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Parent Training: Equivalent Improvement in Externalizing Behavior for Children With and Without Familial Risk

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Objective

The Incredible Years Series intervention has demonstrated efficacy for decreasing conduct disorder (CD) symptomatology in clinically affected youth in multiple randomized controlled trials. Because children with family psychiatric histories of antisocial behavior are at markedly increased risk for enduring symptoms of antisocial behavior (compared with their counterparts with a negative family history), the authors examined whether intervention effects across studies would prevail in that subgroup or would be relatively restricted to children without genetic risk.

Method

A reanalysis was conducted of 5 randomized controlled trials of Incredible Years involving 280 clinically affected children 3 to 8 years of age for whom a family psychiatric history of externalizing behavior in first- and second-degree relatives was ascertained from at least 1 parent.

Results

Incredible Years equally benefitted children with CD with and without family psychiatric histories of externalizing behavior. Family psychiatric history of externalizing behavior and parental depressive symptomatology predicted greater severity of CD symptomatology at baseline.

Conclusion

The beneficial effects of IY are evident in children with CD, irrespective of whether their conditions are more or less attributable to inherited susceptibility to enduring antisocial syndromes. A next phase of research should address whether earlier implementation of group-based education for parents of young children at increased familial risk for antisocial behavior syndromes—before the development of disruptive patterns of behavior—would result in even more pronounced effects and thereby constitute a cost-effective, targeted, preventive intervention for CD.

Section snippets

Method

Data from 5 RCTs of IY in which a history of parental externalizing behavior was systematically acquired were included in this reanalysis. Inclusion characteristics for the studies are summarized as follows: the child was 3 to 8 years old (RCT 4-5: 4 to 7 years old); the child had no debilitating physical impairment, intellectual deficit, or history of psychosis and was not receiving any form of psychological treatment at the time of referral; the primary referral problem was child misconduct

Household Differences

Children in 1-biological-mother households were significantly more likely than children in 2-biological-parent households to have a lower level of maternal education (Mantel-Haenszel χ21,280 = 8.44, p < .01). There was no significant difference in race or ethnicity of children in 1-biological-mother and 2-biological-parent households (χ21,280 = 2.65, p = .10). Maternal depression scores were significantly higher in 1-biological-mother than in 2-biological-parent households (t279 = 2.42, p <

Discussion

This study is comprised of secondary familial risk analyses of a combined meta-analytic sample drawn from 5 RCTs of the IY parent-training intervention to treat conduct problems in children 3 to 8 years old. The findings support and extend previously reported findings on the impact of the IY intervention—namely that children with clinical-level externalizing behavior benefit from the intervention. Moreover, the present analyses confirm that the treatment effect occurs irrespective of the

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    This article was reviewed under and accepted by Deputy Editor John Piacentini, PhD.

    The data collection was supported by the National Institutes of Health National Center for Nursing Research (grant 5 R01 NR01075-11) and the National Institute of Mental Health Research Scientist Development Award (MH00988 to C.H.W.-S.). The reanalysis was supported by the Administration for Children and Families (60329 to J.N.C.), by an anonymous donor, and the Centers for Disease Control and Prevention through the Brown Center for Violence and Injury Prevention (grant R49CE001510-01).

    The views expressed do not necessarily reflect the opinions of the funders.

    The authors thank the families who participated in the original intervention trials, whose efforts made this study possible.

    Disclosure: Dr. Webster-Stratton has disseminated these treatments and stands to gain from favorable reports. Because of this, she has voluntarily agreed to distance herself from certain critical research activities, including recruitment, consenting, primary data handling, and data analysis. The University of Washington has approved these arrangements. Dr. Constantino has received royalties for the authorship of the Social Responsiveness Scale, Second Edition (SRS-2), which is published and distributed by Western Psychological Services. Mr. Presnall reports no biomedical financial interests or potential conflicts of interest.

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