Contact information
Type
Scientific
Primary contact
Dr Stephen Scott
ORCID ID
Contact details
Child and Adolescent Psychiatry
King's College London
Institute of Psychiatry
De Crespigny Park
London
SE5 8AF
United Kingdom
+44 (0)20 7848 0746
s.scott@iop.kcl.ac.uk
Additional identifiers
EudraCT number
ClinicalTrials.gov number
Protocol/serial number
N/A
Study information
Scientific title
Acronym
SPOKES
Study hypothesis
Families allocated to the intervention will show improvements in:
1. Parenting style
2. Child antisocial behaviour, including the rate of oppositional-defiant disorder
3. Child attention-deficit/hyperactivity disorder (ADHD) symptoms
4. Child reading ability
Ethics approval
Institute of Psychiatry Ethics 30/96
Study design
Randomised controlled trial (RCT) of eligible cases, with the individual child being the unit of random allocation, stratified by school, and year.
Primary study design
Interventional
Secondary study design
Randomised controlled trial
Trial setting
Not specified
Trial type
Treatment
Patient information sheet
Condition
Childhood antisocial behaviour/oppositional defiant disorder
Intervention
Intervention arm:
Overall Package. This comprised a 12 week behaviour course in the fall term, a 10 week literacy course in the spring term, and a 6 week course with both elements in the summer term.
Term one: Personal Development Program. This was the 'Incredible Years' (IY) school age videotape parenting program which addresses child behaviour and the parent-child relationship and has a strong evidence base (Webster-Stratton and Hammond 1997). The program is based on social learning principles i.e. that antisocial behaviour is promoted through lack of encouragement of good behaviour, and unwitting rewards for bad behaviour (Patterson 1997). Videotapes are shown to parents of 6-8 children, scenes depict parents sometimes behaving in a way that leads to the child being calm and obedient, and at other times in a way that leads the child misbehave and have tantrums. The first six weeks of the program concentrate on how to promote desirable child behaviour and constructive activity through play, praise and rewards. The second six weeks focus on handling misbehavior, including ignoring minor misbehaviour, applying consequences, and using time out. Through detailed group discussion, the parental behaviour that led to better child behaviour was drawn out. Then parents practised the new techniques in role plays of their own situation. They were instructed to practise the new skills at home, and were telephoned by the group leader mid-week to check progress and solve difficulties.
Term two: Child literacy program. This was a new program devised by the authors, with a manual (Sylva and Crook 2002). It combined the Pause Prompt Praise (PPP; McNaughton, Glynn & Robinson 1987) approach to reading with a whole language approach which focused on discussion of the book and also on language play with sounds and letters. In the PPP parents are trained to provide one-to-one tuition to school-age children (Merrett 1998), and its effectiveness has been replicated in many countries (Wheldall & Glynn 1989). The emphasis of the reading program was to give parents a range of techniques with which to encourage their children to use an active problem-solving approach to reading. This was congruent with the methods they had recently been taught in the behavioral management program, and helped the parents continue to build a positive relationship with their child by widening it to the domain of schoolwork.
Term three: Combined child behaviour and literacy program. Four sessions were offered on how to encourage children to solve disputes themselves (Incredible Years advanced program), and two sessions on further literacy development, culminating in an ending celebration.
Control arm:
Participants allocated to the control group were offered a telephone Access Helpline. If they had concerns, parents were told they would get a response within 24 hours to advise how they could get access to regular services. Information on how to manage the childs difficulties was not offered. Whilst allocation to the parenting program meant giving a substantial fixed time commitment each week, the advantage of the helpline was that no such demands were made: it was available if the parent wanted it. Furthermore it was pointed out that regular services could be quite good if one knew how best to access them.
Intervention type
Other
Phase
Not Specified
Drug names
Primary outcome measure
Parent Account of Child Symptoms (PACS: Taylor et al 1986, 1991); this was the primary outcome of the trial. This is an investigator-based interview similar in format and scoring to the Child and Adolescent Psychiatric Assessment (Angold et al 2001). It is shorter and covers 8 oppositional symptoms/antisocial behaviours scored 0-3 for severity and frequency. It has been used in surveys of over 10,000 children (Taylor et al 1991).
Secondary outcome measures
Parenting:
1. Interview. This was a modified form of the semi-structured interview devised by Quinton et al (1988). It covered three parenting practices taught in the intervention known to be associated with prosocial child behaviour (time spent playing with the child, use of praise, strategic use of rewards); two disciplinary practices shown to diminish antisocial behaviour (the giving of logical consequences, time out); and inappropriate discipline associated with more antisocial behaviour (spanking and exclusion for over ten minutes).
