***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 Although efficacious interventions exist for childhood conduct problems , a majority of families in need of services do not receive them . To address problems of treatment access and adherence , innovative adaptations of current interventions are needed . This r and omized control trial investigated the relative efficacy of a novel format of parent-child interaction therapy ( PCIT ) , a treatment for young children with conduct problems . METHOD Eighty-one families with 3- to 6-year-old children ( 71.6 % boys , 85.2 % White ) with diagnoses of oppositional defiant or conduct disorder were r and omized to individual PCIT ( n = 42 ) or the novel format , Group PCIT . Parents completed st and ardized measures of children 's conduct problems , parenting stress , and social support at intake , posttreatment , and 6-month follow-up . Therapist ratings , parent attendance , and homework completion provided measures of treatment adherence . Throughout treatment , parenting skills were assessed using the Dyadic Parent-Child Interaction Coding System . RESULTS Parents in both group and individual PCIT reported significant improvements from intake to posttreatment and follow-up in their children 's conduct problems and adaptive functioning , as well as significant decreases in parenting stress . Parents in both treatment conditions also showed significant improvements in their parenting skills . There were no interactions between time and treatment format . Contrary to expectation , parents in Group PCIT did not experience greater social support or treatment adherence . CONCLUSIONS Group PCIT was not inferior to individual PCIT and may be a valuable format to reach more families in need of services . Future work should explore the efficiency and sustainability of Group PCIT in community setting s. ( PsycINFO Data base The Incredible Years ( IY ) Series includes separate group interventions to improve parenting interactions , teacher classroom management , and child social-emotional regulation . Although originally developed to treat early onset conduct problems , IY targets many of the proposed mechanisms and risk factors for internalizing distress in early childhood . Prior studies have demonstrated the effects of the IY parent intervention on co-occurring depressive symptoms . We attempted to extend these findings by examining the unique and combined effects of IY interventions on children 's co-occurring internalizing symptoms .  One-hundred and fifty-nine families with children ages 4- to 8-years-old were r and omly assigned to parent training ( PT ) ; parent plus teacher training ( PT + TT ) ; child training ( CT ) ; child plus teacher training ( CT + TT ) ; parent , child , plus teacher training ( PT + CT + TT ) ; or a waiting list control group . Children who received any of the intervention components were more likely to have lower mother-rated internalizing symptoms at posttreatment compared to children in a wait-list control group . Implication s for future research and for design ing interventions and prevention strategies for children with internalizing symptoms  are discussed . ( PsycINFO Data base 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 Objective To investigate the cost effectiveness of a parenting programme . Design An incremental cost effectiveness analysis alongside a pragmatic r and omised controlled trial of the effectiveness of a group parenting programme delivered through Sure Start in the community . Setting Sure Start areas in north and mid Wales . Participants Parents of 116 children aged 36 - 59 months ( 87 % of the clinical sample ) at risk of developing conduct disorders defined by scoring over the clinical cut off on the Eyberg child behaviour inventory ) . Children were identified by health visitors and recruited by the research team . Intervention The Webster-Stratton Incredible Years basic parenting programme or a six month waiting list control . Main outcome measure Incremental cost per unit of improvement on the intensity score of the Eyberg child behaviour inventory . Results The bootstrapped incremental cost effectiveness ratio point estimate was � 73 ( € 109 , $ 142 ) per one point improvement on the intensity score ( 95 % confidence interval � 42 to � 140 ) . It would cost � 5486 ( € 8190 , $ 10 666 ) to bring the child with the highest intensity score to below the clinical cut-off point and � 1344 ( € 2006 , $ 2618 ) to bring the average child in the intervention group within the non- clinical limits on the intensity score ( below 127 ) . For a ceiling ratio of � 100 ( € 149 , $ 194 ) per point increase in intensity score , there is an 83.9 % chance of the intervention being cost effective . The mean cost per child attending the parenting group was � 1934 ( € 2887 , $ 3760 ) for eight children and � 1289 ( € 1924 , $ 2506 ) for 12 children , including initial costs and material s for training group leaders . When we categorised the sample into relatively mild , moderate , and severe behaviour groups based on intensity scores at baseline the intervention seemed more cost effective in those with the highest risk of developing conduct disorder . Conclusion This parenting programme improves child behaviour as measured by the intensity score of the Eyberg child behaviour inventory at a relatively low cost and was cost effective  compared with the waiting list control . This parenting programme involves modest costs and demonstrates strong clinical effect , suggesting it would represent good value for money for public spending 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 Structured parent training has been proven to be effective in reducing  disruptive behavior problems ( DBP ) in children . Most of the programs that are used in Sweden have their origin in North America , and there is an ongoing debate over the transferability to Sweden of manual-based programs developed in other context s. The goal of the present study was to study effectiveness of the Incredible Years parent-training program ( IY ) , developed in the US , in regular clinical work in Sweden , using a r and omized controlled design . Parents of 62 four to eight-year-old children diagnosed with Oppositional Defiant Disorder participated in the study . Parents of 38 children were assigned to  parent training ( PT ) and 24 to a waiting list ( WL ) .  The results indicate that the IYS retains the positive effects on children 's disruptive behavior problems when translated and transferred to Swedish . There was a statistically significant difference in reduction of DBP in children between the groups in favor of the PT . The improvement in the PT group was sustained at the one-year follow-up . The improvement also , at least to some extent , generalized over time to the school context . There was also a statistically significant difference in mothers ' report of pre to post change in parenting alliance between the PT and WL groups . The IYS program was appreciated and well received by the participating mothers A sample of 15 families referred for child behavior problems were r and omly assigned to a group condition ( parent training plus group behavior therapy , n = 7 ) , and an individual condition ( individual family behavior therapy , n = 8) . These children manifested primarily home problems of non-compliance , tantrums and fighting behaviors . Results showed the group condition was more efficient in terms of therapist time and number of subject-families achieving an experimental criterion for behavior change . The group condition scored significantly higher than the individual condition on a post-test measuring knowledge of behavioral principles as applied to children . Most subjects , regardless of treatment condition , rated non-targeted behaviors as decreasing in frequency . Also , both groups were equally satisfied with therapy . Families were contacted 6 months following the conclusion of treatment Behavioral parent training is an efficacious treatment for attention-deficit/hyperactivity disorder ( ADHD ) . However , single-mother households are at high risk for poor outcomes during and following behavioral parent training . This study r and omly assigned cohorts of 120 single mothers of children ( ages 5–12 years ) with ADHD to a waitlist control group , a traditional behavioral parent training program , or an enhanced behavioral parent training program — the Strategies to Enhance Positive Parenting (  STEPP )  program . Intent-to-treat analysis demonstrated benefits of participating in behavioral parent training , in general , and the STEPP program more specifically at immediate posttreatment on child and parental functioning . Moreover , the STEPP program result ed in increased engagement to treatment . However , results indicated that behavioral parent training does not normalize behavior for most children and treatment gains are not maintained Strong evidence supports cognitive-behavioral therapy ( CB 
    Output:
    
Child anxiety symptoms or internalizing problems evident in children with externalizing behavior problems did not change significantly following intervention .
Study quality was a statistically significant moderator of treatment response for child externalizing problems , however hours of planned parent group treatment and treatment recipient were not .
Findings support the use of parent group interventions as an effective treatment for reducing externalizing problems in children aged 4–12 years .