The Effectiveness of the Intervention Incredible Years in the Reduction of Problem Behavior for Preschoolers and the Improvement of Parenting
Muriel Dijkman, 10443932 Bachelor thesis
Assessor: mw. dr. A.L. van den Akker Word Count: 6040
Date: 25-01-2016
Child Development and Education University of Amsterdam
Abstract
This research investigated the effectiveness of the intervention Incredible Years (IY) for reducing problem behavior among preschoolers and improving parenting. This is relevant
since preschool behavioural problems are a predictor of long-term negative outcomes in adolescence and adulthood. This research investigated in specific differences between
different IY forms and differences in initial problem behavior of the children. This is relevant, since different behavioural problems are different influenceable and few research exists on the different IY forms. To research above topics, a systematic review was conducted
and 20 relevant studies were found. Based on these studies most parental reports showed positive results. However observational and childcare reports, showed at times contradictory
findings. Overall a positive result of IY on child behavior and parenting were found. Differences between the different IY forms and initial problem behavior are well documented
in this review.
The Effectiveness of the Intervention Incredible Years in the Reduction of Problem Behavior for Preschoolers and the Improvement of Parenting
Twelve percent of preschoolers in the general population are coping with serious behavioral problems (Egger & Angold, 2006). Behavioural problems can be defined as oppositional, hyperkinetic, impulsive, and inattentive behavior (Verhulst, Koot, van der Ende, & Bongers, 2004). In this research, terms as oppositional/defiant disorder (ODD), conduct disorder (CD), being at or above clinical cut-off behavioural problems measures and attention deficit hyperactivity disorder (ADHD) will be used for problem behavior. Furthermore it is known that dysfunctional parenting practices as harshness, lack of rules, a hostile parent-child relationship, disapproval and corporal punishment can increase the problem behavior among children (Patterson, DeGarmo, & Forgatch, 2004; Ge, Brody, Conger, Simons, & Murry, 2002; Bor, Sanders, & Markie-Dadds, 2002; Gershoff, 2002). On the other hand functional parenting practices as praise, positive and proactive discipline, and joint play contributes to a positive parent-child relationship and can increase desirable behavior among children
(Gardner, Sonuga-Barke, & Sayal, 1999). Moreover, it is related to less behavioural problems for children (Gardner, Shaw, Dishion, Burton, & Supplee, 2007).
Additionally, it is reported that of all problems in mental health services, the main reason for referral for children are conduct problems (Weisz & Kazdin, 2010). Furthermore, young children that are coping with an ODD continue to exhibit problem behavior when they enter the school-age or adolescence (Rockhill, Collett, McClellan, & Speltz, 2006). In
addition, children with early-onset behavioral problems are at a high risk for life-course delinquency, substance use, violent behavior, academic failure and depression (Moffitt, 1993; Shaw, Gilliom, Ingoldsby, & Nagin, 2003). Moreover, research has indicated that
interventions for conduct disorders are less effective in adolescence than when offered in preschool age (Webster-Stratton, Gaspar, & Seabra-Santos, 2012). Hartman, Stage, &
Webster‐Stratton (2003) explained this because preschoolers have not yet went through additional risk factors as school failure, social rejection and deviant peer groups as a consequence of their problem behavior.
Above information urges the need for early intervention in childhood, and then in specific in the preschool age. Based on earlier studies, it is known that Incredible Years (IY) is an effective intervention for parents of preschool children in reducing behavior problems of children and increasing positive parenting and decreasing negative parenting for parents (Pidano, & Allen, 2014). IY is a manualized videotape modeling intervention (Webster-Stratton,1989). IY is different from other interventions that target problem behavior, because it uses videotaped vignettes of parent-child interactions. This gives parents some real,
practical tools to help their own children. Furthermore, IY promotes to use nonharsh, consistent, and appropriate disciplinary strategies, be less critical, and use positive reinforcement (Webster-Stratton, 1989).
IY exists in several forms, the most used form is IY Basic. This intervention focuses only on the parents and exists about 10 to 20 weekly sessions with groups of 6 to 12 parents. In collaboration with 2 group leaders, the video vignettes are discussed and role-plays are used to practice acquainted techniques as praise, rewards, limit setting, and handling misbehavior (Menting, de Castro, Wijngaards-de Meij, & Matthys, 2014).
