Journal of Abnormal Child Psychology

, Volume 46, Issue 8, pp 1613–1629 | Cite as

Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis

  • Janine V. OlthuisEmail author
  • Patrick J. McGrath
  • Charles E. Cunningham
  • Michael H. Boyle
  • Patricia Lingley-Pottie
  • Graham J. Reid
  • Alexa Bagnell
  • Ellen L. Lipman
  • Karen Turner
  • Penny Corkum
  • Sherry H. Stewart
  • Patrick Berrigan
  • Kathy Sdao-Jarvie


Disruptive behavior disorders are prevalent in youth, yet most children with disruptive behavior do not have access to timely, effective treatment. Distance-delivered service (e.g., via telephone, Internet) can overcome several barriers to care. This study tested the effectiveness of a 12-week parent training program, Strongest Families™ Parenting the Active Child, delivered via written material, skill-based videos, and telephone coaching sessions, as compared to usual care in reducing child externalizing behavior. Participants were 172 primary caregivers of a 6- to 12-year-old (29% girls; M age = 8.5 years) recruited from community children’s mental health clinics. Participants were randomized to either Strongest Families™ or usual care and completed measures of child externalizing behavior, parenting practices, parent distress, and intervention services consumed at baseline and 5-, 10-, 16-, and 22-months post-baseline. Growth curve analysis showed significant reductions in externalizing behavior in both conditions over time. Improvements were significantly greater at 10 months in the Strongest Families™ condition (d = 0.43). At 22 months, however, the differences were not significant and small in magnitude (d = −0.05). The intervention decreased inconsistent discipline significantly more than usual care. Parents in both conditions showed significant reductions in distress. We also conducted a cost-effectiveness analysis to assess the value for money of the Strongest Families™ program versus usual care. Distance parent training is a promising way to increase access to, and reduce costs associated with, mental health care for families with a child with disruptive behavior.


Cost-effectiveness Disruptive behavior Distance delivery Parent training Treatment access Usual care 



The authors would like to thank the members of our Data Safety Monitoring Board – Drs. Walter Ambrosius, Christine Arlett, and John Hunsley – for their time and contribution.


This study was funded by Operating Grant 91030 from the Canadian Institutes of Health Research to Drs. McGrath and Cunningham.

Compliance with Ethical Standards

Conflict of Interest

Dr. McGrath is the volunteer Chair of the Board of the Strongest Families Institute (SFI) and owns intellectual property rights for the Strongest Families™ Parenting the Active Child program, but has assigned rights to SFI. Dr. Cunningham receives salary support and holds shares in and receives compensation for workshops and materials for large group COPE parent training programs. Dr. Lingley-Pottie is a full-time paid employee, President, and CEO of SFI and the IRIS platform. The remaining authors have no conflicts of interest.

Ethical Approval

The present trial was approved by Research Ethics Boards at the IWK Health Centre and McMaster University.

Informed Consent

All participants (parents) provided informed consent.

Supplementary material

10802_2018_413_MOESM1_ESM.docx (3.6 mb)
ESM 1 (DOCX 3728 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Janine V. Olthuis
    • 1
    Email author
  • Patrick J. McGrath
    • 2
    • 3
    • 4
  • Charles E. Cunningham
    • 5
    • 6
  • Michael H. Boyle
    • 5
    • 7
  • Patricia Lingley-Pottie
    • 2
    • 3
  • Graham J. Reid
    • 8
    • 9
    • 10
  • Alexa Bagnell
    • 2
    • 3
  • Ellen L. Lipman
    • 5
    • 6
    • 7
  • Karen Turner
    • 2
  • Penny Corkum
    • 11
    • 12
    • 13
  • Sherry H. Stewart
    • 3
    • 11
  • Patrick Berrigan
    • 14
  • Kathy Sdao-Jarvie
    • 15
  1. 1.Department of PsychologyUniversity of New BrunswickFrederictonCanada
  2. 2.Centre for Research in Family HealthIWK Health CentreHalifaxCanada
  3. 3.Department of PsychiatryDalhousie UniversityHalifaxCanada
  4. 4.Departments of Pediatrics and Community Health & EpidemiologyDalhousie UniversityHalifaxCanada
  5. 5.Department of Psychiatry and Behavioural NeurosciencesMcMaster UniversityHamiltonCanada
  6. 6.Offord Centre for Child StudiesHamiltonCanada
  7. 7.Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonCanada
  8. 8.Department of PsychologyUniversity of Western OntarioLondonCanada
  9. 9.Departments of Family Medicine and Pediatrics, Schulich School of Medicine and DentistryUniversity of Western OntarioLondonCanada
  10. 10.Children’s Health Research InstituteLondonCanada
  11. 11.Department of Psychology and NeuroscienceDalhousie UniversityHalifaxCanada
  12. 12.Department of PediatricsIWK Health CentreHalifaxCanada
  13. 13.Colchester East Hants ADHD ClinicColchester Regional HospitalTruroCanada
  14. 14.Research Methods UnitNova Scotia Health AuthorityHalifaxCanada
  15. 15.Peel Children’s CentreMississaugaCanada

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