Effects of Early Family/Parent Training Programs on Antisocial Behavior & Delinquency

Based on evidence that early antisocial behavior is a key risk factor for continued delinquency and crime throughout the life course, early family/parent training, among its many functions, has been advanced as an important intervention/prevention effort. The prevention of behavior problems is one of the many objectives of early family/parent training, and it comprises the main focus of this review. There are several theories concerning why early family/parent training may cause a reduction in child behavior problems including antisocial behavior and delinquency (and have other ancillary benefits in non‐crime domains over the life course). For example, early family/parent training programs are based, in part, on the notion that quality of parent‐child relations will facilitate learning of control over impulsive, oppositional, and aggressive behavior, thus reducing disruptive behavior and its long‐term negative impact on social integration. The main objective of this Campbell systematic review is to assess the available research evidence on the effects of early family/parent training on child behavior problems including antisocial behavior and delinquency. In addition to assessing the overall impact of early family/parent training, this review will also investigate, to the extent possible, in which settings and under what conditions it is most effective. There are 55 different studies in the review covering a total of almost 10,000 children under 5 years old. The studies come from throughout the world, including the US, the UK, Canada, the Netherlands, New Zealand and China. The studies cover more than 30 years, the oldest being published in 1976, and the most recent in 2008. All the studies were randomized controlled experiments which compared a group who took part in a family/parent training program with a control group. The studies included in this systematic review indicate that early family/parent training is an effective intervention for reducing child behavior problems including antisocial behavior and delinquency, and that the effect of early family/parent training appears rather robust across various weighting procedures, and across context, time period, outcome source, and based on both published and unpublished data. It is important going forward that more stringent, experimental evaluations of early family/parent training be carried out and its outcomes assessed over the long‐term (i.e., include more follow‐up periods, especially follow‐ups into late adolescence and into adulthood) in order to cast a wide net with respect to the outcomes under investigation to include non‐crime life domains as well, and to conduct comprehensive cost‐benefit analyses of these programs. Based on evidence that early antisocial behavior is a key risk factor for continued delinquency and crime throughout the life course, early family/parent training, among its many functions, has been advanced as an important intervention/prevention effort. The prevention of behavior problems is one of the many objectives of early family/parent training, and it comprises the main focus of this review. There are several theories concerning why early family/parent training may cause a reduction in child behavior problems including antisocial behavior and delinquency (and have other ancillary benefits in non‐crime domains over the life course). For example, early family/parent training programs are based, in part, on the notion that quality of parent‐child relations will facilitate learning of control over impulsive, oppositional, and aggressive behavior, thus reducing disruptive behavior and its long‐term negative impact on social integration. Additionally, these programs attempt to change the social contingencies in the family context and/or provide advice/guidance to parents on raising their children or general parent education. Results of this review indicate that early family/parent training is an effective intervention for reducing behavior problems among young children and the weighted effect size was 0.35 approximately corresponding to 50% recidivism in the control group compared with 33% recidivism in the experimental group. The results from a series of analog to the ANOVA and weighted least squares regression models (with random effects) demonstrated that there were significant differences in the effect sizes of studies conducted in the US versus those conducted in other countries and that studies that were based on samples smaller than 100 children had larger effect sizes. Sample size was also the strongest predictor of the variation in the effect sizes. Additional descriptive evidence indicated that early family/parent training was also effective in reducing delinquency and crime in later adolescence and adulthood. Overall, the findings lend support for the continued use of early family/parent training to prevent behavior problems such as antisocial behavior and delinquency. Future research should be designed to test the main theories of the effects of early family/parent training, more explicitly including a better articulation of the causal mechanisms by which early family/parent training reduces delinquency and crime, and future early family/parent training program evaluations should employ high quality evaluation designs with long‐term follow‐ups, including repeated measures of antisocial behavior, delinquency, and crime over the life course. Background Early family/parent training programs are intended to serve many purposes, one of them being the prevention of child behavior problems including antisocial behavior and delinquency. While early family/parent training may not often be implemented with the expressed aim of preventing antisocial behavior, delinquency, and crime – sometimes these programs are aimed at more general, non‐crime outcomes – its relevance to the prevention of crime has been suggested in developmentally‐based criminological and psychological literatures. Objectives The main objective of this review is to assess the available research evidence on the effects of early family/parent training on child behavior problems including antisocial behavior and delinquency. In addition to assessing the overall impact of early family/parent training, this review will also investigate, to the extent possible, in which settings and under what conditions it is most effective. Search Strategy Seven search strategies were employed to identify studies meeting the criteria for inclusion in this review: (1) A key word search was performed on an array of online databases; (2) We reviewed the bibliographies of previous reviews of early family/parent training programs; (3) We performed forward searches for works that have cited seminal studies in this area; (4) We performed hand searches of leading journals in the field; (5) We searched the publications of several research and professional agencies; (6) After completing the above searches and reviewing previous reviews, we contacted scholars in various disciplines who are knowledgeable in the specific area of early family/parent training; and (7) We consulted with an information specialist at the outset of our review and at points along the way in order to ensure that we have used appropriate search strategies. Both published and unpublished reports were considered in the searches. Searches were international in scope. Selection Criteria Studies that investigated the effects of early family/parent training on child behavior problems such as conduct problems, antisocial behavior and delinquency were included. Studies were only included if they had a randomized controlled evaluation design that provided before‐and‐after measures of child behavior problems among experimental and control subjects. Data Collection & Analysis Narrative findings are reported for the 55 studies included in this review. A meta‐analysis of all 55 of these studies was carried out. The means and standard deviations were predominantly used to measure the effect size. Results are reported for the unbiased effect sizes and the weighted effect sizes and, where possible, comparisons across outcome sources (parent reports, teacher reports, and direct observer reports). In the case of studies that measure the impact of early family/parent training on antisocial behavior and delinquency at multiple points in time, similar time periods before and after are compared (as far as possible). Main Results The studies included in this systematic review indicate that early family/parent training is an effective intervention for reducing child behavior problems including antisocial behavior and delinquency, and that the effect of early family/parent training appears rather robust across various weighting procedures, and across context, time period, outcome source, and based on both published and unpublished data. Reviewer's Conclusions We conclude that early family/parent training should continue to be used to prevent child behavior problems such as conduct problems, antisocial behavior, and delinquency among young persons in the first five years of life. Such programs appear to have few negative effects and some clear benefits for its subjects. It is important going forward that more stringent, experimental evaluations of early family/parent training be carried out and its outcomes assessed over the long‐term (i.e., include more follow‐up periods, especially follow‐ups into late adolescence and into adulthood) in order to cast a wide net with respect to the outcomes under investigation to include non‐crime life domains as well, and to conduct comprehensive cost‐benefit analyses of these programs

