Judy Hutchings

Who benefits and how does it work? Moderators and mediators of outcome in an effectiveness trial of a parenting intervention.

We examined mediators and moderators of change in conduct problems, in a multiagency randomized trial of the Incredible Years parenting program. Preschoolers (n = 153) at risk for conduct problems were randomly assigned to intervention (n = 104) and wait-list (n = 49) groups. Boys and younger children, and those with more depressed mothers, tended to show greater improvement in conduct problems post-intervention. Other risk factors (i.e., teen or single parenthood, very low income, high initial levels of problem behavior) showed no predictive effects, implying intervention was at least as successful at helping the most disadvantaged families, compared to more advantaged. Mediator analyses found change in positive parenting skill predicted change in conduct problems.

Parenting programme for parents of children at risk of developing conduct disorder: cost effectiveness analysis

Objective To investigate the cost effectiveness of a parenting programme. Design An incremental cost effectiveness analysis alongside a pragmatic randomised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community. Setting Sure Start areas in north and mid Wales. Participants Parents of 116 children aged 36-59 months (87% of the clinical sample) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory). Children were identified by health visitors and recruited by the research team. Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control. Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory. Results The bootstrapped incremental cost effectiveness ratio point estimate was �73 (€109,

Efficacy of the Incredible Years Programme as an early intervention for children with conduct problems and ADHD: long-term follow-up

142) per one point improvement on the intensity score (95% confidence interval �42 to �140). It would cost �5486 (€8190,

Long-term effectiveness of a parenting intervention for children at risk of developing conduct disorder

10 666) to bring the child with the highest intensity score to below the clinical cut-off point and �1344 (€2006,

Attention deficit hyperactivity disorder in pre-school children: current findings,recommended interventions and future directions

2618) to bring the average child in the intervention group within the non-clinical limits on the intensity score (below 127). For a ceiling ratio of �100 (€149,

Treatment fidelity as a predictor of behaviour change in parents attending group-based parent training

194) per point increase in intensity score, there is an 83.9% chance of the intervention being cost effective. The mean cost per child attending the parenting group was �1934 (€2887,

Early prevention of conduct disorder: how and why did the North and Mid Wales Sure Start study work?

3760) for eight children and �1289 (€1924,

EVALUATION OF TWO TREATMENTS FOR CHILDREN WITH SEVERE BEHAVIOUR PROBLEMS: CHILD BEHAVIOUR AND MATERNAL MENTAL HEALTH OUTCOMES

2506) for 12 children, including initial costs and materials for training group leaders. When we categorised the sample into relatively mild, moderate, and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder. Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective compared with the waiting list control. This parenting programme involves modest costs and demonstrates strong clinical effect, suggesting it would represent good value for money for public spending.

COMPARISON OF TWO TREATMENTS FOR CHILDREN WITH SEVERELY DISRUPTIVE BEHAVIOURS: A FOUR-YEAR FOLLOW-UP

BACKGROUND This study examined the long-term efficacy of the Incredible Years (IY) BASIC Parenting Programme delivered as a preventive intervention with parents of pre-school children who display signs of attention deficit hyperactivity disorder (ADHD) and conduct problems. Families were followed up after the completion of a controlled trial with 11 Sure Start areas in North and Mid-Wales and North West England. METHODS Participants in the study were 50 pre-school children whose parents had received the intervention. Child ADHD symptoms were assessed at baseline, at follow-up one (6 months after baseline); at follow-up two (12 months after baseline); and at follow-up three (18 months after baseline). Families in the original waiting-list control group were not assessed after follow-up one as they had subsequently received the same intervention. RESULTS The significant post-intervention improvements in child ADHD symptoms evident at follow-up one were maintained over time, as demonstrated by statistical and clinical stability of measures. No significant differences were found for ADHD symptoms across each follow-up, indicating that the gains made post intervention were maintained for at least 12 months, with 57% of the sample maintaining scores below the clinical cut-off on the Conners. Eighty-six, 58, and 30 per cent respectively had maintained at least a modest, large, or very large improvement in ADHD symptoms at follow-up three. CONCLUSIONS Findings from this study suggest that the IY psychosocial treatment programme is a valuable intervention in the longer term for many pre-school children displaying early signs of ADHD.

The Leader Observation Tool: a process skills treatment fidelity measure for the Incredible Years parenting programme

BACKGROUND The typical pattern for intervention outcome studies for conduct problems has been for effect sizes to dissipate over time with decreasing effects across subsequent follow-ups. AIMS To establish whether the short-term positive effects of a parenting programme are sustained longer term. To observe trends, and costs, in health and social service use after intervention. METHOD Parents with children aged 36-59 months at risk of developing conduct disorder (n = 104) received intervention between baseline and first follow-up (6 months after baseline n = 86) in 11 Sure Start areas in North Wales. Follow-ups two (n = 82) and three (n = 79) occurred 12 and 18 months after baseline. Child problem behaviour and parenting skills were assessed via parent self-report and direct observation in the home. RESULTS The significant parent-reported improvements in primary measures of child behaviour, parent behaviour, parental stress and depression gained at follow-up one were maintained to follow-up three, as were improved observed child and parent behaviours. Overall, 63% of children made a minimum significant change (0.3 standard deviations) on the Eyberg Child Behavior Inventory problem scale between baseline and follow-up (using intention-to-treat data), 54% made a large change (0.8 standard deviations) and 39% made a very large change (1.5 standard deviations). Child contact with health and social services had reduced at follow-up three. CONCLUSIONS Early parent-based intervention reduced child antisocial behaviour and benefits were maintained, with reduced reliance on health and social service provision, over time.