Jordana K Bayer1,2,3, Ruth Beatson1,2, Lesley Bretherton2,3,4, Harriet Hiscock2,3,5, Melissa Wake2,3,6, Tamsyn Gilbertson2,4, Cathrine Mihalopoulos7, Luke A Prendergast8, Ronald M Rapee9. 1. 1 School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia. 2. 2 Murdoch Childrens Research Institute, Melbourne, VIC, Australia. 3. 3 Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia. 4. 4 Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia. 5. 5 Centre for Community Child Health, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia. 6. 6 Department of Paediatrics: Child and Youth Health and The Liggins Institute, University of Auckland, Auckland, New Zealand. 7. 7 Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, VIC, Australia. 8. 8 Department of Mathematics and Statistics, La Trobe University, Melbourne, VIC, Australia. 9. 9 Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
Abstract
OBJECTIVE: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. METHODS: Design: a randomised controlled trial was used. SETTING: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. PARTICIPANTS: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. SECONDARY OUTCOMES: the secondary outcomes were parenting practices and parent mental health. RESULTS: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal - 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms - mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = -0.47, 95% confidence interval = [-0.81, -0.13], p = 0.006). Parents' participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. CONCLUSION: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood.
RCT Entities:
OBJECTIVE: To determine whether a population-delivered parenting programme assists in preventing internalising problems at school entry for preschool children at-risk with temperamental inhibition. METHODS: Design: a randomised controlled trial was used. SETTING: the setting was 307 preschool services across eight socioeconomically diverse government areas in Melbourne, Australia. PARTICIPANTS: a total of 545 parents of inhibited 4-year-old children: 498 retained at 1-year follow up. Early intervention: Cool Little Kids parenting group programme was implemented. Primary outcomes: the primary outcomes were child DSM-IV anxiety disorders (assessor blind) and internalising problems. SECONDARY OUTCOMES: the secondary outcomes were parenting practices and parent mental health. RESULTS: At 1-year follow up (mean (standard deviation) age = 5.8 (0.4) years), there was little difference in anxiety disorders between the intervention and control arms (44.2% vs 50.2%; adjusted odds ratio = 0.86, 95% confidence interval = [0.60, 1.25], p = 0.427). Internalising problems were reduced in the intervention arm (Strengths and Difficulties Questionnaire: abnormal - 24.2% vs 33.0%; adjusted odds ratio = 0.56, 95% confidence interval = [0.35, 0.89], p = 0.014; symptoms - mean (standard deviation) = 2.5 (2.0) vs 2.9 (2.2); adjusted mean difference = -0.47, 95% confidence interval = [-0.81, -0.13], p = 0.006). Parents' participation in the intervention was modest (29.4% attended most groups, 20.5% used skills most of the time during the year). A priori interaction tests suggested that for children with anxious parents, the intervention reduced anxiety disorders and internalising symptoms after 1 year. CONCLUSION: Offering Cool Little Kids across the population for inhibited preschoolers does not impact population outcomes after 1 year. Effects may be emerging for inhibited children at highest risk with parent anxiety. Trial outcomes will continue into mid-childhood.
Authors: Filipa Sampaio; Jan J Barendregt; Inna Feldman; Yong Yi Lee; Michael G Sawyer; Mark R Dadds; James G Scott; Cathrine Mihalopoulos Journal: Eur Child Adolesc Psychiatry Date: 2017-12-29 Impact factor: 4.785