A second form is the IY Advanced, this intervention consists out of IY Basic and 2 to 10 extra weekly sessions for the parents. It works the same as the IY Basic, with video vignettes and role-play, only extra themes are highlighted. These themes are interpersonal communication, anger management and problem-solving skills (Hartman, Stage, & Webster‐Stratton, 2003).
A third form of the IY is the IY Basic or Advanced for parents and an IY intervention for the children. This is called the IY Dinosaur. It consists out of child group sessions which
run parallel to that of the sessions for parents. It focuses on social skills and problem solving (Brotman, Gouley, Chesir-Teran, Dennis, Klein, & Shrout, 2005) The group leaders teach the children social skills, reinforce positive behaviors, and provide consequences for negative behavior. It also offers children chances for socialization with other kids. Furthermore, the leaders expose children to the techniques that parents are learning as time-out, in order to increase children’s positive responses to these procedures at home (Brotman, et al., 2005).
As mentioned, IY has shown to be an effective intervention for preschoolers and parents. However, less is known about the different forms of the intervention. Some research indicated that the supplementation of the IY Dinosaur increases the efficacy of the parent program (Webster-Stratton,Reid,&Hammond,2004). But few information exists on the comparison of the three IY forms.
Additionally, few is known about differences in effectiveness for different kinds of problem behavior. Ruma, Burke, & Thompson, (1996) stated that children with more severe and chronic behavior problems seem to make less positive behavioral changes in reaction to parent interventions than children with less severe and chronic behavioral problems.
Additionally, Abikoff & Klein (1992) discussed that the combination of CD and ADHD presents exceptional treatment problems. Therefore, it is interesting to investigate children with solely behavioural problems, ADHD, ADHD and behavioural problems and at high risk for behavioural problems with each other.
Since as mentioned parent intervention should focus on the preschool age, this systematic review will focus on the effectiveness of IY for preschoolers and parents. In addition, since less is known about the different IY forms and different problem behavior, this research will focus on differences in effectiveness between IY Basic, IY Advance and IY Dinosaur for the different forms of problem behaviour. This research can contribute to a better implementation of IY to children who are coping with or are at risk of problem
behavior. This can cause less children to cope with problem behavior, which causes fewer children in mental health services and thereby less costs for society. It can also make society a safer place, since early behavioural problems are a risk of severe delinquency. In conclusion the effectiveness of IY will be investigated on the the problem behaviour of children and the parenting skills of parents. It is expected that IY yields positive effects for both children and parents. However, no expectations are held considering the different forms of IY and the different problem behaviours.
Method
This systematic review includes only articles who investigate the effect of the intervention Incredible Years on the problem behavior of children and/or the parenting practices of parents. In addition, it includes only studies with preschool children who have or are at risk of developing conduct problems. In order to find these studies, this research has made use of Web of Science. The following seek term was used on Web of Science: TS=(incredible years intervention AND preschool child* OR preschool kid* AND problem behavior* OR conduct disorder* OR conduct problem* OR behavioural problem*) and 158,095 results were found. It was hard to find a seekterm with less results, therefore relevant articles were found by clicking the botton ‘sort by: relevance’. Subsequently, all articles who were relevant for this review were selected. At the end, 20 studies were included. Reasons for not including a study were that the right relation was not investigated, that research was still ongoing and no results were reported and that another study with a more recent publication date was of the same study.
Results
Different forms of externalizing problem behavior will be discussed. These are: behavioural problems, ADHD, ADHD and behavioural problems and high risk of behavioural problems. Within these subgroups there will be looked at the different intervention forms. Firstly the results for children will be described and secondly the results for the parents.
Children Behavioural problems
Basic
Preschoolers who’s parents was offered the IY Basic, improved skills as compliance and attention significantly (McMenamy, Sheldrick, & Perrin, 2011). Results remained at 6 month follow-up, except for attention skills. Externalizing problem behavior reported by the parents and, concerning the amount as well as the intensity, decreased (Axberg, & Broberg, 2012; Hutchings, et al., 2007; McGilloway, et al., 2014; McMenamy, et al., 2011; Perrin, Sheldrick, McMenamy, Henson, & Carter, 2014). The effect sizes were large and the results remained after 6 and 12 months, except for the intensity of problems, this had no results after 6 months but did after 12. Moreover, large effect sizes are found for decreases in behavior disorders, effects remained after 12 months (Axberg, & Broberg, 2012; Hutchings, et al., 2007). For example, children who’s parents received the IY Basic reduced significantly in their ODD. Of all children that were diagnosed before the intervention, only 23% was diagnosed after 12 months. In addition, children yielded significant changes in the by mothers two most reported problematic behaviors after 12 months (Axberg, & Broberg, 2012). Additionally, based on parent reports and observations, antisocial and hyperactive behavior reduced significantly (Hutchings, et al., 2007).
