Can Targeted Intervention Mitigate Early Emotional and Behavioral Problems?: Generating Robust Evidence within Randomized Controlled Trials

<div><p>This study examined the impact of a targeted Irish early intervention program on children’s emotional and behavioral development using multiple methods to test the robustness of the results. Data on 164 <i>Preparing for Life</i> participants who were randomly assigned into an intervention group, involving home visits from pregnancy onwards, or a control group, was used to test the impact of the intervention on Child Behavior Checklist scores at 24-months. Using inverse probability weighting to account for differential attrition, permutation testing to address small sample size, and quantile regression to characterize the distributional impact of the intervention, we found that the few treatment effects were largely concentrated among boys most at risk of developing emotional and behavioral problems. The average treatment effect identified a 13% reduction in the likelihood of falling into the borderline clinical threshold for Total Problems. The interaction and subgroup analysis found that this main effect was driven by boys. The distributional analysis identified a 10-point reduction in the Externalizing Problems score for boys at the 90^th percentile. No effects were observed for girls or for the continuous measures of Total, Internalizing, and Externalizing problems. These findings suggest that the impact of this prenatally commencing home visiting program may be limited to boys experiencing the most difficulties. Further adoption of the statistical methods applied here may help to improve the internal validity of randomized controlled trials and contribute to the field of evaluation science more generally.</p><p><b><i>Trial Registration</i>:</b> ISRCTN Registry <a href="http://www.controlled-trials.com/ISRCTN04631728" target="_blank">ISRCTN04631728</a></p></div

Impact of <i>PFL</i> on emotional and behavioral functioning—Treatment effects by gender.

<p>Impact of <i>PFL</i> on emotional and behavioral functioning—Treatment effects by gender.</p

Impact of <i>PFL</i> on emotional and behavioral functioning—Main and interaction effects.

<p>Impact of <i>PFL</i> on emotional and behavioral functioning—Main and interaction effects.</p

Distribution of unweighted CBCL outcomes.

<p>Distribution of unweighted CBCL outcomes.</p

Stepdown Results.

<p>Stepdown Results.</p

Standardized average negative affect for treatment and control groups.

<p>Standardized average negative affect for treatment and control groups.</p

Treatment Effects for Experienced Well-being: Negative Affect.

<p>Treatment Effects for Experienced Well-being: Negative Affect.</p

Standardized average positive affect for treatment and control groups.

<p>Standardized average positive affect for treatment and control groups.</p

Time Use Amongst Treatment and Control Groups.

<p>Time Use Amongst Treatment and Control Groups.</p

Treatment Effects for Experienced Well-being: Mood Yesterday, Net Affect and U-Index.

<p>Treatment Effects for Experienced Well-being: Mood Yesterday, Net Affect and U-Index.</p