Outcome Findings from a Parent Training
Programme for Young People with Conduct
Problems
Geoffrey Baruch1
, Ioanna Vrouva2
& Charles Wells1
1
Brandon Centre for Counselling and Psychotherapy for Young People, 26 Prince of Wales Road, London NW5 3LG, UK.
E-mail: gfbaruch@btconnect.com
2
Research Department of Clinical, Educational and Health Psychology University College London, 1-19 Torrington Place,
London, WC1E 7HB, UK
Background: Group-based parent training programmes are a common intervention for tackling conduct
problems in young people. The objective of this study was to evaluate the impact of a parent training
programme on young people presenting with conduct problems. Method: 123 parents of young people aged
10 to 17 with conduct problems participated in the study. A one-group, pre-post design was adopted. Participants
completed the Child Behaviour Check List (CBCL) at the beginning and end of the parenting programme.
The degree of change was indexed by: a) Mean change; b) change from clinical to non-clinical status;
and c) Reliable change. Logistic regression was used to identify predictors of reliable positive change in CBCL
problems. Results: Analyses from all three sources suggest that there was a significant reduction in CBCL
internalising, externalising and total scores. Withdrawn score pre-treatment was the only independent predictor
of reliable change in internalising and total scores: the higher the score pre-treatment, the greater the
chances of reliable improvement in post-treatment scores. Conclusions: The study provides evidence in support
of the therapeutic improvement achieved by some young people whose parents attended the group
parent training programme. The programme had a significant impact on internalising as well as externalising
problems. Further studies of the programme would benefit from being run as a randomised clinical trial.
Key Practitioner Message:
• Group-based parent training is effective in reducing conduct problems in young people
• Group-based parent training has a significant impact on internalising problems in young people
• Outcomes for group-based parent training might be improved if the young person as well as the parent attends
group sessions
Keywords: Parent-training; conduct problems; adolescents; outcome
Introduction
Conduct disorder and oppositional defiant disorder
(ODD) affect 8.1% of boys and 2.8% of girls between 11
and 16 (Green et al., 2005) and are the most common
reason for referral to CAMHS (Ford et al., 2007). Conduct
disorder is associated with severe functional
impairment (Lambert et al., 2001) and often presents
with disorders such as depression, anxiety and ADHD
(Ford, Doodman, & Meltzer, 2003). Young people with
conduct disorder are likely to have worse mental health,
less successful family lives, and poorer social and economic
prospects in adulthood (Colman et al., 2009).
Left untreated, conduct disorders are also economically
costly (Scott et al., 2001).
Parent training programmes are effective for treating
conduct and oppositional disorders (NICE, 2006; Reyno
& McGrath, 2006; Kazdin, 2005; Fonagy et al., 2002;
Sanders et al., 2000; Brestan & Eyberg, 1998). Groupbased
parent-training programmes have become a
common intervention for tackling conduct disorders in
children and young people. NICE Clinical Guideline 77
(2009) on the treatment, management and prevention of
antisocial personality disorder recommends parenttraining
programmes for 12 to 17 year olds with
conduct problems among a range of parent and family
focused interventions including Multisystemic Therapy
(MST) and Functional Family Therapy for severe and
persistent antisocial behaviour.
Parent training uses behaviour management principles
taken from social learning theory (Miller & Prinz,
1990; Kazdin, 2005; Scott & Yule, 2008; Scott & Dadds,
2009). It includes training parents in how to track and
monitor behaviour, training in the use of positive reinforcements
and training to use mild punishment in an
immediate and predictable manner.
This paper reports on the outcomes of Parenting with
Love and Limits (PLL), a manualised group parent
Child and Adolescent Mental Health Volume 16, No. 1, 2011, pp. 47–54 doi: 10.1111/j.1475-3588.2010.00574.x
Ó 2010 The Authors. Child and Adolescent Mental Health
Ó 2010 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main St, Malden, MA 02148, USA
training programme for parents of teenagers with
challenging behaviour rated exemplary by the Office of
Juvenile Justice and Delinquency Prevention (Sells,
1998, 2001; Smith et al., 2006; http://www.diffi-
cult.net).
Findings from an audit of the Brandon CentreÕs psychotherapy
service showed a high rate of dropout for
young people with conduct disorders and that a diagnosis
of conduct disorder in younger adolescents increased
the probability of them dropping out (Baruch,
Gerber, & Fearon, 1998; Baruch, Vrouva, & Fearon,
2009). These findings were the impetus for piloting
parent training as an alternative to psychotherapy in
order to improve the impact of our service on young
people presenting with antisocial behaviour. Improving
their attendance in psychotherapy was not a purpose of
the pilot.
