Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 25, 2025
Date Accepted: Mar 10, 2026
Predictors of outcomes of parent training targeting disruptive behavior in 4-year-olds at 6-month follow-up: results from a large prospective cohort implementation study
ABSTRACT
Background:
Randomized controlled trial (RCT) findings consistently indicate that parent training interventions are effective in reducing disruptive behavior in children. However, research on how participant characteristics and program factors influence the efficacy and outcomes of interventions in real-world settings remains scarce.
Objective:
The internet-based and telephone-assisted Strongest Families Parent training program has demonstrated effectiveness in reducing disruptive behavior in children. This study aimed to identify factors that predict program outcomes when the program is implemented in a real-world setting.
Methods:
From a base sample of n=47,641, population-based screening was used to identify children with a high level of conduct problems and functional impairment (n=3204). Multivariate logistic regression analyses were conducted to identify which child-, family- and program-related factors predicted changes in behavior, as measured by the CBCL externalizing subscale, from baseline to a 6-month follow-up.
Results:
In 77.0% of participants, the symptoms had improved at 6-month-follow-up. Longer duration (>12 months) of initial problems, callous-unemotional traits and CBCL internalizing symptoms were linked to a lower likelihood of large improvement (OR 0.43 [95% CI, 0.33–0.56]; p<.001; OR 0.64 [95% CI 0.57–0.73]; p<.001; OR 0.54 [95% CI, 0.47–0.63]; p<.001], respectively). Definite and severe problems at baseline were linked to decline (OR 2.29 [95% CI, 1.62–3.24]; p<.001; OR 4.38 [95% CI, 2.80–6.85]; p<.001, respectively). Parental stress was linked to a lower likelihood of large improvement (OR 0.78[95% CI 0.67–0.91]; p=.002), and anxiety was linked to a higher likelihood of decline (OR 1.20 [95% CI 1.04–1.39]; p=.015). Program completion in 2021 was associated with a lesser likelihood of a positive outcome.
Conclusions:
Children with longer-term and more severe behavioral symptoms may require tailored intervention, and additional support for parents with elevated stress and anxiety may be recommended.
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