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Parenting intervention in Sure Start services for children at risk of developing conduct disorder: pragmatic randomised controlled trial

BMJ 2007; 334 doi: (Published 29 March 2007) Cite this as: BMJ 2007;334:678

This article has a correction. Please see:

  1. Judy Hutchings, research director1,
  2. Tracey Bywater, project trial coordinator1,
  3. Dave Daley, senior research tutor1,
  4. Frances Gardner, reader in child and family psychology2,
  5. Chris Whitaker, statistician1,
  6. Karen Jones, research assistant1,
  7. Catrin Eames, research assistant1,
  8. Rhiannon T Edwards, senior research fellow in health economics3
  1. 1School of Psychology, University of Wales Bangor, Bangor, Gwynedd, LL57 2DG
  2. 2Department of Social Policy and Social Work, University of Oxford
  3. 3Centre for the Economics of Health, Institute of Medical and Social Care Research (IMSCaR), University of Wales Bangor
  1. Correspondence to: J Hutchings j.hutchings{at}
  • Accepted 23 January 2007


Objective To evaluate the effectiveness of a parenting programme as a preventive intervention with parents of preschool children considered to be at risk of developing conduct disorder.

Design Pragmatic randomised controlled trial using a block design with allocation by area.

Setting Eleven Sure Start areas in north and mid-Wales.

Participants 153 parents from socially disadvantaged areas, with children aged 36-59 months at risk of conduct disorder defined by scoring over the clinical cut off on the Eyberg child behaviour inventory. Participants were randomised on a 2:1 basis, 104 to intervention and 49 to remaining on the wait listing (control). Twenty (13%) were lost to follow-up six months later, 18 from the intervention group.

Intervention The Webster-Stratton Incredible Years basic parenting programme, a 12 week group based intervention.

Main outcome measures Problem behaviour in children and parenting skills assessed by self reports from parents and by direct observation in the home. Parents' self reported parenting competence, stress, and depression. Standardised and well validated instruments were used throughout.

Results At follow-up, most of the measures of parenting and problem behaviour in children showed significant improvement in the intervention group. The intention to treat analysis for the primary outcome measure, the Eyberg child behaviour inventory, showed a mean difference between groups of 4.4 points (95% confidence interval 2.0 to 6.9, P<0.001) on the problem scale with an effect size of 0.63, and a mean difference of 25.1 (14.9 to 35.2, P<0.001) on the intensity scale with an effect size of 0.89.

Conclusion This community based study showed the effectiveness of an evidence based parenting intervention delivered with fidelity by regular Sure Start staff. It has influenced policy within Wales and provides lessons for England where, to date, Sure Start programmes have not been effective.

Trial registration ISRCTN46984318


  • We thank all participating families; Sure Start staff, group leaders, and research and intervention staff for their help; Jess Eade for her help in the initial setting up of the project; Pam Dewis for arranging access to families; Dilys Willliams for her administrative support; Caroline White for assessing tapes of programme delivery; Carolyn Webster-Stratton and Ian Russell for their advice and encouragement; Carl Hughes for his support and attendance at steering group meetings, and all members of the research team who helped in the collection and scoring of data, especially Alan Ó'Céilleachair.

  • Contributors: JH had the idea for the study and obtained the grant, with assistance from FG. TB and JH managed the project and obtained further funding to extend the research. TB conducted randomisation and analyses. CW conducted additional analyses. TB and JH wrote the first draft of the paper. DD, RTE, and FG served on the steering group and helped write the manuscript. JH gave weekly supervision to group leaders. KJ and CE collected outcome measures and trained observers in the dyadic parent-child interaction coding system. JH is guarantor.

  • Funding: Research grant from the Health Foundation, grant No 1583/1566.

  • Competing interests: JH is paid by Incredible Years for running occasional training courses in the delivery of the parent programme and has served as an expert witness for the NICE appraisal on parenting and conduct disorder.

  • Ethical approval: North West Wales research ethics committee (ref No 02/12).

  • Accepted 23 January 2007
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