Effectiveness of interventions and factors of relevance in the treatment of children with conduct problems

Abstract

The principal aim of this dissertation was to study the effectiveness of treatment of children for severe conduct problems, and to explore factors of relevance for the effects of treatment on these children. In three studies, 127 children aged 4‐8 years and their families participated in a randomized controlled trial of the Incredible Years training sessions that were implemented in two outpatient clinics for children and adolescent’s mental health in two cities in Norway. In addition, a meta‐analysis was performed in order to identify the effects of treatment on children and adolescents with conduct problems and to explore additional treatment effects, i.e. effects in day‐care and school, changes in children’s and adolescents’ social functioning and changes in parental distress. <br>In the replication study of the Incredible Years moderate reductions in children’s conduct problems were reported by the parents, while 40% of the children were within the normal range in terms of conduct immediately after treatment, according to their mothers. Positive additional effects were obtained in terms of parents experiencing moderate to large reductions in parental stress. Alterations in parenting behaviour were also moderate to large, and self‐reported inconsistent and harsh disciplining were both significant partial mediators of change in children’s conduct problems. Although parents reported positive reductions in parental stress, maternal stress was a significant predictor of worsened treatment outcome. Furthermore, Attention Deficit Hyperactivity Disorder (ADHD) predicted worsened treatment outcome as experienced by both mothers and teachers. Finally, the mothers of girls scored the girls less below cut‐off at posttreatment than did mothers of boys. <br>In general, although the similarities in parents’ perceptions of boys and girls with conduct problems at pretreatment were more evident than the differences, parental stress was more pronounced among parents of girls, and mothers’ of girls reported more symptoms of depression. Teachers, on the other hand, viewed the boys as less socially competent and more aggressive. <br>In the meta‐analysis, the effect sizes (ES) indicated moderate reductions in children’s and adolescents’ conduct problems in studies with untreated control groups, while in studies without untreated controls, the ESs in reductions in aggressive behaviours were large. The changes in aggressive behaviours in daycare or school, alterations in social functioning and reductions in parental distress were moderate in size. In the moderator analyses, the variable sample size was significant in studies with untreated controls, while the following variables; age of the child, diagnostic assessment and mode of treatment, were all significant in studies without untreated comparisons. <br>It is concluded that children’s and adolescents’ conduct problems can be treated with positive results and that important additional treatment gains can be achieved. However, factors such as parental stress and a child diagnosis of ADHD can influence treatment effects negatively. Further steps to improve generalization effects may be needed, both in the treatment of conduct problems in general and specifically when employing the Incredible Years in Norway.

Hensikten var å studere effekten av tiltak for å behandle barn med atferdsproblemer og utforske forhold av betydning for effekten av disse tiltakene. I tre studier deltok 127 barn i alderen 4-8 år og deres familier. Behandlingen har som mål å styrke foreldrekompetansen, foreldrenes oppdragelsespraksis, samspill i familien og foreldrenes ferdigheter i dagligdags problemløsning med barna.

Endringene i barnas aggressive atferd var lovende. Foreldrene rapporterte store endringer i streng og ukonsekvent oppdragelses praksis, og dette var betydningsfulle mekanismer i behandlingen. ADHD hos barnet og mye stress hos foreldrene predikerte dårligere utbytte av behandlingen

En litteraturgjennomgang bestående av 65 studier om behandlingstiltak for utagerende barn og unge, viste at tiltakene hadde moderate, men betydningsfulle effekter for å redusere utagerende atferd.