@article{ref1,
title="Internet-assisted parent training intervention for disruptive behavior in 4-year-old children: a randomized clinical trial",
journal="JAMA Psychiatry",
year="2016",
author="Sourander, Andre and McGrath, Patrick J. and Ristkari, Terja and Cunningham, Charles and Huttunen, Jukka and Lingley-Pottie, Patricia and Hinkka-Yli-Salomäki, Susanna and Kinnunen, Malin and Vuorio, Jenni and Sinokki, Atte and Fossum, Sturla and Unruh, Anita",
volume="73",
number="4",
pages="378-387",
abstract="IMPORTANCE: There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. <br><br>OBJECTIVE: To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS: This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n DESIGN, SETTING, AND PARTICIPANTS:  = 232) or an education control (EC) group (n = 232). INTERVENTIONS: The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES: Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. <br><br>RESULTS: Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P RESULTS:   RESULTS: < RESULTS:  .001), internalizing scale (effect size, 0.35; P  RESULTS: < RESULTS:  .001), and total scores (effect size, 0.37; P  RESULTS: < RESULTS:  .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P  RESULTS: < RESULTS:  .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and s RESULTS: elf-reported parenting skills (effect size, 0.53; P  RESULTS: < RESULTS:  .001). <br><br>CONCLUSIONS AND RELEVANCE: The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01750996.<p /> <p>Language: en</p>",
language="en",
issn="2168-622X",
doi="10.1001/jamapsychiatry.2015.3411",
url="http://dx.doi.org/10.1001/jamapsychiatry.2015.3411"
}