Articles Archive - Incredible Years

There has been rapid global dissemination of parenting interventions, yet little is known about their effectiveness when transported to countries different from where they originated, or about factors influencing success.

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Families with socioeconomically disadvantaged and ethnic minority backgrounds are often hard to reach for the prevention and treatment of disruptive child behavior problems. We
examined whether the Incredible Years parenting intervention can successfully reach and benefit families with socioeconomic disadvantaged and ethnic minority backgrounds in the Netherlands.

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The current paper reports on the feasibility of implementing an existing empirically-based program, The Incredible Years, tailored to parents of young children with Autism Spectrum Disorder (ASD). Parents raising preschool-age children (ages 3 to 6) with ASD (N=17) participated in a 15-week pilot trial of the intervention. Quantitative assessments of the program revealed fidelity was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, play-based child behavior skills, parent stress management, social support, and visual resources. More work is needed to further refine the program to address parent self-care, partner relationships, and the diverse behavioral and communication challenges of children across the autism spectrum. Furthermore, parent access and retention could potentially be increased by providing in-home childcare vouchers and a range of times and locations in which to offer the program. The findings suggest The Incredible Years is a feasible intervention for parents seeking additional support for child- and family-related challenges, and offers guidance to those communities currently using The Incredible Years or other related parenting programs with families of children with ASD.

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Abstract

There is lack of research on the importance of including fathers in parent training programs. This study?s? main purpose is to examine the short-term effects of fathers attending an Incredible Years Parent Training (IY) for Portuguese preschoolers with oppositional/defiant symptoms. Thirty-six children (whose fathers were willing to attend a parenting group with their wives or partners) were randomly assigned either to receive the IY Program or to a waiting-list control group. Outcomes for the study included self-reported parenting-related variables and parents? ratings of their children?s behaviors. Data were collected before the intervention and six months after it. Results showed significant effects on fathers? positive parenting practices and ratings of children?s prosocial behaviors, as well as a reduction of the impact of symptoms on family functioning. Findings provided support for the short-term effectiveness of the IY intervention in Portuguese fathers of preschoolers with oppositional symptoms.

Read the article on the Fathering: A Journal of Theory, Research, and Practice about Men as Fathers website

Several aspects of the evidence-based IY BASIC parenting series make it particularly effective for families involved with child welfare due to maltreatment. The programs make extensive use of video modeling methods, showing a vignettes of families from different cultural and socioeconomic backgrounds with a variety of parenting styles and child temperament and development. The observational modeling and practice training approach is more effective learning for some of these families than the more cognitive, verbal training approaches.

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Abstract Only: Objective: This article reports on the acceptability and results from an evaluation of an empirically supported practice, The Incredible Years, tailored to parents of children with autism spectrum disorder (ASD). Methods: Two groups of parents (n ? 17) participated in a mixed methods test with no comparison group of the 15-week intervention. Data were collected at baseline, posttest, and on a weekly basis. Results: Acceptability and attendance were high, attrition was modest, and parent stress decreased significantly after program completion. Parents highlighted several barriers to their success in the program, including difficulty applying some program content (e.g., time-out for noncompliance) to children with sensory or self-regulation challenges. However, participants reportedly enjoyed the play-based approach of the program, as well as opportunities for social support and peer learning. Conclusion: The Incredible Years is a promising intervention for parents raising preschoolers with ASD. A randomized controlled trial is needed to rigorously test the intervention.

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Parents raising young children with Autism Spectrum Disorder (ASD) experience disproportionately high levels of stress and burden, which are associated with a plethora of other negative child and family outcomes. Yet, few interventions address parent mental health or related outcomes in this population.

Chapter 1 describes a comprehensive review of randomized controlled trials which included parents of preschool-age children with ASD. Seven interventions met the review criteria. The studies were strengthened by the use of fidelity measures and developmentally-appropriate interventions. However, while all of the studies collected parent measures, none reported significant posttest improvements in parent mental health or other outcomes. Furthermore, numerous issues, such as unclear randomization strategies, small sample sizes, and poor external validity further limited the ability to draw significant conclusions regarding the promise of the interventions. The chapter concludes with a call to develop and rigorously test family-centered interventions aimed at improving both child and parent outcomes.

Chapter 2 highlights the feasibility of implementing an existing evidence-based practice, The Incredible Years, tailored to parents of children with ASD. Two groups of parents raising preschool-age children (ages 3 to 6) with ASD (N =17) participated in a 15-week pilot trial of the intervention. The fidelity of the program was generally maintained, with the exception of program-specific videos. Qualitative data from individual post-intervention interviews reported parents benefited most from child emotion regulation strategies, parent stress management, social support, and visual resources.

