Study Review

Incredible Years Parenting Programme

Parenting programme to improve parenting skills and promote children’s academic, social and emotional skills as well as reduce their disruptive behaviours.

Outcome Overall
effectiveness

This rating shows how effective the intervention is at achieving the evaluated outcome.

Click here for information about how effectiveness ratings are applied.

Strength of
evidence

This rating shows how confident we can be about a finding, based on how the research was designed and carried out.

Child attention deficit hyperactivity disorder symptoms Overall effectiveness: 1 (maximum 2) Strength of evidence : 3 (maximum 3)
Child emotional problems Overall effectiveness: 0 (maximum 2) Strength of evidence : 3 (maximum 3)
Parental mental health Overall effectiveness: 0 (maximum 2) Strength of evidence : 3 (maximum 3)
Harsh and inconsistent parenting Overall effectiveness: 1 (maximum 2) Strength of evidence : 3 (maximum 3)
Positive parenting Overall effectiveness: mixed (maximum 2) Strength of evidence : 3 (maximum 3)

Headline points

  • This summary comes from the original systematic review: Gardner, F., Leijten, P., Mann, J., Landau, S., Harris, V., Beecham, J., ... & Scott, S. (2017). Could scale-up of parenting programmes improve child disruptive behaviour and reduce social inequalities? Using individual participant data meta-analysis to establish for whom programmes are effective and cost-effective. Public Health Research, 5(10)
  • The Incredible Years intervention showed benefits for attention deficit hyperactivity disorder symptoms and some aspects of parenting.
  • It was found to have the strongest effect on children with the most severe disruptive behaviours.
  • The evidence was high strength and based on studies in England, Wales, Netherlands, Ireland, Norway, Sweden and Portugal.

Useful contacts

What is this?

  • Persistent disruptive behaviour is the most common mental health problem in children. Such problems, including Oppositional Defiance Disorder, often stem from childhood and can negatively affect a person’s life outcomes; for example, increasing the risk of alcoholism; drug abuse; criminality; domestic violence; sexually transmitted infections; poor mental health, including psychosis; and early death.
  • Incredible Years is an evidence based parenting programme in which parents learn to break negative parent-child interaction cycles. It has been rolled out in England and Wales.
  • The authors highlight that given the extreme consequences and potential high public health and financial cost, there is a good rationale for early preventative parenting programmes for parents of children who display persistent disruptive behaviour.

How is it meant to work?

Underpinned by social learning theory and attachment theory the intervention is designed to teach parents techniques to break coercive cycles of parent-child interaction which reinforce negative and aggressive behaviours. The Incredible Years programme is similar to other parenting programmes such as ‘Triple-P’, ‘Parent-Child Interaction Therapy’, and Parent Management Training: Oregon Model. With regards to the potential for the programme’s enhanced applicability to socio-economically disadvantaged families and ethnically diverse families, the authors suggest this is due to the collaborative and culturally sensitive nature of the programme.

What are the evaluated outcomes?

  • Child attention deficit hyperactivity disorder symptoms
  • Child emotional problems
  • Parental mental health
  • Harsh and inconsistent parenting
  • Positive parenting

How effective is it?

Child attention deficit hyperactivity disorder symptoms
Overall, Incredible Years tended to show a positive effect on child attention deficit hyperactivity disorder symptoms. This is based on high strength evidence. A 12% decrease in attention deficit hyperactivity disorder symptoms (ADHD) was seen in children whose parents attended the Incredible Years programme. This suggests that interventions targeting one type of ‘externalising behaviour’ like conduct disorder can have a positive effect on other externalising behaviours such as ADHD.

Child emotional problems
Incredible Years tended to show no effect for child emotional problems.This is based on high strength evidence. No differences were found in child emotional symptoms between children whose parents took part in Incredible Years and those who did not.

Parental mental health
Similarly to child emotional problems, the Incredible Years intervention showed no effect for parental mental health. This is based on high strength evidence. There was no statistically significant improvement in parental depression, parental stress or self-efficacy with the intervention.

Harsh and inconsistent parenting 
The Incredible Years parenting programme tended to show a positive effect on harsh and inconsistent parenting. This is based on high strength evidence. This included reductions in corporal punishment, threatening and shouting.

Positive parenting
Incredible Years tended to show a mixed effect on positive parenting. This is based on high strength evidence. The findings showed an increased use of positive praise. However parents did not report using more rewards or monitoring behaviours.

The high strength of evidence rating for this meta-analysis is based on having a large overall sample size and inclusion of only Randomised Controlled Trials (RCTs).

Where has it been studied?

  • There were 14 studies in this review, six studies were undertaken in England, two in Wales, two in the Netherlands and one trial each in Ireland, Norway, Sweden and Portugal.
  • Therefore applicability of the findings to the UK context is relatively strong.

