Objective

Families with disruptive child behavior are typically referred to services based on children’s behavior alone, rather than on underlying mechanisms of disruptive behavior. Yet, the presence of the precise mechanisms targeted by services might be essential for intervention success. We integrated person- and variable-centered approaches to test whether families with combined disruptive child behavior and harsh/inconsistent parenting indeed benefit most from a behavioral parenting intervention in indicated prevention context, compared to families with disruptive child behavior but less harsh/inconsistent parenting, and families with less severe disruptive behavior.

Method

Families (N = 387) of children aged 4 to 8 years (disruptive behavior >75^th percentile) participated in a randomized trial of the Incredible Years parenting intervention (Trial NTR3594, www.trialregister.nl). We identified different response trajectories and tested whether families with combined child and parenting difficulties had a higher probability of responding well, compared to families with only child difficulties or less severe difficulties.

Results

Most intervention group families (82%) showed a nonresponse trajectory. A minority (18%) showed a response trajectory with strong reductions in disruptive behavior (Cohen’s d =1.45). As expected, families with both child and parenting difficulties were most likely to respond: 20% more than families with only child difficulties, and 40% more than families with less severe difficulties.

Conclusion

Incredible Years, as an indicated prevention program, benefits mainly families in which the mechanisms targeted by the intervention (ie, harsh/inconsistent parenting) is actually present, rather than all families. Careful matching of children to services based on assessments of both child and parenting behavior seems critical for intervention success.

Clinical trial registration information

ORCHIDS: Study on Children’s Genetic Susceptibility to Their Environment; https://www.trialregister.nl; 3594.

中文翻译：

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受益家庭和不受益家庭：整合以人为中心和以变量为中心的育儿干预反应分析。

客观的

具有破坏性儿童行为的家庭通常被称为仅基于儿童行为的服务，而不是基于破坏性行为的潜在机制的服务。但是，以服务为目标的精确机制的出现对于干预成功而言可能是必不可少的。我们整合了以人和以变量为中心的方法，以测试与具有破坏性儿童行为但父母行为不严格/不一致的家庭相比，在指示性预防背景下，具有破坏性孩子行为且父母行为恶劣/父母不一致的家庭是否确实从行为育儿干预中真正受益最大，以及破坏行为不太严重的家庭。

方法

儿童的家庭（N = 387）年龄在4至8岁（破坏性行为> 75^个百分位）参加了难以置信年养育干预的随机试验（试行NTR3594，www.trialregister.nl）。我们确定了不同的反应轨迹，并测试了与只有儿童困难或轻度困难的家庭相比，合并有儿童和父母的困难的家庭是否有较高的反应良好机率。

结果

大多数干预组家庭（82％）显示无反应轨迹。少数（18％）表现出反应轨迹，破坏行为明显减少（Cohen d  = 1.45）。正如预期的那样，有子女和父母养育困难的家庭最有可能做出反应：比有独生子女的家庭多20％，比重度较轻的家庭多40％。

结论

作为指示性的预防计划，不可思议的年限主要惠及实际上存在干预目标机制的家庭（即刻薄的父母/不一致的养育子女），而不是所有家庭。根据对孩子和父母行为的评估，仔细地将孩子与服务进行匹配，对于干预成功与否至关重要。

临床试验注册信息

兰花：儿童对环境遗传易感性的研究；https://www.trialregister.nl; 3594。