King's College London, Institute of Psychiatry, UK.
J Child Psychol Psychiatry. 2010 Jan;51(1):48-57. doi: 10.1111/j.1469-7610.2009.02127.x. Epub 2009 Sep 1.
There is a pressing need for cost-effective population-based interventions to tackle early-onset antisocial behaviour. As this is determined by many factors, it would seem logical to devise interventions that address several influences while using an efficient means of delivery. The aim of this trial was to change four risk factors that predict poor outcome: ineffective parenting, conduct problems, attention deficit/hyperactivity disorder (ADHD) symptoms, and low reading ability.
A randomised controlled trial was carried out in eight schools in London, England. Nine hundred and thirty-six (936) 6-year-old children were screened for antisocial behaviour, then parents of 112 high scorers were randomised to parenting groups held in schools or control; 109 were followed up a year later. The intervention lasted 28 weeks and was novel as it had components to address both child behaviour (through the Incredible Years programme) and child literacy (through a new 'SPOKES' programme to help parents read with their children). Fidelity of implementation was emphasised by careful training of therapists and weekly supervision. Controls received an information helpline. Assessment of conduct problems was by parent interview, parenting by direct observation and child reading by psychometric testing.
At follow-up parents allocated to the intervention used play, praise and rewards, and time out more often than controls, and harsh discipline less; effect sizes ranged from .31 to .59 sd (p-values .046 to .005). Compared to control children, whose behaviour didn't change, intervention children's conduct problems reduced by .52sd, (p < .001), dropping from the 80th to the 61st percentile; oppositional-defiant disorder (ODD) halved from 60% to 31% (p = .003). ADHD symptoms reduced by .44sd (p = .002), and reading age improved by six months (.36sd, p = .027). Teacher-rated behaviour didn't change. The programme cost pound2,380 ($3,800) per child.
Effective population-based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity.
需要采取经济有效的基于人群的干预措施来解决早期出现的反社会行为问题。由于这受到许多因素的影响，因此设计能够解决多种影响因素的干预措施，并采用高效的实施方式似乎是合乎逻辑的。本试验的目的是改变四个预测不良预后的风险因素：无效的育儿方式、行为问题、注意力缺陷/多动障碍（ADHD）症状和阅读能力低下。
在英国伦敦的 8 所学校进行了一项随机对照试验。对 936 名 6 岁儿童进行反社会行为筛查，然后对 112 名高分儿童的家长进行随机分组，分别进入学校育儿组或对照组；其中 109 名儿童在一年后进行了随访。干预持续 28 周，具有创新性，因为它既有针对儿童行为的组成部分（通过“难以置信的岁月”计划），也有针对儿童读写能力的组成部分（通过新的“SPOKES”计划，帮助父母与孩子一起阅读）。通过对治疗师进行仔细培训和每周监督，强调了实施的保真度。对照组接受信息热线。通过家长访谈评估行为问题，通过直接观察评估育儿方式，通过心理测试评估儿童阅读能力。
随访时，与对照组相比，分配到干预组的家长更频繁地使用游戏、表扬和奖励，以及使用暂停时间，而更少使用严厉的纪律；效果大小范围从 0.31 到 0.59 标准差（p 值分别为 0.046 到 0.005）。与对照组儿童的行为没有变化相比，干预组儿童的行为问题减少了 0.52 标准差（p < 0.001），从第 80 百分位降至第 61 百分位；对立违抗障碍（ODD）从 60%减半至 31%（p = 0.003）。ADHD 症状减少了 0.44 标准差（p = 0.002），阅读年龄提高了 6 个月（0.36 标准差，p = 0.027）。教师评定的行为没有变化。该方案每个孩子的成本为 2380 英镑（3800 美元）。
通过针对多个风险因素并强调实施保真度，以改善具有反社会行为的人群的有效基于人群的早期干预在实践上是可行的。
