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Published on: December 2, 2015
Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: the
Stephen Scott1, Kathy Sylva, Moira Doolan
1King's College London, Institute of Psychiatry, UK. s.scott@iop.kcl.ac.uk
Insights
This study shows that a combined parenting and literacy program effectively reduces early childhood antisocial behavior and attention deficit/hyperactivity disorder (ADHD) symptoms. The intervention also improved reading skills, demonstrating a feasible approach for population-based early intervention.
Area of Science:
- Child Psychology
- Developmental Psychology
- Educational Psychology
Background:
- Early-onset antisocial behavior requires cost-effective, population-based interventions.
- Multifactorial causes necessitate interventions addressing multiple influences.
- Key risk factors include ineffective parenting, conduct problems, ADHD symptoms, and low reading ability.
Purpose of the Study:
- To evaluate a novel intervention targeting multiple risk factors for early-onset antisocial behavior.
- To assess the impact of a combined parenting and literacy program on child behavior and academic skills.
- To determine the feasibility and cost-effectiveness of a population-based early intervention.
Main Methods:
- A randomized controlled trial involving 936 six-year-old children in London.
- Parents of 112 high-scoring children were randomized to an intervention or control group.
- The 28-week intervention combined the Incredible Years parenting program with the SPOKES literacy program.
Main Results:
- Intervention parents increased positive discipline and decreased harsh discipline (effect sizes .31–.59).
- Children in the intervention group showed reduced conduct problems (.52sd), ODD (halved), and ADHD symptoms (.44sd).
- Reading age improved by six months (.36sd); teacher-rated behavior did not change. Cost: $3,800 per child.
Conclusions:
- Population-based early intervention targeting multiple risk factors is feasible.
- Combined parenting and literacy programs can effectively improve child functioning.
- Emphasis on implementation fidelity is crucial for intervention success.
Background:
There is a pressing need for cost-effective population-based interventions to tackle early-onset antisocial behaviour. As this is determined by many factors, it would seem logical to devise interventions that address several influences while using an efficient means of delivery. The aim of this trial was to change four risk factors that predict poor outcome: ineffective parenting, conduct problems, attention deficit/hyperactivity disorder (ADHD) symptoms, and low reading ability.
Methods:
A randomised controlled trial was carried out in eight schools in London, England. Nine hundred and thirty-six (936) 6-year-old children were screened for antisocial behaviour, then parents of 112 high scorers were randomised to parenting groups held in schools or control; 109 were followed up a year later. The intervention lasted 28 weeks and was novel as it had components to address both child behaviour (through the Incredible Years programme) and child literacy (through a new 'SPOKES' programme to help parents read with their children). Fidelity of implementation was emphasised by careful training of therapists and weekly supervision. Controls received an information helpline. Assessment of conduct problems was by parent interview, parenting by direct observation and child reading by psychometric testing.
Results:
At follow-up parents allocated to the intervention used play, praise and rewards, and time out more often than controls, and harsh discipline less; effect sizes ranged from .31 to .59 sd (p-values .046 to .005). Compared to control children, whose behaviour didn't change, intervention children's conduct problems reduced by .52sd, (p < .001), dropping from the 80th to the 61st percentile; oppositional-defiant disorder (ODD) halved from 60% to 31% (p = .003). ADHD symptoms reduced by .44sd (p = .002), and reading age improved by six months (.36sd, p = .027). Teacher-rated behaviour didn't change. The programme cost pound2,380 ($3,800) per child.
Conclusions:
Effective population-based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity.
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