Method
Participants
The data are drawn from 224 adult parents of 10-17
year old adolescents with behavioural problems who
attended the CentreÕs parent-training programme for
the first time between January 2005 and May 2008.
About 77.1% of the parents who participated were
mothers, 2.7% were fathers, and both parentsÕ participation
rate was 20.2%. We confirm the research meets
the ethical guidelines, including adherence to the legal
requirements of the UK.
Fifty-eight parents (25.9%) completed the programme
but did not complete the Child Behaviour Check List
(CBCL) (Achenbach, 1991a) post-treatment and 43
parents (19.2%) dropped out. The analysed sample
therefore consists of 123 adults (54.9% of the total
sample), who provided CBCL data pre-and post-treatment.
The mean CBCL scores of the analysed sample
pre-treatment were 62.8 (SD=11), 69.1 (SD=7.9) and
67.5 (SD=8.3) for internalising, externalising and total
problems respectively. The corresponding means for the
non-analysed sample were very similar, i.e. 62.7
(SD=9.9), 68.6 (SD=1.7) and 67.5 (SD=9.8) for internalising,
externalising, and total problems respectively.
Table 1 presents some demographic characteristics and
problems presented by the young people whose parents
participated in the study.
The majority of participants lived with their mother,
and attended mainstream school. They were primarily
referred for behaviour problems at home and at school.
Antisocial behaviour problems (97.5%), family problems
(90.9%) and school problems (81.8%) were the
most common problems presented. About 83% of participants
lived in the London Boroughs of Camden or
Islington, and represented most wards of these
boroughs, which are among the 20% most deprived
boroughs in the country (Index of Multiple Deprivation
(IMD), 2007).
Using the variables presented in Table 1 and the
parenting and CBCL scale scores at intake (see
Table 2), we carried out independent samples t-tests
and found that the analysed group had significantly
higher overall level of functioning and significantly
lower scores on severity of psychosocial stressors than
those parents who did not provide data post-treatment
(p < .001). Moreover, the analysed group attended significantly
more sessions (p < .01). The analysed group
attended on average 8.5 (SD=3.7) sessions, whereas the
non-analysed group attended on average 6.2 (SD=3)
sessions. There were no other significant differences
between these groups.
Setting and intervention
The Brandon Centre is a community-based, voluntary
sector service that provides contraception, sexual
health and psychotherapy for 12 to 21 year olds. As well
as parent training, the Centre also offers MST (Wells et
al., in press). Parents referred to the programme receive
a consultation with one of the group facilitators. Following
the consultation they receive the dates of sessions
in writing and are sent a text message before each
session as a reminder about the class.
Parenting With Love and Limits (PLL) can be delivered
as a group and family intervention or as a parenttraining
programme with or without teenagers participating
in the programme. At the Brandon Centre PLL is
aimed at parents of 11 to 17 year olds with behaviour
problems, which are assessed according to parentsÕ
concerns. The programme is intended to equip parents
with strategies for managing and improving challenging
behaviour. The group can accommodate up to 12 parents.
There are six, 2-hour classes that cover parentteen
interaction, behavioural contracts, appropriate
consequences for high-risk challenging behaviour,
praising the teenager, nurturance strategies, and how
to enlist and use outside support. The classes use direct
teaching, role-play and DVD clips that accompany the
programme.
Parents are encouraged to prepare for classes by
reading the relevant chapter from Parenting your out-ofcontrol
teenager (Sells, 2001), a manual for parents that
accompanies the programme. They are also encouraged
to practise specific skills, which they learn through roleplays
in the sessions and through practice with their
teenager at home as part of homework.
Design
After a parent or carer has been accepted on the programme,
she/he is sent a CBCL form to complete and
return by first class mail. After completion of the programme,
usually 3 to 6 months after the first class, the
parent or carer is asked to complete the CBCL form for a
second time.
Measures
The measures used in this study (including reliabilities)
follow those presented in earlier papers (e.g. Baruch,
1995; Baruch & Fearon, 2002). Following an
interview with the young personÕs parent(s), the therapist
assigns one or more diagnoses using a slightly
modified version of ICD-10 (World Health Organisation,
1990). There are nine commonly used diagnostic
groupings describing psychological problems. The
therapist fills out the CentreÕs own Presentation of
Problems Form comprising 34 items describing the
young personÕs current problems. Other areas of
interest assessed include the young personÕs demographic
characteristics, as well as treatment related
information, including source of referral, number of
weeks between first approach and first appointment at
the Centre.
