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Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial

  • Helen Baker-Henningham (a1), Stephen Scott (a2), Kelvyn Jones (a3) and Susan Walker (a1)
Abstract
Background

There is an urgent need for effective, affordable interventions to prevent child mental health problems in low- and middle-income countries.

Aims

To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home.

Method

In a cluster randomised design, 24 community pre-schools in inner-city areas of Kingston, Jamaica, were randomly assigned to receive the Incredible Years Teacher Training intervention (n = 12) or to a control group (n = 12). Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation, giving 225 children aged 3–6 years. The primary outcome was observed child behaviour at school. Secondary outcomes were child behaviour by parent and teacher report, child attendance and parents' attitude to school. The study is registered as ISRCTN35476268.

Results

Children in intervention schools showed significantly reduced conduct problems (effect size (ES) = 0.42) and increased friendship skills (ES = 0.74) through observation, significant reductions to teacher-reported (ES = 0.47) and parent-reported (ES = 0.22) behaviour difficulties and increases in teacher-reported social skills (ES = 0.59) and child attendance (ES = 0.30). Benefits to parents' attitude to school were not significant.

Conclusions

A low-cost, school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school.

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Copyright
Royal College of Psychiatrists, This paper accords with the Wellcome Trust Open Access policy and is governed by the licence available athttp://www.rcpsych.ac.uk/pdf/Wellcome%20Trust%20licence.pdf
Corresponding author
Helen Baker-Henningham, Tropical Medicine Research Institute, University of the West Indies, Mona, Kingston, Jamaica. Email: helen.henningham@uwimona.edu.jm
Footnotes
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See editorial, pp. 85–87, this issue.

The project was funded by a Wellcome Trust Research Training Fellowship to H.B.H. [080534/Z/06/Z].

Declaration of interest

S.S. is a trainer in the Incredible Years Parenting Programme.

Footnotes
References
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Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial

  • Helen Baker-Henningham (a1), Stephen Scott (a2), Kelvyn Jones (a3) and Susan Walker (a1)
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eLetters

Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial - a reply

Rishab Gupta, Senior Resident (Deptt of Psychiatry)
15 August 2012

We commend Baker-Henningham et al 1 for carrying out a relevant and important intervention study on pre-school children with conduct problems and poor social skills in a middle income country. Classroom and school intervention studies are sparse from lower and middle income countries andthis work is advancement in the appropriate direction. The study, however,merits attention on certain issues. Authors chose pre-school children (age3-6 years) as target population for their intervention whereas typical ageof manifesting conduct disorder is 11.6 years.2 They also did not mention explicitly whether the children had syndromal diagnosis of conduct disorder. Assessment of ADHD, visual and hearing deficits, intellectual disability, and pervasive developmental disorders would have led to betterinterpretation of results, as these conditions may impact the outcome of conduct problems.3 Children with low attendance were excluded from the study, while it is known that children with severe conduct problems may show truancy from school. This might have led to inadvertent selection of children with less severe conduct problems in the study. Statistically significant improvements were not found in the parent reports of conduct problems. This suggests that the improvements were limited to the school setting, and did not generalize further to home. Probably, interventions like Incredible Years Teacher Training helps teachers to manage difficult pupils better in school and promote friendships, and deserves place in the teachers' training curricula. The authors took only children with severe problems for assessment and wonder benefits accrued to those with low-to-moderate levels of conduct problems. Evidence on other psychiatric disorders suggests that improvement is more in those with severe form of illness and effects are less when the symptoms are sub-threshold and approach normalcy.4 Drawing acorollary, severely disordered children are expected to be benefitted more. This in turn may have a domino effect on behaviour of other children.The developmental complexities of child behaviour are immense. Interventions that afford help to children and the community are likely topay dividends as these children mature. References:1 Baker-Henningham H, Scott S, Jones K, Walker S. Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial. Br J Psychiatry 2012; 201: 101-8.2 Nock MK, Kazdin AE, Hiripi E, Kessler RC. Prevalence, subtypes, and correlates of DSM-IV conduct disorder in the National Comorbidity Survey Replication. Psychol Med 2006; 36: 699-710.3 Connor DF. Disruptive Behavior Disorders. In Kaplan & Sadock's comprehensive textbook of psychiatry (Ninth.) (eds BJ Sadock, VA Sadock, PRuiz): 3580-96. Wolters Kluwer Health/Lippincott Williams & Wilkins, 2009.4 Ustun TB, Sartorius N. Mental Illness in General Health Care: An International Study. John Wiley & Sons, 1995.

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