The amount and intensity of problem behavior decreased more when parents reported a positive change in their parenting (Eames, Daley, Hutchings, Whitaker, Jones, Hughes, Bywater, 2009). Moreover, changes in observed child positive behaviours reduced more when an observation in positive parenting was found. IY Basic seems thus successful in influencing parental practices and thereby reducing child behavioural problems.
However, the study of Axberg and Broberg (2012) measured next to parent reports also childcare reports. When childcare reports were considered, no significant results were found for reducing the intensity and amount of problem behavior of children. This study reported overall big differences between childcare and parent reports. In addition, the study of McGilloway, et al. (2014) that made next to parent reports use of observations, found significant improvements in problem behavior after 6 months but after 12 months the problem behavior had returned to base-line. The other mentioned study here that made use of observations, found significant results in problem behavior after 6 months, but no follow-up existed after 12 months therefore nothing can be said about remaining effects after 12 months (Hutchings, et al., 2007).
This is interesting since all other studies used mostly parent reports. It might be that parents who receive the IY Basic think that the problem behavior of their children reduced since they were offered an intervention, but that factually no decrease in problem behavior took place. On the other hand, the differences between parent and childcare reports might be explained by the fact that the improvements in problem behavior did not generalize to the daycare context. However, the differences between parent reports and observations is harder to explain.
In conclusion, all 6 mentioned studies did find positive results on child behavior when parent reports were considered. Four of these were randomized controlled trials (RCT), this is the best method of research. However, two of these RCT’s found no results by means of
observations and childcare reports. More research is needed to investigate if genuine intervention effects exist.
Advance
When parents of preschoolers were offered the IY Advance significant decreases in mother reports of externalizing behavior were revealed (Hartman, Stage, & Webster-Stratton, 2003). Observations of children’s problem behavior confirmed these findings. Results remained after 12 months. Furthermore, parent reports showed large decreases on conduct problems (Posthumus, Raaijmakers, Maassen, Van Engeland, and Matthys, 2012). This effect remained after 1 and 2 years.
However, childcare reports of externalizing problem behavior did not significantly decrease from pretest to 1 and 12 months later (Hartman, et al., 2003). Additionally, the study of Posthumus, et al. (2012) showed no differences on compliance between children in the intervention group and children in the control group and between pretest and 1 and 2 years later. In fact, between 1 and 2 years differences on compliance were found in favor of the control group. These results were based on observations. Moreover, no significant effects were found between the intervention and the control group on parental reports of externalizing problem behavior.
One longitudinal study showed that when preschoolers were offered the IY Advance, after 8 to 12 years 16.1% mothers and 12.0% fathers reported teenage externalizing behavior in the clinical range (Webster-Stratton, Rinaldi, & Reid, 2011). From all teenagers, 12.7% were expelled from school, 18.2% were involved in the criminal justice system, 23% had committed one or more serious acts, 18% had committed minor delinquent acts and 7.9% were removed from their home. These results might appear severe, but when considered that these children were coping with behavioral problems in the preschool age and that this is a big risk factor for later delinquency, results seem more positive.
In conclusion, contradictory findings exist. Three studies showed some positive results on child behavior when parental reports were considered, whereof one RCT study. However, one study that was no RCT found no significant results when childcare reports were used. Once again, last observation might be explained by a non-generalization to the daycare context. However, the only RCT study here did not find significant results when observation measures and one parental measure were used. More research is needed to clarify these findings.
ADHD Basic
Children who were initially coping with ADHD revealed significant decreases in ADHD and oppositional problems when parents were offered the IY Basic. Large effect sizes were found and results remained after 12 months. These results were based on parent and childcare reports. Based on mother reports, ADHD decreased even further from the 6 to 12 months follow-up (Azevado, Seabra-Santos, Gaspar, & Homem, 2014).
In conclusion, IY Basic seems effective in reducing behavior problems among children. Despite the fact that this is only based on one study, the study was a RCT and it was based on parents and childcare reports, therefore it gives some evidence.
