University of Amsterdam, Amsterdam, The Netherlands.
University of Exeter, Exeter, UK.
J Child Psychol Psychiatry. 2022 Feb;63(2):132-142. doi: 10.1111/jcpp.13483. Epub 2021 Jul 9.
Programs to support parents are the recommended strategy to reduce disruptive child behavior problems. Efforts have been made to demonstrate which program components (i.e., clusters of techniques taught) increase program effects, but these methods fail to account for the fact that components rarely operate in isolation. We examine how combinations of components cluster together to form program types and use network meta-analysis to estimate the relative effects of these program types.
We updated an existing systematic review of parenting programs for disruptive child behavior and identified 197 randomized trials. We modeled clusters of components in each trial arm and chose the best-fitting model. We subsequently took 20 draws from the probability distribution of the latent class for each arm, entered each draw into a network meta-analysis model and combined findings using Rubin's rules. Combined estimates were bootstrapped to rank the clusters. We estimated main models and separate models for prevention and treatment settings.
A five-class solution fit the data best: (1) behavior management; (2) behavior management with parental self-management; (3) behavior management with psychoeducation and relationship enhancement; (4) maximal component loading and (5) no/minimal component loading (i.e. control). In the main model and in treatment settings, all four program types were effective compared to no/minimal components. In prevention settings, only behavior management and behavior management with parental self-management were effective compared to no/minimal components. Probabilistic ranking showed that overall and in treatment settings, behavior management had the largest chance, and in prevention settings, behavior management with self-management had the largest chance, of being most effective compared to no/minimal components.
Programs with more focused content seem more likely to yield stronger effects, and different foci may be needed in treatment versus prevention settings. Next steps include identifying individual family differences in optimal program content.
支持父母的计划是减少儿童行为问题的推荐策略。已经努力证明哪些计划组成部分（即教授的技术集群）可以增加计划效果，但这些方法没有考虑到一个事实，即组成部分很少孤立地运作。我们研究了组件如何组合成程序类型，并使用网络荟萃分析来估计这些程序类型的相对效果。
我们更新了关于破坏性儿童行为的养育计划的现有系统评价，并确定了 197 项随机试验。我们对每个试验组的组件集群进行建模，并选择最佳拟合模型。随后，我们从每个臂的潜在类别概率分布中抽取 20 个样本，将每个样本输入网络荟萃分析模型，并使用鲁宾规则进行合并。合并的估计值进行了自举，以对集群进行排名。我们估计了主要模型和预防与治疗环境的单独模型。
五类解决方案最适合数据：（1）行为管理；（2）行为管理加上父母自我管理；（3）行为管理加上心理教育和关系增强；（4）最大组件加载；（5）最小组件加载（即对照）。在主要模型和治疗环境中，与最小组件相比，所有四种计划类型均有效。在预防环境中，只有行为管理和父母自我管理的行为管理与最小组件相比有效。概率排名显示，总体而言，在治疗环境中，行为管理比最小组件更有可能最有效，而在预防环境中，行为管理加上自我管理比最小组件更有可能最有效。
内容更集中的计划似乎更有可能产生更强的效果，并且在治疗与预防环境中可能需要不同的重点。下一步包括确定最佳计划内容的个体家庭差异。
