Reducing child conduct problems and promoting social skills in a middle-income country: cluster randomised controlled trial

Background There is an urgent need for effective, affordable interventions to prevent child mental health problems in low- and middle-income countries. Aims To determine the effects of a universal pre-school-based intervention on child conduct problems and social skills at school and at home. Method In a cluster randomised design, 24 community pre-schools in inner-city areas of Kingston, Jamaica, were randomly assigned to receive the Incredible Years Teacher Training intervention (n = 12) or to a control group (n = 12). Three children from each class with the highest levels of teacher-reported conduct problems were selected for evaluation, giving 225 children aged 3-6 years. The primary outcome was observed child behaviour at school. Secondary outcomes were child behaviour by parent and teacher report, child attendance and parents' attitude to school. The study is registered as ISRCTN35476268. Results Children in intervention schools showed significantly reduced conduct problems (effect size (ES) = 0.42) and increased friendship skills (ES=0.74) through observation, significant reductions to teacher-reported (ES=0.47) and parent-reported (ES=0.22) behaviour difficulties and increases in teacher-reported social skills (ES=0.59) and child attendance (ES=0.30). Benefits to parents' attitude to school were not significant. Conclusions A low-cost, school-based intervention in a middle-income country substantially reduces child conduct problems and increases child social skills at home and at school.