Abstract
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.
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References
Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA school-age forms and profiles. Burlington: University of Vermont, Research Center for Children, Youth, and Families.
Akker, A. L., Deković, M., Prinzie, P., & Asscher, J. J. (2010). Toddlers’ temperament profiles: Stability and relations to negative and positive parenting. Journal of Abnormal Child Psychology, 38, 485–495. https://doi.org/10.1007/s10802-009-9379-0.
Balan, R., Dobrean, A., Roman, G. D., & Balazsi, R. (2017). Indirect effects of parenting practices on internalizing problems among adolescents: The role of expressive suppression. Journal of Child and Family Studies, 26, 40–47. https://doi.org/10.1007/s10826-016-0532-4.
Borduin, C. M., & Dopp, A. R. (2015). Economic impact of multisystemic therapy with juvenile sexual offenders. Journal of Family Psychology, 29, 687–696. https://doi.org/10.1037/fam0000113.
Boyle, M. H., Cunningham, C. E., Georgiades, K., Cullen, J., Racine, Y., & Pettingill, P. (2009). The brief child and family phone interview (BCFPI): 2. Usefulness in screening for child and adolescent psychopathology. Journal of Child Psychology & Psychiatry, 50, 424–431. https://doi.org/10.1111/j.1469-7610.2008.01971.x.
Briggs, A. H., Goeree, R., Blackhouse, G., & O’Brien, B. J. (2002). Probabilistic analysis of cost-effectiveness models: Choosing between treatment strategies for gastroesophageal reflux disease. Medical Decision Making, 22(4), 290–308.
Burke, J. D., Loeber, R., & Birmaher, B. (2002). Oppositional defiant disorder and conduct disorder: A review of the past 10 years, part II. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1275–1293. https://doi.org/10.1097/00004583-200211000-00009.
Canadian Agency for Drugs and Technologies in Health. (2017). Guidelines for the economic evaluation of health technologies: Canada (4th ed.). Ottawa: Authors.
Christenson, J. D., Crane, D. R., Malloy, J., & Parker, S. (2016). The cost of oppositional defiant disorder and disruptive behavior: A review of the literature. Journal of Child and Family Studies, 25, 2649–2658. https://doi.org/10.1007/s10826-016-0430-9.
Cohen, D. J., & Reynolds, M. R. (2008). Interpreting the results of cost-effectiveness studies. Journal of the American College of Cardiology, 52, 2119–2126. https://doi.org/10.1016/j.jacc.2008.09.018.
Collins, K. A., Westra, H. A., Dozois, D. J. A., & Burns, D. D. (2004). Gaps in accessing treatment for anxiety and depression: Challenges for the delivery of care. Clinical Psychology Review, 24, 583–616. https://doi.org/10.1016/j.cpr.2004.06.001
Cunningham, C. E., Boyle, M., Offord, D., Racine, Y., Hundert, J., Secord, M., & McDonald, J. (2000). Tri-ministry study: Correlates of school-based parenting course. Journal of Consulting and Clinical Psychology, 68, 928–933. https://doi.org/10.1037/0022-006X.68.5.928.
Cunningham, C. E., Boyle, M. H., Hong, S., Pettingill, P., & Bohaychuk, D. (2009). The brief child and family phone interview (BCFPI): 1. Rationale, development, and description of a computerized children’s mental health intake and outcome assessment tool. Journal of Child Psychology and Psychiatry, 50, 416–423. https://doi.org/10.1111/j.1469-7610.2008.01970.x.
Cunningham, C. E., Rimas, H., Chen, Y., Deal, K., McGrath, P., Lingley-Pottie, P., et al. (2015). Modeling parenting programs as an interim service for families waiting for children’s mental health treatment. Journal of Clinical Child and Adolescent Psychology, 44, 616–629. https://doi.org/10.1080/15374416.2014.888666.
Dadds, M. R., Maujean, A., & Fraser, J. A. (2003). Parenting and conduct problems in children: Australian data and psychometric properties of the Alabama parenting questionnaire. Australian Psychologist, 38, 238–241. https://doi.org/10.1080/00050060310001707267.
