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PhD Study: Evaluation of the Efficacy of the Incredible Years Parenting Training

Programme for children with conduct problems and ADHD

A PhD study, funded by the Economic and Social Research Council (ESRC) in collaboration with North West Wales NHS Trust, and sponsored by the University of Wales, Bangor.

Karen JonesSupervisors: Dr David Daley & Dr Judy Hutchings

ATTENTION DEFICIT-HYPERACTIVITY DISORDER (ADHD)•Developmentally inappropriate inattention, impulsivity, and hyperactivity, typically arising in early childhood•Symptoms are relatively persistent, and result in cross-situational impairment (e.g. at home and at school)•Most common reason for referral into specialist mental health services•3-5% meet diagnostic criteria for ADHD•Poor long-term outcome if untreated•Children at increased risk of developing problems in academic, personal, and social domainsCO-MORBIDITY WITH CONDUCT PROBLEMS•Often co-morbid with conduct disorder (CD): 30-70% of children diagnosed with ADHD also meet criteria for CD•Co-morbid condition associated with poorer outcomesTREATMENT•Guidance from both the National Institute for Clinical Excellence (NICE) and the American Pediatric Association (APA) suggest combination of medication and psychosocial treatment•Good short-term evidence, but no controlled evidence for generalised long-term effects•Increasing evidence that parenting programmes are equally effective for families of pre-school children with ADHD as they are for Conduct Problems (Sonuga-Barke et al., 2001; Bor et al., 2002)•Recent studies suggest IY BASIC Parent Training Programme is as effective for ADHD as for conduct problems (Scott et al., 2001; Hartman et al., 2003)RATIONALE FOR STUDY•Growing evidence of effectiveness of the IY programme for ADHD•Availability of Sure Start data set evaluating IY for families of pre-school children with conduct problems•Many children in the sample also demonstrated high levels of ADHD type symptoms, with 79 scoring above clinical cut-off on the Hyperactivity subscale of the Strengths and Difficulties QuestionnaireEVALUATION AIMS•To evaluate the effectiveness of the IY parenting programme for families who have children presenting signs of early onset conduct problems and ADHD•To examine the long-term stability of outcome

EVALUATION METHOD•PARTICIPANTS:

•79 participants drawn from existing Sure Start trial•50 intervention, 29 control

•INCLUSION CRITERIA:•Child aged between 36-48 months•Living in designated Sure Start areas•Score above clinical cut-off on either problem or intensity subscale of the Eyberg Child Behaviour Inventory (ECBI; Intensity score 127 or above; Problems score 11 or above•Score above clinical cut-off on the Hyperactivity subscale of the Strengths and Difficulties Questionnaire (SDQ; 7 or above; Goodman, 1997)

•DEMOGRAPHICS•All primary care givers were mothers (mean age at baseline = 27.71)•Mean age of child at baseline = 46.28 months, predominantly male (68%)

Play: Promote Positive

Parent-Child Relationships

Praise & Incentives:

Build Social Competence

Effective Limit Setting:

Increase Cooperation

Ignore,

redirect, distract:

Decrease Aggression

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Liberally

Use

SelectivelyPARENTING

PYRAMID

The Incredible Years Training Series 3/00

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Out

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DESIGN•Families randomly allocated to either intervention or wait-list control group (stratified for age and sex of child)•Both groups assessed at baseline and 6 months later at follow-up 1 (post intervention)•Control families offered intervention once follow up 1 completed•Intervention group assessed again at follow-up 2 and 3 (12 and 18 months after baseline, respectively)MEASURES•ECBI used for screening for clinical levels of child conduct problems•SDQ used for screening for clinical levels of hyperactivity•Conners Abbreviated Parent/Teacher Rating Scale (Conners, 1994) used as primary outcome measure of ADHD symptoms•Dyadic Parent-Child Observation Coding System (DPICS; Eyberg & Robinson, 1981) used as a direct observational measure of child devianceINTERVENTION•12 week IY BASIC PT programme•Run in 11 Sure Start areas in North & Mid Wales and borders•Run by experienced and certified group leaders

RESULTSSHORT-TERM FINDINGS (INTERVENTION VS. CONTROL)•Intervention group associated with significantly lower levels of parent reported ADHD symptoms (on Conners)•Improvements remained significant even after controlling for post intervention change in observed child deviance (F[3,65] = 8.77, p = 0.004)•52% of intervention compared with 21% of control group showed clinically reliable improvements at follow-up 1 (using Reliable Change Index; Jacobson & Truax, 1991), yielding a NNT (number needed to treat) of 3.23

RESULTSLONG-TERM FINDINGS (INTERVENTION GROUP)•Original improvements in parent-reported ADHD symptoms maintained at each follow-up, as indicated by non-significant differences between follow-up scores on the Conners•Follow-up 1 to follow-up 2: F (1, 48) = 0.70, p = 0.41•Follow-up 2 to follow-up 3: F (1, 49) = 0.72, p = 0.40

CONCLUSIONS•In the short term, intervention was associated with significantly more positive outcomes for children, suggesting that the IY BASIC Parent Training programme is a successful early intervention for pre-school children presenting signs of ADHD symptoms and disruptive behaviour.•The improvements made following intervention were maintained for at least 12 months after intervention

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