Dinosaur
When parents of children with ADHD were offered the IY Advance and Dinosaur, parental reports of externalizing problem behavior, the intensity as well as the amount, and ADHD symptoms decreased at post-test and 6 months later (Trillingsgaard, Trillingsgaard, & Webster-Stratton, 2014). The amount of the problem behavior decreased even further from post-test to 6 months later. In conclusion, positive results in the reduction of problem behavior for children with ADHD do exist. However, this study was no RCT and solely
parent reports were used, therefore it does not provide enough evidence to state this with certainty.
ADHD and behavioural problems Basic
Children who were initially coping with ADHD and conduct problems, had less conduct problems and ADHD symptoms when their parents were offered the IY Basic (Jones, Daley, Hutchings, Bywater, & Eames, 2008). These results were based on parental reports and observations and remained 18 months after the intervention was completed. Moreover, children had less oppositional/aggressive and oppositional/explosive behaviors according to parents after 6 and 12 months (Azevedo, Seabra-Santos, Gaspar, & Homem, 2015; Homem, Gaspar, Santos, Azevado, & Canavarro, 2014). In addition, children with high hyperactivity and conduct problems showed greater improvements in problem behavior than children with low hyperactivity and conduct problems (Azevado, et al., 2015). However, no effects were found for parental reports of children’s antisocial/aggressive behaviors (Homem, et al., 2014).
In conclusion, most studies found positive results for the reduction of behavioural problems. This was based on 2 RCT’s and one no RCT study. In addition, parental reports and observational measures were in one line. Therefore, it can be concluded that IY Basic is effective in improving behaviour among children with ADHD and conduct problems.
Dinosaur
Children with initial ADHD and conduct problems showed less externalizing problem behavior after parents completed the IY Advance and Dinosaur (Webster-Stratton, Reid, & Beauch, 2011). More mother than father and childcare reports showed decreases in named behavior. In addition, the father and childcare reports were only significant directly after the
intervention, but not at a later posttest. Mother reports were significant at a later posttest. Moreover, observed child deviance in the lab and school setting showed decreases after completion of the parenting intervention. However, at posttest results were not longer significant.
In conclusion, one RCT study showed contradictory findings based on different measures. Observational measures showed no results. In addition, childcare and father reports showed fewer results than mother reports. More research is needed to clarify these findings.
High risk of conduct problems Basic
Children who are at high risk for problem behavior showed strong reductions in parental reports of child behavior , when parents were offered the IY Basic (Little, et al., 2012). Children with a developmental disability and a risk for developing behavioural problems showed a reduce in observed maladaptive behaviour and parental reports of total problems (McIntyre, 2008a; McIntyre, 2008b). However, McIntyre (2008a) found no change on parental reports of the total problems of children. McIntyre (2008b), found also no effects for externalizing behaviors.
In conclusion, although contradictory findings seem to exist, one RCT with a considerable amount of participants showed positive results. In addition, the contradictory findings were from research with children with a developmental disability. These children are a heavy target, therefore a more intensive intervention might be needed. In addition, IY Basic did seem effective for some externalizing problem behavior for children with a developmental delay.
Children who were at high risk for developing behavioural problems and had incarcerated mothers, showed significant decreases in the intensity and amount of disruptive behavior according to mothers (Menting, de Castro, Wijngaards-de Meij, & Matthys, 2014). Same children who’s parents were not offered an intervention showed no decrease in this behavior. According to caregiver reports, significant decreases in the intensity and amount of disruptive behavior were also found. Additionally, caregivers reported that children in the intervention group showed a decrease and children in the control group an increase of aggressive behavior.
In conclusion, IY Advance seems effective in reducing problem behavior for children at high risk. Although solely one study is reported here, this study was a RCT. Additionally, results were based on parent and caregiver reports. Moreover, since this sample concerned mothers who were incarcerated, a heavy target group, aggressive behaviors among children seemed to increase when no intervention or help is offered. This stresses the importance of intervention among high risk children.
Dinosaur
When parents of high risk children were offered the IY Basic and IY Dinosaur, no effects on disruptive behavior were found. This disruptive behavior remained relatively low in both the intervention and the control group. Results were the same after 8 to 10 months. In conclusion, the IY Dinosaur revealed no effect on child behavior. This result can be explained by the fact that more strong results can be obtained in the case of more severe situations. Since all children had low disruptive behaviors, no results were obtained. On the other hand, all children who are at high risk have no high problem behavior, therefore above intervention forms might be better for this specific group of children.
