Review: group-based behavioural and cognitive-behavioural parenting interventions are effective and cost-effective for reducing early-onset child conduct problems.

ED FROM Furlong M, McGilloway S, Bywater T, et al. Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev 2012;2:CD008225. Correspondence to: Mairead Furlong, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co Kildare, Ireland; [email protected] to: Mairead Furlong, Department of Psychology, John Hume Building, National University of Ireland Maynooth, Maynooth, Co Kildare, Ireland; [email protected] Sources of funding The Health Research Board of Ireland, and National University of Ireland Maynooth. CO M M EN TA RY Furlong et al conclude that group-based behavioural and cognitive-behavioural parenting interventions are effective for improving children’s conduct problems, and parents’ parenting skills and mental health. So what’s new, when many earlier reviews have drawn similar conclusions? First, this review asks a clearlyfocused clinical question, and is conducted to an impressive Cochrane level of thoroughness and rigour. Second, in a field that is moving rapidly from developer-led efficacy trials, to implementation trials in complex realworld services, we need to be sure that effect sizes are not declining over time, as developer control over trials is relaxed. Lower effect sizes tend to result from improved standards of trial conduct and reporting. This review sheds new light on both these issues, using a careful series of sensitivity analyses. Reassuringly, and in contrast to findings from other fields, the authors neither found decline in effect sizes with increasing study quality nor were the effect sizes stronger when the programme developer conducts the trial. Although other aspects of the efficacy versus effectiveness dimension are not investigated, the findings are striking in suggesting that parenting interventions are effective across a wide range of countries, ‘real-world’ service settings and families. Examining findings from this review and other high-quality studies (some excluded as they focus on targeted prevention), we can conclude that parenting interventions appear to be effective for families with high and low levels of deprivation, with and without maternal depression, those from ethnic minorities and majorities and those with severe and moderate levels of conduct problems. The question of age effects is not addressed. Of course, basic science tells us younger children will benefit more from intervention. Yet surprisingly, some intervention reviews suggest the opposite: this needs up-to-date synthesis. Overall, this review shows it is feasible, and likely to be cost effective, to take these beneficial intervention effects into real-world services. It affirms the continuation of sterling efforts to go ‘to scale’ (eg, in the UK by the Improving Access to Psychological Therapies Programme), but this requires careful attention to practitioner fidelity, training and supervision, as well as high levels of political and professional enthusiasm.