Exploring parenting profiles to understand who benefits from the incredible years parenting program

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

Cost-effectiveness analysis of The Incredible Years Parenting Program as an indicated prevention of child conduct problem

Conduct problems in childhood affect the daily lives of children and their families and have serious economic implications for society. The Incredible Years parent program (IY) is a manualized behavioral parent training that aims to improve parenting skills in order to reduce conduct problems of children. We conducted a cost-effectiveness analysis of IY, compared to care-as-usual (CAU), in pre-schoolers at risk for a chronic pattern of conduct problems. In a case-control design with a two-year follow-up, we assessed intervention costs, use of public services (e.g., healthcare and special education), property damage, travel costs, and parental productivity losses. Conduct problems reduced in children in the IY condition, relative to CAU. From the public authorities perspective, the net costs to reduce the child’s conduct problems by one point of observed conduct problems (meaning a reduction of one disruptive behavior each 20 minutes) were €187. Taking the parents’ perspective and the societal perspective it was €88 and €155, respectively

Sustained Effects of Incredible Years as a Preventive Intervention in Preschool Children with Conduct Problems

The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time

Cross-Sectional Study into the Costs and Impact on Family Functioning of 4-Year-Old Children with Aggressive Behavior

Early-onset aggressive behavior is known for its negative developmental consequences, and the associated high costs for families, the health care system and wider society. Although the origins of aggressive behavior are to be found in early childhood, the costs incurred by aggressive behavior of young children have not been studied extensively. The present study aimed to investigate whether preschool children with a high level of aggressive behavior already differ in the generated amount of costs and impact on family functioning from children with lower levels of aggressive behavior. A population-based sample of 317 preschool children was divided into four groups with different levels of aggression (moderate, borderline, clinical). Parents filled out questionnaires to assess service use (lifetime and past 3 months) and impact on family functioning. Over the past 3 months as well as over the first 4 years of life, children with a clinical level of aggression were more costly than children with a low level of aggression (mean total costs over the past 3 months: low = €167,05 versus clinical € = 1034,83 and mean lifetime costs: low € = 817,37 versus clinical € = 1433,04), due to higher costs of services used by the child. In addition, families of children with a borderline or clinical level of aggressive behavior reported more impairment in their daily functioning than families of children with lower levels of aggression. The findings demonstrate that a high level of aggressive behavior results in high costs and impaired family functioning in the preschool years already

Executive functions in preschool children with aggressive behavior: impairments in inhibitory control

The question whether executive function (EF) deficits in children are associated with conduct problems remains controversial. Although the origins of aggressive behavior are to be found in early childhood, findings from EF studies in preschool children with aggressive behavior are inconsistent. The current study aimed to investigate whether preschool children with aggressive behavior show impairments in EF. From a population-based sample, 82 preschool children who were showing aggressive behavior as indicated by scores at or above the 93rd percentile on the Aggressive Behavior Scale of the CBCL 1 1/2-5 were selected. These children with aggressive behavior were matched on IQ to a group of typically developing control children (N=99). Six neuropsychological tasks were administered to assess set shifting, inhibition, working memory and verbal fluency. A factor analysis was conducted which yielded one clear factor: inhibition. Aggressive preschool children showed poorer performance on this inhibition factor than control children and boys performed worse on this factor than girls. This association between aggressive behavior and inhibition deficits was maintained after controlling for attention problems. In addition, gender differences in all EFs measured were found with boys exhibiting more impairment in EF than girls. These findings demonstrate that preschool children with aggressive behavior show impairments in inhibition, irrespective of attention problems

Cost-Effectiveness Analysis of the Incredible Years Parenting Program as an Indicated Prevention of Child Conduct Problems