Parents Conduct problems
Basic
When parents of children with conduct problems were given the IY Basic, parent reports of parenting stress, use of harsh discipline and inconsistent use of discipline declined and use of positive parenting techniques and appropriate discipline increased. These effects remained after 6 months (McMenamy, et al., 2011). In addition, self-reports of negative parenting behaviors and reported stress in their role as parents were lower and a more positive development in perceived parental alliance was found after 6 and 12 months of completion of the intervention (Axberg, & Brober, 2012; McGilloway, et al., 2014; Perrin, et al., 2014). Both parents in the intervention and the control group showed less negative parenting and child disruptive behaviors at posttest and 12 month follow-up as compared to pretest for IY (Perrin, et al., 2014). However, the intervention group was superior to the control. In addition, the intervention group showed less negative parent-child interactions at post and 12 month follow-up, the control did not (Perrin, et al., 2014). Moreover, observed measures of parenting confirm these findings, more positive changes in observed positive parenting were found after the intervention (Eames et al., 2009; Hutchings, et al., 2007; McGilloway, et al., 2014). This effect remained after 6 and 12 months.
On the other hand, two RCT studies found no significant effects for parental criticism and parental control (Axberg, & Brober, 2012; Hutchings, et al., 2007). However, another RCT study did find longer term increases in critical parenting after 12 months (McGilloway, et al., 2014 ).
In conclusion, most results report positive effects of IY Basic on problem behavior. Improvements in positive parenting and a decline in negative parenting were reported. This is based on 6 studies whereof 4 RCT’s and observational measures and parent reports. Three
RCT’s seemed to contradict each other on parental criticism. Overall there seems to be a positive effect of IY basic on parents with children with conduct problems.
Advance
When parents of children with conduct problems were offered the IY Advance, parents showed less parent-child coercive interactions and less critical statements (Hartman, et al., 2003; Posthumus, et al., 2012). This was based on independent observations of parents and children. The effect of less critical statements remained after 2 years (Posthumus, et al., 2012). In addition, based on parent reports larger improvements in appropriate discipline, harsh and inconsistent discipline and praise and incentives were found (Posthumus, et al., 2012). This effect remained after 2 years. Furthermore, the decrease in observed critical parenting mediated the decrease in observed child conduct problems.
In conclusion, there seems to be a positive effect of the IY Advance in the improvement of positive parenting and a decline in negative parenting. This is based on one RCT and one no RCT study with parental reports and independent observations.
ADHD Basic
For parents of children with ADHD the IY Basic yielded an increase of mothers’ self-reported sense of competence and efficacy (Azevado, et al., 2014). This effect remained after 12 months. Moreover, self-rated dysfunctional practices as laxness, overreactivity and verbosity, decreased significantly at post and 12 months follow-up. Large effect sizes were found. Considering observed parenting, a significant effect for positive parenting was found but no significant effect for coaching after 12 months.
Overall, positive results of IY Basic for parents with children with ADHD seem to be found. This is based on one RCT study with parental and observational reports. Solely no
effect for observed coaching was found, other results did show positive effects for positive parenting.
Dinosaur
The study of Trillingsgaard et al. (2014) investigated parents of children with ADHD who were given the IY Advance and IY Dinosaur. They revealed that parents reported using more incentives and praise and less negativity. After 6 months, these effects were still the same. However, this study was no RCT and solely parent reports were used, therefore it does not provide enough evidence to state that IY Dinosaur is effective for parents of children with ADHD.
ADHD and conduct problems Basic
For parents of children with ADHD and conduct problems, the IY Basic increased mothers observed positive parenting behaviors and decreased dysfunctional practices as laxness, overreactivity and verbosity (Azevado, et al., 2015; Homem, et al., 2014). These effects sustained after 6 and 12 months. Moreover, observed coaching skills increased for IY Basic parents, and decreased for parents in the control after 6 months. Nonetheless, this effect faded away after 12 months (Homem, et al., 2014).
In conclusion, IY Basic increased positive parenting behaviors and decreased negative parenting behaviors. However, observed coaching skills did not improve. This is based on one RCT and one no RCT study and based on independent observations.
Dinosaur
When parents with ADHD and conduct problems were offered the IY Advance and IY Dinosaur, lab and school observations revealed that mother praise and coaching increased, while critical/negative statements decreased (Webster-Stratton, et al., 2011). The first two
yielded longer term effects. Additionally, appropriate discipline and monitoring increased and harsh discipline and physical punishment decreased concerning mother reports. No significant effects were found for father reports.
In conclusion, one RCT study revealed improvements in positive parenting and a decrease in negative parenting for mothers. This is based on lab and school observations. However no results were found for fathers.
