Effectiveness of Alles Kidzzz: an indicated preventive intervention for externalizing problem behavior in school age children

According to several longitudinal studies an elevated level of externalizing
problem behavior (prevalence 5-10%) in elementary school is relatively stable
and predictive of poor mental health. These children are more at risk for
developing a Conduct Disorder (CD) and delinquency in adolescence, CD with a
co-morbidity of mood disorder and substance abuse in adulthood, and the
longitudinal societal costs are largely elevated. Whereas in a recent
meta-analysis parent-management-training (PMT) as well as child
cognitive-behavioral treatment (CBT) both proved to be effective interventions,
in the Netherlands an evidence based indicated preventive intervention for
externalizing problem behavior in school is lacking. Alles Kidzz (AK), a
manualized individual social skills training based on the principals of the
cognitive behavior therapy, for 9- to 12-year-old children with externalizing
behavior problems has been developed by Dutch mental health care centers and
has been implemented in schools. A quasi-experimental pilot study showed
promising results in terms of decrease of externalizing problems.

The purpose of this study is to evaluate in a Randomized Controlled Trial (RCT)
study the effectiveness of AK alone and in combination with parent-management-
training (PMT). The PMT component is added because parental involvement
increases effectiveness of individual child interventions. We hypothesize that
1) children receiving AK will show less externalizing behavior and more
pro-social behavior after intervention and at follow up, compared to children
in the control condition and; 2) effectiveness will be moderated by several
child, family and school factors and mediated by child social information
processing, parenting behavior and parental involvement and treatment integrity
and 3) effectiveness of AK plus PMT on child outcome will be more enduring at
follow-up compared to AK alone, whereas parents receiving individualized PMT
after AK training will show more positive and less negative parenting behavior
at follow-up compared to parents in the AK only and in the control condition.

The RCT design is an intervention study (pre- and post measurement, follow-up
at 6 and 12 months after intervention) with two experimental conditions a) AK
alone and b) AK plus PMT and c) a non-intervention control condition.
Participating schools (n = 48) are randomized into three groups of 16, and each
school participates in each condition in a prescribed order during three years.
Every year two children per school participate (N= 288 children; N=192 parents
in PMT).

(1) AK: children receive an individualized manualized training programme during
school time at school during 8 weeks; parents and teachers are weekly involved
receiving a written report. At start, after three weeks and after completion
parents are informed orally by the trainer. (2) PMT (Parents as Coach): after
completion of AK, parents receive a written manual and are contacted every week
for 8 weeks by telephone or email or home visit (if necessary) by their child*s
trainer.

Without these child participants the study could not be executed. We aim to
study the intervention in a way as close as possible to the regular practice;
trainers are encouraged to perform in the same way as they are used to for
years now. The aim of the study is to keep the burden of the research demands
as minimal as possible for all involved (schools, teachers, parents, children,
trainers). Questionnaires for teachers, children, parents and trainers are
added at four moments during 1,5 years. Protocols for research demands (contact
with parents, dosage of information, informed consent forms, questionnaires
etc) are developed in close consultation with trainers and schools. The risks
are negligible using well known world wide used questionnaires. Benefit of the
study hopefully will be an evidence-based effective intervention for a
recognized important every day problem in school age children.