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Background Early risk factors for poor child outcomes are well established, and some group parenting programmes have demonstrated good outcomes for children under 3 years of age. This randomized controlled trial evaluated the effectiveness of the Incredible Years® Toddler Parenting Programme with parents of 1-year-old and 2-year-old children recruited by staff in disadvantaged Flying Start areas across Wales. Methods Eighty-nine families with a child aged between 12 and 36 months at baseline participated in a pragmatic community-based trial of the programme in eight Flying Start areas. Outcomes were measured at baseline, 6 months and 12 months using measures of parental mental health, competence, child behaviour, child development, home environment and blinded-observation of parent-child interactions. Results Significant intervention group improvements were found in parental mental well-being and observed praise at 6 months. Significant improvements for the intervention group at 12 months included child development, home environment and parental depression. Conclusion The study provides preliminary evidence for programme attendance. [ABSTRACT FROM AUTHOR]

Background Parental language is associated with children's later language development. Parenting programmes, based on social learning theory, enhance a range of parenting behaviours, yet there is limited evidence for their effect on parental language. Aim To assess the benefits of a behavioural-based parenting programme, which features components of language and communication, to enhance parental language. Method Parents of toddlers, aged 12 to 36 months, were recruited from eight Flying Start early intervention centres across Wales. Participants were randomised 2:1 either to a parenting programme ( n = 60) or to a wait-list control group ( n = 29). Researchers were blind to participant allocation throughout the trial. Fifteen-minute video-recorded observations of parents and children interacting during free-play, both at a pre-intervention and at 6-month follow-up, provided the data for the study. Five observed measures of parental language were assessed; quantity and variety, encouraging, critical, child-led and parent led interactions. Intervention The Incredible Years Parent- Toddler Programme ( IYPTP) is a 12-week group-based behavioural intervention that teaches effective relationship and behavioural management skills including social, emotional and persistence coaching to enable parents to better support their children's development. Results Of 89 dyads that completed pre-intervention assessments 81 (54 intervention and 27 control) met the criteria for the current study. Intention to treat analysis indicated that child-led language interactions significantly benefited from the intervention [regression coefficient ( B) = −1.44, 95% confidence intervals ( CI) = −2.59 to −0.29, P = 0.015, effect size ( ES) = 0.47] and a positive trend for encouraging language in favour of the intervention sample was evident. Per-protocol sample analysis replicated these findings with encouraging language reaching statistical significance ( B = 1.07, 95% CI = 0.11 to 2.03, P = 0.03, ES = 0.52). No further benefits were evident. Conclusions The IYPTP has limited evidence as an effective programme for enhancing some aspects of parental language. [ABSTRACT FROM AUTHOR]

Abstract: Background: Parent training (PT) is identified as the most effective intervention for the treatment of conduct disorder (CD). Intervention observational outcomes are often reported as summarised composite scores, providing an overview of overall construct change. Methods and aims: Parents of children aged 3–5 years identified ‘at risk’ of developing CD were randomly allocated to either PT intervention or waiting list control group. Parent and child behaviours were assessed before and after the intervention period. The current paper aims to establish which individual observed parenting categories change as a result of PT, and which specific observed leader categories predict these changes. Results: Controlling for baseline scores, ANCOVA demonstrated changes in parent praise and reflective behaviours as significant post-intervention. One-way ANOVAs demonstrated higher levels of leader praise and reflective behaviours resulted in greater change in parental praise and reflective behaviours respectively. Regression analyses indicated these leader behaviours predict positive change in parental praise and reflective behaviours for intervention families. Conclusions: Composite observational scores provide an account of behaviour constructs, whereas individual behaviour categories provide an insight into the core components of these constructs. The results suggest praise and reflection as key leader behaviours that influence the mechanisms of change in parenting behaviours as a result of PT. [Copyright &y& Elsevier]

This paper outlines the presentation, aetiology and treatment of attention deficit hyperactivity disorder (ADHD) in pre-school children. A review of current parenting training interventions demonstrates that there is good evidence for their efficacy in reducing symptoms of ADHD in pre-school children, and three interventions are evaluated: The new forest parent training programme (NFPP); the triple P--positive parenting programme and the incredible years parent training programme (IY). The evaluation of the NFPP provides strong evidence demonstrating its effectiveness for pre-school children with ADHD, while the efficacy of the Triple--P and the IY programme have, to date, only been demonstrated on children with conduct problems and co-morbid ADHD. It is suggested that parent training should be the first choice treatment for pre-school children presenting signs of ADHD, and medication introduced only for those children where parent training is not effective. Few moderators of outcome have been identified for these interventions, with the exception of parental ADHD. Barriers to intervention and implementation fidelity will need to be addressed to achieve high levels of attendance, completion and efficacy. The IY programme is a good model for addressing fidelity issues and for overcoming barriers to intervention. The future directions for parent training are also discussed. [ABSTRACT FROM AUTHOR]