Who does it work for?

  • Children involved in these interventions were between two and 10 years old. Older and younger children were found to be equally likely to benefit from involvement in the Incredible Years programme.
  • The results suggested that the intervention is more effective for boys than girls.
  • There was no difference in effectiveness by ethnicity, meaning that families of all ethnicities are equally likely to benefit from the intervention.
  • Findings also suggest equal benefit to those families experiencing social disadvantage, and those who don’t. This suggests that this intervention will neither increase or decrease existing social inequalities in child disruptive behaviour.
  • Families who displayed greater levels of distress and higher levels of problems, particularly higher child disruptive behaviour or parental depression found greater positive effect, with more improvement from this intervention.

When, where and how does it work?

The review considered whether characteristics of delivery, such as staff training or number of sessions, affected intervention outcomes. However, given the small number of included studies the authors were hesitant to draw any conclusions from this.

What are the costs and benefits?

  • The authors used a public sector perspective when considering the cost effectiveness of the intervention, taking into account the cost of the intervention itself as well as the cost to the public sector.
  • Cost-effectiveness analyses suggests that the Incredible Years intervention can provide savings to the public sector in the longer term.

How is it implemented?

  • Incredible Years parenting programme was developed by Carolyn Webster-Stratton in 1997. It is designed to be a community based programme to help parents of children with ADHD, conduct problems and promote emotional and social development, emotional regulation,  and improve academic success.
  • The long term goal of the programme is to prevent delinquency, drug abuse, and violence.
  • The programme has now been implemented in over 20 countries around the world. These include Canada, England, Wales, Scotland, Norway, Palestine, New Zealand, Ireland, Portugal, Australia, Denmark, The Netherlands, Russia, Finland, Sweden.
  • There are Incredible Years programmes aimed at parents, children and teachers.
  • The intervention comprises 12 to 14 weekly sessions which are two to two and a half hours long.
  • The sessions are delivered to groups of between six and 15 parents.
  • The groups are shown videos of parent-child interactions covering a range of topics such as, relationship building through playing or spending special time with the child; providing praise and rewards as reinforcements of positive behaviour; effective limit-setting; adequate disciplining techniques such as ignore and time-out techniques; and coaching children in social, emotional and academic skills.
  • Parents are guided to set weekly goals and to identify key parenting principles and behaviours.
  • Group discussion in which parents come up with their own topics and solutions is encouraged.
  • Parents in the programme receive weekly check-ins via a phone call.

Who can deliver it?

The programme is delivered by accredited therapists, counsellors, social workers, nurses, teachers or physicians.

 

What are the training and supervision requirements?

  • There is a standardised training for therapists, counselors, social workers, nurses, teachers and physicians, to deliver Incredible Years.
  • This training is accessed through the Incredible Years organisation.

What supports good implementation?

  • Using a collaborative and flexible approach, the intervention can be shaped by each parent to meet the needs of their own family.
  • Viewing parents as the experts in their own children
  • The use of groups can help create more social-support for parents.

Case study

  • The Incredible Years programme has been implemented in numerous places and contexts. In Manchester (England) the intervention has been delivered by the Manchester University NHS Foundation Trust’s Children and Parents Service (CAPS). In the city, at least 20 per cent of the city’s population of 34,000 under-fives is at risk of having or developing behavioural problems.
  • CAPS deliver the Incredible Years programme for 14 weeks to parents of children aged two to four, or for 10 weeks for parents of children aged up to two.
  • The staff are all certified in Incredible Years.
  • The sessions include using Video Interaction Guidance, where families reflect on video clips of interactions with their children.
  • Between September 2017 and August 2018, CAPS delivered 75 Incredible Years parenting courses to 989 parents of children aged under four.
  • From these interventions,  the proportion of families at risk of neglect or abuse fell from 86 per cent before the intervention, to 56 per cent afterwards. Parents presenting signs of clinical depression fell from 68 per cent to 19 per cent and the  proportion of parents with clinical stress fell from 72 per cent to 12 per cent.
  • Children also benefited from the intervention in Manchester with the proportion of children with clinical behavioural problems falling from 69 to 32 per cent.
  • Incredible Years implementation examples
  • CAPS

In summary...

  • The evaluations of the Incredible Years parenting programme have high strength evidence.
  • The intervention improves outcomes for attention deficit hyperactivity disorder symptoms and some aspects of parenting, and is most effective for children who display severe disruptive behaviour.
  • There is no evidence that Incredible Years would widen social inequalities.
  • There seems to be equal effect across age and ethnicity. However it is suggested that the intervention is more effective for boys.
  • The intervention can be considered cost-effective.

Further resources