Remote Intervention of Children's Disruptive Behaviour Yielded Effective Results

​The Strongest Families intervention programme supports parents and provides them with tools to confront and reduce their child's disruptive behaviour. The study and its results were published in the esteemed JAMA Psychiatry journal. It is the first randomised study of the effectiviness of web based parent training intervention which is  based on screening a high risk group from the whole population.

In a collaborative effort, researchers from the University of Turku, Finland   and Dalhouse University, Nova Scotia, Canada  led jointly by Drs. Andre Sourander and Patrick McGrath developed web based intervention and designed whole population screening of 4-year old with disruptive behaviour. The Strongest Family parent training intervention is based on previous research in Canada   by Dr McGrath and his  group.

The effectiveness of the programme was evaluated on a six and twelve-month follow-up period. The target group of the study consisted of the 4,656 families that participated in the annual child health clinic check-ups for four-year-old children. 730 families, whose four-year-old had significant behavioural problems based on questionnaire assessments were selected to the study.

Half of the screened families participated in the 11-week intervention programme.  The parents received parent training  each week over the telephone by their personal family coach  and, at the same time, they studied skills for positive parenting on the Strongest Families website. In contrast, the control group received an information package supporting parenting skills and one phone call. 

The study indicates that during the 12-month follow-up the behavioural problems of the four-year-old children reduced significantly in the families who participated in the 11-week programme compared to the control group . In the intervention group, parenting skills as well as the child's disruptive behaviour, ADHD symptoms, anxiety, sleep problems and empathy improved significantly when compared with the control group and the results were permanent throughout the 12-month follow-up. During the year's follow-up, over 80 percent of the children whose parents received the training would not have been selected for the intervention programme for their disruptive behaviour.  In the control group that received more limited support, the percent was 66.

– The significance of the results becomes apparent when they are compared with our earlier cohort study, which have indicated that the behavioural problems are permanent in half of  children when followed from age 4 to age 5 , explains Dr Andre Sourander.

Sourander emphasises the importance of the intervention programme in preventing antisocial behaviour.

– The results are significant as disruptive behaviour in childhood is linked to mental health problems, criminality, substance abuse and higher mortality in adulthood.  Disruptive behaviour that starts in childhood is also associated with smoking and alcohol use  from an early age, poor life management skills and excess weight, which are key risk factors for health problems later in life.

The intervention programme focuses on noticing and strengthening children's good behaviour. The parents were instructed to ignore mild bad behaviour and to anticipate transitional situations.  It is easier for a child to succeed in new situations when they are planned beforehand together with the child.  Parents who earlier experienced their child as difficult received tools for solving everyday problems and learnt to value their child in a new way. 

The Strongest Families is a suitable support and intervention programme for the risk group identified from the entire age group. .Given flexibility, anonymity, and ease of access, remote interventions have important benefits for reaching at-risk individuals. The strategy of population-based screening of children at an early age and offering Internet-assisted parent training that uses telephone coaching could be a promising solution for providing early prevention and intervention for a variety of child mental health problems.

– There are great opportunities in Finland to systematically utilise this kind of intervention, as the needed expertise and infrastructure exist already and the entire population is covered by the national health care system. With a nation-wide early intervention programme, Finland could be a pioneer in the prevention of different kinds of problems related to health and behaviour, concludes Sourander.

The research was supported by the Academy of Finland, the Canadian Institutes of Health Research, Jane and Aatos Erkko Foundation, Kummit Association and Margaretha Foundation.

>> The abstract of the study in the JAMA Psychiatry journal

Text: Erja Hyytiäinen
Translation: Mari Ratia
Photos: Hanna Oksanen