Evaluation of a parenting program for treating children’s early disruptive behavior problems delivered in a pediatric setting.
In well child visits pediatricians frequently see parents who are asking about their children’s hyperactivity, aggression and defiant behaviors. Such behaviors are a developmentally normal phase for toddlers because they lack the language and self-regulation skills to control their impulses. However, toddlers and preschoolers who exhibit these behaviors at high intensity and frequency are at risk for continuing this disruptive behavior pattern in later childhood and many parents and caregivers do not have the parenting tools to respond effectively. These early onset behavior problems are associated with academic underachievement, and confer risk for later life psychopathology including criminality and substance abuse (Tremblay, Nagin, & Seguin, 2004). Effective early intervention is crucial.
Unfortunately even though numerous clinical trials, meta-analyses, and consensus guidelines recommend that psychosocial interventions should constitute the first-line approach for treatment of early disruptive behavior problems, the proportion of children receiving evidence-based programs is decreasing (Comer, Chow, Chan, Cooper-Vince, & Wilson, 2013). Children are more likely to receive psychotropic medications, even though controlled trials of the efficacy of this approach for this age group have not been conducted.
Primary care physicians, who see families frequently during a child’s early years, are strategically placed to help parents prevent the development of serious disruptive behavior problems and to expand the availability and accessibility of services by offering evidence-based parent training programs.
A newly published randomized control group trial has tested the efficacy of using the Incredible Years® (IY) toddler parent program in 11 diverse primary care rural and urban pediatric practices (Perrin, Sheldrick, McMenamy, Henson, & Carter, 2014).
This study was conducted by Dr. Ellen Perrin, a developmental-behavioral pediatrician who is Director of Research at the Center for Children with Special Needs and Professor at Tufts University School of Medicine in Boston Massachusetts.
This particular evidence-based program was chosen because of its extensive research and ease of delivery. A recent meta-analyses of 50 studies utilizing the IY program reported its success in improving child behavior in a diverse range of families (Menting, Orobio de Castro, & Matthys, 2013).
Study Method
Parents were selected for this program based on behavioral screening above the 80th percentile on the Infant-Toddler Social-Emotional Assessment Scale. The study sample is characterized as high risk or borderline clinical because children were selected based on elevated symptoms of behavior problems. A total of 150 parents were randomly assigned to either the IY 10-week, 2-hour parent program or a waiting list control group. An additional 123 parents were assigned to the parent intervention without a randomly selected comparison group. The parent program was offered primarily by psychologists or social workers in conjunction with a member of the pediatric office staff. Among the 3 study groups, 54% to 73% completed at least 7 group sessions.
Positive results
Results showed that parents who participated in the IY program reported more change in self-reported parent and toddler outcomes at post treatment than did parents in the waiting list control condition. Analyses of independent videotaped observations of parent-toddler interactions showed that negative parenting, child disruptive behaviors and negative child-parent interactions were lower at post treatment and at 12-month follow-up compared with baseline observations for parents who received the program. No differences were found for the waiting list control parents at post condition compared with baseline.
The findings are very promising and suggest that offering the IY program as a group model in pediatric settings is a cost effective way of reducing children’s behavior problems and providing secondary preventive intervention (Stein, 2014). (Stein, 2014). The next step is to convince practitioners, who typically see these families in individual treatment sessions, of the value of the group learning model for providing behavioral training for parents of young children and building support networks for their families.
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References:
Comer, J. S., Chow, C., Chan, P. T., Cooper-Vince, C., & Wilson, L. A. (2013). Psychosocial treament efficacy for disruptive behavior problems in very young children: A meta-analytic examination Journal of American Academy of Child and Adolescent Psychiatry, 52(1), 26-36.
Menting, A. T. A., Orobio de Castro, B., & Matthys, W. (2013). Effectiveness of the Incredible Years Parent Training to Modify Disruptive and Prosocial Child Behavior:A Meta-Analytic Review. Clinical Psychology Review, 33, 901-913.
Perrin, E. C., Sheldrick, R. C., McMenamy, J. M., Henson, B. S., & Carter, A. S. (2014). Improving parenting skills for families of young children in pediatric settings: a randomized clinical trial. Journal of American Medical Association Pediatrics, 168(1), 16-24.
Stein, M. T. (2014). Group-Based Parenting-Skills training in primary care offices:Are we ready for the challenge? Journal of American Medical Association, 168(1), 7-9.
Tremblay, R., Nagin, D., & Seguin, J. (2004). Physical aggression during early childhood: trajectories and predictors. Pediatrics, 114, 43-50.