Social Inequality in Child Development: Family Cumulative Disadvantage and Heterogeneity of Treatment Effects in Two Parent-Training Interventions

Introduction: Low economic and social resources has been found to be risk factors for child behavior problem development (e.g. externalizing problems, conduct problems) and to be a moderator of treatment effects. Also, Cumulative Disadvantages (CD) has been associated with behavior problem development. However, no one have studied whether CD moderate treatment effects. If CD is both associated with higher rates of problem behavior and less benefit in treatment, this could intensity the already existing social inequalities in child development. Inspired by Sameroff & colleagues, we created a CD index containing nine different family factors, including family and parent social and economic resources together with somatic and mental health. We used data from two randomized effectiveness studies of the high intensive Parent Management Training, Oregon group therapy (PMTO) and the low intensive PMTO short-form Brief Parent Training (BPT). The aim of this study was (1) to examine whether having more cumulative disadvantages overall moderated treatment effects according to treatment condition, and (2), whether there was differential moderation related to the intensity of treatment.

Method: In total, 353 families were included in the present study. Autoregressive multigroup SEM-models were run in Mplus to investigate heterogeneity in treatment effects. Post-treatment and follow-up effects were examined.

 

Results: Findings revealed differential effects of CD in the treatment group, P = -0.19, SE = 0.051, P = < .001, and control group, P = 0.15, SE = .036, p = < .001. High CD children in the treatment group displayed lower levels of problem behavior whereas disadvantaged control group children experienced more problems at post-treatment. Results were replicated in follow-up. Further analyses showed that there was differential moderation related to intensity of treatment. High CD children receiving PMTO-treatment benefitted more, P = -0.31, SE .09, p < .001, than children from CD families receiving BPT, P = - 0.12, SE = .07, p = ns. Follow-up analysis replicated the results. Thus, giving to high intensity PMTO to disadvantaged families significantly improved treatment effects.  

 

Conclusions: Overall, the findings indicate children from families with high levels of CD benefits from receiving both PMTO treatments regardless of their children’s initial level of behavior problems. Moreover, in families with high rates of CD, the high intensive PMTO treatment is more efficient. Results indicate that addressing behavior problems particularly with high intensive PMTO reduces social inequality in child development. When screening for interventions, the cumulative level of family disadvantages should be taken into account.