TOPLINE

Among children with conduct problems persisting after parent training, allocation to Reflective Interpersonal Therapy for Children and Parents (RICAP) produced greater parent-reported reductions than clinical treatment as usual (CTAU) in both externalizing and internalizing problems. However, teacher reports favored CTAU, particularly for reactive aggression and total problems.

METHODOLOGY

• A two-phase pragmatic pilot randomized controlled trial recruited 105 children aged 4-10 years with conduct problems referred to Child and Adolescent Mental Health Services in the United Kingdom.
• All families were initially offered the Incredible Years (IY) parent training intervention; 102 families completed this phase.
• A total of 72 children remained above clinical threshold on parent or teacher report after IY; 62 were randomly assigned to either RICAP (N = 31) or CTAU (N = 31).
• RICAP comprised 14 sessions over 16 weeks with concurrent child and parent components focusing on enhancing reflective capacity about thoughts, feelings, and interpersonal behaviors; CTAU comprised a range of routine services, and of children randomly assigned to CTAU, 42% received a school-based component.
• Outcome measures included Child Behavior Checklist (CBCL), assessing internalizing, externalizing, and total problems; Teacher Report Form, the school version of the CBCL; Strengths and Difficulties Questionnaire (SDQ), a parent and teacher report assessing conduct problems and total problems; along with other measures, at baseline, 4 months (post-IY), and 12-14 months (post-intervention).

TAKEAWAY

• By parent report on the CBCL, RICAP was superior to CTAU for externalizing problems (adjusted mean difference, 6.00; 95% CI, 1.84-10.17; P = .006; Cohen's d = 0.37) and internalizing problems (adjusted mean difference, 7.36; 95% CI, 3.39-11.33; P = .001; d = 0.46).
• The percentage of children in the clinical range for CBCL externalizing fell by 30.0% in the RICAP arm vs 4.1% in CTAU, leaving 57.1% and 75.9% still in the clinical range, respectively; for internalizing problems, the clinical range decreased by 27.0% in RICAP but increased by 15.0% in CTAU.
• By teacher report on the SDQ, CTAU was superior to RICAP for total problems (adjusted mean difference, -3.57; 95% CI, -6.68 to -0.67; P = .017; d = 0.33); on a separate teacher-rated reactive aggression scale, CTAU scored lower than RICAP (adjusted mean difference, -1.84; 95% CI, -3.46 to -0.22; P = .027; d = 0.32).
• Retention was high across both phases: 97% of families completed IY, 89% of eligible families consented to randomization, and 94% of randomly assigned families provided follow-up data with no differential attrition between arms.

IN PRACTICE

"UK NICE (2013) guidelines acknowledge that complex families may need alternative approaches to first-line group-based parenting interventions devised to better meet their needs... The method and process of RICAP was devised specifically with the complexities of these families in mind. Whilst providing a structure for the therapists to work within, the considerable flexibility of formulation within the RICAP method allows different aspects of child and/or parent vulnerability to be addressed, arguably making it more sensitive to the heterogeneity evident in the most complex families," the authors wrote.

SOURCE

The study was led by Helen Sharp, University of Liverpool, Liverpool, England. It was published online on July 28 in PLoS One.

LIMITATIONS

Parents were not blinded to treatment allocation, potentially introducing bias in parent-reported outcomes. The heterogeneity of CTAU interventions, including school-based components received by 42% of CTAU participants but none in RICAP, is another major limitation. The sample was overwhelmingly White British, limiting generalizability to other ethnic groups.

DISCLOSURES

The study was supported by grants from the NHS National R&D Programme on Forensic Mental Health (UK). The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.