Sustained effects of incredible years as a preventive intervention in preschool children with conduct problems.

The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time.

The two errors of using the within-subject standard deviation (WSD) as the standard error of a reliable change index.

In this Journal, Lewis and colleagues introduced a new Reliable Change Index (RCI(WSD)), which incorporated the within-subject standard deviation (WSD) of a repeated measurement design as the standard error. In this note, two opposite errors in using WSD this way are demonstrated. First, being the standard error of measurement of only a single assessment makes WSD too small when practice effects are absent. Then, too many individuals will be designated reliably changed. Second, WSD can grow unlimitedly to the extent that differential practice effects occur. This can even make RCI(WSD) unable to detect any reliable change.

Reliable change and practice effects: outcomes of various indices compared.

In this article the outcomes of three indices for the assessment of reliable change (RCIs) are compared: the null hypothesis method of Chelune, Naugle, Luders, Sedlak, and Awad (1993), the regression-based method of McSweeny, Naugle, Chelune, and Luders (1993), and a recently proposed adjustment to the latter procedure (Maassen, 2003). Simulated data demonstrated the importance of using large control samples. The regression-based method proved to be the most lenient in designating individuals as reliably changed, resulting in the most correct and the most incorrect designations. The adjusted procedure resulted in fewer correct designations and the lowest numbers of incorrect designations. Real-world data showed the same patterns.

Executive functions in preschool children with aggressive behavior: impairments in inhibitory control.

The question whether executive function (EF) deficits in children are associated with conduct problems remains controversial. Although the origins of aggressive behavior are to be found in early childhood, findings from EF studies in preschool children with aggressive behavior are inconsistent. The current study aimed to investigate whether preschool children with aggressive behavior show impairments in EF. From a population-based sample, 82 preschool children who were showing aggressive behavior as indicated by scores at or above the 93rd percentile on the Aggressive Behavior Scale of the CBCL 1 1/2-5 were selected. These children with aggressive behavior were matched on IQ to a group of typically developing control children (N = 99). Six neuropsychological tasks were administered to assess set shifting, inhibition, working memory and verbal fluency. A factor analysis was conducted which yielded one clear factor: inhibition. Aggressive preschool children showed poorer performance on this inhibition factor than control children and boys performed worse on this factor than girls. This association between aggressive behavior and inhibition deficits was maintained after controlling for attention problems. In addition, gender differences in all EFs measured were found with boys exhibiting more impairment in EF than girls. These findings demonstrate that preschool children with aggressive behavior show impairments in inhibition, irrespective of attention problems.

The effectiveness of an experimental treatment when compared to care as usual depends on the type of care as usual.

In psychotherapy, effectiveness of an experimental treatment often is compared to care as usual. However, little if any attention has been paid to the heterogeneity of care as usual. The authors examined the effectiveness of manualized behavior therapy on school-aged disruptive behavior disordered (DBD) children in everyday clinical practice. A total of 77 DBD children (8-13 years) were randomly assigned to the Utrecht Coping Power Program (UCPP) condition or the care as usual condition. Care as usual consisted of family therapy (FT) or behavior therapy (BT). Decrease in parent-reported overt aggression was significantly larger in the UCPP condition than in the FT condition, but UCPP and BT did not differ significantly in this respect. The effect sizes of difference scores on other variables were more in favor of UCPP when compared to FT than to BT. The comparison of an experimental treatment to care as usual depends on the type of usual treatment.

Quality of paediatric rehabilitation from the parent perspective: validation of the short Measure of Processes of Care (MPOC-20) in the Netherlands.

OBJECTIVE: In the present study we aim to assess the reliability and validity of the 20-item version of the Dutch Measure of Processes of Care (MPOC). DESIGN: The reliability, concurrent validity, predictive validity and construct validity of the Dutch MPOC-20 were determined. A subset of MPOC-20 data was extracted from a large Dutch MPOC (56-item version) database. SUBJECTS: Participants were 405 mothers and 22 fathers of children aged 1-18 years recruited through nine paediatric rehabilitation centres in the Netherlands. MAIN MEASURES: The participants filled out the MPOC-20 items, the Client Satisfaction Questionnaire (CSQ), and two additional questions about satisfaction with services and the amount of stress they experienced. RESULTS: The internal consistency analyses (alphas 0.75-0.87) and the test-retest analyses (intraclass correlation coefficients (ICCs) 0.78-0.91) showed that the Dutch MPOC-20 is a reliable tool. The concurrent validity of the Dutch MPOC-20 was confirmed by positive correlations between MPOC-20 scale scores and the CSQ (r 0.39-0.69), and between MPOC-20 scale scores and an overall satisfaction variable (r 0.37-0.66). The predictive validity of the Dutch MPOC-20 was supported by moderately negative correlations between MPOC-20 scores and a stress variable (r -0.27 to -0.44). The construct validity of the Dutch MPOC-20 was confirmed by significant scale intercorrelations (r 0.41-0.84) and a factor analysis. CONCLUSIONS: The 20-item version of the MPOC (Dutch MPOC-20) is a reliable and valid measure of the family-centredness of paediatric rehabilitation.

The standard error in the Jacobson and Truax Reliable Change Index: the classical approach to the assessment of reliable change.

Researchers and clinicians using Jacobson and Truax's index to assess the reliability of change in patients, or its counterpart by Chelune et al., which takes practice effects into account, are confused by the different ways of calculating the standard error encountered in the literature (see the discussion started in this journal by Hinton-Bayre). This article compares the characteristics of (1) the standard error used by Jacobson and Truax, (2) the standard error of difference scores used by Temkin et al. and (3) an adaptation of Jacobson and Truax's approach that accounts for difference between initial and final variance. It is theoretically demonstrated that the last variant is preferable, which is corroborated by real data.