IMPORTANCE There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.

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This intervention holds promise as an accessible, sustainable, and effective program to address insomnia in school-aged children.

This systematic review and meta-analysis evaluated the efficacy of distance-delivered, guided approaches to treatment (e.g., delivered via telephone, Internet, mail, videoconferencing) for clinical and subclinical posttraumatic stress disorder (PTSD). A comprehensive search yielded 19 randomized controlled trials (1491 participants) to be included. Meta-analyses revealed that distance-delivered interventions led to significant within-group improvements in PTSD symptoms at post-treatment (g=0.81, 95% CI 0.65 to 0.97) and 3-6 month follow-up (g=0.78, 95% CI 0.59 to 0.97). Within-group depression and quality of life outcomes showed similar results, with medium post-treatment and follow-up effects. Compared to a waiting list, distance delivery (specifically, Internet treatments) led to superior PTSD outcomes (g=0.68, 95% CI 0.51 to 0.86). Compared to face-to-face interventions, distance delivery (specifically, videoconferencing treatments) did not result in significantly different PTSD outcomes at post-treatment (g=-0.05, 95% CI -0.31 to 0.20) but led to inferior outcomes at 3-6 month follow-up (g=-0.25, 95% CI -0.44 to -0.07). Distance delivery of PTSD treatment is promising, but research is needed to determine its optimal use.