Detsky, A. S., & Naglie, I. G. (1990). A clinician’s guide to cost-effectiveness analysis. Annals of Internal Medicine, 113, 147–154. https://doi.org/10.7326/0003-4819-113-2-147.
Feinfield, K. A., & Baker, B. L. (2004). Empirical support for a treatment program for families of young children with externalizing problems. Journal of Clinical Child and Adolescent Psychology, 33, 182–195. https://doi.org/10.1207/S15374424JCCP3301_17.
Fernandez, E., Salem, D., Swift, J. K., & Ramtahal, N. (2015). Meta-analysis of dropout from cognitive behavioral therapy: Magnitude, timing, and moderators. Journal of Consulting and Clinical Psychology, 83, 1108–1122. https://doi.org/10.1037/ccp0000044.
Forgatch, & Patterson, G. R. (2010). Parent management training – Oregon model: An intervention for antisocial behavior in children and adolescents. In J. R. Weisz & A. E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents (2nd ed., pp. 159–178). New York: Guilford Press.
Gallart, S. C., & Matthey, S. (2005). The effectiveness of group triple P and the impact of the four telephone contacts. Behaviour Change, 22, 71–80. https://doi.org/10.1375/bech.2005.22.2.71.
Greene, R. W., Biederman, J., Zerwas, S., Monuteaux, M. C., Goring, J. C., & Faraone, S. V. (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. American Journal of Psychiatry, 159, 1214–1224. https://doi.org/10.1176/appi.ajp.159.7.1214.
Hahlweg, K., Heinrichs, N., Kuschel, A., & Feldmann, M. (2008). Therapist-assisted, self-administered bibliotherapy to enhance parental competence: Short- and long-term effects. Behavior Modification, 32, 659–681. https://doi.org/10.1177/0145445508317131.
Harvey, E. A., Metcalfe, L. A., Herbert, S. D., & Fanton, J. H. (2011). The role of family experiences and ADHD in the early development of oppositional defiant disorder. Journal of Consulting and Clinical Psychology, 79, 784–795. https://doi.org/10.1037/a0025672.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the depression anxiety stress scales (DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 44, 227–239. https://doi.org/10.1348/014466505X29657.
Hoagwood, K., Hibbs, E., Brent, D., & Jensen, P. (1995). Introduction to the special section: Efficacy and effectiveness in studies of child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 683–687. https://doi.org/10.1037/0022-006X.63.5.683.
Hoagwood, K. E., Jensen, P. S., Arnold, E., Roper, M., Severe, J., Odbert, C., et al. (2004). Reliability of the Services for Children and Adolescents–Parent Interview. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1345–1354. https://doi.org/10.1097/01.chi.0000139558.54948.1f.
Jensen, P. S., Eaton Hoagwood, K., Roper, M., Arnold, L. E., Odbert, C., Crowe, M., et al. (2004). The Services for Children and Adolescents–Parent Interview: Development and performance characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1334–1344. https://doi.org/10.1097/01.chi.0000139557.16830.4e.
Kierfeld, F., Ise, E., Hanisch, C., Gortz-Dorten, A., & Dopfner, M. (2013). Effectiveness of telephone-assisted parent-administered behavioral family intervention for preschool children with externalizing problem behavior: A randomized controlled trial. European Journal of Child and Adolescent Psychiatry, 22, 553–565. https://doi.org/10.1007/s00787-013-0397-7.
Lavigne, J. V., Gouze, K. R., Hopkins, J., Bryant, F. B., & LeBailly, S. A. (2012). A multi-domain model of risk factors for ODD symptoms in a community sample of 4-year-olds. Journal of Abnormal Child Psychology, 40, 741–757. https://doi.org/10.1007/s10802-011-9603-6.
Lingley-Pottie, P., & McGrath, P. J. (2016). Imagine a mental health service that builds stronger families. Journal of the Canadian Paediatric Society, 21(5), 247–248.
Lingley-Pottie, P., McGrath, P. J., & Andreou, P. (2013). Barriers to mental health care: Perceived delivery system differences. Advances in Nursing Science, 36, 51–61. https://doi.org/10.1097/ANS.0b013e31828077eb.
