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Promoting self-regulation and cooperation in pre-kindergarten children with conduct problems: a randomized controlled
1School of Education, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem, Israel. .
Insights
Hitkashashrut, a parent training program, significantly reduced conduct problems in preschoolers. Improvements in parenting practices and reduced parental distress mediated long-term positive outcomes.
Area of Science:
- Child Psychology
- Developmental Psychology
- Intervention Science
Background:
- Preschoolers at risk for conduct problems (CP) benefit from early intervention.
- Parent training (PT) programs are effective but require accessible, adaptable models.
Purpose of the Study:
- To assess the effectiveness and mechanisms of Hitkashrut, a culturally adapted "common elements" co-parent training program.
- To evaluate its impact on preschoolers (3-5 years) at risk for conduct problems.
Main Methods:
- Randomized controlled trial (140 PT, 69 control).
- Assessed primary outcome (CP) at pre-, post-, and 1-year follow-up.
- Measured secondary outcomes including callous-unemotional traits, effortful control, and parenting.
Main Results:
- Large intervention effect (ES = .76) at post-intervention, maintained at follow-up (ES = 0.63).
- Significant improvements in callous-unemotional traits (ES = 0.85) and effortful control (ES = 0.47) were sustained.
- Improvements in CP were mediated by enhanced parental practices and reduced distress.
Conclusions:
- Hitkashashrut demonstrates effectiveness for real-world dissemination, supporting "common elements" approaches.
- Findings support cascade models of early development and the preventive impact of facilitated parental change.
Objective:
To evaluate the effectiveness and mechanisms of Hitkashrut, a "common elements" co-parent training (PT) program for early intervention with preschoolers (3-5 years of age) at risk for conduct problems (CP).
Method:
A randomized controlled trial with 140 participants in PT and 69 in a minimal intervention control group. The primary outcome (presence of CP) was assessed at pre-intervention, post-intervention, and 1-year follow-up. Callous-unemotional traits, effortful control, parental distress, negative/inconsistent parenting, and couple relationship quality were assessed at pre- and post-intervention, whereas callous-unemotional traits and effortful control were also assessed in the PT group at follow-up. Retention was 87.1% at post-intervention and 60% at follow-up. Hitkashrut incorporated evidence-based components of established PT programs into a culturally adapted protocol. The facilitators were trained and supervised psychologists working in Israel's Educational Psychology Services.
Results:
Intervention effect (Cohen's d) was large at post-intervention (ES = .76, p < .001), and an additional medium effect was found at follow-up (ES = 0.63, p < .001). Parallel post-intervention and follow-up intervention effects were also found in the degree of clinically significant improvements. Effects of the intervention on callous-unemotional traits (ES = 0.85, p < .001) and effortful control (ES = 0.47, p < .001) were maintained at follow-up. Follow-up improvement in CP was mediated by improvements in parental practices and distress.
Conclusions:
Hitkashrut's implementation and subsequent dissemination in real-world settings demonstrates the potential effectiveness of common elements programs to promote innovations within service-delivery systems. Improvements in dispositional variables and the mediated follow-up effect support theoretical cascade models that emphasize early developmental malleability and the growing preventive effects of PT's facilitated parental changes on disruptive developmental trajectories. Clinical trial registration information - The effect of a "common elements" co-parent training program (called 'Hitkashrut') on conduct in preschoolers at risk for conduct problems; http://www.anzctr.org.au; ACTRN12612000148875.
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