Remote intervention of children's disruptive behaviour yields effective results

Training parents online and over the telephone significantly decreased preschool children's disruptive behaviour, shows the new Strongest Families study from the Research Centre for Child Psychiatry at the University of Turku. The intervention programme decreased children's aggressiveness, noncompliant behaviour, ADHD symptoms, and emotional problems as well as strengthened their ability to feel empathy.

The research was supported by the Academy of Finland, the Canadian Institutes of Health Research, Jane and Aatos Erkko Foundation, Kummit Association and Margaretha Foundation.

The Strongest Families intervention programme supports parents and provides them with tools to confront and reduce their child's disruptive behaviour. The study and its results were published in the esteemed JAMA Psychiatry journal. It is the first randomised study in the world to be published and it was based on screened population and carried out in a digital treatment environment as a secondary prevention parent training. The study is also the largest research project in Finland that focuses on early detection, intervention and prevention of mental health problems in families with children.

The effectiveness of the programme was evaluated on a six and twelve-month follow-up period. The target group of the study consisted of the 4,656 families that participated in the annual child health clinic check-ups for four-year-old children. 730 families, whose four-year-old had behavioural problems and parents felt that the child's behaviour was disruptive, were selected to the study.

Half of the screened families participated in the 11-week intervention programme. The parents received support each week over the telephone by their personal family coach and, at the same time, they studied skills for positive parenting on the Strongest Families website. In contrast, the control group received an information package supporting parenting skills and one phone call.

The study indicates that during the 12-month follow-up the behavioural problems of the four-year-old children reduced significantly in the families who participated in the 11-week programme compared to the control group . In the intervention group, parenting skills as well as the child's disruptive behaviour, ADHD symptoms, anxiety, sleep problems and empathy improved significantly when compared with the control group and the results were permanent throughout the 12-month follow-up. During the year's follow-up, over 80 percent of the children whose parents received the training would not have been selected for the intervention programme for their disruptive behaviour. In the control group that received more limited support, the percent was 66.

The significance of the results becomes apparent when they are compared with earlier cohort studies, which have indicated that the behavioural problems are permanent in half of preschool children , explains Professor of Child Psychiatry Andre Sourander who led the study.

Sourander emphasises the importance of the intervention programme in preventing antisocial behaviour.

The results are significant as disruptive behaviour in childhood is linked to mental health problems, criminality, substance abuse and higher mortality in adulthood. Disruptive behaviour that starts in childhood is also connected to adolescent intoxication, smoking from an early age, poor life management skills and excess weight, which are central risk factors for health problems later in life.

The intervention programme focuses on noticing and strengthening children's good behaviour. The parents were instructed to ignore mild bad behaviour and to anticipate transitional situations. It is easier for a child to succeed in new situations when they are planned beforehand together with the child. Parents who earlier experienced their child as difficult received tools for solving everyday problems and learnt to value their child in a new way.

At the Research Centre for Child Psychiatry, researchers are developing new low-threshold treatment programmes that are based on digital care environment and telephone coaching. Sourander reveals that the Strongest Families programme will be incorporated into the preventive mental health care system in different parts of Finland. The Strongest Families is a suitable support and intervention programme for the risk group identified from the entire age group.

There are great opportunities in Finland to systematically utilise this kind of intervention, as the needed expertise and infrastructure exist already and the entire population is covered by the national health care system. With a nation-wide early intervention programme, Finland could be a pioneer in the prevention of different kinds of problems related to health and behaviour, concludes Sourander.