Multi-Component Intervention Teaching Children Emotion Self-Regulation Skills: Weighting Parent Participation to Estimate Intervention Effects and Mediators

Introduction: Problems with self-regulation of emotions are linked to the etiology and maintenance of a wide range of problems, including externalizing behavior, substance use problems, and depression.  Little is known about the mechanisms whereby children learn and apply emotion self-regulation skills and the impact on different domains of behavior.  We tested a 2-year multi-component intervention (Rochester Resilience Project) teaching at-risk 1^st-3^rd grade children emotion self-regulation (ER) skills through (a) individual mentoring, and (b) home visit lessons with parents to engage them as teachers of ER skills to their children. A brief classroom curriculum was provided to children to both intervention and controls.  To assess the putative mediator, an interview was developed measuring children’s knowledge of ER skills that was videotaped and scored (both E and C groups). 

Methods: 401 1^st-3^rd grade children from 5 urban schools were randomized within classroom to E or C condition.  Multi-source internalizing and externalizing measures were collected over 3 years.  Children’s completion of the 24-session curriculum was ~ 85%.  In contrast, 63% of parents participated in > 1 home visit and few completed the 12 visits.  ITT estimates of intervention effects used multi-level growth models.  Second, estimates of intervention effects incorporated parent participation by identifying baseline predictors of participation in the E group (i.e.,  older age, higher perceived need of help for child) and imputing participation for the C group (Henry et al. 2011). Weights were applied to both conditions using a four-level ordinal variable ranging from 0 visits to > 6 visits. 

Results:  ITT estimates showed modest intervention effects only on reducing self-report internalizing problems.  Weighted analyses showed intervention impact on reducing both externalizing and internalizing problems that were consistently larger for older children.  Older children also learned more ER skill knowledge.  Using weighted analyses, tests of mediation showed partial mediation of internalizing (child and parent-report) and self-reported externalizing problems through children’s gain in verbal knowledge of ER skills. 

Conclusion: Using analyses that focused on parents who participated, we conclude that parent participation assisted young at-risk children to learn and apply emotion self-regulation skills, which reduced internalizing and, to a lesser extent, externalizing problems over a 3-year period.