Sturla Fossum

Parent training for young Norwegian children with ODD and CD problems: Predictors and mediators of treatment outcome

Participants were 121 children, aged 4-8 years referred for conduct problems, and their mothers. A parent training intervention was implemented in two outpatient clinics in Norway. Treatment responders were defined as children scoring below a cut-off on the Eyberg Child Behavior Inventory, a score below an optimal cut-off for children in day-care and school as reported by teachers, in addition to a 30% reduction or greater in observed negative parenting. Self-reported parenting practices were explored as potential mediators. The results of logistic regression analyses showed that high levels of maternal stress, clinical levels of ADHD, and being a girl predicted a poorer outcome in conduct problems at home, while pretreatment clinical levels of ADHD predicted a poorer outcome as perceived by the teachers. Harsh and inconsistent parental disciplining emerged as significant partial mediators of changes in conduct problems, highlighting the importance of altering parenting practices to modify young childrens conduct problems.

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents: a meta-analysis

BackgroundThe effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated.MethodSixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated.ResultsThe mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively.ConclusionPsychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.

Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training

BACKGROUND While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. METHOD In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5-6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5-6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview. RESULTS While all children qualified for a diagnosis of ODD/CD before treatment, 5-6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5-6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems. CONCLUSION The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials.

BackgroundPreventive interventions for adolescents are an important priority within school systems. Several interventions have been developed, but the effectiveness of such interventions varies considerably between studies. The purpose of this study was to assess the effectiveness of universal school-based prevention programs on alcohol use among adolescents by using meta-analytic techniques.MethodA systematic literature search in the databases, PubMed (Medline), PsycINFO (Ovid), EMBASE (Ovid) and WEB of Science (ISI) was conducted to search for empirical articles published in the period January 1990 to August 2014.ResultsIn total, 28 randomized controlled studies with 39,289 participants at baseline were included. Of these 28 articles, 12 studies (N = 16279) reported continuous outcomes (frequency of alcohol use and quantity of alcohol use), and 16 studies (N = 23010) reported categorical data (proportion of students who drank alcohol). The results of the random effects analyses showed that the overall effect size among studies reporting continuous outcomes was small and demonstrated a favorable effect from the preventive interventions (Hedges’ g¯ = 0.22, p < .01). The effect size among studies reporting categorical outcomes was not significant (OR¯ = 0.94, p = .25). The level of heterogeneity between studies was found to be significant in most analyses. Moderator analyses conducted to explore the heterogeneity showed neither significant difference between the different school levels (junior high schools and high schools), nor between the varied program intensities (low, medium and high intensity programs). The meta-regression analyses examining continuous moderators showed no significant effects for age or gender.ConclusionsThe findings from this meta-analysis showed that, overall, the effects of school-based preventive alcohol interventions on adolescent alcohol use were small but positive among studies reporting the continuous measures, whereas no effect was found among studies reporting the categorical outcomes. Possible population health outcomes, with recommendations for policy and practice, are discussed further in this paper.

Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial

IMPORTANCE There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). CONCLUSIONS AND RELEVANCE The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01750996.

Pervasive and non-pervasive conduct problems in a clinic sample aged 4-8 years: child, family and day-care/school factors

Differences between pervasive (home and day‐care/school) versus non‐pervasive (home only) conduct problems were examined in regard to various child, parent/family, and day‐care/school characteristics in an outpatient clinic sample of 120 children aged 4–8 years. All children scored above the 90th percentile on the Eyberg Child Behavior Inventory for home problems and met the criteria for a possible or a confirmed diagnosis of oppositional defiant behaviours. The proportion of children with pervasive conduct problems was high, 83%. Teachers in day care and school reported children in the pervasive group to have significantly more attention and internalizing problems as well as lower social competence scores than those in the non‐pervasive group. Children in the pervasive group also showed consistently more problems in their relationships both with teachers and peers than those in the non‐pervasive group. The implications for assessment and treatment of children with conduct problems in these age‐groups are discussed.

