Treating Children With Early-Onset Conduct Problems: Intervention Outcomes for Parent, Child, and Teacher Training

Findings

External behavior outcomes—Statistically significant positive effect found for the domain

Outcome measure	Comparison	Period	Sample	Intervention mean	Comparison mean	Significant?	Improvement     index	Evidence tier
Child Conduct Problems (CCP) at Home: Mother report	The Incredible Years vs. None	Posttest	Ages 4–8; 51 students	36.99	47.28	No	--
Child Conduct Problems (CCP) at School	The Incredible Years vs. None	Posttest	Ages 4–8; 51 students	29.58	39.55	No	--

Social outcomes outcomes—Substantively important positive effect found for the domain

Outcome measure	Comparison	Period	Sample	Intervention mean	Comparison mean	Significant?	Improvement     index	Evidence tier
Child Social Competence (CSC) with Peers	The Incredible Years vs. None	Posttest	Ages 4–8; 51 students	53.15	44.13	No	--

Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.

Study Details

Setting

The teacher, parent, and child trainings were primarily instituted in the University of Washington Parenting Clinic. The children assigned to treatment conditions came to the clinic’s “Dinosaur School.” Participants then practiced their skills at home and in the classroom.

Study sample

A sample of 159 families was randomly assigned to one of six conditions: parent training alone (PT; n = 31); child training alone (CT; n = 30); parent training plus teacher training (PT + TT; n = 24); child training plus teacher training (CT + TT; n = 23); parent and child training combined with teacher training (PT + CT + TT; n = 25); or a wait-list comparison group (n = 26). The final sample sizes for each of the six conditions differ by outcome measure. Participants were recruited from families requesting treatment at the University of Washington Parenting Clinic. Families were self-referred or referred by professionals in the community (20% by teachers and 38% by physicians). The primary referral problem was child misconduct (e.g., noncompliance, aggression, oppositional behaviors) that had been occurring for at least six months. Families entered the study in three cohorts (50 to 55 families per cohort) in the fall of 1995, 1996, and 1997. Random assignment was conducted by lottery after all families in the cohort had completed baseline assessments. The student sample was predominantly European American (79%), 90% were boys, and the mean age was 71 months. The sample consisted of students in preschool, kindergarten, first grade, and second grade.

Intervention Group

The children assigned to CT, CT + TT, and CT + PT + TT conditions came to the clinic’s Dinosaur School for 2 hours each week for 18 to 19 weeks (lasting approximately six months) and met with two therapists. The Dinosaur School program specifically addressed interpersonal difficulties that are problematic for young children with oppositional defiant disorder (ODD). Weekly letters were sent to teachers and parents explaining the key concepts and the rationale for the targeted skill (e.g., sharing, teamwork, friendly talk, listening, compliance to requests, feeling talk, and problem solving). Teachers and parents were asked to reinforce the targeted social skills whenever they noticed the child using them in the home or school, and children were given weekly homework assignments to complete with their parents. The parents assigned to PT, PT + TT, and PT + CT + TT conditions met at the clinic each week for a 2-hour session. Over the course of 22 to 24 weeks, they watched 17 videotape programs on parenting and interpersonal skills designed to reduce parents’ coercive interactions and strengthen positive interactions and relationships with their children. Teachers in the PT + TT, CT + TT, and PT + CT + TT conditions came to the clinic for 4 full days (32 hours) of group training sequenced throughout the school year, to correspond roughly with the beginning, first quarter, second quarter, and end of the PT and CT treatments.

Comparison Group

The families assigned to the comparison condition received no treatment from the Parenting Clinic and had no contact with therapists during the 8- to 9-month waiting period. These families were offered the parent training program after the outcomes from the first year of the study had been measured.

Outcome descriptions

This study included measures of Child Conduct Problems (CCP) at Home, Child Conduct Problems (CCP) at School, and Child Social Competence (CSC) with Peers. For a more detailed description of these outcome measures, see Appendix B.

Support for implementation

The teacher curriculum targeted teachers’ use of effective classroom management strategies for handling misbehavior, promoting positive relationships with difficult students, and strengthening social skills in all school settings. Workshop topics included promoting social skills through praise and encouragement, proactive teaching, using incentives to motivate children, strategies to decrease disruptive behavior, and collaborative approaches for working with parents. Teachers also learned to prevent peer rejection by helping the aggressive child learn appropriate problem-solving strategies and by helping his or her peers respond appropriately to aggression. Teachers were trained to have age-appropriate expectations and to be sensitive to individual developmental differences and biological deficits in children, and to understand the relevance of these differences for enhanced teaching efforts that are positive, accepting, and consistent. To ensure the integrity of the treatment, therapists co-led their first parent or child group with a supervisor, completed a weekly checklist of standards, and were monitored weekly. All child and parent sessions were videotaped for feedback and analyses, and the supervisor randomly selected videotapes for fidelity checks. Analyses indicated that all required videotape vignettes were shown and that all required homework was assigned.

Additional Sources

Findings

Evidence Tier rating based solely on this study. This intervention may achieve a higher tier when combined with the full body of evidence.