High risk of conduct problems Basic
One RCT study found that parents with children at high risk for developing conduct problems, reported reductions in negative parenting behaviour after having followed the IY Basic (Little, et al., 2012). In addition, for parents of children with developmental disabilities, a significant reduction in inappropriate behavior of parents was found after they followed the IY Basic (McIntyre, 2008a; McIntyre, 2008b). These inappropriate behaviors were things as inappropriate play, intrusion on child’s independence, inappropriate commands and lack of follow through. On the other hand, no effects were found for criticism and praise (McIntyre, 2008a; McIntyre, 2008b). Both the intervention and the control group increased on child-directed praise (McIntyre, 2008b).
In conclusion, positive results of the IY Basic for parents of high risk children are found, even when children had a developmental disability. This is based on 2 RCT’s and one no RCT study. However, only parent reports were used and for child-directed praise and criticism no improvements were found for parents of children with a developmental delay. This might be because it is hard for parents to deal with these children, therefore less intervention effects are found.
When these parents were offered the IY Advance, one RCT study with incarcerated mothers found that mothers inconsistent discipline decreased, while increased for incarcerated mothers in the control (Menting, et al., 2014). On the other hand, no effects were found for parental involvement, positive parenting, poor monitoring and corporal punishment between mothers in the treatment group and mothers in the control. Both groups showed an increase in parental involvement and less poor monitoring over time.
In conclusion, reductions are found for inconsistent discipline but no other effects are found as positive parenting or poor monitoring. This is based on one RCT study and parental reports. Since these parents are a heavy target group and they were coping with social and economical stress, it might be harder to improve their parenting. Therefore more research with parents of different circumstances is needed.
Dinosaur
When parents of children at high risk were offered the IY Basic and IY Dinosaur, they decreased strongly in negative parenting. This was based on parent ratings and observations and sustained after 8 to 10 months. However, no effects on positive parenting were found. This last finding might be due to the fact 50% of parents had not completed high school, which could mean that these parents are harder to reach than parents with higher education levels. It can also be explained by the fact that 61% of the parents were Afro-American, and this culture might differ from western perspectives of good parenting.
In conclusion, IY Dinosaur yielded a decline in negative parenting, but no effects for positive parenting. This is based on one RCT study and parental and observational reports. However, the sample of the study was not representative for the whole population, since 50 % had a low education level.
Discussion
In conclusion, the purpose of this research was to investigate the effectiveness of IY in reducing problem behavior of preschoolers and parenting skills of parents. Overall, mentioned research points into the direction that IY reduces child behavioural problems and improves parenting. Concerning the results for children, the IY Basic and IY Advance worked equally well for children with conduct problems, this is based on parental reports. No results were found for childcare reports and observations. For children with ADHD, IY Advance worked good based on parental and childcare reports, more research for IY Basic and IY Dinosaur is needed. The IY Basic worked best for children with ADHD and conduct problems. This is based on parental reports and observations. For IY Advance more research is needed. The IY Basic and IY Advance seem to work best for children at high risk. This is based on parental reports and observations.
Moreover, concerning the results for parents, the IY Basic and IY Advance seemed to work equally well for parents of children with conduct problems. This is based on parental reports and observations. More research for IY Dinosaur is needed. For parents of children with ADHD, IY Basic seems effective in improving parenting. This is based on parental and observational measures. More research for IY Advance and IY Dinosaur is needed. Additionally, IY Basic and IY Dinosaur seem equally effective in improving parenting behavior for parents of children with ADHD and conduct problems. This was based on observations. More research for IY Advance is needed. At last, the IY Basic seems best for improving parenting for parents of children at high risk. This was solely based on parent reports and for parents of children with a developmental delay, less positive results were found.
However, observational measures, childcare and parent reports showed sometimes contradictory findings. Whereof the first two showed less positive results than the last. One
study of Berg-Nielsen, Solheim, Belsky and Wichstrom (2012) revealed that higher reports of behavioural problems of children by teachers as compared to parents might be explained by negative child-teacher interactions. These interactions biases the actual problem behavior of children. This finding could also be true for childcare workers. In addition, it is found in the literature that parents can predict their children’s behavior well in social situations (Fisher, Mello, & Dykens, 2014). This implicates reliance to parental in favor of childcare reports.