48 Geoffrey Baruch et al.
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
The Global Assessment of Functioning Scale (GAF;
APA, 1994) was used to estimate the young personÕs
overall level of functioning, as described by the parent,
according to guidelines on a scale of 1 to 100 of
increasing functioning. In addition, the Severity of
Psychosocial Stressors Scale for Children and Adolescents
(SPSS; APA, 1994) was used to assess the young
personÕs psychosocial stressors, as reported by the
parent, on a scale of increasing severity from 1 to 6.
The CBCL was the primary outcome measure in the
study. The CBCL is a broad-spectrum inventory that
records, in standardised format, the emotional and
behavioural problems of children and adolescents aged
4–18, as reported by their parents or parent surrogates.
The CBCL comprises 118 items, which contribute to
eight specific dimensions of dysfunction: anxious/depressed,
somatic complaints, withdrawn, social
problems, thought problems, attention problems,
delinquent and aggressive behaviour. Five of the subscales
are aggregated into two global dimensions of
disturbance, termed internalising behaviour and
externalising behaviour, and yield a total problem
score. A large body of research has demonstrated the
reliability and validity of the CBCL in clinical and nonclinical
populations (e.g. Ivanova et al., 2007; Lengua et
al., 2001) and there is substantial empirical evidence
supporting the usefulness of the CBCL as an outcome
measure (Achenbach, 1991a; Be´rube´ & Achenbach,
2007).
Statistical analysis
Outcome in internalising problems, externalising
problems and total problems was assessed in three
ways: a) comparing pre-and post-treatment CBCL mean
scores; b) estimating the percentage of participants who
moved from the clinical into the non-clinical range or
vice versa; and c) estimating the presence of reliable
change (RC) in the level of adaptation (Christensen &
Mendoza 1986), which is based upon estimates of the
Table 1. Demographic and clinical characteristics of the young people whose parents attended the Centre’s parenting programme
Demographic and clinical characteristics
of the young people
Study sample
(N=123)
No follow-up
sample (N=101)
Mean age, years (SD) (min. 10 - max. 17) 14 (1.4) 13.9 (1.5)
Female (%) 42.6 46
Ethnic minorities (%) 26.8 33
Parents married (%) 28.3 16.3
Living with mother (%) 62.8 75.5
Living with father (%) 5.8 2
Living with relatives (%) 1.7 1
Living with both natural parents (%) 25.6 12.2
Living with adoptive or foster parents (%) 3.3 4.1
Living in other situations (%) .8 5.2
Attending mainstream school (%) 89.3 90.6
Attending PRU/EBD1
school (%) 6.6 4.2
Not attending school (%) 3.3 3.1
Permanently excluded from school in the last 12 months (%) 10.7 20.4
Temporarily excluded from school in the last 12 months (%) 15.7 22.6
Primarily referred for behaviour problems at home (%) 42.5 52.1
Primarily referred for behaviour problems at school (%) 42.3 33.3
Primarily referred for antisocial behaviour (%) 13.3 14.6
Secondarily referred for behaviour problems at home (%) 49.5 41
Secondarily referred for behaviour problems at school (%) 28 44.9
Secondarily referred for antisocial behaviour (%) 8.4 5.1
Antisocial behaviour (%) 97.5 99
Family problems (%) 90.9 96.9
School problems (%) 81.8 85.4
Emotional problems (%) 28.9 28.1
Substance misuse (%) 30 32.3
Developmental Issues and Separation Anxiety (%) 10 9.4
Bereavement (%) 9.2 15.6
Thoughts of Deliberate Self-Harm (%) 7.4 6.2
Sexual and Relationship Problems (%) 8.3 16.7
Suicide Attempt (%) 5.8 6.2
Median number of current problems presented 4 4
Median rating for Severity of Psycho-Social Stressors (SPSS) scale (1-6) 4 4
Mean score (SD) on Global Assessment of Functioning (GAF) Scale2 (min. 40- max. 70) 57.3 (6.3) 53.6 (7.8)
1
RU: Pupil Referral Unit. EBD: Emotional and Behavioural Difficulties
2
score of 70 is normally considered to be the cut-off point between the normal and clinical ranges.
