title: Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial.
abstract: OBJECTIVE
  There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems.
  
  
  OBJECTIVE
  To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment.
  
  
  METHODS
  This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232).
  
  
  METHODS
  The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching.
  
  
  METHODS
  Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization.
  
  
  RESULTS
  Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001).
  
  
  CONCLUSIONS
  The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01750996.
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland2Turku University Hospital, Turku, Finland.
authors.forename: Andre
authors.initials: A
authors.lastname: Sourander
authors.affiliation: Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada4Faculty of Science, Dalhousie University, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie Uni.
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: McGrath
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Terja
authors.initials: T
authors.lastname: Ristkari
authors.affiliation: Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Charles
authors.initials: C
authors.lastname: Cunningham
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Jukka
authors.initials: J
authors.lastname: Huttunen
authors.affiliation: Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia, Canada5Strongest Families Institute, Halifax, Nova Scotia, Canada6Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lingley-Pottie
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Susanna
authors.initials: S
authors.lastname: Hinkka-Yli-Salomäki
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Malin
authors.initials: M
authors.lastname: Kinnunen
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Vuorio
authors.affiliation: Department of Child Psychiatry, University of Turku, Turku, Finland.
authors.forename: Atte
authors.initials: A
authors.lastname: Sinokki
authors.affiliation: Center for Child and Adolescent Mental Health, North Norway, University of Tromsø, Breivika, Norway.
authors.forename: Sturla
authors.initials: S
authors.lastname: Fossum
authors.affiliation: Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Unruh
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D001007:Anxiety / Q000523:psychology; D019958:Attention Deficit and Disruptive Behavior Disorders / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D002652:Child Behavior / Q000523:psychology; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000517:prevention & control* / Q000523:psychology; D002675:Child, Preschool; D004644:Emotions; D005240:Feasibility Studies; D005260:Female; D005387:Finland; D006801:Humans; D020407:Internet; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting / Q000523:psychology; D010290:Parents / Q000193:education*; D011322:Primary Prevention / Q000379:methods*; D000066553:Problem Behavior / Q000523:psychology; D013689:Telephone