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Incredible Years

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Helping Vulnerable Children, Supporting Parenting and Assisting with Childcare

Recommendation Pillars

Reduce inequality at a young age by investing in early childhood education and care

Countries that have implemented practice

Denmark, United Kingdom, Norway, Ireland, Portugal, Sweden

Age Groups

Middle Childhood (age 6 to 12), Young Children (age 0 to 5)

Years in Operation

2001  - still operating

Type of Organization Implementing Practice

Private Human Services Organization, Private Education Organization

Practice Overview

The Incredible Years programme consists of twelve weeks of 2-2.5 hour parenting sessions designed to teach parents how to recognize and treat their child’s emotional and behavioural problems through positive parenting. This programme can be used for parents of both pre-school and school-aged children who already have or are at risk of developing conduct problems (including antisocial behaviour, frequent anger, and a propensity towards violence).

  • Using praise and incentives to reinforce positive child behaviour
  • Improving parent-child interaction
  • Limit setting and non-aversive child management strategies to deal with child misbehaviour/non-compliance
  • Applying consistent gentle consequences for problem behaviour

 

In addition, the programme uses a variety of teaching techniques, including:

  • Parent/child role play
  • Helping parents understand social learning principles
  • Modelling positive behaviours by example
  • Discussing previous experiences with and feelings about raising their children
  • Practising new skills during the session and through homework
  • Analyzing video material of family behaviour for discussion

 

This programme addresses barriers to attendance through a variety of methods, including offering transportation, providing lunch, and ensuring access to childcare. Consistency of implementation is ensured by providing uniform course materials to each instructor, ensuring instructors attend training, having instructors and parents complete self-evaluation surveys, providing course-specific checklists, and taping sessions for review by an Incredible Years trainer (Hutchings, et al. 2008).

Evidence of Effectiveness

Note: The following results show a change in behavioural and psychological outcomes for children and parents as measured by psychometric scales and by researcher or parent observation. While the keys to each scale are copyrighted and cannot be reprinted here, in general, a higher score indicates that the child or parent has more of the symptoms of the condition the scale is measuring (depression, hyperactivity, etc.). As such, when we show reduction in scale scores after treatment, this generally indicates a positive outcome.

 

Evaluation 1 (UK)

 

Hutchings, J et al. “Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial.” British Medical Journal. 2008. 334(7595): 678-682.

 

Note: This randomized controlled trial is “pragmatic” because researchers randomized by area instead of across all areas.

 

Summary of Results for Evaluation 1

Outcome

Mean Difference Between Treatment and Control Groups

Outcomes improved (statistically significant)

 

 

Eyberg Child Behavior Inventory – Intensity

-29.19

Eyberg Child Behavior Inventory – Problems

-4.99

Conners Parent Rating Scale for Hyperactivity

-4.32

Kendall Self-Control Rating Scale

-10.19

Strengths and Difficulties Questionnaire – Conduct Problems

-0.82

Strengths and Difficulties Questionnaire – Total Deviance

-1.92

Strengths and Difficulties Questionnaire – Hyperactivity

-1.07

Sibling-Rated Eyerbg Child Behavior Inventory – Intensity

-21.35

Child Deviance – Observation

-4.55*

Parenting Stress Index

-15.08

Beck Depression Inventory

-4.66

Arnold Parenting Scale

-0.8

Positive Parenting – Observation

-10.96

Critical Parenting – Observation

-5.83

Outcomes with no effect

 

 

Sibling-Rated Eyerbg Child Behavior Inventory –Problems

 

*Outcome is only statistically significant at the 90% confidence level

 

 

 

 

Evaluation 2  (Sweden)

 

Axberg, U. and Broberg, A. “Evaluation of ‘The Incredible Years’ in Sweden: The transferability of an American parent-training program to Sweden.” Scandinavian Journal of Psychology. 2012. 53: 224-232.

 

Summary of Results for Evaluation 2

Outcome

Mean Difference Between Treatment and Control Groups

Outcomes improved (statistically significant)

 

 

Eyberg Child Behavior Inventory – Intensity Scale

-25.6

Eyberg Child Behavior Inventory – Problems Scale

-6.82

Sutter-Eyberg Student Behavior Inventory – Problems Scale

-3.21*

Parenting Alliance Measure

7.3

Outcomes with no effect

 

 

Sutter-Eyberg Student Behavior Inventory – Intensity Scale

Strengths and Difficulties Questionnaire – Emotions Scale

 

 

Strengths and Difficulties Questionnaire – Teacher –  Emotions Scale

 

 

Symptom Check List – Index

 

 

Parental Locus of Control – Perceived Parental Control

 

 

 

 

 

 

 

 

 

 

 

All outcomes reported as difference-in-difference (pre-post change in score between groups).

*Outcome is only statistically significant at the 90% confidence level

 

Evaluation 3 (UK)

 

Summary of Results for Evaluation 3

Outcome

Mean Difference Between Treatment and Control Groups

Outcomes improved (statistically significant)

 

 

Eyberg Child Behavior Inventory – Intensity

-5.99

Strengths and Difficulties Questionnaire – Total Deviance

0.67

Beck Depression Inventory

-2.23

Arnold Parenting Scale

-0.8

Outcomes with no effect

 

 

Arnold Parenting Scale

 

 

 

All outcomes reported as difference-in-difference (pre-post change in score between groups).