Chapter 3 reports on a mixed method test of the acceptability and results from the trial described in Chapter 2. Attendance was high (88% to 100% weekly) and attrition was modest (18%). Participants reported high acceptability of all aspects of the program (mean 3.3 out of 4). Parent stress decreased significantly after program completion, as compared to baseline. Parents highlighted several barriers to their success in the program, including trouble finding time to focus on their own needs and difficulty applying some program content (e.g., time-out for noncompliance) to children with sensory or self-regulation challenges. However, parents reportedly enjoyed the strengths-based, play-based approach of the program, as well as opportunities for social support and peer learning.

Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking.

The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13.

In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group.

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As part of the Drivers of Crime work programme the Ministries of Education, Health and Social Development established a pilot study of the Incredible Years Parent (IYP) programme to assess its effectiveness in reducing conduct problems in a New Zealand context. ?? The New Zealand Incredible Years Pilot Study provided evidence to suggest that IYP, a programme developed overseas, can be successfully implemented in New Zealand and retain its general level of effectiveness for both M?ori and non-M?ori families. The Follow-up Study investigated the longterm outcomes for 136 (82%) of the 166 children and parents who were in the original sample. The key finding of the Follow-up Study is that the IYP programme outcomes were maintained over the 30-month follow-up with no diminution in the size of effects for almost all of the outcome measures.

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Incredible Years equally benefitted children with CD with and without family psychiatric histories of externalizing behavior. Family psychiatric history of externalizing behavior and parental depressive symptomatology predicted greater severity of CD symptomatology at baseline.

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Background: This study examined the effectiveness of an evidence-based parent training program in a real-world Scandinavian setting.

Method: Parents of 36 young children with or at risk of Attention Deficit Hyperactive Disorder (ADHD) self-referred to participate in the Incredible Years? Parent Training Program (IYPT) through a Danish early intervention clinic. Using a benchmarking approach, we compared self-report data with data from a recent efficacy study.

Results: Eight out of nine outcome measures showed comparable or higher magnitude of effect from pretest to posttest. Effects were maintained or improved across six months.

Conclusions: The methodology of this study exemplifies a rigorous but feasible approach to assessing effectiveness when evidence-based U.S. protocols are transferred into the existing Scandinavian service delivery. Findings suggest that IYPT can be implemented successfully as an easy-access early intervention to families of children with or at risk of ADHD.

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Symptoms of hyperactivity, impulsivity and/or inattention can emerge early in preschool years, and there are high developmental changes in this age period. Preschool years are critical moment for early identification and intervention.

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Background: Conduct problems in children are common and have attracted considerable interest, not least because of their negative psychological, social and economic consequences. Controlled trials demonstrate that parenting programmes can be effective in reducing childhood behavioural problems, but much less is known about the processes of change or contextual factors that influence trial outcomes.

Objective: This study involved a process evaluation which was nested within a randomised controlled trial (RCT) of the Incredible Years Parenting Programme (IYPP) in Ireland. The study was designed to: (1) identify and examine the key facilitative and inhibitive factors associated with the implementation of the programme in disadvantaged settings; and (2) to assess the level of implementation fidelity (IF) achieved within the RCT evaluation.

Method: The process evaluation employed a longitudinal, mixed-methods approach, and consisted of two separate but related stages. In Stage One, the experiences of stakeholders (parents, practitioners and organisational managers) were assessed and explored using semi-structured interviews and focus groups. A series of in-depth interviews (N=81) was conducted with parents at pre-intervention (n=20), and at three follow-up time points, including 6- (n=33), 12- (n=20), and 18-months later (n=8). A further 16 interviews were conducted with group facilitators (n=11) and service managers (n=5) following delivery of the IYPP. Interview data were analysed using constructivist grounded theory. Stage Two was based on a mix of parent reports (N=103) and facilitator reports (N=11) designed to investigate aspects of fidelity within the RCT. Data were examined using a series of ANOVAs and correlational analyses.

Results: Three overarching themes were identified from Stage One, including: (1) ?Experiences of learned helplessness? (e.g. the association between child conduct problems and family conflict and social isolation); (2) ?Perceived benefits and mechanisms of change? (e.g. the links between positive outcomes and a number of factors, including key parenting skills, social support, longer-term resilience and commitment, and facilitative organisational practices); and (3) ‘Challenges in programme implementation’ (e.g. cultural discomfort with praise and positive attention,conflict with partners; and organisational difficulties with fidelity, attrition and sustainability). The findings from Stage Two indicated that IF was high in relation to therapist adherence (M=90%, SD=4%) and parental satisfaction (M=6.69, SD=0.14), but lower with regard to the retention of parents (M=8.23 sessions, SD=4.79). There were no statistically significant relationships between IF and the primary child behaviour outcome.

