Most interventions for children are designed to tackle single disorders. But in real life, disorders usually come in clusters. For instance, up to 83% of children with depression are also diagnosed with disruptive behaviours. High rates of “co-morbidity” – when multiple disorders occur simultaneously – are found in both clinical settings and in the community, and among all races and ethnic groups.
Co-morbidity presents a real challenge for interventions like the popular Incredible Years(IY) parenting programme. Like most interventions, when IY was developed, it targeted only a single disorder: early onset conduct problems. However, some researchers have suggested that the pathways that create conduct problems are similar to those that create internalising disorders such as depression. So can the programme treat both childhood problems together?
A study led by researchers at the University of Missouri, in collaboration with IY’s developer Carolyn Webster-Stratton, suggests this may be possible. Children were selected for the study because they had conduct problems, but nearly two-thirds of the children also had internalising disorders, including 16% who had severe clinical anxiety and depression. The researchers found that IY reduced symptoms in about 40% of the children who began the study with internalising disorders.
Why was Incredible Years effective in treating co-morbidity in some of these children? The answer may lie in its three-part structure, which targets multiple risk factors – poor parenting, the child’s low social skills, and negative school environments. All three are risks for both conduct problems and internalising disorders. The three components of IY, parent training, teacher training and child training, can be delivered separately or in combination.
Their study recruited 159 families from the University of Washington Parenting Clinic. Each family had a child between four and eight years of age who was displaying aggressive or oppositional behaviour, and who was confirmed to have “oppositional defiant disorder.” Eligible families were randomly assigned to one of six conditions: parent training only; child training only; parent and teacher training; child and teacher training; all three simultaneously; or a control group. Families were interviewed before randomisation, after treatment, and one year later.
The results suggest that each of the five programme options produced better outcomes for children compared to the untreated control group, although the average amount of improvement was modest. But what really packed a punch was the three components in combination. Children in families that received all three components – the parent training, teacher training, and child training – benefited the most.
The authors note that the study, although relatively large by intervention evaluation standards, was too small to provide strong tests when the participants were divided across six different conditions.
Nonetheless, the findings from this study provide some important messages for practice. First, interventions currently in place to work with problem behaviour may be effective for emotional difficulties as well. Second, integration between services in the community and in schools is needed in order to coordinate the efforts of school psychologists and counsellors, social workers and clinicians, and families.
The authors conclude that multi-component interventions “that can simultaneously impact multiple problem behaviours of youth hold great potential for reducing the public burden of youth emotional and behaviour problems.”
Herman, K.C., Borden, L.A., Reinke, W.M., & Webster-Stratton, C. (2011). The impact of the Incredible Years parent, child, and teacher training programs on children’s co-occurring internalizing symptoms. School Psychology Quarterly, 26(3), 189-201.Return to Features