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PhD Study: Evaluation of the Incredible Years BASIC Parent Training Programme for preschool children

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Title: PhD Study: Evaluation of the Incredible Years BASIC Parent Training Programme for preschool children


1
PhD Study Evaluation of the Incredible Years
BASIC Parent Training Programme for pre-school
children with conduct problems and ADHD symptoms
  • Presentation for the Incredible Years Wales
    Conference, Llandrindod-Wells, February 2008.
  • Karen Jones
  • Supervisors Dr David Daley Professor Judy
    Hutchings
  • Funded by ESRC Case award in collaboration
    with NWW NHS Trust

2
Overview of Presentation
  • ADHD
  • Treatment
  • Rationale for study
  • Evaluation aims
  • Methods
  • Results
  • Conclusions

3
ADHD
  • Characterised by inattention, hyperactivity, and
    impulsivity
  • Early onset, persistent, and results in
    cross-situational impairment
  • Estimated 3-5 of school aged children meet
    diagnostic criteria (American Psychiatric
    Association, 1994)
  • At risk of developing problems within academic,
    social, and personal domains (Daley, 2006)

4
ADHD Co-morbidity
  • Commonly co-morbid with Conduct Disorder (CD)
  • 30-70 also meet criteria for CD
  • Poorer long-term outcome

5
Preschool ADHD
  • Growing numbers of preschool children presenting
    with ADHD
  • Similar presentation
  • Same symptom structure
  • Similar associated impairments
  • Similar patterns of co morbidity

6
Treatment
  • National Institute of Clinical Excellence (UK)
    and the American Psychiatric Association (US)
    recommend that a combination of psycho stimulant
    medication and psychosocial intervention is
    optimal for school-aged children with ADHD

7
Treatment
  • PATS limited short- and long-term efficacy
    compared with school aged children
  • More side effects.
  • Ethical objections
  • Behavioural-psychosocial treatment suitable
    first level intervention for preschoolers

8
Treatment
  • Research suggest that some parenting programmes
    as effective for ADHD as for CD (Pisterman et
    al., 1992 and more recently, Sonuga-Barke et
    al., 2001 Bor et al., 2002)
  • Increasing evidence of efficacy of the
    evidence-based IY BASIC parenting programme for
    children with co-occurring ADHD and conduct
    problems (Hartman et al., 2003 Scott et al.,
    2001).

9
Rationale for Study
  • Growing evidence of effectiveness of the IY BASIC
    parenting programmes for children with ADHD
    symptoms
  • Availability of Sure Start data set (Hutchings,
    et al, 2007)
  • Community sample of disadvantaged families
  • Living in designated Sure Start areas
  • Preschool children at risk for conduct problems
  • Robust findings
  • Improved parent-child interaction
  • Reduction in conduct problems
  • Improved parental stress and mental health
  • High proportion of Sure Start sample scored above
    clinical cut off on the Hyperactivity subscale of
    SDQ

10
Evaluation Aims
  • To evaluate the IY BASIC programme on a sub-group
    of families whose children display signs of both
    early emerging symptoms of ADHD and conduct
    problems. Specifically
  • To evaluate the short-term efficacy of
    intervention
  • To examine the long-term stability of outcome
  • To explore potential moderators and mediators of
    outcome
  • Moderators Who benefits from intervention
  • Mediators How does intervention work

11
Method Participants
  • 79 participants drawn from existing Sure Start
    trial
  • 50 intervention, 29 control
  • Above cut off on the ECBI (127 or above on the
    intensity subscale, or 11 or above on the problem
    subscale)
  • Also above cut-off on the hyperactivity subscale
    of the SDQ (7 or above)
  • All primary care givers were mothers (mean age at
    baseline 28)
  • Mean age of child at baseline 46 months.
    Predominantly male (68)

12
Method Design
  • Both intervention and control groups assessed at
    baseline, and follow-up one, six months after
    baseline (after intervention)
  • Control families offered intervention once
    collection of follow-up 1 data completed
  • Further follow ups of intervention group at 12,
    and 18 months after baseline

13
Method Measures
  • Screening
  • ECBI - frequency and perceived severity of child
    behaviour problems
  • SDQ (hyperactivity subscale)
  • Primary outcome measure
  • Conners Abbreviated Parent/Teacher Rating Scale
  • Observation
  • Observed child deviance used as covariate to
    establish whether any improvement in ADHD
    symptoms is independent of improvements in child
    problem behaviour

14
Method Measures
  • Potential moderators
  • Child age, sex, teen parenthood, lone parenthood,
    income (Personal Data and Health Questionnaire
    PDHQ Hutchings, 1996)
  • Severity conduct problems (ECBI)
  • Severity ADHD (Conners)
  • Maternal depression (Beck Depression Inventory
    Beck et al., 1961)
  • Mediator
  • Positive parenting skill (Observed DPICS)

15
The Intervention
  • 12-week IY BASIC parent-training programme
  • Run in 11 Sure Start areas by experienced group
    leaders

16
Results
  • Analysis based on intention to treat strategy
  • Attendance 88 of intervention group attended
    at least one session, 75 attended at least eight
    sessions (mean attendance rate 9.47)
  • Attrition Eight families were lost to follow-up
    (6 intervention and 2 control)

17
Results Short Term Efficacy
  • Short term findings (Jones et al, 2007)
  • Intervention group associated with significantly
    lower levels of parent reported ADHD symptoms (on
    Conners)
  • Improvements remained significant even after
    controlling for change in observed child deviance
    (F 3, 65 8.77, p 0.004)

18
Results Short-Term Efficacy
19
Results Long-Term Stablity
  • Long-term findings
  • Intervention group only baseline follow up 1
    (6 months after baseline) follow up 2 (12 months
    after baseline) and follow up 3 (18 months after
    baseline)
  • Original gains maintained at each follow-up
  • No significant differences between follow-ups,
    indicating stability of intervention effects over
    time
  • 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

20
Results Long-Term Stability
21
Results Moderators and Mediators
  • Moderators of outcome
  • Only one specific predictor associated with
    intervention group
  • Severity of ADHD symptoms better outcomes
  • No other moderating effects
  • Suggesting that intervention effective regardless
    of initial risk characteristics
  • Mediators
  • Positive parenting skill significant partial
    mediator of outcome

22
Conclusions
  • IY effective, and stable, first-line intervention
    for preschool ADHD
  • Greater ADHD severity at baseline better
    outcomes
  • Lack of moderation effects of other candidate
    variables suggests intervention effective even
    for most disadvantaged families

23
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