Transferability

Incredible Years has been shown to improve outcomes for children in both the UK (Hutchings, et al. 2008) and in Sweden (Axberg, et al. 2012).

Enduring Impact

No long-term follow-ups have been conducted.

Issues to Consider

Hutchings, et al. cite the following conflicts of interest: “JH [Judith Hutchings, primary author] is paid by Incredible Years for running occasional training courses in the delivery of the parent programme and has served as an expert witness for the NICE [National Institute for Health and Clinical Excellence] appraisal on parenting and conduct disorder.”

In addition, a cost-effectiveness analysis was performed. Edwards et al. (2007) show that on average a 1 point decrease in the Eyberg intensity scale costs £71, and for the child with an average initial intensity score, the programme will cost £1344 to reduce the child’s score by X points to below the clinical cutoff.

Contact Information

Name

Lisa St. George

Title

Administrative Director

Organization

Incredible Years

Address

1411 8th Avenue West, Seattle, WA 98119 USA

Phone

(888) 506-3562

Email

lisastgeorge@comcast.net

Available Resources

The best resource for Incredible Years is the project’s main website: www.incredibleyears.com.

Evaluation Details

 

Evaluation 1

In the first UK evaluation, participants were eligible to be selected if they were children aged 3-4 living in one of 11 areas with access to Sure Start children’s centres in north and mid-Wales, scored above clinical cutoff on Eyberg Problem Behavior Scale (which measures the presence or absence of problem behaviors) or Intensity scale (which measures the intensity of problem behaviors), and there was a primary caregiver that lived with child and could attend interventions (Hutchings et al. 2008). The final sample consisted of 47 parent-child dyads in the control group, and 86 parent-child dyads in treatment group, for an approximately 2:1 treatment to control ratio. Children were block randomized by Sure Start area, and stratified by age and sex.

 

Parents in the treatment group underwent twelve 2-2.5 hour training sessions taught by Incredible Years instructors. Parents in the control groupreceived no treatment initially, but were put on a waitlist and received treatment after the study ended.

Before and after the intervention, researchers measured several outcomes for both the children and the parents. Parents filled out surveys to rate their children using the Eyberg Child Behaviour Inventory (Intensity and Problems Scales), Strengths and Difficulties Questionnaire (Conduct Problems, Total Deviance, and Hyperactivity Scales), the Conners Parent Rating Scale for Hyperactivity, and the Kendall Self-Control Rating Scale. In addition, researchers observed children when they were interacting with their parents at home for 30 minutes to assess child deviance according to a behaviour coding system.

Parents also completed surveys using the Parenting Stress Index, Beck Depression Inventory, and Arnold Parenting Scale. During the parent-child home observation, researchers also assessed positive and critical parenting using a coding system.

Outcomes were collected at baseline and follow-up six months after the administration of treatment.

 

Evaluation 2

 

In this Swedish evaluation, children were eligible for inclusion if they were aged 4-8, met the criteria for Oppositional Defiant Disorder (ODD) as per the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IVTR), had parents that can read/write in Swedish, and those parents were willing to take part in the study.

Researchers were able to recruit 16-24 parent-child dyads for the control group (sample size varied by each measure), and 30-37 parent-child dyads (sample size varied here by measure as well) for the treatment group.

For treatment, parents underwent twelve 2-2.5 hour training sessions taught by Incredible Years instructors. Parents in the control group remained on a waiting list for treatment if they desired it.

Before and after the intervention, researchers measured several outcomes for both the children and the parents. Parents were administered surveys to rate their children using the Eyberg Child Behaviour Inventory (Intensity and Problems Scales), the Sutter-Eyberg Student Behaviour Inventory (Intensity and Problem Scales), and the Strengths and Difficulties Questionnaire (Full and Emotional Scales).

Parents also were administered surveys for the Symptom Check List, the Parental Locus of Control-Perceived Parental Control, and the Parenting Alliance Measure.

Outcomes were collected at baseline and follow-up one year after the administration of treatment.

 

Evaluation 3

 

In this second UK evaluation, children and foster parents were recruited from three local authorities in North and Mid Wales. Researchers randomized participants to a control group of 17 foster parent-child dyads, and a treatment group of 29 foster parent-child dyads.

In the treatment group, parents underwent twelve 2-2.5 hour training sessions taught by Incredible Years instructors. In the control group, parents sat on a waiting list to receive treatment after the study was completed.

Before and after the intervention, researchers measured several outcomes for both the children and the parents. Foster parents were administered surveys to rate their children using the Eyberg Child Behaviour Inventory (Intensity Scale), and Strengths and Difficulties Questionnaire (Full and Hyperactivity Scales). Foster parents rated themselves using the Beck Depression Inventory and the Arnold Parenting Scale.

Outcomes were collected at baseline and follow-up six months after the administration of treatment.

Bibliography

Last updated

December 2012