2. Expressed emotion (EE). This is a measure of parental warmth and criticism expressed towards the child during the whole interview, and was rated globally on a 5 point scale using Camberwell Family Interview criteria (Vaughn and Leff 1986).
3. Direct observation. This is the gold standard in the sense that it is what actually happens, rather than an account. The procedure of the Conduct Problems Research Group (1999) was used, with videotaping of parent-child interaction across three tasks:
i. Child directed play, in which the child is allowed to play with any of several toys provided (five minutes)
ii. Parent directed task, in which the child is told by parent to copy a complex Lego toy brick construction (five minutes)
iii. Clean-up segment in which the child is instructed to tidy away the toys (three minutes)
Scoring was frequency counts by three raters blind to intervention allocated; coders used a slightly modified version of the CPRG scheme (PBCS, Aspland and Gardner 2003).
Child:
1. ADHD symptoms. PACS interview. Intraclass correlation was 0.81 (CI 0.71-0.91).
2. Child reading ability. British Ability Scale Word Reading (BAS II: Elliot, Smith and McCullough 1996). This is an individually administered standardized test of the childs ability to read single words.
Overall trial start date
01/02/1999
Overall trial end date
31/03/2002
Reason abandoned (if study stopped)
Eligibility
Participant inclusion criteria
First, children had to score above the cutoff on the screening questionnaire, set at one standard deviation above the population mean on conduct symptoms summing parent and teacher ratings (thus putting them at high risk of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM IV] oppositional defiant disorder).
Second, their parents were then contacted to assess further eligibility criteria:
1. Ability to understand English
2. Ability to attend at group times
3. Interest in attending
4. Acceptance of RCT study
5. Index child free of clinically apparent generalized developmental delay (mental retardation)
Participant type
Patient
Age group
Child
Gender
Both
Target number of participants
936 screened, 112 randomized
Participant exclusion criteria
Opposite of inclusion criteria above, hence children below the cutoff on the screening questionnaire, set at one standard deviation above the population mean on conduct symptoms summing parent and teacher ratings (thus putting them at low risk of DSM IV oppositional defiant disorder).
Second, their parents were then contacted to assess further eligibility criteria, and were excluded for:
1. Inability to understand English
2. Inability to attend at group times
3. No interest in attending
4. Did not accept RCT study
5. Index child has clinically apparent generalized developmental delay (mental retardation)
Recruitment start date
01/02/1999
Recruitment end date
31/03/2002
Locations
Countries of recruitment
United Kingdom
Trial participating centre
Child and Adolescent Psychiatry
London
SE5 8AF
United Kingdom
Sponsor information
Organisation
King's College London (UK)
Sponsor details
Institute of Psychiatry
De Crespigny Park
London
SE5 8AF
United Kingdom
g.dale@iop.kcl.ac.uk
Sponsor type
University/education
Website
Funders
Funder type
Government
Funder name
Department of Health (UK)
Alternative name(s)
Funding Body Type
Funding Body Subtype
Location
Results and Publications
Publication and dissemination plan
Not provided at time of registration
Intention to publish date
Participant level data
Not provided at time of registration
Basic results (scientific)
Publication list
2009 results in: http://www.ncbi.nlm.nih.gov/pubmed/19732250
2012 further results in: http://www.ncbi.nlm.nih.gov/pubmed/22881827
2014 follow-up in: http://www.ncbi.nlm.nih.gov/pubmed/24626738
Publication citations
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Results
Scott S, Sylva K, Doolan M, Price J, Jacobs B, Crook C, Landau S, Randomised controlled trial of parent groups for child antisocial behaviour targeting multiple risk factors: the SPOKES project., J Child Psychol Psychiatry, 2010, 51, 1, 48-57, doi: 10.1111/j.1469-7610.2009.02127.x.
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Further results
Scott S, O'Connor TG, An experimental test of differential susceptibility to parenting among emotionally-dysregulated children in a randomized controlled trial for oppositional behavior., J Child Psychol Psychiatry, 2012, 53, 11, 1184-1193, doi: 10.1111/j.1469-7610.2012.02586.x.
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Scott S, Briskman J, O'Connor TG, Early prevention of antisocial personality: long-term follow-up of two randomized controlled trials comparing indicated and selective approaches., Am J Psychiatry, 2014, 171, 6, 649-657, doi: 10.1176/appi.ajp.2014.13050697.