The Incredible Years Parenting Program: Efficacy for Portuguese Preschoolers with AD/HD Behaviors

1. The Incredible Years Parenting Programme: Efficacy in a sample of Portuguese pre-school age children with AD/HD behaviours Andreia Azevedo Maria João Seabra Santos Maria Filomena Gaspar [Grant number: PTDC/PSI-PED/102556/2008]

3. Overview of Presentation Introduction Study Aims Methods Results Conclusions & Implications

4. Introduction

5. AD/HD in Preschool Years Introduction • Symptomsofhyperactivity,impulsivityand/orinattentioncan emerge earlyinpreschoolyears • Cause impairmentfor thechild, family, school • Can bemoderatelypersistentovertime Harveyetal., 2009; Laheyetal., 2004 • Increaserisk for further negative long-termdifficultiesDuPauletal., 2001 • Predictsthedevelopmentofcomorbidproblems(ODD, CD)Beauchaineetal., 2010 • Highdevelopmentalchangesinthis age period: • Carefulstagedapproachto identification/interventionNICE, 2008; Sayaletal., 2012 • Comprehensiveandmultidisciplinaryassessment • Preschoolyears: criticalmoment for earlyidentification/interventionandprime targetofinvestment(clinicians, policies) • Preventionof negative developmentalpathways

6. AD/HD in Preschool Years Introduction Potential risk factors Social Environment/ Community Family • Bidirectionalandreciprocalinfluences • CoercivecyclePatterson, 2002 Child Target PARENTS inearlyeffectiveintervention

7. I am the mother of a naughty 4, almost 5 year old boy. In this moment I feel a bit lost because I fear a lot for my sun’s future. It’s not only attention and concentration that worry me, but also his impulsivity and non-compliance, not only towards us but also with his teacher and all the other adults. As a mother, I want to try anything to prevent my son from “getting lost”. I don’t want that my puppy reaches 6/7 years under medication. If it has to be so, it will, but I would like to try other kinds of help first.

8. WhytheIncredibleYearsParentingProgramme? Study Rationale

9. WhytheIncredibleYearsParentingProgramme? Study Rationale

10. Study Aims

11. Main Purposes Study Aims

12. Methods Study design Participants Procedures Instruments Intervention

13. Study Design Methods Longitudinal Study

14. InclusionExclusionCriteria Methods

15. Participants Methods

16. Participants Methods

17. Procedures Methods

18. Instruments Methods

19. Instruments Methods

20. Intervention – IncredibleYears Basic ParentingProgramme Methods

21. Results

22. Pre-Post Comparison: child variables Results: Repeatedmeasures GLM; Group: between-subjects; Time: within-subjects WWPAS: p < .01, p² = .11 PKBS-O/I_home: p < .01, p² = .11 PKBS-O/I_school: p < .05, p² = .06 PKBS-SS_home: p = .052, p² = .04

23. Pre-Post Comparison: mother variables Results: Repeatedmeasures GLM; Group: between-subjects; Time: within-subjects PSOC: p < .05, p² = .05 PS: p < .001, p² = .19 DPICS_PP:p < .001, p² = .21 DPICS_COACH: p < .05, p² = .06

24. 12-month effects: childvariables Results: Repeatedmeasures GLM; Time: within-subjects : WWPAS: p < .001, p² = .44 WWPAS_T2-T3: p =.536, ns PACS-HY: p <.001, p² = .35 PACS-HY_T2-T3:p = .011, p² = .12 PKBS-SS: p < .001, p² = .32 PKBS-SS: p = .111, ns

25. 12-month effects: mothervariables Results: Repeatedmeasures GLM; Time: within-subjects : DPICS-PP: p < .001, p² = .23 DPICS-PP_T2-T3: p = .813, ns DPICS-COACH: p = .407, ns PSOC: p < .001, p² = .20 PSOC_T2-T3:p = .900, ns PS: p < .001, p² = .49 PS_T2-T3: p = .337, ns

26. Clinical Significant Reduction of AD/HD behaviours Results: Non-parametrictests 30% reductionofinitialbaseline scores = clinicallysignificantimprovement Axberg et al., 2007; Webster-Stratton et al., 1989 43%IYGvs11% WLG (6 monthfollow-up) [χ² (1) = 11.66; p =.003] 59% IYG (12 monthfollow-up)

27. Programme’sAcceptance: AttendanceandSatisfactionVariables Results: Descriptive data • Programmeattendance rate: • - High: 88% on 9 or ↑ sessions (mean:11 sessions)- Droppedout: 8% (4 mothers < 4 sessions) • Programmesatisfaction: • - IY approach to changebehavioursappropriate (29%) orveryappropriate (71%) • - Highsatisfactionwiththesessions’ contentandprogramcomponents(methods, strategies, leaders, group)

28. Conclusions and implications

29. MainConclusions Discussion • Encouragingresults, suggestiveofsignificantshort-terminterventioneffects : • Children: Reductionof AD/HD behaviours (home, school) [medium ES]; marginal increaseofsocial skills(onlyathome – targetcontext) • Mothers: Improvementofpositive parenting, senseofcompetenceandlessdysfunctionalpractices[medium to large ES] • II. Maintenanceofgainsfrom 6 to 12-month afterbaseline(small ES): • CoachingeffectfadedoutandAD/HD behaviours(mothers’ interview) continued to decrease (sleepeffects?)

30. MainConclusions Discussion III. High acceptability of IY model Preliminaryevidenceof IY as a promising P Earlypreventiveinterventionoption for Portuguese children/motherswith similar characteristics

31. For Research Implications • Data replication (differentcontextsandpopulations) • Largerrandomizedsamplewithlongerfollow-upperiods: • mediators(keyingredients ?) andmoderatorsofchange(for whomandinwhat • conditions ?) Gardneretal., 2010 • Interventionintegritystudy(facilitator’sadherence to protocol) • Directlyrecruitfathers - largersamplesizes(Fabiano etal., 2012) • Compare IY with usual care: Whatis more cost-effectiveinthelongrun?; orwithother IY setofprogrammes: Additionalbenefits?

32. LessonsLearned: Interventionand Policies Implications • Early identification (community settings): even low-hyp children • Disseminate effective early intervention • Investment in training and supervision (fidelity process) IY BasicParentProgrammeinterventiontestedin a portuguese sample: 14 + 2 Sessions (2001 version; with some contentadjustments, tailored to AD/HD needsandcharacteristics) • Longer version (flexibility): reinforce Coaching parenting skills • Promote continuous support after the end of the programme • Monitor children with more severe problems

36. DIOLCH I CHI DANKE MERCI OBRIGADA TAKK GRAZIE THANK YOU GRACIAS 谢谢 seabramj@fpce.uc.pt