Division of Psychiatry, University College London, London, United Kingdom.
Evelina London Children's Hospital, St Thomas' Hospital, and King's College London, London, United Kingdom.
PLoS One. 2024 Aug 13;19(8):e0306182. doi: 10.1371/journal.pone.0306182. eCollection 2024.
There is limited evidence on the effectiveness of parenting interventions to improve disruptive behaviour in children with intellectual developmental disabilities. This clinical trial evaluated whether an adapted group parenting intervention for preschool children with intellectual developmental disabilities who display challenging behaviour is superior to treatment as usual in England.
261 children aged 30-59 months with moderate to severe intellectual developmental disabilities and challenging behaviour were randomised to either the intervention (Stepping Stones Triple P) and treatment as usual or treatment as usual alone. The primary outcome was the parent-rated Child Behaviour Checklist at 52 weeks after randomisation. A health economic evaluation was also completed.
We found no significant difference between arms on the primary outcome (mean difference -4.23; 95% CI: -9.99 to 1.53; p = 0.147). However, a subgroup analysis suggests the intervention was effective for participants randomised before the COVID-19 pandemic (mean difference -7.12; 95% CI: -13.44 to -0.81; p = 0.046). Furthermore, a complier average causal effects analysis (mean difference -11.53; 95% CI: -26.97 to 3.91; p = 0.143) suggests the intervention requires participants to receive a sufficient intervention dose. The intervention generated statistically significant cost savings (-£1,057.88; 95% CI -£3,218.6 to -£46.67) but the mean point estimate in Quality Adjusted Life Years was similar in both groups.
This study did not find an effect of the intervention on reducing challenging behaviour, but this may have been influenced by problems with engagement. The intervention could be considered by services as an early intervention if families are supported to attend, especially given its low cost.
针对有智力发育障碍且表现出问题行为的学龄前儿童，现有育儿干预措施在改善其行为问题方面的效果证据有限。本临床试验评估了针对有智力发育障碍且表现出问题行为的学龄前儿童的改良团体育儿干预措施在英国是否优于常规治疗。
261 名年龄在 30-59 个月、有中度至重度智力发育障碍且行为问题严重的儿童被随机分配至干预组（Stepping Stones Triple P）和常规治疗组或仅接受常规治疗组。主要结局是在随机分组后 52 周时家长评定的儿童行为检查表。同时还进行了健康经济学评价。
我们未发现干预组和常规治疗组在主要结局上有显著差异（平均差值-4.23；95%CI：-9.99 至 1.53；p=0.147）。但是，亚组分析表明，该干预措施对在 COVID-19 大流行前随机分组的参与者有效（平均差值-7.12；95%CI：-13.44 至 -0.81；p=0.046）。此外，遵从性平均因果效应分析（平均差值-11.53；95%CI：-26.97 至 -0.41；p=0.143）表明，该干预需要参与者接受足够的干预剂量。该干预措施产生了统计学上显著的成本节约（-£1057.88；95%CI：-£3218.6 至 -£46.67），但两组的健康调整生命年的平均点估计值相似。
本研究未发现该干预措施在减少行为问题方面有效果，但这可能受到参与度问题的影响。如果家庭得到支持参加，该干预措施可被服务部门考虑作为早期干预措施，尤其是因为其成本低。
