Programs for Prevention of Externalizing Problems in Children: Limited Evidence for Effect Beyond 6 Months Post Intervention

Abstract

BackgroundPreventing externalizing problems in children is a major societal concern, and a great number of intervention programs have been developed to this aim. To evaluate their preventive effects, well-controlled trials including follow-up assessments are necessary.MethodsThis is a systematic review of the effect of prevention programs targeting externalizing problems in children. The review covered peer reviewed publications in English, German, French, Spanish and Scandinavian languages. Experimental studies of standardized programs explicitly aiming at preventing externalizing mental ill-health in children (2–19 years), with outcome assessments at ≥6 months post intervention for both intervention and control groups, were included. We also included long-term trials with consecutive observations over several years, even in the absence of follow-up ≥6 months post intervention. Studies of clinical populations or children with impairments, which substantially increase the risk for mental disorders, were excluded.ResultsThirty-eight controlled trials assessing 25 different programs met inclusion criteria. Only five programs were supported by scientific evidence, representing selective parent training (Incredible Years and Triple-P), indicated family support (Family Check-Up), and school-based programs (Good Behavior Game, universally delivered, and Coping Power, as an indicated intervention). With few exceptions, effects after 6–12 months were small. Long-term trials showed small and inconsistent effects.ConclusionsDespite a vast literature, the evidence for preventive effects is meager, largely due to insufficient follow-up post intervention. Long-term follow up assessment and effectiveness studies should be given priority in future evaluations of interventions to prevent externalizing problems in children.

Introductory Chapter: Parenting – Empirical Advances and Intervention Resources

“…Second, since children's disruptive problems often extend from family to peer relationships, several programs add other components that could be implemented with the teachers and the children themselves (both alone or combined). School-based programs resulted eicacious to improve self-regulation and social skills [28]. However, multimodal interventions are necessary when BPT alone is not suicient with children presenting severe disruptive behaviors or comorbid internalizing problems [29].…”

Long-term effects of two childhood psychosocial interventions on adolescent delinquency, substance use, and antisocial behavior: a cluster randomized controlled trial

“…Meta-analyses have also revealed larger effect sizes in studies with smaller sample sizes (Farrington and Welsh 2003;Koehler et al 2012), shorter follow-up periods (e.g., Dekovic et al 2011;Lösel and Beelman 2003), and high-risk samples (e.g., Koehler et al 2012), and in studies carried out by program developers (Beelmann and Lösel 2006;Wilson et al 2012). Thus, a recent meta-analysis concluded that there is "an obvious need for more effectiveness studies, carried out by independent researchers" (Smedler et al 2014).…”

“…In addition, very few methodologically rigorous studies have examined the long-term effectiveness of parent training and social skills programs on delinquency and externalizing behavior (Piquero et al 2009;Smedler et al 2014). In a recent review, Farrington and Welsh (2013) found only 12 studies that had followed participants in the long-term (at least 10 years), had sufficient sample size (at least 50 persons per condition), and included offending as an outcome.…”

Mental health in adolescence and subsequent receipt of medical benefits in young adulthood: The mediating role of upper secondary school completion

“…Effects sizes within this range are commonly reported in studies evaluating the effects of psychotherapy in children and adolescents [33]. When considering general, selective or indicated prevention programmes for mental health problems smaller effect sizes are reported (small-to-moderate at the best) [34,35]. Nevertheless, assuming our main model to be adequate, our results indicate that interventions reducing mental health problems in adolescence may have the potential to reduce the receipt of medical benefits in young adulthood, and that a mechanism for this estimated effect may be through school completion.…”