Moreover, studies which included also father reports showed no significant or less strong effects of IY on child behavior problems and parenting as compared to mother reports. In almost all studies, the majority of parent participants consisted of mothers, thus it might be that IY works better for improving mothers parenting behavior. However, less effects of father reports for child behavior are harder to explain. One study into differences in reports of mothers and fathers concerning child temperament, found that when mothers had attributes of temperament as well, they overestimated their child behavior more as positive, as compared to fathers with attributes (Bayly, & Gartstein, 2013). Additionally, marital conflict was related to differences in reports. This can be explained by the fact that when parents in marital conflict share less experiences with their child, less consistency in their reports are found. In conclusion, all different measures might give different perspectives, which are all valuable.
This systematic review has also some limitations. Firstly, all studies in this systematic review did not contain a very big sample, samples differed between 23 and 273 participants. Future research should conduct studies with more participants to optimize the effect of randomization. Moreover, this research contained mostly mothers and more boys than girls, future research should therefore direct itself also on fathers and girls. Especially because differences between mother and father reports are existent. At last every research should
contain parent reports, childcare reports (when possible) and independent observations to better state something about the effectiveness of the intervention.
In conclusion, overall findings of IY on child behavior and parenting are found. In addition, different IY forms for different forms of problem behavior are described. This information can contribute to a better implementation of IY in the field. This causes less children in mental health services and keeps society a safer place.
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Table 1
Summary of the Research Characteristics
Authors + year Type IY N % boys; %
mothers
Age children; age parents
Sample characteristics
Design Child behaviour
Measures Parenting measures Axberg & Broberg, 2012 IY Basic 62, IY: 38, C: 24
83.9% ;100% 4-8 yrs; u.n. Children with ODD, wide range SES, Sweden RCT, pre-test, post-test and 1 yr follow-up K-SADS, ECBI, SESBI-R, SDQ PLOC-PPC, PAM Azevado et al., 2014 IY Basic 100, IY: 52, C: 48 71% ; 100% 3-6 yrs; M=36 yrs
Children with ADHD, average SES, Portugal
RCT, pre-test,post-test ( 6 mths) and 1 yr follow-up WWPAS, PKBS-2, PACS PS, DPICS Azevedo et al., 2015
IY Basic 52 67% ; 94% 3-6 yrs; u.n. Children with ADHD,
wide range SES, Portugal
Pre-test, 1 yr follow-up SDQ, WWPAS, PKBS-2, PACS PS Brotman et al., 2005 Eames et al., 2009 Hartman, et al., 2003 Homem, et al., 2014 IY Basic + Dinosaur IY Basic IY Basic + Advance IY Basic 92 , IY: 47, C: 45 86 81 81 47% ; 83% 57% ; 99% 100% ;100% 75.3 %;100% 2.8 – 5.3 yrs; M=36.30 yrs 3-5 yrs; M=30 yrs 4-7 yrs; M=34.73 yrs 3-6 yrs; 34.47 yrs .
Children at high risk, 61% afro-american, 50% no high school Children with behavioural problems, Wales Children with behavioural problems, North-America Children with behavioural problems and ADHD, high SES, Portugal RCT, pre-test, post-test (8-10 mths) Pre-test, post-test (6 mth) Pre-test, 1 mth and 1 yr follow-up Pre-test, post-test (6 mths) and 1 yr follow-up OPPUS ECBI CBCL, DPICS-R, TRF SDQ, PKBS PPI, home observations: DPICS-R, GIPCI PS, DPICS DPICS-R DPICS, PS
Hutchings et al., 2007 IY Basic 153, IY: 104, C:49 u.n.
