Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Medicine
Published in: BMC Medicine 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Marijke Kleefman, Daniëlle EMC Jansen, Roy E Stewart, Sijmen A Reijneveld

Published in: BMC Medicine | Issue 1/2014

Login to get access

Abstract

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
Appendix
Available only for authorised users
Literature
1.
Kaptein S, Jansen DE, Vogels AG, Reijneveld SA: Mental health problems in children with intellectual disability: use of the Strengths and Difficulties Questionnaire. J Intellect Disabil Res. 2008, 52: 125-131.PubMed
2.
Dekker MC, Koot HM, van der Ende J, Verhulst FC: Emotional and behavioral problems in children and adolescents with and without intellectual disability. J Child Psychol Psychiatry. 2002, 43: 1087-1098. 10.1111/1469-7610.00235.CrossRefPubMed
3.
Tonge B, Einfeld S: The trajectory of psychiatric disorders in young people with intellectual disabilities. Aust N Z J Psychiatry. 2000, 34: 80-84. 10.1046/j.1440-1614.2000.00695.x.CrossRefPubMed
4.
Einfeld SL, Piccinin AM, Mackinnon A, Hofer SM, Taffe J, Gray KM, Bontempo DE, Hoffman LR, Parmenter T, Tonge BJ: Psychopathology in young people with intellectual disability. JAMA. 2006, 296: 1981-1989. 10.1001/jama.296.16.1981.CrossRefPubMedPubMedCentral
5.
Baker BL, Blacher J, Crnic KA, Edelbrock C: Behavior problems and parenting stress in families of three-year-old children with and without developmental delays. Am J Intellect Dev Disabil. 2002, 107: 433-444. 10.1352/0895-8017(2002)107<0433:BPAPSI>2.0.CO;2.CrossRef
6.
Beck A, Daley D, Hastings RP, Stevenson J: Mothers’ expressed emotion towards children with and without intellectual disabilities. J Intellect Disabil Res. 2004, 48: 628-638. 10.1111/j.1365-2788.2003.00564.x.CrossRefPubMed
7.
Friedrich WN, Friedrich WL: Psychosocial assets of parents of handicapped and nonhandicapped children. Am J Ment Defic. 1981, 85: 551-553.PubMed
8.
Lecavalier L, Leone S, Wiltz J: The impact of behaviour problems on caregiver stress in young people with autism spectrum disorders. J Intellect Disabil Res. 2006, 50: 172-183. 10.1111/j.1365-2788.2005.00732.x.CrossRefPubMed
9.
McGillivray JA, McCabe MP: Early detection of depression and associated risk factors in adults with mild/moderate intellectual disability. Res Dev Disabil. 2007, 28: 59-70. 10.1016/j.ridd.2005.11.001.CrossRefPubMed
10.
Sanders MR, Bor W, Morawska A: Maintenance of treatment gains: a comparison of enhanced, standard, and self-directed Triple P-Positive Parenting Program. J Abnorm Child Psychol. 2007, 35: 983-998. 10.1007/s10802-007-9148-x.CrossRefPubMed
11.
Sanders MR, Mazzucchelli TG, Studman LJ: Practitioner’s Manual for Standard Stepping Stones Triple P: for Families with a Child Who Has a Disability: 1st ed. 2003, The University of Queensland and Disability Services Commission of Western Australia, Brisbane
12.
Plant KM, Sanders MR: Reducing problem behavior during care-giving in families of preschool-aged children with developmental disabilities. Res Dev Disabil. 2007, 28: 362-385. 10.1016/j.ridd.2006.02.009.CrossRefPubMed
13.
Roberts C, Mazzucchelli T, Studman L, Sanders MR: Behavioral family intervention for children with developmental disabilities and behavioral problems. J Clin Child Adolesc Psychol. 2006, 35: 180-193. 10.1207/s15374424jccp3502_2.CrossRefPubMed
14.
Whittingham K, Sofronoff K, Sheffield J, Sanders MR: Stepping Stones Triple P: an RCT of a parenting program with parents of a child diagnosed with an autism spectrum disorder. J Abnorm Child Psychol. 2009, 37: 469-480. 10.1007/s10802-008-9285-x.CrossRefPubMed
15.
Whittingham K, Sanders M, McKinlay L, Boyd RN: Interventions to reduce behavioral problems in children with cerebral palsy: an RCT. Pediatrics. 2014, 133: e1249-1257. 10.1542/peds.2013-3620.CrossRefPubMed
16.
Speetjens P, de Graaf I: Stepping Stones Triple P Opvoedhulp voor ouders van kinderen met een beperking. Evaluatie van een pilot studie [SSTP Support for Parents with a Child with a Disability: Evaluation of a Pilot Study]. 2010, Utrecht, Trimbos Instituut
17.
Wilson P, Rush R, Hussey S, Puckering C, Sim F, Allely CS, Doku P, McConnachie A, Gillberg C: How evidence-based is an `evidence-based parenting program’? A PRISMA systematic review and meta-analysis of Triple P. BMC Med. 2012, 10: 130-145. 10.1186/1741-7015-10-130.CrossRefPubMedPubMedCentral
18.
Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P: Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med. 2008, 148: 295-309. 10.7326/0003-4819-148-4-200802190-00008.CrossRefPubMed
19.
Kleefman M, Jansen DE, Reijneveld SA: 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. BMC Public Health. 2011, 11: 676-682. 10.1186/1471-2458-11-676.CrossRefPubMedPubMedCentral
20.
Organisatie van het onderwijssysteem in Nederland 2008/2009 [Organisation of the Dutch Education System 2008/2009]. 2008, The Netherlands, EURYDICE
21.
