 for each parent in parent groups, $775 for each child in child treatment groups, $15 for each child receiving the Dinosaur curriculum in school, and $30 for each teacher receiving the teacher training.

Read the intervention summary on the NREPP website (This link will open a new window)

The National Registry of Evidence-based Programs and Practices (NREPP) is a searchable online registry of mental health and substance abuse interventions that have been reviewed and rated by independent reviewers.

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Treating Children with Early-Onset Conduct Problems: A Comparison of Child and Parent Training Interventions

Families of 97 children with early-onset conduct problems, 4 to 8 years old, were randomly assigned to 1 of 4 conditions: a parent training treatment group (PT), a child training group (CT), a combined child and parent training group (CT + PT), or a waiting-list control group (CON). Post treatment assessments indicated that all 3 treatment conditions had resulted in significant improvements in comparison with controls. Comparisons of the 3 treatment conditions indicated that CT and CT + PT children showed significant improvements in problem solving as well as conflict management skills, as measured by observations of their interactions with a best friend; differences among treatment conditions on these measures consistently favored the CT condition over the PT condition. As for parent and child behavior at home, PT and CT + PT parents and children had significantly more positive interactions, compared with CT parents and children. One-year follow-up assessments indicated that all the significant changes noted immediately post treatment had been maintained over time. Moreover, child conduct problems at home had significantly lessened over time. Analyses of the clinical significance of the results suggested that the combined CT + PT conditions produced the most significant improvements in child behavior at 1-year follow-up.


As has become all too evident to researchers in the field as well as to the general public, the incidence of conduct problems in young children is increasing. Current estimates are that 7% to 25% of children are affected. This trend is disturbing, both in itself and in its social implications, for research has shown that the emergence of early-onset conduct problems in young children (in the form of high rates of oppositional defiant, aggressive, and noncompliant behaviors) is related to a variety of health and behavioral problems in adolescence – peer rejection, drug abuse, depression, juvenile delinquency, and school dropout (Campbell, 1991; Loeber, 1991).

In response to this growing social problem, a variety of innovative parent training interventions have been designed with the aim of reducing children’s conduct problems. The rationale for targeting parenting behavior as the primary focus of intervention arises from the considerable body of research indicating that parents of children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) lack certain fundamental parenting skills.

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Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training

Families of 159, 4- to 8-year-old children with oppositional defiant disorder (ODD) were randomly assigned to parent training (PT); parent plus teacher training (PT + TT); child training (CT); child plus teacher training (CT + TT); parent, child, plus teacher training (PT + CT + TT); or a waiting list control. Reports and independent observations were collected at home and school. Following the 6-month intervention, all treatments resulted in significantly fewer conduct problems with mothers, teachers, and peers compared to controls. Children?s negative behavior with fathers was lower in the 3 PT conditions than in control. Children showed more prosocial skills with peers in the CT conditions than in control. All PT conditions resulted in less negative and more positive parenting for mothers and less negative parenting for fathers than in control. Mothers and teachers were also less negative than controls when children received CT. Adding TT to PT or CT improved treatment outcome in terms of teacher behavior management in the classroom and in reports of behavior problems./p>

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Treating Children with Early-onset Conduct Problems: Key Ingredients to Implementing The Incredible Years Programs with Fidelity

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It is essential that sound theory and research support new treatment and that procedures are described elearly and are followed closely. This chapter describes the training, supervisory and organizational requirements to implement the Incredible Years (IY) Training Series to prevent and to treat early onset of conduct problems in children. Five key elements are identified and descussed.

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