Conduct problems in childhood affect the daily lives of children and their families and have serious economic implications for society. The Incredible Years parent program (IY) is a manualized behavioral parent training that aims to improve parenting skills in order to reduce conduct problems of children. We conducted a cost-effectiveness analysis of IY, compared to care-as-usual (CAU), in preschoolers at risk for a chronic pattern of conduct problems. In a case-control design with a two-year follow-up, we assessed intervention costs, use of public services (e.g., healthcare and special education), property damage, travel costs, and parental productivity losses. Conduct problems reduced in children in the IY condition, relative to CAU. From the public authorities perspective, the net costs to reduce the child’s conduct problems by one point of observed conduct problems (meaning a reduction of one disruptive behavior each 20 minutes) were €187. Taking the parents’ perspective and the societal perspective it was €88 and €155, respectively

Assessing performance of a randomized versus a non-randomized study design

Introduction: Randomization is the most optimal design for evaluating program-effectiveness. In practice, however, conducting a randomized controlled trial is not always feasible. For a non-randomized study into the effect of a parent management training, predefined intervention and control groups of families were matched on six key characteristics. The quality of this match was then compared with the quality which is to be expected from a randomized study. Methods: The performance of matching intervention and control families for predefined and randomized groups was evaluated by simulating new hypothetical intervention and control groups. The Mahalanobis metric was used to assess the distance between families in the intervention and the control groups and pairwise matching was performed. The global distance between these groups was used as measure of the balance of covariates in all matched pairs, with a smaller distance indicating a higher match quality. Results: In the ideal situation, when predefined groups are actually equal to randomized groups, the expected probability of a more equal balance of characteristics in the former groups than in the latter groups is 0.50. Using the data obtained in our study, and our predefined groups, this expected probability was 0.34. Conclusion: Even when randomized groups are more balanced than predefined groups, using the latter groups for analyses might still be acceptable when the differences in group means are small. Findings suggest that matching can be a viable alternative to randomization for situations in which randomization is not feasible due to pragmatic constraints. However, a more accurate judgment on the value of the results obtained in this study requires results from similar analyses performed in other studies for comparison

Parenting intervention for children’s conduct problems: Equally effective for different families?

Parenting programmes are an effective strategy for reducing children’s behavioural problems. It is important to understand who benefits more from these programmes and who benefits less. There are trends that suggest that families with a migration background or lower levels of education are not referred to evidence-based programmes, based on the untested assumption that these programmes do not meet their needs. The same holds for families of children with co-occurring ADHD symptoms and emotional problems. A better understanding of who benefits from parenting programmes will allow more careful matching between families and programmes. We used data from 786 families (with children aged 2–10 years) from four trials in the Incredible Years parenting programme in the Netherlands. Of these families, 29 % had a migration background and 31 % had lower educational levels. Our findings show that Incredible Years reduced disruptive child behaviour. Effects did not differ between families with different migration or educational backgrounds, or between children showing more or fewer ADHD symptoms. Children with more severe disruptive behaviour and children with more emotional problems benefited more in terms of reduced disruptive child behaviour. Thus the parenting programme yielded similar benefits for families with diverse backgrounds. (PsycINFO Database Record (c) 2018 APA, all rights reserved

Ouderinterventie voor gedragsproblemen bij kinderen : Even effectief voor verschillende gezinnen?

Parenting programmes are an effective strategy for reducing children’s behavioural problems. It is important to understand who benefits more from these programmes and who benefits less. There are trends that suggest that families with a migration background or lower levels of education are not referred to evidence-based programmes, based on the untested assumption that these programmes do not meet their needs. The same holds for families of children with co-occurring ADHD symptoms and emotional problems. A better understanding of who benefits from parenting programmes will allow more careful matching between families and programmes. We used data from 786 families (with children aged 2–10 years) from four trials in the Incredible Years parenting programme in the Netherlands. Of these families, 29 % had a migration background and 31 % had lower educational levels. Our findings show that Incredible Years reduced disruptive child behaviour. Effects did not differ between families with different migration or educational backgrounds, or between children showing more or fewer ADHD symptoms. Children with more severe disruptive behaviour and children with more emotional problems benefited more in terms of reduced disruptive child behaviour. Thus the parenting programme yielded similar benefits for families with diverse backgrounds. (PsycINFO Database Record (c) 2018 APA, all rights reserved