Oeseburg B: Prevalence and impact of chronic diseases in adolescents with intellectual disability. PhD thesis. University of Groningen; 2010..
22.
Goodman R: The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry. 1997, 38: 581-586. 10.1111/j.1469-7610.1997.tb01545.x.CrossRefPubMed
23.
van Widenfelt BM, Goedhart AW, Treffers PD, Goodman R: Dutch version of the Strengths and Difficulties Questionnaire (SDQ). Eur Child Adolesc Psychiatry. 2003, 12: 281-289. 10.1007/s00787-003-0341-3.CrossRefPubMed
24.
Robinson EA, Eyberg SM, Ross AW: The standardization of an inventory of child conduct problem behaviours. J Clin Psychol. 1980, 9: 22-28.
25.
Burns GL, Patterson DR: Normative data on the Eyberg Child Behavior Inventory and Sutter-Eyberg Student Behavior Inventory parent and teacher rating scales of disruptive behavior problems in children and adolescents. Child Fam Behav Ther. 2001, 23: 15-28. 10.1300/J019v23n01_02.CrossRef
26.
Shelton KK, Frick PJ: Assessment of parenting practices in families of elementary school-age children. J Clin Child Psychol. 1996, 25: 317-329. 10.1207/s15374424jccp2503_8.CrossRef
27.
Essau CA, Sasagawa S, Frick PJ: Psychometric properties of the Alabama Parenting Questionnaire. J Child Fam Stud. 2006, 15: 595-614. 10.1007/s10826-006-9036-y.CrossRef
28.
de Brock AJ, Vermulst AA, Gerris JR, Abidin RR: NOSI-Nijmeegse Ouderlijke Stress Index, Handleiding experimentele versie [NOSI-Nijmegen Parenting Stress Index, Manual experimental version]. 1992, Swets en Zeitlinger, Lisse. the Netherlands
29.
Creinin MD, Meyn LA, Borgatta L, Barnhart K, Jensen J, Burke AE, Westhoff C, Gilliam M, Dutton C, Ballagh SA: Multicenter comparison of the contraceptive ring and patch: a randomized controlled trial. Obstet Gynecol. 2008, 111: 267-277. 10.1097/01.AOG.0000298338.58511.d1.CrossRefPubMed
30.
Hopewell S, Hirst A, Collins GS, Mallett S, Yu L, Altman DG: Reporting of participant flow diagrams in published reports of randomized trials. Trials. 2011, 12: 253-263. 10.1186/1745-6215-12-253.CrossRefPubMedPubMedCentral
31.
Tripepi G, Jager KJ, Dekker FW, Zoccali C: Selection bias and information bias in clinical research. Nephron Clin Pract. 2010, 115: c94-c99. 10.1159/000312871.CrossRefPubMed
32.
Rothwell PM: Factors that can affect the external validity of randomised controlled trials. PLoS Clin Trials. 2006, 3: 1-5. 10.1191/1740774506cn135oa.CrossRef
33.
Achenbach TM, McConaughy SH, Howell CT: Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull. 1987, 101: 213-232. 10.1037/0033-2909.101.2.213.CrossRefPubMed
34.
De Los RA, Kazdin AE: When the evidence says, “yes, no, and maybe so”: attending to and interpreting inconsistent findings among evidence-based interventions. Curr Dir Psychol Sci. 2008, 17: 47-51. 10.1111/j.1467-8721.2008.00546.x.CrossRef
35.
Goodman R, Renfrew D, Mullick M: Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka. Eur Child Adolesc Psychiatry. 2000, 9: 129-134. 10.1007/s007870050008.CrossRefPubMed
36.
Tamm L, Holden GW, Nakonezny PA, Swart S, Hughes CW: Metaparenting: associations with parenting stress, child-rearing practices, and retention in parents of children at risk for ADHD. Atten Defic Hyperact Disord. 2012, 4: 1-10. 10.1007/s12402-011-0068-9.CrossRefPubMed
37.
Mildon R, Wade C, Matthews J: Considering the contextual fit of an intervention for families headed by parents with an intellectual disability: an exploratory study. J Appl Res Intellect Disabil. 2008, 21: 377-387. 10.1111/j.1468-3148.2008.00451.x.CrossRef
38.
Wade CM, Mildon RL, Matthews JM: Service delivery to parents with an intellectual disability: family-centred or professionally centred?. J Appl Res Intellect Disabil. 2007, 20: 87-98. 10.1111/j.1468-3148.2005.00297.x.CrossRef
39.
Durlak JA, DuPre EP: Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008, 41: 327-350. 10.1007/s10464-008-9165-0.CrossRefPubMed
40.
Romney S, Israel N, Zlatevski D: Exploration-stage implementation variation: its effect on the cost-effectiveness of an evidence-based parenting program. Z Psychol. 2014, 222: 37-48.
Metadata
Title
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
Authors
Marijke Kleefman
Daniëlle EMC Jansen
Roy E Stewart
Sijmen A Reijneveld
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Medicine / Issue 1/2014
Electronic ISSN: 1741-7015
DOI
https://doi.org/10.1186/s12916-014-0191-5

Other articles of this Issue 1/2014

BMC Medicine 1/2014 Go to the issue

Commentary

In-/off-label use of biologic therapy in systemic lupus erythematosus

Research article

Interaction between stress and the BDNFVal66Met polymorphism in depression: a systematic review and meta-analysis

Research article

School-based mental health intervention for children in war-affected Burundi: a cluster randomized trial

Reviewer acknowledgement

Reviewer acknowledgements for 2013

Editorial

Obscurity on Obesity

Research article

Incidence and risk of severe infections associated with anti-epidermal growth factor receptor monoclonal antibodies in cancer patients: a systematic review and meta-analysis