***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND There is a pressing need for cost-effective population -based interventions to tackle early-onset antisocial behaviour . As this is determined by many factors , it would seem logical to devise interventions that address several influences while using an efficient means of delivery . The aim of this trial was to change four risk factors that predict poor outcome : ineffective parenting , conduct problems , attention deficit/hyperactivity disorder ( ADHD ) symptoms , and low reading ability . METHODS A r and omised controlled trial was carried out in eight schools in London , Engl and . Nine hundred and thirty-six ( 936 ) 6-year-old children were screened for antisocial behaviour , then parents of 112 high scorers were r and omised to parenting groups held in schools or control ; 109 were followed up a year later . The intervention lasted 28 weeks and was novel as it had components to address both child behaviour ( through the Incredible Years programme ) and child literacy ( through a new ' SPOKES ' programme to help parents read with their children ) . Fidelity of implementation was emphasised by careful training of therapists and weekly supervision . Controls received an information helpline . Assessment of conduct problems was by parent interview , parenting by direct observation and child reading by psychometric testing . RESULTS At follow-up parents allocated to the intervention used play , praise and rewards , and time out more often than controls , and harsh discipline less ; effect sizes ranged from .31 to .59 sd ( p-values .046 to .005 ) . Compared to control children , whose behaviour did n't change , intervention children 's conduct problems reduced by .52sd , ( p < .001 ) , dropping from the 80th to the 61st percentile ; oppositional-defiant disorder ( ODD ) halved from 60 % to 31 % ( p = .003 ) . ADHD symptoms reduced by .44sd ( p = .002 ) , and reading age improved by six months ( .36sd , p = .027 ) . Teacher-rated behaviour did n't change . The programme cost pound2,380 ( $ 3,800 ) per child . CONCLUSIONS Effective population -based early intervention to improve the functioning of with antisocial behaviour is practically feasible by targeting multiple risk factors and emphasising implementation fidelity OBJECTIVE A community-based r and omized controlled trial ( RCT ) was conducted in urban areas characterized by high levels of disadvantage to test the effectiveness of the Incredible Years BASIC parent training program ( IYBP ) for children with behavioral problems . Potential moderators of intervention effects on child behavioral outcomes were also explored . METHOD Families were included if the child ( aged 32 - 88 months ) scored above a clinical cutoff on the Eyberg Child Behavior Inventory ( ECBI ) . Participants ( n = 149 ) were r and omly allocated on a 2:1 ratio to an intervention group ( n = 103 ) or a waiting-list control group ( n = 46 ) . Child behavior , parenting skills , and parent well-being were assessed at baseline and 6 months later using parent-report and independent observations . An intention-to-treat analysis of covariance was used to examine postintervention differences between groups . RESULTS Statistically significant differences in child disordered behavior favored the intervention group on the ECBI Intensity ( effect size = 0.7 , p < .001 ) and Problem subscales ( effect size = 0.75 , p < .001 ) . Intervention effects on child hyperactive-inattentive behaviors and social competence , as well as parent competencies and well-being , were also found . Moderator analyses showed that the effects of the IYBP intervention on the primary child outcomes were not moderated by child or family demographic characteristics or risk factors . CONCLUSION The results demonstrate the effectiveness of the IYBP in alleviating problem behavior among children and in improving well-being among families living in disadvantaged areas . The findings also highlight the importance of parental intervention in early childhood for parents and children most in need of support OBJECTIVE We evaluated the effectiveness of 4 parent-training programs for children with externalizing problems .  We tested the effectiveness of 3 behavioral programs ( Comet , Cope , and Incredible Years ) and 1 nonbehavioral program ( Connect ) in reducing child behavior problems and attention-deficit/hyperactivity disorder ( ADHD ) symptoms , in improving positive parenting and parenting competence , and in decreasing negative parenting and parents ' stress and depressive symptoms . METHOD This national study was design ed as a r and omized-controlled effectiveness trial ( RCT ) . The treatments were carried out in 30 clinical and community-based practice s. Parents of 908 children ( ages 3 - 12 years ) were r and omly assigned to 1 of 2 parent training programs available at each practice , or to a wait-list condition , where parents had sought help from regular services . Before and after treatment , parents rated child behavior problems and parenting strategies . RESULTS At