Validation and development of models using clinical, biochemical and ultrasound markers for predicting pre-eclampsia: An individual participant data meta-analysis

Background: Pre-eclampsia is a leading cause of maternal and perinatal mortality and morbidity. Early identification of women at risk is needed to plan management. Objectives: To assess the performance of existing pre-eclampsia prediction models and to develop and validate models for pre-eclampsia using individual participant data meta-analysis. We also estimated the prognostic value of individual markers. Design: This was an individual participant data meta-analysis of cohort studies. Setting: Source data from secondary and tertiary care. Predictors: We identified predictors from systematic reviews, and prioritised for importance in an international survey. Primary outcomes: Early-onset (delivery at < 34 weeks’ gestation), late-onset (delivery at ≥ 34 weeks’ gestation) and any-onset pre-eclampsia. Analysis: We externally validated existing prediction models in UK cohorts and reported their performance in terms of discrimination and calibration.We developed and validated 12 new models based on clinical characteristics, clinical characteristics and biochemical markers, and clinical characteristics and ultrasound markers in the first and second trimesters. We summarised the data set-specific performance of each model using a random-effects meta-analysis. Discrimination was considered promising for C-statistics of ≥ 0.7, and calibration was considered good if the slope was near 1 and calibration-in-the-large was near 0. Heterogeneity was quantified using I2 and 2. A decision curve analysis was undertaken to determine the clinical utility (net benefit) of the models. We reported the unadjusted prognostic value of individual predictors for pre-eclampsia as odds ratios with 95% confidence and prediction intervals. Results: The International Prediction of Pregnancy Complications network comprised 78 studies (3,570,993 singleton pregnancies) identified from systematic reviews of tests to predict pre-eclampsia. Twenty-four of the 131 published prediction models could be validated in 11 UK cohorts. Summary C-statistics were between 0.6 and 0.7 for most models, and calibration was generally poor owing to large between-study heterogeneity, suggesting model overfitting. The clinical utility of the models varied between showing net harm to showing minimal or no net benefit. The average discrimination for IPPIC models ranged between 0.68 and 0.83. This was highest for the second-trimester clinical characteristics and biochemical markers model to predict early-onset pre-eclampsia, and lowest for the first-trimester clinical characteristics models to predict any pre-eclampsia. Calibration performance was heterogeneous across studies. Net benefit was observed for International Prediction of Pregnancy Complications first and second-trimester clinical characteristics and clinical characteristics and biochemical markers models predicting any pre-eclampsia, when validated in singleton nulliparous women managed in the UK NHS. History of hypertension, parity, smoking, mode of conception, placental growth factor and uterine artery pulsatility index had the strongest unadjusted associations with pre-eclampsia. Limitations: Variations in study population characteristics, type of predictors reported, too few events in some validation cohorts and the type of measurements contributed to heterogeneity in performance of the International Prediction of Pregnancy Complications models. Some published models were not validated because model predictors were unavailable in the individual participant data. Conclusion: For models that could be validated, predictive performance was generally poor across data sets. Although the International Prediction of Pregnancy Complications models show good predictive performance on average, and in the singleton nulliparous population, heterogeneity in calibration performance is likely across settings. © 2020, NIHR Journals Library. All rights reserved