The Early Risers preventive intervention: testing for six-year outcomes and mediational processes.
ABSTRACT We examined effects of the Early Risers "Skills for Success" early-age-targeted prevention program on serious conduct problems following 5 years of continuous intervention and one year of follow-up. We also examined if intervention effects on proximally-targeted variables found after 3 years mediated intervention effects on conduct problems found after 6 years. Participants included 151 at-risk children (106 males and 45 females) followed from first through sixth-grade, from 23 semi-rural schools in Minnesota. After 6 years, program children showed fewer oppositional defiant disorder (ODD) symptoms than control children. Program children did not significantly differ from controls on number of conduct disorder (CD) symptoms, DSM-IV diagnoses of ODD and CD, or drug use involvement. Results of the mediation analysis indicated that fewer ODD symptoms among program youth after 6 years were partially mediated by social skills and effective discipline. The study provides support for the early-starter model of conduct problems development that provides the framework for the Early Risers intervention. The study's implications for prevention and limitations are discussed.
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ABSTRACT: This article reports 2-year outcomes from a cluster randomized, controlled trial of the Early Risers (ER) program implemented as a selective preventive intervention in supportive housing settings for homeless families. Based on the goals of this comprehensive prevention program, we predicted that intervention participants receiving ER services would show improvement in parenting and child outcomes relative to families in treatment-as-usual sites. The sample included 270 children in 161 families, residing in 15 supportive housing sites; multimethod, multi-informant assessments conducted at baseline and yearly thereafter included parent and teacher report of child adjustment, parent report of parenting self-efficacy, and parent-child observations that yielded scores of effective parenting practices. Data were modeled in HLM7 (4-level model accounting for nesting of children within families and families within housing sites). Two years' postbaseline, intent-to-treat (ITT) analyses indicated that parents in the ER group showed significantly improved parenting self-efficacy, and parent report indicated significant reductions in ER group children's depression. No main effects of ITT were shown for observed parenting effectiveness. However, over time, average levels of parenting self-efficacy predicted observed effective parenting practices, and observed effective parenting practices predicted improvements in both teacher- and parent-report of child adjustment. This is the first study to our knowledge to demonstrate prevention effects of a program for homeless families residing in family supportive housing. (PsycINFO Database Record (c) 2015 APA, all rights reserved).Journal of Family Psychology 04/2015; 29(2):242-252. DOI:10.1037/fam0000066 · 1.89 Impact Factor
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ABSTRACT: There is a burgeoning and varied literature examining the associations between parental factors and depression or anxiety disorders in children. However, there is hitherto no systematic review of this complex literature with a focus on the 5-11 years age range, when there is a steep increase in onset of these disorders. Furthermore, to facilitate the application of the evidence in prevention, a focus on modifiable factors is required. Employing the PRISMA method, we conducted a systematic review of parental factors associated with anxiety, depression, and internalizing problems in children which parents can potentially modify. We identified 141 articles altogether, with 53 examining anxiety, 50 examining depression, and 70 examining internalizing outcomes. Stouffer׳s method of combining p-values was used to determine whether associations between variables were reliable, and meta-analyses were conducted with a subset of eligible studies to estimate the mean effect sizes of associations between each parental factor and outcome. Limitations include sacrificing micro-level detail for a macro-level synthesis of the literature, the lack of generalizability across cultures, and the inability to conduct a meta-analysis on all included studies. Parental factors with a sound evidence base indicating increased risk for both depression and internalizing problems include more inter-parental conflict and aversiveness; and for internalizing outcomes additionally, they include less warmth and more abusive parenting and over-involvement. No sound evidence linking any parental factor with anxiety outcomes was found. Copyright © 2015 Elsevier B.V. All rights reserved.Journal of Affective Disorders 01/2015; 175C:424-440. DOI:10.1016/j.jad.2015.01.050 · 3.71 Impact Factor
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ABSTRACT: Parenting problems and child behavior problems are being viewed as putative precursors of adult criminal and violent behavior. Moreover, aggressive behavior in early childhood affects daily life of both children and their surroundings, resulting in serious economic implications to society. In many countries, early detection and the prevention of conduct problems have become important goals for authorities in child development and those who provide community mental health services. Hence, intervention programs specifically designed to prevent the development of conduct problems in at risk children have been developed. Since parenting has the most proximal influence on young children’s development, it is not surprising that behavioral parent trainings have been found to effectively reduce aggressive behavior problems in young children. The Incredible Years (IY) parent program appeared to be effective from treatment studies, but evidence for the preventive effectiveness of this program remains inconclusive. The present study aimed to evaluate the effects and cost-effectiveness of the IY parent program for parents of preschool children who were at risk for a chronic pattern of conduct problems two years after termination of the intervention. The IY parent program is a manualized behavioral parent training aiming at the improvement of parenting skills in order to reduce child aggressive behavior. A population based sample of 144 preschool children with a high level of aggressive behavior was divided into an intervention group and a matched control group. The control group received care as usual (CAU). In order to measure intervention effects, a direct observation and parent questionnaires were used to measure parenting skills and child behavior. Results revealed significant improvements in observed and parent rated parenting skills. Moreover, observed negative child behavior in the intervention group was significantly decreased, relative to the control group. The change in observed critical parenting from pre to post-intervention mediated the change in negative child behavior from pre-intervention to two-year follow up, and from structural equation modelling analyses, in which bidirectional influences of parenting skills and child behavior over time were investigated, it became clear that parental influence increased over time. The intervention was most beneficial to children with a high level of initial aggressive behavior. With respect to the cost-effectiveness analysis, cost data were collected including intervention costs, use of public services such as health care and special education, damage caused by the child, travel costs and parental productivity losses. The intervention appeared to be dominant over care as usual; the IY parent program showed better effects and was cost-saving. In conclusion, The IY parent program is unambiguously dominant, i.e. cost-saving and effective in reducing negative behavior. This population based study highlights the potential of the IY parent program as an indicated preventive intervention for preschool children at risk for a chronic pattern of conduct problems.