Lovibond, S. H., & Lovibond, P. F. (1993). Manual for the depression anxiety stress scales (DASS) (2nd ed.). Sydney: Psychology Foundation.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behavior Research and Therapy, 33, 335–342. https://doi.org/10.1016/0005-7967(94)00075-U.
McGrath, P. J., Lingley-Pottie, P., Thurston, C., MacLean, C., Cunningham, C., Waschbusch, D. A., et al. (2011). Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: Randomized trials and overall analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 1162–1172. https://doi.org/10.1016/j.jaac.2011.07.013.
McIntyre, L. L. (2008). Adapting Webster-Stratton’s incredible years parent training for children with developmental delay: Findings from a treatment group only study. Journal of Intellectual Disability Research, 52, 1176–1192. https://doi.org/10.1111/j.1365-2788.2008.01108.x.
Menting, A. T. A., Orobio de Castro, B., & Matthys, W. (2013). Effectiveness of the incredible years parent training to modify disruptive and prosocial child behavior: A meta-analytic review. Clinical Psychology Review, 33, 901–9013. https://doi.org/10.1016/j.cpr.2013.07.006.
Michelson, D., Davenport, C., Dretzke, J., Barlow, J., & Day, C. (2013). Do evidence-based interventions work when tested in the “real world?” a systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clinical Child and Family Psychology Review, 16, 18–34. https://doi.org/10.1007/s10567-013-0128-0.
Morawska, A., & Sanders, M. R. (2006). Self-administered behavioral family intervention for parents of toddlers: Part 1. Efficacy. Journal of Consulting and Clinical Psychology, 74, 10–19. https://doi.org/10.1037/0022-006X.74.1.10.
Muntz, R., Hutchings, J., Edwards, R. T., Hounsome, B., & O'Ceilleachair, A. (2004). Economic evaluation of treatments for children with severe behavioural problems. The Journal of Mental Health Policy and Economics, 7(4), 177–189.
Nock, M. K., Kazdin, A. E., Hiripi, E., & Kessler, R. C. (2007). Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: Results from the national comorbidity survey replication. Journal of Child Psychology and Psychiatry, 48, 703–713. https://doi.org/10.1111/j.1469-7610.2007.01733.
O'Brien, B. J., Gertsen, K., Willan, A. R., & Faulkner, A. (2002). Is there a kink in consumers' threshold value for cost-effectiveness in health care? Health Economics, 11, 175–180. https://doi.org/10.1002/hec.655.
Olsson, T. M. (2010). Intervening in youth problem behavior in Sweden: A pragmatic cost analysis of MST from a randomized trial with conduct disordered youth. International Journal of Social Welfare, 19, 194–205. https://doi.org/10.1111/j.1468-2397.2009.00653.x.
Patterson, G. R., Reid, J. B., & Dishion, T. J. (1992). Antisocial boys. Eugene: Castalia.
Polanczyk, G. V., Salum, G. A., Sugaya, L. S., Caye, A., & Rohde, L. A. (2015). Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. Journal of Child Psychology and Psychiatry, 56, 345–365. https://doi.org/10.1111/jcpp.12381.
Rai, A. A., Stanton, B., Wu, Y., Li, X., Galbraith, J., Cottrell, L., et al. (2003). Relative influences of perceived parental monitoring and perceived peer involvement on adolescent risk behaviors: An analysis of six cross-sectional data sets. Journal of Adolescent Health, 33, 108–118. https://doi.org/10.1016/S1054-139X(03)00179-4.
Rasbash, J., Steele, F., Browne, W., & Goldstein, H. (2009). A user’s guide to MLwiN, version 2.10. Bristol: University of Bristol.
Shelton, K. K., Frick, P. J., & Wootton, J. (1996). Assessment of parenting practices in families of elementary school-age children. Journal of Clinical Child Psychology, 25, 317–329. https://doi.org/10.1207/s15374424jccp2503_8.
Slatcher, R. B., & Trentacosta, C. J. (2012). Influences of parent and child negative emotionality on young children’s everyday behaviors. Emotion, 12, 932–942. https://doi.org/10.1037/a0027148.
Sourander, A., McGrath, P. J., Ristkari, T., Cunningham, C., Huttunen, J., Lingley-Pottie, P., et al. (2016). Internet-assisted parent training intervention for disruptive behavior in 4-year-old children: A randomized clinical trial. JAMA Psychiatry, 73, 378–387. https://doi.org/10.1001/jamapsychiatry.2015.3411.