Conclusion: This process evaluation is one of the first studies to investigate the key short- and long-term factors associated with implementing the IYPP within disadvantaged settings. The findings underline the many benefits gained from participating in the IYPP whilst also indicating that extra supports may be required to enhance outcomes for the most vulnerable families, particularly in the longer term. Overall, the study highlights the feasibility of implementing the IYPP within the existing infrastructure of mainstream health and social service settings in Ireland. These findings represent a valuable addition to current evidence on the effectiveness of the programme, whilst also informing its routine implementation both within Ireland and elsewhere.

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Abstract: To evaluate the 12-month efficacy of a parentbased intervention programme on children?s and mothers? outcomes in a sample of Portuguese preschoolers displaying early hyperactive and inattentive behaviours (AD/HD behaviours), 52 preschool children whose mothers had received the Incredible Years basic parent training (IY) were followed from baseline to 12 months of follow-up. Reported and observational measures were used. Effects were found in the children?s reported AD/HD behaviours at home and at school after 12 months. Large effect sizes were also found in mothers? variables: a decrease in selfreported dysfunctional parenting practices and an improved sense of competence and observed positive parenting. However, the improvements in coaching skills that have been observed after 6 months of follow-up decreased over time. No other significant differences were found between 6 and 12 months follow-up, with small effect sizes indicating that the significant post-intervention changes in child and parenting measures were maintained. After 12 months of follow-up, there was a clinically important reduction of over 30 % in reported AD/HD behaviours in 59 % of children. The sustained effects observed both for children and their mothers suggest long-term benefits of IY. Therefore, efforts should be made by Portuguese policy makers and professionals to deliver IY as an early preventive intervention for children displaying early AD/HD behaviours.

Children of incarcerated mothers are considered at risk for disruptive behavior problems and later delinquency. Parenting may play a key role in this intergenerational transmission of delinquency. The present study aimed to evaluate the effectiveness of the Incredible Years parent training, enhanced with home visits, for (formerly) incarcerated mothers to prevent disruptive behavior problems in their 2- to 10-year-old children, by means of a nationwide randomized controlled trial. Mothers of 133 children
(M age?76.91 months; 48.9% boys) were assigned to an intervention, consisting of group sessions and individual home visits, or a no-intervention control group. The intervention yielded significant effects on parenting and child behavior for maternal report. Marginally significant effects on child behavior were found for teacher report. The
results show short-term effectiveness of parent training for the high-risk and hard-toreach population of (formerly) incarcerated mothers and their children.

Read the article on the Journal of Clinical Child & Adolescent Psychology website

Objective: To evaluate measures of cardiac activity and reactivity as prospective biomarkers of treatment response to an empirically supported behavioral intervention for attention-deficit/hyperactivity disorder (ADHD). Method: Cardiac preejection period (PEP), an index of sympathetic-linked cardiac activity, and respiratory sinus arrhythmia (RSA), an index of parasympathetic-linked cardiac activity, were assessed among 99 preschool children (ages 4?6 years) with ADHD both at rest and in response to behavioral challenge, before participants and their parents completed 1 of 2 versions of the Incredible Years parent and child interventions. Results: Main effects of PEP activity and reactivity and of RSA activity and reactivity were found. Although samplewide improvements in behavior were observed at posttreatment, those who exhibited lengthened cardiac PEP at rest and reduced PEP reactivity to incentives scored higher on measures of conduct problems and aggression both before and after treatment. In contrast, children who exhibited lower baseline RSA and greater RSA withdrawal scored lower on prosocial behavior before and after treatment. Finally, children who exhibited greater RSA withdrawal scored lower on emotion regulation before and after treatment. Conclusions: We discuss these findings in terms of (a) individual differences in underlying neurobiological systems subserving appetitive (i.e., approach) motivation, emotion regulation, and social affiliation and (b) the need to develop more intensive interventions targeting neurobiologically vulnerable children.

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Abstract

Background

Evidence-based psychosocial interventions such as parent training programs are strongly recommended as first-line treatment for preschool-age children with or at-risk of attention deficit/hyperactivity disorder (AD/HD).

Objective

Evaluate the effectiveness of the Incredible Years Basic Parent Training (IY) in hyperactive and inattentive behaviors of Portuguese preschoolers.

Methods

One hundred children, between three and six years-old, with AD/HD behaviors, who were part of a larger randomized controlled trial in which participants were allocated to either an intervention or control group. In this subsample analysis, there were 52 participants in the intervention condition (IYC) and 48 in the waiting-list control condition (WLC). Multi-informants and multi-measures of child and parenting behaviors were taken before and after the 14-week intervention.

Results

Medium-to-large intervention effects were found in primary caregivers? reported measures of children?s AD/HD behaviors and on self-reported parenting practices. Independent observations indicated significant short-term effects on positive parenting and coaching. Primary caregivers had a high attendance rate and reported high satisfaction with the program. Additionally, 43 % of children in the IYC clinically improved in the primary AD/HD outcome measure, compared with 11 % in the WLC.

