One size fits all? Incredible!

Practitioners are often surprised and incredulous when they find that proven programs advise an identical approach to the needs of many children. Surely the subtle differences between cases call for a unique prescription? 

They suspect that programs must have been designed in a tidy theoretical world where children fit into neat categories. But out in the “real world” this must be a gross oversimplification. Children often suffer from several disorders at the same time. 

In truth, most program designers know the complexities only too well. Writing in the Journal of Children’s Services, Carolyn Webster-Stratton, creator of The Incredible Year, points out, for example, that children referred to mental health clinics with conduct problems frequently have other problems, such as attention deficit disorder, hyperactivity, learning and language delays and autism spectrum disorders. 

From her and Jamila Reid’s studies of children with conduct problems it emerged that over 40% also suffered from ADHD. 

They recognized that although all such children could benefit from some variation of The Incredible Years, it would be delivered more effectively by taking their other issues into account.  

Describing the experience of developing The Incredible Years Dinosaur program, they explain how it was a question of working out which were the core elements necessary for all children, and which parts could be tailored to individual’s needs, without compromising program fidelity. [See: Fidelity – prevention byword (or new F-word? [1].]

The Dinosaur curriculum is for children already experiencing difficulties. It is designed to strengthen social, emotional and academic competencies and has been shown in randomized controlled trials to significantly reduce conduct problems. 

The program has been designed for children of different age groups, offering developmentally suitable content. Usually delivered to groups of six by specially trained counselors, therapists or teachers, the core messages are conveyed using videos, role-play, puppets, and problem solving activities. 

The recent adaptations make it more suitable for children with ADHD, learning difficulties and autism spectrum disorders.

“The way the skills are taught, the level of sophistication with which they are presented, and the time spent on each content area must depend on each child’s behavioral and emotional needs, as well as his or her developmental level,”  Reid and Webster-Stratton say. 

For example, for children with ADHD, the intervention was modified to include livelier activities such as songs, role-play and movement. 

The normal routine includes half an hour of ‘circle time’ during which the children are expected to pay attention to the therapist. In the ADHD adaptation this has been split to three shorter periods. 

The new version also has several additions. Children are being given more physical space to more around in where they can let off steam; sessions also end with an additional 20 minutes of coached playtime. 

However, The Incredible Years team counsel caution when adapting proven programs. “Therapists delivering the program must be very familiar with the basic content, methods and processes before making adaptations,” they warn. 

Looking ahead, they plan to carry out further research into the effectiveness of Incredible Years with children suffering from combinations of disorders, and they urge other program developers to do likewise. 

[For more about the Dinosaur curriculum, see Dinosaur may rescue kids from tide of troubles [2].]

See: Webster-Stratton C and Reid J (2008), "Adapting The Incredible Years child Dinosaur social, emotional, and problem-solving intervention to address comorbid diagnoses” Journal of Children's Services, 3, 3, pp 17-30