Does the Incredible Years reduce child externalizing problems through improved parenting? The role of child negative affectivity and serotonin transporter linked polymorphic region (5-HTTLPR) genotype

Taking Care Triple P for Foster Parents With Young Children in Foster Care: Results of a 1-Year Randomized Trial

Young children with a history of maltreatment or neglect in foster families often confront their caregivers with particularly challenging behaviors. This may lead to more parenting stress, an increased risk for the child in foster care to experience further maltreatment, and placement disruptions. We conducted a randomized controlled trial to investigate the efficacy of a parent group training tailored to the special needs of foster families. We hypothesized significant short- and long-term improvements regarding foster parents' parenting competencies, child mental health problems, and related outcomes. Eighty-one families with 87 children in foster care aged 2 to 7 years participated in the trial. For the intervention study, 44 randomly selected families (54%) were offered to participate in the parent group training. Intervention and control group families were reassessed three times over a period of 1 year. Contrary to our expectations, we found no advantages of the intervention group compared with the usual care control group on any outcome measure. Instead, we found some significant changes in both groups across time. Placement into foster care is associated with some favorable outcomes for children in foster care. Additional support for foster families beyond the services delivered in the youth welfare system to foster parents was not associated with more favorable outcomes. The present intervention is likely associated with a low risk of harm but also with a high likelihood of a lack of significant benefits for foster parents and their young children going beyond feeling satisfied about the delivered services. Participating foster families showed favorable baseline results on parenting measures which may have impeded intervention effects to unfold on these proximal variables.

Longer-Term Outcomes of the Incredible Years Parenting Intervention

Conduct problems can develop into behavior disorders and put children at risk for other mental health problems. Parenting interventions have been shown to successfully reduce conduct problems and are often expected to prevent the development of broader mental health problems. Few studies have evaluated the longer-term and broader effects of these interventions. To what extent are parenting intervention effects sustained in the years after the intervention? And do effects pertain to conduct problems specifically, or do they also affect broader aspects of children's mental health? We used a randomized controlled trial to assess the longer-term (2.5 years) effects of the Incredible Years parenting intervention on children's conduct problems in an indicated prevention setting (N = 387; 79% retention rate). Using a multi-method (survey and computerized tasks) and multi-informant (parents, teachers, and children) approach, we tested whether initial effects on conduct problems were sustained, and whether Incredible Years had broader effects on children's peer problems, emotional problems, attention-deficit/hyperactivity disorder (ADHD) symptoms, attention and inhibition deficits, and service use. Incredible Years, relative to control (no intervention), led to sustained reductions in parent-reported conduct problems (Cohen's d = 0.31), but not teacher- and child-reported conduct problems. There were no broader benefits: Incredible Years did not reduce children's peer problems, emotional problems, ADHD-symptoms, attention and inhibition deficits, or their service use. Improvements in parents' perceptions of child conduct problems sustained until 2.5 years later. Our findings do not show benefits of Incredible Years as a preventive intervention for children's broader mental health.

Early Detection of Temperament Risk Factors: A Comparison of Clinically Referred and General Population Children

Despite an extensive literature on associations between early childhood temperament and behavior problems, most of this evidence is based on general population samples. Hence, relatively little is known about the temperament characteristics of children who have been referred for in- or outpatient treatment of emotional and/or behavioral problems. Whether temperament-to-behavior problems identified in community samples would also be found in samples of clinically referred children is poorly understood. To redress this limitation, we compared temperament attributes of a predominantly preschool-aged sample of children referred for treatment of emotional and/or behavioral disorders (N = 87) with those from a similarly-aged general population sample (N = 85) by using the Integrative Child Temperament Screener (ICTS)-a new nine-item scale to identify clinically significant temperament attributes. Behavioral symptoms in the clinical sample were assessed through diagnostic interviews in combination with the Child Behavior Checklist (CBCL), which was also administered to the general population children. Compared with general population children, referred children exhibited substantially higher scores on all ICTS subscales except behavioral inhibition. Furthermore, areas under the curve analyses showed that discrimination of both groups based on CBCL scales could be improved by adding the ICTS. Overall, the findings fill a long-standing gap in evidence regarding temperament characteristics of children with serious emotional and/or behavioral symptoms and suggest a useful role for the ICTS in assessment, screening, and prevention.