Table 2. Means and standard deviations of pre- and post-treatment
CBCL1
internalising, externalising and total scores (N = 123)
Outcome variable
Pre-treatment
Mean (SD)
Post-treatment
Mean (SD)
CBCL Internalising scores 62.8 (11) 56.5 (10.4)
CBCL Externalising scores 69.1 (7.9) 63.3 (9.7)
CBCL Total scores 67.5 (8.3) 61.3 (9)
1
CBCL: Child Behaviour Check List
A Parent Training Programme 49
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
standard error (SE) of measurement (Guilford, 1965). If
the change in a scale score from pre-treatment to the
follow-up assessment has changed as much as 1.65 SE
of measurement, there is a 90% chance that this is a
non-chance change.
Changes over time were analysed using paired samples
t tests. The McNemar test was used to assess the
difference in the proportion of those in the clinical range
between pre- and post-treatment. Independent samples
t tests and chi-square tests were conducted to test for
differences in demographic, diagnostic characteristics,
and CBCL, GAF and SPSS scores at intake, between
participants who reported positive RC after completion
of programme and participants who did not report such
change. Binary logistic regression was used to identify
predictors of reliable improvement in CBCL problems.
Results
The results are presented in two sections. Section one
deals with the degree of change in CBCL problems
between pre- to post-treatment as indexed by: (1) Mean
change; (2) Clinical significance; and (3) Reliable
change. The second section describes a series of
exploratory analyses aimed at identifying factors associated
with reliable positive change at the end of the
programme.
Mean change
Although there is arguably less clinical utility in measuring
broad changes in group means over time, one
advantage of doing so is that these analyses offer a
detailed description of the change, and they also facilitate
comparisons with previous work (Baruch & Fearon,
2002). We thus carried out three paired samples t tests
of pre- and post-treatment CBCL scores. There were
significant decreases post-treatment for internalising
problems, t(122) = 6.8, p < .001, externalising problems,
t(122) = 8.1, p < .001, and total problems, t(122) =
8.7, p < .001. The means and standard deviations of
these scores are presented in Table 2.
Given that the data analysed represent just above
half (54.9%) of the total sample, an intention-to-treat
analysis was conducted, assuming that the missing
post-treatment data of the non-analysed group would
be equal to this groupÕs pre-treatment data (i.e.
assuming no change). The decreases remained significant
for the total sample, for internalising problems,
t(223) = 6.3, p < .001, for externalising problems, t(223)
= 7.3, p < .001, and for total problems, t(223) = 7.7, p <
.001.
As there were substantial correlations between the
three dimensions of the CBCL, the results of the t tests
are overlapping. For example, total behaviour problems
should be seen as a summary score rather than a distinct
domain of symptomatology.
Upon completion of the programme, the group mean
for internalising problems changed from the clinical to
the non-clinical range (i.e. below 60), for externalising
problems it remained within the clinical range, and for
total problem scores the group mean changed from the
clinical to the borderline range (i.e. below 63). The effect
sizes of these differences in mean behaviour problems
over time were CohenÕs d = 0.61 for internalising problems,
d = 0.73 for externalising problems and d = 0.79
for total problems.
Clinical significance
Using a score of 60 recommended by Achenbach
(1991a) as the boundary between the borderline clinical
and the non-clinical range, there were significant
improvements in the proportion of participants reporting
problems in the non-clinical range. The difference in
the proportion of young people falling in the clinical
range pre- and post-treatment was significant for internalising,
externalising and total problems (McNemar
test, p < .001). Table 3 shows the overall frequencies of
improvement, deterioration, and no change.
Reliable change
In the data presented in this paper, the RC index for
boys is 6, 5 and 5 points (using 1.65 SE of measurement)
for the CBCL internalising, externalising and
total problem scores respectively. For girls, the corresponding
RC index was the same, apart from the total
scoresÕ index, which was 6 points.
Using RC as the criterion for improvement, there were
substantial levels of improvement at the end of the
programme. More than half of the participants reported
reliable improvement for all types of problems (54.5%
for internalising, 55.3% for externalising and 54.5% for
total problems). The rate of reliable deterioration was
12.2%, 8.1% and 5.7% for internalising, externalising
and total problems respectively.
Table 4 shows the frequency of reliable improvement,
reliable deterioration and no change for internalising,
externalising and total problems.
Predictors of improvement
On the basis of the previous independent samples t
tests and chi-square tests, we then selected the predictors
and carried out binary logistic regressions, in
order to identify which variables, when taken together,
make significant independent contributions to the prediction
of reliable positive change in CBCL internalising
scores.
