Cluster Analysis of Child Externalizing and Prosocial Behaviors in a Randomized Effectiveness Trial of the Family-Check Up and Internet-Delivered Parent Training (iComet).

Abstract

Objective: To explore whether children with various externalizing/prosocial behavior profiles benefit differently from face-to-face training than from an internet-based parent management training (PMT) programme.

Methods: A total of 231 families with children (aged 10 to 13 years) with externalizing behavior problems (EBP) were randomized to receive either the Family Check-Up, delivered by therapists in the community, or the internet-based PMT program (iComet). Person-oriented analysis was used for subtyping the children according to combinations of prosocial behavior and EBP.

Results: The person-oriented analysis resulted in five significantly different clusters. There were no significant differences between the five clusters in relation to the total difficulties score of the Strengths and Difficulties Questionnaire, family warmth or family conflict, but the within-group effect sizes for the main outcome (total difficulties score) from baseline to post-treatment varied from Cohen's d of 0.52 to 2.56. There were no significant interaction effects between the clusters and type of intervention. However, for children high on symptoms of attention deficit hyperactivity disorder and moderate to high on oppositional defiant disorder, and low to relatively high on prosocial behaviors (Cluster 3 respectively 5), substantial residual EBP-symptomatology remained at post-treatment, although both interventions resulted in significant effects. The other three clusters were within the non-clinical EBP-range at post-intervention, irrespective of treatment condition. There were no significant differences between the clusters regarding treatment completion rate (ranging from 47.2% to 67.4%). This study illustrates the value of distinguishing between different profiles of children in the context of PMT for parents of children with EBP.