Co-occurring change in children's conduct problems and maternal depression: Latent class individual participant data meta-analysis of the Incredible Years parenting program

Children vary in the extent to which they benefit from parenting programs for conduct problems. How does parental mental health change if children benefit less or more? We assessed whether changes in conduct problems and maternal depressive symptoms co-occur following participation in the Incredible Years parenting program. We integrated individual participant data from 10 randomized trials (N = 1280; children aged 2–10 years) and distinguished latent classes based on families' baseline and post-test conduct problems and maternal depressive symptoms, using repeated measures latent class analysis (RMLCA) and latent transition analysis (LTA). Classes differed mainly in severity of conduct problems and depression (RMLCA; 4 classes). Conduct problems reduced in all classes. Depressive symptoms did not change in most classes, except in a class of families where conduct problems and depression were particularly severe. Incredible Years led to a greater likelihood of families with particularly severe conduct problems and depression moving to a class with mild problems (LTA; 3 classes). Our findings suggest that for the majority of families, children's conduct problems reduce, but maternal depressive symptoms do not, suggesting relative independence, with the exception of families with severe depression and severe conduct problems where changes for the better do co-occur.

Mechanisms of child behavior change in parent training: Comment on Weeland et al. (2018)

Recently in this journal, Weeland et al. (2018) published a thought-provoking article reporting moderating effects of children's serotonin transporter-linked polymorphisms (5-HTTLPR) on negative parenting during prevention with the Incredible Years series. Participants were parents and young children of 387 families enrolled in the Observational Randomized Control Trial of Childhood Differential Susceptibility study. An equally important finding, which we focus on in this comment, involved null effects for all tests of parenting as a mediator of prevention-induced improvements in children's externalizing behavior. Although such findings may seem surprising, both confirmations of and failures to confirm parenting change as a mediator of child behavior change are common in the prevention and intervention literatures. In this comment, we explore likely reasons for heterogeneity in findings, including both moderators of treatment effect size and methods used to test mediation. Common moderators of prevention and intervention response to Incredible Years include dose, parenting problems at intake, high-risk versus clinical nature of samples, how parenting is measured, and whether child training is included with parent training. All of these moderators affect power to detect mediation. We then discuss conceptual criteria for testing mediation in randomized clinical trials, and problems with interpreting mediating paths in cross-lag panel models. Although the gene effect reported by Weeland et al. is important, their cross-lag panel models do not provide strong tests of parenting as a mediator of child behavior change. We conclude with recommendations for testing mediation in randomized clinical trials.

What changes when? A reply to Beauchaine and Slep

In their commentary, Beauchaine and Slep (2018) raise important issues regarding research on behavioral parenting training (BPT). In this reply we highlight key points of agreement and respond to issues that we feel require clarification. BPT has been repeatedly proven effective in decreasing disruptive child behavior (also in the work of our research team). Yet, there is much to learn about for whom and how BPT is effective. Specifically, assessing the how (i.e., mediation) comes with many challenges. One of these challenges is taking into account the timeline of change, and being able to infer causal mechanisms of change. We argue that cross-lagged panel models (which we, and many other scholars, used) are a valid and valuable method for testing mediation. At the same time, our results raise important questions, specifically about the timing and form of expected changes in parenting and child behavior after BPT. For example, are these changes linear and gradual or do they happen more suddenly? To select the appropriate design, assessment tools, and statistical models to test mediation, we need to state detailed hypotheses on what changes when. An important next step might be to assess multiple putative mediators on different timescales, not only before and after, but specifically also during BPT.