Online‐delivered parenting intervention for young children with disruptive behavior problems: a noninferiority trial focused on child and parent outcomes

Abstract

Background: This study evaluated whether an evidence-based parenting intervention, when delivered online, could effectively address disruptive behavior problems in young children and yield outcomes comparable to in-person delivery of the same intervention. Methods: Families (n = 334) of children (3-7 years; 63% White, 22% African American, 15% other races; 63% male) with disruptive behavior problems were randomized to online-delivered intervention (ODI) or staff-delivered intervention (SDI), resulting in baseline and demographic equivalence. Primary outcome measures for child disruptive behavior (independent observation, parent report) and secondary outcome measures of parenting and family impact were assessed at baseline, postintervention, and follow-up. Conducted using intent-to-treat (ITT) as well as per-protocol (PP) methods, noninferiority analyses, which drew on an HLM framework with repeat measures across three timepoints and on REML to provide unbiased estimates of model parameters, tested whether the outcome-difference CI did not exceed the a priori noninferiority margin. Results: For ITT and PP analyses, the ODI was found to be noninferior to the SDI on the primary outcome: independently observed child disruptive behavior and parent-reported child behavior problems. The pattern for secondary outcomes was more varied: (a) noninferiority for observed positive and aversive parenting; (b) noninferiority for observed quality of parent-child relationship at post but not follow-up assessment; (c) noninferiority for parent-reported inappropriate/ inconsistent discipline for PP but not ITT analyses; and (d) noninferiority not confirmed for parenting daily hassles and adverse family quality of life, despite large effect sizes for the ODI (Cohen's d .75-1.07). Finally, ODI noninferiority was found for teacher-reported child disruptive behavior. Conclusions: The tested online-delivered parenting intervention demonstrated clear noninferiority with the corresponding staff-delivered parenting intervention on the primary outcome, child disruptive behavior problems, and reflected substantial though nonuniform noninferiority and meaningful effect sizes for secondary outcomes related to parenting and family. Future research will guide optimization of online interventions.

Online-Delivered Over Staff-Delivered Parenting Intervention for Young Children With Disruptive Behavior Problems: Cost-Minimization Analysis

“…When comparing interventions from an economic perspective, cost-effectiveness is much more common than CMA because incremental effectiveness and costs are taken into account. In this study, however, CMA is more suitable because the two interventions were comparably efficacious [ 14 ], which obviates the need for cost-effectiveness analysis. The apparent simplicity of CMA should not detract from the fact that it rests on the same theoretical underpinnings as more complex economic evaluation methods such as cost-effectiveness analysis [ 21 ].…”

“…Characteristics of the trial included demographic and baseline equivalence across conditions, multi-source outcome measures (ie, observers, parents, and teachers), post-intervention and follow-up (12 months after baseline) outcome assessments, independent assessment of intervention fidelity, and analyses using both ITT and PP methods. A full description of the trial and outcomes is reported elsewhere [ 14 ]. The study design for the costing analysis was built on this randomized clinical trial.…”

“…DBPs assessed by both independent observation and parental reports defined the primary outcome. Details and results of the trial are reported elsewhere [ 14 ]. The main finding was that the online intervention substantially reduced child DBPs to a comparable extent as the staff-delivered intervention.…”

Kisgyermeket nevelő szülők támogatásának hazai és nemzetközi lehetőségei, személyes és távsegítő formái – szakirodalmi áttekintés

“…A Triple-P program esetében a már bizonyítottan hatékony jelenléti formát hasonlították össze az online megvalósított tréninggel. Az óvodáskorú gyermekek szüleinek nyújtott távolléti tréning legalább olyan olyan hatékonynak bizonyult, mint a jelenléti tréning (Prinz et al, 2021). Pozitívum ezeknél a programoknál, hogy a különböző tréningvariációkról is van elérhető hatásvizsgálat, például a Triple-P program esetében a szülőknek szóló podcastok hatékonyságát is vizsgálták.…”

“Will it Work as Well on Zoom?” A Natural Experiment During the Covid-19 Pandemic of Delivering Parenting Groups Via Video Conferencing or in Person

“…There is a growing evidence base for the effectiveness of delivering parenting programs through digital solutions (Baumel et al, 2016 ; Bausback & Bunge, 2021 ; Thongseiratch et al, 2020 ). Even when modes of delivery were compared directly in the same study, a digital version was found to be non-inferior to the on-site version of a parenting program (Prinz et al, 2022 ). However, most studies of remotely delivered parenting programs have relied on self-directed content (e.g., internet-based programs with text, videos, and online-based exercises) with therapist support through text messaging or telephone.…”