Conclusions

Preliminary results suggest that IY parent training seems to be an effective tool, making the difference in the behavior of Portuguese preschoolers with early signs of AD/HD and their mothers.

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We used the experimental power of an intervention trial to test the differential susceptibility hypothesis that children with emotional dysregulation would show greater response to an experimentally-induced improvement in their parenting environment.

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Summary: Parenting programmes that are delivered in group settings have the potential to help parents develop parenting skills that improve the behaviour of their young children. This review provides evidence that group-based parenting programmes improve childhood behaviour problems and the development of positive parenting skills in the short-term, whilst also reducing parental anxiety, stress and depression. Evidence for the longer-term effects of these programmes is unavailable. These group-based parenting programmes achieve good results at a cost of approximately $2500 (?1712 or ?2217) per family. These costs are modest when compared with the long-term social, educational and legal costs associated with childhood conduct problems.

Background: Early-onset child conduct problems are common and costly. A large number of studies and some previous reviews have focused on behavioural and cognitive-behavioural group-based parenting interventions, but methodological limitations are commonplace and evidence for the effectiveness and cost-effectiveness of these programmes has been unclear.

Objectives: To assess the effectiveness and cost-effectiveness of behavioural and cognitive-behavioural group-based parenting programmes for improving child conduct problems, parental mental health and parenting skills.

Search methods:
We searched the following databases between 23 and 31 January 2011: CENTRAL (2011, Issue 1), MEDLINE (1950 to current), EMBASE (1980 to current), CINAHL (1982 to current), PsycINFO (1872 to current), Social Science Citation Index (1956 to current), ASSIA (1987 to current), ERIC (1966 to current), Sociological Abstracts (1963 to current), Academic Search Premier (1970 to current), Econlit (1969 to current), PEDE (1980 to current), Dissertations and Theses Abstracts (1980 to present), NHS EED (searched 31 January 2011), HEED (searched 31 January 2011), DARE (searched 31 January 2011), HTA (searched 31 January 2011), mRCT (searched 29 January 2011). We searched the following parent training websites on 31 January 2011: Triple P Library, Incredible Years Library and Parent Management Training. We also searched the reference lists of studies and reviews.

Selection criteria:
We included studies if: (1) they involved randomised controlled trials (RCTs) or quasi-randomised controlled trials of behavioural and cognitive-behavioural group-based parenting interventions for parents of children aged 3 to 12 years with conduct problems, and (2) incorporated an intervention group versus a waiting list, no treatment or standard treatment control group. We only included studies that used at least one standardised instrument to measure child conduct problems.

Data collection and analysis:

Two authors independently assessed the risk of bias in the trials and the methodological quality of health economic studies. Two authors also independently extracted data. We contacted study authors for additional information.

Main results:
This review includes 13 trials (10 RCTs and three quasi-randomised trials), as well as two economic evaluations based on two of the trials. Overall, there were 1078 participants (646 in the intervention group; 432 in the control group). The results indicate that parent training produced a statistically significant reduction in child conduct problems, whether assessed by parents (standardised mean difference (SMD) -0.53; 95% confidence interval (CI) -0.72 to -0.34) or independently assessed (SMD -0.44; 95% CI -0.77 to -0.11). The intervention led to statistically significant improvements in parental mental health (SMD -0.36; 95% CI -0.52 to -0.20) and positive parenting skills, based on both parent reports (SMD -0.53; 95% CI -0.90 to -0.16) and independent reports (SMD -0.47; 95% CI -0.65 to -0.29). Parent training also produced a statistically significant reduction in negative or harsh parenting practices according to both parent reports (SMD -0.77; 95% CI -0.96 to -0.59) and independent assessments (SMD -0.42; 95% CI -0.67 to -0.16). Moreover, the intervention demonstrated evidence of cost-effectiveness. When compared to a waiting list control group, there was a cost of approximately $2500 (GBP 1712; EUR 2217) per family to bring the average child with clinical levels of conduct problems into the non-clinical range. These costs of programme delivery are modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems.

Authors’ conclusions: Behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective for improving child conduct problems, parental mental health and parenting skills in the short term. The cost of programme delivery was modest when compared with the long-term health, social, educational and legal costs associated with childhood conduct problems. Further research is needed on the long-term assessment of outcomes.

Article is available for purchase: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008225.pub2/abstract

Children of substance abusers are at risk for behavioral/emotional problems. To improve outcomes for these children, we developed and tested an intervention that integrated a novel contingency management (CM) program designed to enhance compliance with an empiricallyvalidated parent training curriculum. CM provided incentives for daily monitoring of parenting and child behavior, completion of home practice assignments, and session attendance.

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