Surjadi, F. F., Lorenz, F. O., Conger, R. D., & Wickrama, K. A. S. (2013). Harsh, inconsistent parental discipline and romantic relationships: Mediating processes of behavioral problems and ambivalence. Journal of Family Psychology, 27, 762–772. https://doi.org/10.1037/a0034114.
Thomas, A., & Chess, S. (1977). Temperament and development. New York: Brunner/Mazel.
Thompson, R., Tabone, J. K., Litrownik, A. J., Briggs, E. C., Hussey, J. M., English, D. J., & Dubowitz, H. (2011). Early adolescent risk behavior outcomes of childhood externalizing behavioral trajectories. Journal of Early Adolescence, 31, 234–257. https://doi.org/10.1177/0272431609361203.
Timmermans, M., van Lier, P. A. C., & Koot, H. M. (2009). Pathways of behavior problems from childhood to late adolescence leading to delinquency and academic underachievement. Journal of Clinical Child and Adolescent Psychology, 38, 630–638. https://doi.org/10.1080/15374410903103502.
Van de Wiel, N. M. H., Matthys, W., Cohen-Kettenis, P., & van Engleland, H. (2003). Application of the Utrecht coping power program and care as usual to children with disruptive behavior disorders in outpatient clinics: A comparative study of cost and course of treatment. Behavior Therapy, 34, 421–436. https://doi.org/10.1016/S0005-7894(03)80028-X.
Van Leeuwen, K. G., Mervielde, I., Braet, C., & Bosmans, G. (2004). Child personality and parental behavior as moderators of problem behavior: Variable- and person-centered approaches. Developmental Psychology, 40, 1028–1046. https://doi.org/10.1037/0012-1649.40.6.1028.
Vermeulen, K. M., Jansen, D. E., Knorth, E. J., Buskens, E., & Reijneveld, S. A. (2017). Cost-effectiveness of multisystemic therapy versus usual treatment for young people with antisocial problems. Criminal Behavior and Mental Health, 27, 89–102. https://doi.org/10.1002/cbm.1988.
Waddell, C., Offord, D. R., Shepherd, C. A., Hua, J. M., & McEwan, K. (2002). Child psychiatric epidemiology and Canadian public policy-making: The state of the science and the art of the possible. Canadian Journal of Psychiatry, 47(9), 825–832.
Weisz, J. R., Donenberg, G. R., Han, S. S., & Weiss, B. (1995). Bridging the gap between laboratory and clinic in child and adolescent psychotherapy. Journal of Consulting and Clinical Psychology, 63, 688–701. https://doi.org/10.1037/0022-006X.63.5.688.
Weisz, J. R., Kuppens, S., Eckshtain, D., Ugueto, A. M., Hawley, K. M., & Jensen-Doss, A. (2013). Performance of evidence-based youth psychotherapies compared with usual clinical care: A multilevel meta-analysis. JAMA Psychiatry, 70, 750–561. https://doi.org/10.1001/jamapsychiatry.2013.1176.
Wozney, L., McGrath, P. J., Newton, A., Huguet, A., Franklin, M., Perri, K., et al. (2015). Usability, learnability and performance evaluation of intelligent research and intervention software: A delivery platform for eHealth interventions. Health Informatics Journal, 22, 730–743. https://doi.org/10.1177/1460458215586803.
Acknowledgements
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.
Funding
This study was funded by Operating Grant 91030 from the Canadian Institutes of Health Research to Drs. McGrath and Cunningham.
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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 BCFPI.inc 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.
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The present trial was approved by Research Ethics Boards at the IWK Health Centre and McMaster University.
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All participants (parents) provided informed consent.
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Olthuis, J.V., McGrath, P.J., Cunningham, C.E. et al. Distance-Delivered Parent Training for Childhood Disruptive Behavior (Strongest Families™): a Randomized Controlled Trial and Economic Analysis. J Abnorm Child Psychol 46, 1613–1629 (2018). https://doi.org/10.1007/s10802-018-0413-y
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DOI: https://doi.org/10.1007/s10802-018-0413-y