Table 3. Frequency of clinical levels of pre- and post-treatment CBCL1
internalising, externalising and total scores (N = 123)
Internalising problems Externalising problems Total problems
Frequencies Percent Frequencies Percent Frequencies Percent
Clinical to non-clinical change 42 34.1 26 21.1 33 26.8
Non-clinical to clinical change 6 4.9 3 2.4 1 .8
Remained in clinical range 41 33.3 83 67.5 73 59.3
Remained in non-clinical range 34 27.6 11 8.9 16 13
1
CBCL: Child Behaviour Check List
50 Geoffrey Baruch et al.
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
As described in Table 5, independent samples t-tests
showed young people whose internalising scores were
reduced reliably to have higher scores on four CBCL
subscales pre-treatment. These subscales were anxious/depressed,
somatic complaints, withdrawn, and
attention problems. Moreover, the chi-square test
showed young people whose internalising scores were
reduced reliably to be more likely to have emotional
problems, as reported by their parents during the initial
interview. When these variables were entered as predictors
in the logistic regression, the model was significant,
v2(5) = 20.9, p < .001. However, only the
withdrawn subscale was a significant independent
predictor of RC in internalising scores (p < .01).
Young people whose externalising scores were
reduced reliably had higher scores on pre-treatment
CBCL social problems. Moreover, they were more likely
to have faced developmental issues (e.g. separation
anxiety) as reported by their parents during the initial
interview. These differences are presented in Table 6.
When these variables were entered as predictors in the
logistic regression, the model was significant, v2(2) =
8.4, p < .05. However, no variable was a significant
independent predictor of RC in externalising scores.
Young people whose total problem scores were
reduced reliably had higher scores on two pre-treatment
CBCL subscales, namely withdrawn and thought
problems. Moreover, their parents had waited on average
more weeks before joining the CentreÕs programme
compared to the parents of young people whose total
scores did not decrease reliably. These differences are
presented in Table 7. When these variables were entered
as predictors in the logistic regression, the model
was significant, v2(3) = 14.3, p = .01. The withdrawn
subscale was the only significant independent predictor
of RC in total scores (p < .05).
Discussion
The findings from this study are in line with those found
by previous studies (National Institute for Clinical
Excellence, 2006). Analyses from all three sources
(change in mean scores, change in numbers from the
clinical to the non-clinical range, and RC) provide evidence
in support of the therapeutic improvement
achieved by some young people. There was a reduction
in CBCL internalising, externalising and total scores,
which was similar for all three domains.
The findings need to be treated with caution because
follow-up data were not obtained from 45% of parents
who completed a CBCL at intake. However when a
conservative approach was adopted and no change was
assumed for the sample that did not supply follow-up
data, the decrease in mean CBCL scores for the total
sample for internalising, externalising and total problems
was still statistically significant.
Nonetheless the findings suggest that although Parenting
with Love and Limits can run as a stand alone
group parent training programme, its impact may be
limited in doing so. The group programme might have a
Table 4. Reliable change in pre- and post-treatment CBCL1
internalising, externalising and total problem scores (N = 123)
Internalising problems Externalising problems Total problems
Frequencies Percent Frequencies Percent Frequencies Percent
No change-1.65 SE2
or measurement
(90% chance that this is a non-chance change)
41 33.3 45 36.6 49 39.8
Reliable improvement -1.65 SE or measurement
(90% chance that this is a non-chance change)
67 54.5 68 55.3 67 54.5
Reliable deterioration -1.65 SE or measurement
(90% chance that this is a non-chance change)
15 12.2 10 8.1 7 5.7
1
CBCL: Child Behaviour Check List
2
SE: Standard Error
Table 5. Significant differences between young people whose CBCL1
internalising scores decreased reliably (positive change) posttreatment,
and young people whose internalising CBCL scores did not change reliably (no positive change) on the pre-treatment CBCL
scores and one presented problem (N = 123)
Independent variable
Reliable positive
change group
Mean (SD)
No reliable positive
change group
Mean (SD) t p
Pre-treatment CBCL anxious/depressed 65.1 (10.4) 60.4 (9.9) 2.57 .011
Pre-treatment CBCL somatic complaints 63.4 (9.7) 58.8 (7.8) 2.87 <.005
Pre-treatment CBCL withdrawn 65.4 (9.7) 58.0 (9.0) 4.30 <.001
Pre-treatment CBCL attention problems 64.7 (8.6) 61.5 (7.8) 2.14 .034
Independent variable
Positive reliable
change group
frequency
No positive reliable
change group
frequency
Chi- squared
(df = 1) p
Presence of emotional problems 36.4% 20% 3.91 .048
1
CBCL: Childhood Behaviour Check List
A Parent Training Programme 51
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
greater impact if, as recommended by the developer of
the programme, both parent and teenager were present
and sessions for parents and teenager between the
group sessions were included as part of the overall
intervention. For families of teenagers presenting with
severe antisocial behaviour an intensive intervention
such as MST would be appropriate. Indeed, at the
Brandon Centre we have been able to offer MST to a
small number of parents of teenagers with severe antisocial
behaviour who have attended the group parent
training programme when local commissioners have
agreed to commission the service.
