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

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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 2007.
• Karen Jones
• Supervisors Dr Judy Hutchings Dr David Daley
• Funded through collaboration between the ESRC and
  NWW NHS Trust

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Overview of Presentation

• ADHD
• Co-morbid conduct problems
• Evaluation aims
• Methods
• Results
• Conclusion

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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)

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ADHD Co-morbidity

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

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Treatment

• National Institute of Clinical Excellence (UK)
  and the American Psychiatric Association (US)
  recommend that a combination of psychostimulant
  medication and psychosocial intervention is
  optimal
• Evidence of short term effectiveness
• No controlled evidence for generalised long-term
  effect

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Treatment

• Ethical objections
• Behavioural-psychosocial treatment suitable
  first level intervention
• Evidence for efficacy of psychosocial
  intervention for parents of children with ADHD
  strongest for pre-school children (Sonuga-Barke,
  Daley, Thompson et al, 2001)

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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).

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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, in press)
• High proportion of Sure Start sample scored above
  clinical cut off on the Hyperactivity subscale of
  SDQ

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Evaluation Aims

• To evaluate efficacy of IY parenting programme
  for families whose children display signs of both
  early emerging symptoms of ADHD and conduct
  problems
• To examine the long-term stability of outcome

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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 27.71)
• Mean age of child at baseline 46.28 months.
  Predominantly male (68)

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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

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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 co-variate to
  establish whether any improvement in ADHD
  symptoms is independent of improvements in child
  problem behaviour

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The Intervention

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

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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)

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Results

• Short term findings (see Jones et al, in press)
• 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)
• 52 per cent of intervention group compared with
  21 per cent of control group showed clinically
  reliable improvements at follow-up 1 (using the
  Reliable Change Index Jacobson Truax, 1991)

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Results
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Results

• 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

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Results
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Results

• The majority of the sample maintained at least a
  modest improvement
• Over half maintained at least a large change
• Around a third maintained a very large change
• These improvements relatively stable across each
  follow-up

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Conclusions

• Short-term intervention condition was
  associated with significantly more positive
  outcomes for children
• IY BASIC parent training programme is a
  successful intervention for pre-school children
  presenting signs of ADHD and conduct problems
• Long-term the improvements made following
  intervention were maintained for at least 12
  months

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Thank you for listening