Reaching Families in Most Need of Change: Examining Baseline Conduct Problems As a Moderator of Intervention Effectiveness

An estimated 5-13% of preschoolers demonstrate moderate to severe conduct problems (CP). As numerous aspects of parenting have been linked to emerging CP, it is not surprising that many interventions for CP target parenting. One such intervention is the Family Check-Up (FCU), which has demonstrated moderate to large effects in reducing CP. While these results are promising, parenting interventions such as the FCU are not effective for all children. Therefore, investigating moderators of effectiveness is of critical importance.

This study examines initial level of CP as a moderator, a variable of particular interest given the importance of understanding whether the FCU is effective for children at heightened risk for future problem behavior. Further, the current study explores whether mediating mechanisms through which the FCU has been found to reduce CP – through improved caregiver depression and parenting – are moderated by baseline CP. Finally, this study examines the effect of initial level of CP on rates of engagement in the FCU.

The sample includes 731 high risk families, half randomly assigned to the FCU. Primary caregivers (PC) reported on depressive symptoms using the CES-D and child CP using the Eyberg Child Behavior Inventory and Child Behavior Checklist. The CP outcome was created using 8 CBCL items that mapped onto DSM-IV criteria for Oppositional Defiant Disorder and Conduct Disorder and averaging values for items at each age. PC Positive Engagement was derived from 50 minutes of observational data. Data is used from the age 2, 3, 4, and 5 home assessments. Structural equation modeling (SEM) was utilized in Mplus 5.21.

The multi-group model examining the effect of the FCU on growth in CP for children with high baseline CP (one SD > mean on the age 2 ECBI intensity factor) versus children low on baseline CP was first examined. The FCU was linked with reduced growth in CP only for children with higher baseline CP. The multi-group model examining PC depression as a mediator also found that the FCU was linked to reduced growth in CP only for children with higher baseline CP. The significant pathways from the FCU to lower PC depression and from PC depression to CP did not differ by baseline CP. The indirect effect of the FCU on CP through PC depression was significant. Additional analyses will examine similar moderated mediation paths from the FCU to observed positive engagement to CP using initial levels of CP as a moderator.  Further, the effect of initial level of CP on engagement in the FCU over time will be examined.

Results demonstrate that the FCU is effective in reducing depression in PCs of children with varying baseline levels of CP; however, the direct effect of the FCU on CP is significant only for those at higher baseline risk.