The findings from the study show that although
young people of parents attending the programme were
primarily referred for externalising problems, the programme
has a significant impact on both internalising
and externalising problems. This finding has been
found in other studies evaluating the impact of parent
training on conduct problems using the CBCL (Kazdin
et al., 1987). Although internalising and externalising
problem scores reflect different kinds of problems, they
are not mutually exclusive (Achenbach, 1991a). Typically,
they correlate positively because young people
that present with high scores in one domain usually
also have at least above average scores in the other
domain. It would be expected that there would be
change in both areas.
Limitations
The study has a number of limitations. First, the conclusions
that can be drawn are limited because the
analysis of outcome covers only a subset of parents
(55.8%) that attended the programme and completed a
CBCL pre- and post-intervention. Elsewhere we have
considered strategies that could be used in order to
improve the rate of return of follow-up data in routine
outcome studies (Baruch et al., 2009).
Second, the study does not use a parenting scale to
measure parenting practices. A parenting scale implemented
pre- and post-intervention would help to learn
whether changes in the young person are accompanied
by changes in parenting practices as measured by such
a scale. The inclusion of this measure would be useful
for future studies.
Third, the study solely relies on the parental perspective
for measuring the young personÕs emotional
and behavioural problems. Measures from multiple
perspectives, including the Youth Self Report Form, are
recommended, as reports from young people and parents
about emotional and behavioural problems tend
not to agree (Achenbach, 1991b; Kolko & Kazdin, 1993).
Teacher reports using the TeacherÕs Report Form
(Achenbach, 1991c) and police records are also useful
sources of information in monitoring changes in antisocial
behaviour.
Fourth, since this was a routine outcome monitoring
study, there was no control group for comparison with
the group that received treatment. We therefore cannot
say whether the improvement in young peopleÕs problems
as shown in CBCL scores occurred because of the
intervention. Also it is not clear how far the findings can
be generalised to parents other than the ones who
Table 7. Significant differences between young people whose total CBCL1
scores decreased reliably (positive change) post-treatment,
and young people whose total CBCL scores did not change reliably (no positive change) on the pre-treatment CBCL scores and one
service-related factor (N = 123)
Independent variable
Reliable Positive
Change group
Mean (SD)
No Reliable Positive
Change group
Mean (SD) t p
Pre-treatment CBCL withdrawn 64.5 (10.3) 59 (9.1) 3.00 .013
Pre-treatment CBCL thought problems 62.2 (9.9) 58 (7.8) 2.44 .019
Weeks waiting before first appointement2
3.6 (4.6) 2.1 (1.7) 2.43 .017
1
CBCL: Childhood Behaviour Check List
2
Unequal variances assumed
Table 6. Significant differences between young people whose CBCL1
externalising scores decreased reliably (positive change) posttreatment,
and young people whose externalising CBCL scores did not change reliably (no positive change) on the pre-treatment CBCL
scores and one presented problem (N = 123)
Independent variable
Reliable positive
change group
Mean (SD)
No reliable positive
change group
Mean (SD) t p
Pre-treatment CBCL Social
Problems2
60 (8.5) 57.1 (7.4) 1.99 .049
Independent variable
Positive reliable
change group
frequency
No positive reliable
change group
frequency
Chi- squared
(df = 1) p
Presence of developmental issues
(e.g. separation anxiety)
15.2 3.7 4.33 .038
1
BCL: Childhood Behaviour Check List
2
nequal variances assumed
52 Geoffrey Baruch et al.
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
participated in the present study. More studies are
needed, preferably using randomised clinical trial
methodology, to determine whether the intervention
would benefit a wider population.
Fifth, most parents involved in the programme were
only followed up once, shortly after the end of the group
parent training programme. Clearly this is insufficient
for determining whether or not the programme achieves
longer lasting change (Kazdin, 2000). A follow-up at 6
and 12 months would provide this information.