posttreatment , children whose parents had received interventions showed a strong decrease in child conduct problems and a moderate to strong decrease in ADHD symptoms . About half of parents whose children scored over the 95th percentile on the behavior measures ( Eyberg Child Behavior Inventory , Swanson , Nolan , and Pelham Rating Scale ) , a clinical ly meaningful cutoff , reported that their children were no longer above the cutoff after the intervention . Parents showed considerably less negative behaviors toward their children at posttest compared with pretest ; they increased in parental competence , and decreased in both stress and depressive symptoms . Overall , the behavioral programs were more effective than the nonbehavioral program . CONCLUSIONS The results support the general efficacy of parent training in a short-term perspective We tested the effectiveness of the preventive behavioral parent training ( BPT ) program , The Incredible Years ( IY ) , and the independent effects of previously suggested sociodemographic and intervention-based moderator variables ( i.e. , initial severity of externalizing problem behavior , child gender , social economic status , family composition , and number of sessions parents attended ) , in a large-scale r and omized controlled trial . Question naire and observation data from 387 parents and children ages 4 - 8 years ( Mage= 6.21 , SD = 1.33 , 55.30 % boys ) across pretest , posttest , and 4-month follow-up were analyzed , using full intention-to-treat analyses and correcting for multiple testing . IY was successful in decreasing parent-reported child externalizing behavior ( Cohen 's d = 0.20 at posttest , d = 0.08 at follow-up ) , increasing parent-reported ( d = 0.49 , d = 0.45 ) and observed ( d = 0.06 , d = 0.02 ) positive parenting behavior , and decreasing parent-reported negative parenting behavior ( d = 0.29 , d = 0.25 ) . No intervention effects were found for reported and observed child prosocial behavior , observed child externalizing behavior , and observed negative parenting behavior . Out of 40 tested moderation effects ( i.e. , 8 Outcomes × 5 Moderators ) , only three significant moderation effects appeared . Thus , no systematic evidence emerged for moderation of IY effects . The present multi-informant trial demonstrated that many previously suggested moderators might not be as potent in differentiating BPT effects as once thought BACKGROUND Children with conduct problems that persist into adulthood are at increased risk for future behavioral , health , and social problems . However , the longer term public service usage among these children has not been fully documented . To aid public health and intervention planning , adult service usage across criminal justice , health care , and social welfare domains is compared among all individuals from a representative cohort who followed different conduct problem trajectories from childhood into adulthood . METHODS Participants are from the Dunedin Multidisciplinary Health and Development Study , a prospect i ve , representative cohort of consecutive births ( N = 1,037 ) from April 1972 to March 1973 in Dunedin , New Zeal and . Regression analyses were used to compare levels of public service usage up to age 38 , gathered via administrative and electronic medical records , between participants who displayed distinct subtypes of childhood conduct problems ( low , childhood-limited , adolescent-onset , and life-course persistent ) . RESULTS Children exhibiting life-course persistent conduct problems used significantly more services as adults than those with low levels of childhood conduct problems . Although this group comprised only 9.0 % of the population , they accounted for 53.3 % of all convictions , 15.7 % of emergency department visits , 20.5 % of prescription fills , 13.1 % of injury cl aims , and 24.7 % of welfare benefit months . Half of this group ( 50.0 % ) also accrued high service use across all three domains of criminal justice , health , and social welfare services , as compared to only 11.3 % of those with low conduct problems ( OR = 7.27 , 95 % CI = 4.42 - 12.0 ) . CONCLUSIONS Conduct problems in childhood signal high future costs in terms of service utilization across multiple sectors . Future evaluations of interventions aim ed at conduct problems should also track potential reductions in health burden and service usage that stretch into midlife BACKGROUND Parenting programs have been shown to work when delivered to motivated ethnic majority parents in demonstration projects , but comparatively little is known about their impact when delivered to high-risk , multi-ethnic population s by routine local services . METHODS The Primary Age Learning Skills ( PALS ) trial was a r and omized controlled trial of an evidence -based parenting-group program that targeted the parent-child relationship and child literacy . Parents of 174 children were selected from a population of 672 5- and 6-year-olds attending four primary schools in a high-risk , ethnically diverse , inner-city area . Eighty-eight children