Does the Incredible Years Teacher Classroom Management Training programme have positive effects for young children exhibiting severe externalizing problems in school?: a quasi-experimental pre-post study

BackgroundYoung children exhibiting severe externalizing problems in school are at risk of developing several poor outcomes. School-based intervention programs have been found to be effective for students with different problems, including those with behavioral problems, emotional distress, or social problems. The present study investigated whether the IY-TCM programme, as a universal stand-alone school intervention programme, reduced severe child externalizing problems as reported by the teacher, and evaluated if these children improved their social competence, internalizing problems, academic performances and student- teacher relationship as a result of the IY TCM training.MethodsA quasi-experimental pre-post study was conducted, including 21 intervention schools and 22 control schools. Children in 1st – 3rd grade (age 6–8 years) assessed by their teacher as having severe externalizing problems on the Sutter–Eyberg Student Behavior Inventory-Revised (SESBI-R) total Intensity score, were included in the study, N = 83 (65 boys and 18 girls). Treatment effects were evaluated using 3- level linear mixed models analysis.ResultsIn our study we found no differences in change between the two conditions from baseline to follow-up in externalizing problems, social skills, internalizing problems and closeness with teacher. The intervention condition did however show advantageous development in terms of student-teacher conflicts and increased academic performances.ConclusionThe IY Teacher Classroom Management program is not sufficient being a stand-alone universal program in a Norwegian primary school setting, for students with severe externalizing problems. However; some important secondary findings were found. Still, young school children with severe externalizing problems are in need of more comprehensive and tailored interventions.

Comparing two evidence-based parent training interventions for aggressive children

Purpose – The purpose of this paper is to explore whether the changes in externalising behaviour for young aggressive children differ between two evidence-based parent training (PT) programmes after treatment. The treatment formats between these programmes differ, and the authors were particularly interested in whether this influenced the results for participants with co-occurring problems (child variables such as heightened levels of attention and internalising problems, and parental variables such as marital status and education) and the consequent additional risk of poorer treatment outcomes. Design/methodology/approach – A comparison of the individual treatment programme “Parent Management Training – Oregon model” (PMTO) and the group intervention programme “The Incredible Years” (IY) basic training sessions. Outcomes were explored in matched samples from two earlier Norwegian replication studies. The participants were matched on pre-treatment characteristics using a quasi-experimental mis-matching procedure. Findings – There were no significant differences between the two interventions in parent ratings of externalising behaviours and the lack of differing effects between the two treatments remained when the co-occurring risk factors were introduced into the analyses. Research limitations/implications – The participants were matched on pre-treatment characteristics using a quasi-experimental mis-matching procedure. Practical implications – A possible implication of these findings is that parents should be allowed to choose the treatment format of their preference. Further, individual PT may be more appropriate in rural settings with difficulties in forming group interventions. Social implications – Treatment effects did not differ between these two evidence-based interventions. Originality/value – To the best of the knowledge independent comparisons of two evidence-based PT interventions are not previously conducted.

Does parental mental health moderate the effect of a telephone and internet-assisted remote parent training for disruptive 4-year-old children?

This study explores the moderators affecting the success of an Internet-based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4-year-old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self-reported parenting skills. The measures were completed at baseline, six and 12-months follow-up. The 232 families randomized to active treatment received 11 Internet-based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45-minute phone-call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatments personalization, the formats flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.

Unmet needs of child and adolescent psychiatrists among Asian and European countries: does the Human Development Index (HDI) count?

Andre Sourander1 · Roshan Chudal1 · Norbert Skokauskas2 · Ahmed Malallah Al‐Ansari3 · Anat Brunstein Klomek4 · Chanvit Pornnoppadol5 · Gerasimos Kolaitis6 · Junko Maezono1 · Hans‐Cristoph Steinhausen7,8,9 · Helena Slobodskaya10 · Hitoshi Kaneko11 · Jaya Regmee12 · Liping Li13 · Mai Huong Nguyen14 · Meytal Grimland15 · Olga Osokina16 · Say How Ong17 · Samir Kumar Praharaj18 · Sigita Lesinskienė19 · Sturla Fossum20 · Tjhin Wiguna21 · Valentina A. Makasheva22 · Venla Lehti1,23