Findings from the audit of the CentreÕs psychotherapy
service suggested the need for a model of intervention
that was specifically tailored for conduct
problems. This led to the introduction of a manualised
parent training programme. Five and a half years later
we consider the provision of this intervention to be a
valuable addition to the CentreÕs services.
References
Achenbach, T.M. (1991a). Manual for the child behaviour
checklist/4-18 and 1991 profile. Burlington, VT: Department
of Psychiatry, University of Vermont.
Achenbach, T. M. (1991b). Manual for the TeacherÕs Report
Form and 1991 Profile. Burlington VT: University of
Vermont: Department of Psychiatry.
Achenbach, T. M. (1991c). Manual for the Youth Self-Report
and 1991 Profile. Burlington, VT: University of Vermont,
Department of Psychiatry.
American Psychiatric Association (1994). Diagnostic and statistical
manual of mental disorders (4th edition). Washington,
DC: American Psychiatric Association.
Baruch, G. (1995). Evaluating the outcome of a communitybased
psychoanalytic psychotherapy service for young
people between 12 and 25 years old: Work in progress.
Psychoanalytic Psychotherapy, 9, 243–267.
Baruch, G., & Fearon, P. (2002). The evaluation of mental
health outcome at a community-based psychodynamic psychotherapy
service for young people: A 12-month follow-up
based on self-report data. Psychology and Psychotherapy:
Theory, Research and Practice, 75, 261–278.
Baruch, G., Gerber, A., & Fearon, P. (1998). Adolescents who
drop out of psychotherapy at a community-based psychotherapy
centre: A preliminary investigation of the characteristics
of early dropouts, late dropouts and those who
continue treatment. British Journal of Medical Psychology,
71, 233–245.
Baruch, G., Vrouva, I., & Fearon, P. (2009). A follow-up study
of characteristics of young people that dropout and
continue psychotherapy: Service implications for a clinic
in the community. Child and Adolescent Mental Health, 14,
69–75.
Be´rube´, R. L., & Achenbach, T. M. (2007). Bibliography of
published studies using the ASEBA. Burlington, VT: University
of Vermont, Research Center for Children, Youth &
Families.
Brestan, E. V., & Eyberg, S. M. (1998). Effective psychosocial
treatments of conduct-disordered children and adolescents:
29 years, 82 studies and 5,272 kids. Journal of Clinical Child
Psychology, 27, 180–189.
Christensen, L., & Mendoza, J.L. (1986). A method of assessing
change in a single subject: An alteration in the RC index.
Behaviour Therapy, 17, 305–308.
Colman, I., Murray, J., Abbott, R. A., Maughan, B., Kuh, D.,
Croudace, T.J., & Jones, P.B. (2009). Outcomes of conduct
problems in adolescence: 40 year follow-up of national
cohort. British Medical Journal, 338:a, 2981.
Fonagy, P., Target, M., Cottrell, D., Phillips, J., & Kurtz, Z.
(2002). What works for whom. New York: The Guilford Press.
Ford, T., Doodman, R., & Meltzer, H. (2003). The British child
and adolescent mental health survey 1999: The prevalence
of DSM-IV disorders. Journal of the American Academy of
Child and Adolescent Psychiatry, 42, 1203–1211.
Ford, T., Hamilton, H., Meltzer, H., & Goodman, R. (2007).
Child mental health is everybodyÕs business: The prevalence
of contacts with public sector services by the types of
disorder among British school children in a three-year
period. Child and Adolescent Mental Health, 12, 13–20.
Green, H., McGinnity, A., Meltzer, H., Ford, T., & Goodman, R.
(2005). Mental health of children and young people in Great
Britain, 2004. London: TSO.
Guilford, J. P. (1965). Fundamental statistics in psychology
and education. New York: McGraw Hill.
Index of Multiple Deprivation (IMD) (2007). Office for National
Statistics, HM Government.
Ivanova, M.Y., Achenbach, T.M., Dumenci, L., Rescorla, L.A.,
Almqvist, F., Bilenberg, N., Bird, H., Chen, W.J., Dobrean,
A., Do¨pfner, M., Erol, N., Fombonne, E., Fonseca, A.C.,
Frigerio, A., Grietens, H., Hannesdottir, H., Kanbayashi, Y.,
Lambert, M.C., Larsson, B., Leung, P., Liu, X., Minaei, A.,
Mulatu, M.S., Novik, T.S., Oh, K.J., Roussos, A., Sawyer, M.,
Simsek, Z., Steinhausen, H-C., Weintraub, S., Winkler,
C.M., Wolanczyk, T., Yang, H-J., Zilber, N., Zukauskiene,
R., & Verhulst, F.C. (2007). Testing the 8-syndrome structure
of the Child Behavior Checklist in 30 societies. Journal
of Clinical Child and Adolescent Psychology, 36, 405–417.