3-4.9 yrs; u.n. Children with
behavioural problems, low SES, Wales
RCT, pre-test and 6 mths follow-up
ECBI, SDQ, CP/TRS PSI-SF, PS,PDHQ, DPICS-R
Jones et al., 2008 IY Basic 79, IY:50, C:29
64% ; 100% M=3.9 yrs;
M=27.54 yrs
Children with behavioural problems and ADHD, Wales
RCT, pre-test, 6, 12 and 18 mth follow-up
ECBI, SDQ, CP/TRS, DPICS
---
Little et al., 2012 IY Basic 161, IY:110, C:51
62.7 % ; u.n. 3-4 yrs; u.n. Children at high risk, 50% low SES, Birmingham (UK) RCT and 6 mths follow-up SDQ, ECBI APS McGilloway et al., 2014 IY Basic 149, IY:103, C:46
58% ;95% 2.7-7.3; 33 yrs Children with
behavioural problems, low SES, Ireland
RCT, pre-test, 6 and 12 mth follow-up
ECBI, SDQ, CPRS PSI-SF, OLPS,
DPICS-R
McIntyre, 2008a IY Basic 25 92% ; 92% 2-5 yrs;
M=33.56 yrs
Children at high risk with developmental disability, high SES,
Pre-test, post-test CBCL, PIO PIO
McIntyre, 2008b IY Basic 44, IY:21, C:23
u.n. 2-5 yrs; M=35 Children at high risk
with developmental disability, high SES, New York State
RCT, pre-test, post-test CBCL PIO
McMenamy et al., 2011
IY Basic 28 u.n.;100% 2-3 yrs; u.n. Children with
behavioural problems, low SES, Boston + Massachusetts
Pre-test, post-test and 6 mths follow-up CBCL PPI, PSI Menting et al., 2014 IY Basic + Advance 82, IY:55, C:27
48.9% ; 100% 2-10 yrs Children at high risk, incarcerated mothers, severe circumstances, low SES, the
Netherlands
IY: Incredible Years group C: Control group
u.n.: unknown Children
COCA–R: Coder Observation of Child Adaptation–Revised Perrin et al., 2014 IY Basic 273, IY:89,
C:61, NR-IY:123 62% ; 96% 1.8-3.5 yrs; 34 yrs Children with behavioural problems, wide range SES, Greater Boston Area
Pre-test, post-test, 6 and 12 mths follow-up
ECBI PS, DPICS-R, CII
Posthumus et al., 2012 IY Basic + Advance 144, IY; 72, C:72
u.n.; 86% 4 yrs; u.n.
Children with
behavioural problems, the Netherlands
RCT, pre-test, post-test, 1 yrs and 2 yr follow-up
CBCL, ECBI DPICS-R, PPI
Trillingsgaard et al., 2014 IY Basic + Advance + Dinosaur 36 75% ; u.n. 3-8 yrs;M=34.4 yrs
Children with ADHD, wide range SES, Denmark
Pre-test, post-test and 6 mth follow-up
C3-AI, ECBI, SDQ PPI
Webster‐Stratton, Rinaldi, et al., 2011
IY Basic 78 74.4 % ;57 % 3-8 yrs; u.n. Children with
behavioural problems, Washington
Pre-test, long-term follow-up 8-12 yrs later
CBCL, PI, EDC, SSA --- Webster-Stratton, Reid et al., 2011 IY Basic + Advance + Dinosaur 99, IY:49, C:50
75.5%; 56% 4-6 yrs; u.n. Children with behavioural problems and ADHD,
Washington
RCT, pre-test, post-test PPI, CBCL, CPRS–R
ECBI, TRF, CTRS-R, DPICS-CTRS-R, COCA-R, WPST
CP/TRS: the Conners Abbreviated Parent/Teacher Rating Scale CPRS(-R): The Conners Abbreviated Parent Rating Scale-(Revised) C-TRF: Caregiver-Teacher Report Form
C3-AI: Conners3-ADHD Index
CTRS-R: Conners' Teacher Rating Scale–Revised
DPICS-R: the Dyadic Parent-Child Interaction Coding System- Revised ECBI: the Eyberg Child Behavior Inventory
EDC: the Elliott Delinquency Scale
K-SADS-PL: The Kiddie-SADS-Present and Lifetime Version OPPUS : Observed Peer Play in Unfamiliar Settings
PACS: Parental Account of Childhood Symptoms PI: Parent Interview
PKBS(-2): The Preschool and Kindergarten Behavior Scales(-2nd Edition) SDQ: the Strengths and Difficulties Questionnaire
SESBI-R: The Sutter-Eyberg Student Behavior Inventory – Revised SSA: Substance use and Sexual Activity
TRF: Teacher Report Form
WPST: Wally Problem Solving Test
WWPAS: Werry-Weis Peters Activity Scale Parents
APS: the Arnold and O’Leary Parenting Scale CII: Coder Impression Inventory
DPICS-R: the Dyadic Parent-Child Interaction Coding System- Revised GIPCI: The Global Impressions of Parent–Child Interactions (parenting style) OLPS: The O’Leary–Porter Scale
PAM: the Parenting Alliance Measure
PDHQ: the Personal Data and Health Questionnaire PLOC-PPC: Parental Locus of Control
PPI: Parenting Practices Interview
PS: the Parenting Scale (parental competencies) PSI(-SF): the Parenting Stress Index (– Short Form)