were allocated to the Incredible Years preventive program plus a shortened six-week version of the SPOKES literacy program , delivered by local services ; 86 to usual community services ; 152/174 ( 87 % ) of families were successfully followed up . Parent-child relationship quality and child behavior were measured using direct observation and parent interview ; child reading was assessed psychometrically . RESULTS Two-thirds ( 58/89 ) of those offered the parenting program attended at least one session , with similar enrollment rates across the Black African , African-Caribbean , White-British and Other ethnic groups . Mean attendance was four relationship-building sessions and one literacy-development session . Satisfaction question naires were completed by 43/58 starters ; 93 % said they were well or extremely satisfied , with equally high rates across ethnic groups . At follow-up after one year , those allocated to the intervention showed significant improvements in the parent-child relationship on observation and at interview compared to controls ; effects were similar across all ethnic groups . However , child behavior problems and reading did not improve . The cost was £ 1,343 ( $ 2,100 ) per child . CONCLUSIONS Programs can be organized to be engaging and effective in improving parenting among high-risk , multi-ethnic communities , which is of considerable value . To also be cost-effective in achieving child changes may require a set-up that enables parents to attend more sessions and /or an exclusive focus on children with clinical ly significant behavior problems Aims : To assess the effectiveness of a parenting programme , delivered by health visitors in primary care , in improving the mental health of children and their parents  among a representative general practice population . Methods : Parents of children aged 2–8 years who scored in the upper 50 % on a behaviour inventory were r and omised to the Webster-Stratton 10 week parenting programme delivered by trained health visitors , or no intervention . Main outcome measures were the Eyberg Child Behaviour Inventory and the Goodman Strengths and Difficulties Question naire to measure child behaviour , and the General Health Question naire , Abidin ’s Parenting Stress Index , and Rosenberg ’s Self Esteem Scale to measure parents ’ mental health . These outcomes were measured before and immediately after the intervention , and at six months follow up . Results : The intervention was more effective at improving some aspects of the children ’s mental health , notably conduct problems , than the no intervention control condition . The Goodman conduct problem score was reduced at immediate and six month follow up , and the Eyberg Child Behaviour Inventory was reduced at six months . The intervention also had a short term impact on social dysfunction among parents . These benefits were seen among families with children scoring in the clinical range for behaviour problems and also among children scoring in the non- clinical ( normal ) range . Conclusion : This intervention could make a useful contribution to the prevention of child behaviour problems and to mental health promotion in primary care Children of incarcerated mothers are considered at risk for disruptive behavior problems and later delinquency . Parenting may play a key role in this intergenerational transmission of delinquency . The present study aim ed to evaluate the effectiveness of the Incredible Years parent training , enhanced with home visits , for ( formerly ) incarcerated mothers to prevent disruptive behavior problems in their 2- to 10-year-old children , by means of a nationwide r and omized controlled trial . Mothers of 133 children ( M age = 76.91 months ; 48.9 % boys ) were assigned to an intervention , consisting of group sessions and individual home visits , or a no-intervention control group . The intervention yielded significant effects on parenting and child behavior for maternal report . Marginally significant effects on child behavior were found for teacher report . The results show short-term effectiveness of parent training for the high-risk and hard-to-reach population of ( formerly ) incarcerated mothers and their children BACKGROUND To test effectiveness of a parenting intervention , delivered in a community-based voluntary-sector organisation , for reducing conduct problems in clinical ly-referred children . METHODS R and omised controlled trial , follow-up at 6 , 18 months , assessors blind to treatment status . Participants --76 children referred for conduct problems , aged 2 - 9 , primarily low-income families , r and omised 
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INTERPRETATION We found no evidence for differential effects by social disadvantage , suggesting that Incredible Years is unlikely to widen socioeconomic inequalities in conduct problems .
Furthermore , the programme might be an important tool for reducing social disparities and improving poor long-term outcomes in disadvantaged families because follow-up studies indicate that benefits persist .