Kazdin, A. E. (2000). Psychotherapy for children and adolescents.
New York: Oxford University Press.
Kazdin, A. E. (2005). Parent management training. New York:
Oxford University Press.
Kazdin, A. E., Esveldt-Dawson, K., French, N. H., & Unis, A. S.
(1987). Problem-solving skills training and relationship
therapy in the treatment of antisocial child behaviour.
Journal of Consulting and Clinical Psychology, 55, 76–85.
Kolko, D. J., & Kazdin, A. E. (1993). Emotional/behavioral
problems in clinic and non-clinic children: Correspondence
among child, parent and teacher reports. Journal of Child
Psychology and Psychiatry, 34, 991–1006.
Lambert, E.W., Wahler, R.G., Andrade, A.R., & Bickman, L.
(2001). Looking for the disorder in conduct disorder. Journal
of Abnormal Psychology, 110, 110–123.
Lengua, L.J., Sadowski, C.A., Friedrich, W.N., & Fisher, J.
(2001). Rationally and empirically derived dimensions of
childrenÕs symptomatology: Expert ratings and confirmatory
factor analyses of the CBCL. Journal of Consulting and
Clinical Psychology, 69, 683–98.
Miller, G. E., & Prinz, R. J. (1990). Enhancement of social
learning family interventions for childhood conduct disorder.
Psychological Bulletin, 108, 291–307.
National Institute for Clinical Excellence (2006). Parent training/education
programmes in the management of children
with conduct disorders. A health technology appraisal.
London: NICE.
National Institute for Clinical Excellence (2009). Antisocial
personality disorder: Treatment, management and prevention.
London: NICE.
Reyno, S. M., & McGrath, P. J. (2006). Predictors of parent
training efficacy for child externalising behavior problems: A
meta-analytic review. Journal of Child Psychology and Psychiatry,
37, 99–111.
Sanders, M. R., Markie-Dadds, C., Tully, L. A, & Bor, W.
(2000). The Triple P-Positive Parenting Program: A comparison
of enhanced, standard, and self-directed behavioral
family intervention for parents of children with early onset
conduct problems. Journal of Consulting and Clinical Psychology,
68, 624–640.
Scott, S., & Dadds, M. R. (2009). Practitioner review: When
parent training doesnÕt work: Theory-driven clinical strategies.
Journal of Child Psychology and Psychiatry, 50, 1441–
1450.
A Parent Training Programme 53
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
Scott, S., & Yule, W. (2008): Behavioural therapies. In M.
Rutter, D. Bishop, D. Pine, S. Scott, J. Stevenson, E. Taylor
& A. Thapar (Eds.), RutterÕs child and adolescent psychiatry
(5th edn.). Oxford: Blackwell.
Scott, S., Knapp, M., Henderson, J., & Maughan, B. (2001).
Financial cost of social exclusion: Follow-up study of antisocial
children into adulthood. British Medical Journal, 323,
1–5.
Sells, S. (1998). Treating the tough adolescent: A family-based,
step-by-step guide. New York: The Guilford Press.
Sells, S. (2001). Parenting your out-of-control teenager: 7 steps
to re-establish authority and reclaim love. New York: St
MartinÕs Griffin.
Smith, T.E., Sells, S.P., Rodman, J., & Reynolds, S.R. (2006).
Reducing adolescent substance abuse and delinquency:
Pilot research of a family-oriented psychoeducation curriculum.
Journal of Child and Adolescent Substance Abuse, 15,
105–115.
Wells, C., Adhyaru, J., Cannon, J., Lamond, M., & Baruch, G.
(in press). Multisystemic therapy (MST) for youth offending,
psychiatric disorder and substance abuse: Case examples
from a UK MST team. Child and Adolescent Mental Health.
World Health Organisation (1990). ICD - 10, 1990 Draft of
Chapter V, Mental and Behavioural Disorders (including
disorders of psychological development). Geneva: World
Health Organisation.
http://www.difficult.net. Parenting With Love & Limits - PLL
http://www.dsgonline.com/mpg2.5/TitleV_MPG_Table_Ind_
Rec.asp?ID=463
54 Geoffrey Baruch et al.
Ó 2010 The Authors
Child and Adolescent Mental Health Ó 2010 Association for Child and Adolescent Mental Health.
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