Background Change in parenting skills, particularly increased positive parenting, has been identified as the key component of successful evidence-based parent training (PT), playing a causal role in subsequent child behaviour change for both prevention and treatment of Conduct Disorder. The amount of change in parenting skills observed after PT varies and may be accounted for by both the content of the programme and by the level of PT implementer process skills. Such variation in implementer skills is an important component in the assessment of treatment fidelity, itself an essential factor in successful intervention outcome. Aims To establish whether the Leader Observation Tool, a reliable and valid process skills fidelity measure, can predict change in parenting skills after attendance on the Incredible Years PT programme. Results Positive leader skills categories of the Leader Observation Tool significantly predicted change in both parent-reported and independently observed parenting skills behaviour, which in turn, predicted change in child behaviour outcome. Conclusions Delivering an intervention with a high level of treatment fidelity not only preserves the behaviour change mechanisms of the intervention, but can also predict parental behaviour change, which itself predicts child behaviour change as a result of treatment. [ABSTRACT FROM AUTHOR]

Background This study examined the long-term efficacy of the Incredible Years (IY) BASIC Parenting Programme delivered as a preventive intervention with parents of pre-school children who display signs of attention deficit hyperactivity disorder (ADHD) and conduct problems. Families were followed up after the completion of a controlled trial with 11 Sure Start areas in North and Mid-Wales and North West England. Methods Participants in the study were 50 pre-school children whose parents had received the intervention. Child ADHD symptoms were assessed at baseline, at follow-up one (6 months after baseline); at follow-up two (12 months after baseline); and at follow-up three (18 months after baseline). Families in the original waiting-list control group were not assessed after follow-up one as they had subsequently received the same intervention. Results The significant post-intervention improvements in child ADHD symptoms evident at follow-up one were maintained over time, as demonstrated by statistical and clinical stability of measures. No significant differences were found for ADHD symptoms across each follow-up, indicating that the gains made post intervention were maintained for at least 12 months, with 57% of the sample maintaining scores below the clinical cut-off on the Conners. Eighty-six, 58, and 30 per cent respectively had maintained at least a modest, large, or very large improvement in ADHD symptoms at follow-up three. Conclusions Findings from this study suggest that the IY psychosocial treatment programme is a valuable intervention in the longer term for many pre-school children displaying early signs of ADHD. [ABSTRACT FROM AUTHOR]

Background Despite recognition of the need to deliver evidence-based programmes in the field of mental health, there is little emphasis on implementing such programmes with fidelity. Attempts by programme developers to ensure adherence to their programmes include the development of training, manuals and content scales, but these alone may be insufficient to ensure fidelity in replication. Observational measures lend themselves as a potentially useful assessment of intervention outcomes, providing accurate and objective accounts of the intervention process. Aim To develop a reliable and valid observational treatment fidelity tool of process skills required to deliver the Incredible Years (IY) BASIC parenting programme effectively. Methods An objective observational fidelity measure was developed to assess adherence to the IY BASIC parenting programme protocol. Observations were conducted on 12 IY BASIC parenting programme groups, attended by parents of pre-school children displaying signs of early onset conduct disorder. Results The Leader Observation Tool (LOT) achieved high internal reliability and good code–recode and inter-rater reliability. Evidence of concurrent validity was also obtained. Conclusions Having demonstrated that the LOT is a reliable and valid measure of implementation fidelity, further research is necessary to examine the relationship between LOT scores and intervention outcome. [ABSTRACT FROM AUTHOR]

Background The efficacy of the Incredible Years (IY) Basic parent training (PT) programme for a community-based sample of families with pre-school children at risk of developing both conduct problems and attention deficit hyperactivity disorder (ADHD) was examined. Methods Pre-school children displaying signs of both early-onset conduct problems and ADHD were randomly allocated to either IY PT intervention, or to a waiting list (WL) control group. Child symptoms were assessed before and after the intervention. Results Post intervention, the intervention group was associated with significantly lower levels of parent-reported inattention and hyperactive/impulsive difficulties, even after controlling for post-intervention changes in child deviance. In addition, 52% of those in the intervention condition, compared with 21% in the control condition, displayed clinically reliable improvements post intervention, giving an absolute risk reduction of 31% and a number needed to treat of 3.23. Conclusions Findings from this study indicate that the IY PT programme is a valuable intervention for many pre-school children displaying early signs of ADHD. [ABSTRACT FROM AUTHOR]

Complex interventions, such as parenting programs, are rarely evaluated from a public sector, multi-agency perspective. An exception is the Incredible Years (IY) Basic Parenting Program; which has a growing clinical and cost-effectiveness evidence base for preventing or reducing children's conduct problems. The aim of this paper was to provide a micro-costing framework for use by future researchers, by micro-costing the 12-session IY Toddler Parenting Program from a public sector, multi-agency perspective. This micro-costing was undertaken as part of a community-based randomized controlled trial of the program in disadvantaged Flying Start areas in Wales, U.K. Program delivery costs were collected by group leader cost diaries. Training and supervision costs were recorded. Sensitivity analysis assessed the effects of a London cost weighting and group size. Costs were reported in 2008/2009 pounds sterling. Direct program initial set-up costs were £3305.73; recurrent delivery costs for the program based on eight parents attending a group were £752.63 per child, falling to £633.61 based on 10 parents. Under research contexts (with weekly supervision) delivery costs were £1509.28 per child based on eight parents, falling to £1238.94 per child based on 10 parents. When applying a London weighting, overall program costs increased in all contexts. Costs at a micro-level must be accurately calculated to conduct meaningful cost-effectiveness/cost-benefit analysis. A standardized framework for assessing costs is needed; this paper outlines a suggested framework. In prevention science it is important for decision makers to be aware of intervention costs in order to allocate scarce resources effectively. [ABSTRACT FROM AUTHOR]