Stepping Stones Triple P: the importance of putting the findings into context--a response to Tellegen and Sofronoff.

Recently, we reported the findings of a randomized controlled trial on the effectiveness of Stepping Stones Triple P (SSTP) compared to Care as Usual (CAU), in BMC Medicine. The study involved parents of 209 children with Borderline to Mild Intellectual Disability (BMID), included following a school-based assessment of psychosocial problems. We found that SSTP had some short-term advantages over CAU, i.e., a reduction of parenting stress and of teacher-reported psychosocial problems, but no long-term advantages, at 6 months after the intervention. Tellegen and Sofronoff criticized that we included a limited amount of studies on the effectiveness of SSTP, and that the interpretation of our findings was inadequate. Regarding available evidence, we confined our summary to published high-quality RCTs regarding individual SSTP on level 4--our RCT concerned that type of SSTP. Consequently, many studies were excluded but in a very adequate way. Regarding interpretation, Tellegen and Sofronoff criticized that we compared SSTP with CAU, but seem to be unware that this is consonant with current guidelines. Moreover, they noted that 49% of the parents who started SSTP followed less than half of the intended number of sessions. However, our findings on those who completed SSTP showed no more advantages of SSTP in the long term than CAU. We therefore stick to our conclusion that SSTP has some advantages in the short term compared to CAU, but not in the long term. The major burden of psychosocial problems in children with BMID prompts for further improvements. Please see related articles: http://www.biomedcentral.com/1741-7015/12/191 and http://www.biomedcentral.com/1741-7015/13/25.

The effectiveness of Stepping Stones Triple P parenting support in parents of children with borderline to mild intellectual disability and psychosocial problems: a randomized controlled trial.

BACKGROUND: Children with borderline to mild intellectual disability (BMID) have been shown to be at increased risk for psychosocial problems. The presence of these psychosocial problems leads to parenting stress. Stepping Stones Triple P (SSTP) is a parenting support program to support parents with children with BMID and psychosocial problems. The aim of this study was to evaluate the effectiveness of SSTP compared to Care as Usual (CAU) in reducing psychosocial problems in children with BMID. METHOD: We conducted a randomized controlled trial in the Northern provinces of the Netherlands. Parents of children aged 5 to 12 with borderline (IQ 70 to 85) or mild (IQ 70 to 50) ID and psychosocial problems were invited. Psychosocial problems were identified using the Strengths and Difficulties Questionnaire (SDQ) parent report (≥14). Measurements were assessed before the intervention (T0), immediately after the intervention (T1) and after a follow-up of six months (T2). SSTP takes 8 to 10 individual sessions of 40-90 minutes, provided over 10 to 12 weeks. CAU concerned any service, except SSTP. Primary outcomes were the child's psychosocial problems (SDQ parent and teacher forms and the Eyberg Child Behavior Inventory, ECBI). Secondary outcomes were parenting stress (Parenting Stress Index, PSI) and parenting skills (Alabama Parenting Questionnaire, APQ). RESULTS: In total 209 parents of children aged 5 to 12 with BMID were allocated blindly to either SSTP (n =111) or CAU (n =98). In the intention to treat analyses, SSTP achieved no significantly better effect than CAU for the SDQ parent report, the ECBI and the APQ on the short- and long- term. In the short term, SSTP was significantly more effective than CAU for the SDQ teacher report (B = -2.25, 95% CI -3.79 to -0.71) and the PSI (B = -7.06, 95% CI -12.11 to -2.01). For both SDQ teacher report and PSI, there was no statistically significant effect in the long term. Dropout from SSTP was considerable (49%), with the effects being solely found in the adherent SSTP subgroup. CONCLUSIONS: SSTP had some short-term advantages over CAU, but not in the longer term. TRIAL REGISTRATION: Dutch Trial Register NTR2624. Registered 26 November 2010.

The effectiveness of Stepping Stones Triple P: the design of a randomised controlled trial on a parenting programme regarding children with mild intellectual disability and psychosocial problems versus care as usual.

BACKGROUND: Children with an intellectual disability are at increased risk of psychosocial problems. This leads to serious restrictions in the daily functioning of the children and to parental stress. Stepping Stones Triple P aims to prevent severe behavioural, emotional and developmental problems in children with a (intellectual) disability by enhancing parenting knowledge and skills, and the self-confidence of parents. This paper aims to describe the design of a study of the effectiveness of parenting counselling using Stepping Stones Triple P compared to Care as Usual. METHODS/DESIGN: The effects of Stepping Stones Triple P will be studied in a Randomised Controlled Trial. Parents of children aged 5-12 years with an IQ of 50-85 will be recruited from schools. Prior to randomisation, parents complete a screening questionnaire about their child's psychosocial problems and their parenting skills. Subsequently, parents of children with increased levels of psychosocial problems (score on Strengths and Difficulties Questionnaire ≥ 14) will be invited to participate in the intervention study. After obtaining consent, parents will be randomised either to the experimental group (Stepping Stones Triple P) or to Care as Usual. The primary outcome is a change in the child's psychosocial problems according to parents and teachers. The secondary outcome is a change in parenting skills. Data will be collected before the start of the intervention, immediately after the intervention, and six months after. DISCUSSION: This paper presents an outline of the background and design of a randomised controlled trial to investigate the effectiveness of Stepping Stones Triple P, which aims to decrease psychosocial problems in children with a mild intellectual disability. Stepping Stones Triple P seems promising, but evidence on its effectiveness for this population is still lacking. This study provides evidence about the effects of this intervention in a community-based population of children with a mild intellectual disability. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR2624.