Effectiveness of a Teacher-Based Indicated Prevention Program for Preschool Children with Externalizing Problem Behavior

Externalizing behavior is common in preschool children and shows stability over the lifespan implying that strategies for early intervention and prevention are needed. Improving parenting reduces child behavior problems but it is unproven whether the effects transfer to kindergarten. Strategies implemented directly by teachers in the kindergarten may be a promising approach. The effectiveness of the teacher's module of the Prevention Program for Externalizing Problem Behavior (PEP-TE) was investigated in a study using a within-subject control group design. Each of the 144 teachers enrolled identified one child with externalizing problem behavior (aged 3-6 years) and rated that child's behavior problems [broadband externalizing, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder] as well as their own behavior (attending skills) and burden by the child. Changes in child symptoms and teacher behavior or burden during the 3-month waiting period (control) and 3-month treatment period were compared. Stability of treatment effects at both 3- and 12-months follow-up after treatment was examined. Multilevel modeling analyses showed that, despite a reduction in externalizing behavior and ADHD scores during the waiting period, all child problem behavior scores decreased during the treatment period compared with the waiting period. The teacher's behavior also improved and their burden decreased. These treatment effects were stable during follow-up for the subsample remaining in the kindergarten for up to 1 year. This study shows that a teacher-based intervention alone is associated with improvements in both the externalizing behavior of preschoolers and teacher behavior and burden. Indications of long-term stability of effects were found.