Summary: A new video-feedback parenting program shows promise in helping to reduce behavioral problems in children as young as 12 months old. Researchers say addressing problematic behaviors in toddlers could help reduce behavioral problems later in life.
Source: University of Cambridge
A home-based parenting programme to prevent childhood behaviour problems, which very unusually focuses on children when they are still toddlers and, in some cases, just 12 months old, has proven highly successful during its first public health trial.
The six-session programme involves providing carefully-prepared feedback to parents about how they can build on positive moments when playing and engaging with their child using video clips of everyday interactions, which are filmed by a health professional while visiting their home.
It was trialled with 300 families of children who had shown early signs of behaviour problems. Half of the families received the programme alongside routine healthcare support, while the other half received routine support alone.
When assessed five months later, the children whose families had access to the video-feedback approach displayed significantly reduced behavioural problems compared with those whose families had not.
All of the children were aged just one or two: far younger than the age at which interventions for behaviour problems are normally available. The results suggest that providing tailored support for parents at this earlier stage, if their children show early signs of challenging behaviour – such as very frequent or intense tantrums, or aggressive behaviour – would significantly reduce the chances of those problems worsening.
Children with enduring behaviour problems often experience many other difficulties as they grow up: with physical and mental health, education, and relationships. Behaviour problems currently affect 5% to 10% of all children.
The trial – one of the first ever ‘real-world’ tests of an intervention for challenging behaviours in children who are so young – was carried out by health professionals at six NHS Trusts in England and funded by the National Institute for Health Research. It was part of a wider project called ‘Healthy Start, Happy Start’, which is testing the video-based approach, led by academics at the University of Cambridge and Imperial College London.
Dr Christine O’Farrelly, from the Centre for Play in Education, Development and Learning (PEDAL), Faculty of Education, University of Cambridge, said: “Often, as soon as you move a programme like this to a real health service setting, you would expect to see a voltage drop in its effectiveness compared with research conditions. Instead, we saw a clear and striking change in child behaviour.”
Beth Barker, a research assistant at the PEDAL Centre, said: “The fact that this programme was effective with children aged just one or two represents a real opportunity to intervene early and protect against enduring mental health problems. The earlier we can support them, the better we can do at improving their outcomes as they progress through childhood and into adult life.”
The programme, known as the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), is delivered across six home visits, each lasting about 90 minutes.
Health professionals film the family in everyday situations – such as playing together, or having a meal – and then analyse the content in depth. During the next visit, they review specific clips, highlighting often fleeting moments when the parents and child appear to be ‘in tune’.
They discuss what made these successful, as well as any incidents in which more challenging issues arose. This helps the parents to identify particular cues and signals from their children and respond in a manner that helps their children feel understood and reinforces positive engagement and behaviours.
The 300 participating families all had children who scored within the top 20% for behaviour problems during standard healthcare assessments. Misbehaviour is a normal part of toddlerhood, and not all of the children would necessarily have gone on to develop serious problems. All were, however, deemed ‘at-risk’ because they exhibited challenging behaviours like tantrums and rule-breaking more severely and frequently than most. These are often the early symptoms of disruptive behaviour disorders and typically emerge at 12 to 36 months.
The researchers used various tools, principally interviews with the parents, to assess each child’s behaviour before the trial, and again five months after. Each child received a score based on the frequency and severity of challenging behaviours including tantrums, ‘destructive’ behaviours (such as deliberately breaking a toy or spilling a drink); resisting rules and requests; and aggressive behaviour (hitting or biting).
Between the assessments, all 300 families received the routine healthcare available to them for early symptoms of behaviour problems. The researchers describe this as ‘typically minimal’, as there is currently no standard pathway of support for behaviour problems in such young children. Only half of the families were given access to the parenting programme.
In the second assessment, five months later, children from families who received the extra video feedback support scored significantly lower for all measures of behaviour problems than those who only received routine care.
The average difference between the scores of the two groups was 2.03 points. While the exact meaning of this varied depending on the specific problems exhibited by the child, the researchers describe it as roughly equivalent to the difference between having tantrums every day, and having tantrums once or twice a week. Similarly, in the case of destructive behaviours, it represents the disparity between regularly throwing or breaking toys and other items, and barely doing so at all.
Encouragingly, 95% of the participants persevered with the trial to its conclusion, suggesting that most families are able to accommodate the visits.
Paul Ramchandani, Professor of Play in Education, Development and Learning at the University of Cambridge, said: “To provide this programme in any health service would require investment, but it can realistically be delivered as part of routine care. Doing so would benefit a group of children who are at risk of going on to have problems with their education, behaviour, future wellbeing and mental health. There is a chance here to invest early and alleviate those difficulties now, potentially preventing problems in the longer term that are far worse.
The results are reported in JAMA Pediatrics.
The Healthy Start, Happy Start project is also reviewing further data from the project – including assessments of the children two years after the trial – which will be reported at a later date.
About this behavioral neuroscience research news
Source: University of Cambridge Contact: Tom Kirk – University of Cambridge Image: The image is in the public domain
A Brief Home-Based Parenting Intervention to Reduce Behavior Problems in Young Children: A Pragmatic Randomized Clinical Trial
Behavior problems are one of the most common mental health disorders in childhood and can undermine children’s health, education, and employment outcomes into adulthood. There are few effective interventions for early childhood.
To test the clinical effectiveness of a brief parenting intervention, the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), in reducing behavior problems in children aged 12 to 36 months.
Design, Setting, and Participants
The Healthy Start, Happy Start study was a 2-group, parallel-group, researcher-blind, multisite randomized clinical trial conducted via health visiting services in 6 National Health Service trusts in England. Baseline and 5-month follow-up data were collected between July 30, 2015, and April 27, 2018. Of 818 eligible families, 227 declined to participate, and 300 were randomized into the trial. Target participants were caregivers of children who scored in the top 20% for behavior problems on the Strengths and Difficulties Questionnaire. Participants were randomly allocated on a 1:1 basis to receive either VIPP-SD (n = 151) or usual care (n = 149), stratified by site and number of participating caregivers. Analysis was performed on an intention-to-treat basis. Statistical analysis was performed from September 5, 2019, to January 17, 2020.
All families continued to access usual care. Families allocated to VIPP-SD were offered 6 home-based video-feedback sessions of 1 to 2 hours’ duration every 2 weeks.
Main Outcomes and Measures
The primary outcome was the score on an early childhood version of the Preschool Parental Account of Children’s Symptoms, a semistructured interview of behavior symptoms, at 5 months after randomization. Secondary outcomes included caregiver-reported behavior problems on the Child Behavior Checklist and the Strengths and Difficulties Questionnaire.
Among 300 participating children (163 boys [54%]; mean [SD] age, 23.0 [6.7] months), primary outcome data were available for 140 of 151 VIPP-SD participants (93%) and 146 of 149 usual care participants (98%). There was a mean difference in the total Preschool Parental Account of Children’s Symptoms score of 2.03 (95% CI, 0.06-4.01; P = .04; Cohen d = 0.20 [95% CI, 0.01-0.40]) between trial groups, with fewer behavior problems in the VIPP-SD group, particularly conduct symptoms (mean difference, 1.61 [95% CI, 0.44-2.78]; P = .007; d = 0.30 [95% CI, 0.08-0.51]). Other child behavior outcomes showed similar evidence favoring VIPP-SD. No treatment or trial-related adverse events were reported.
Conclusions and Relevance
This study found that VIPP-SD was effective in reducing symptoms of early behavior problems in young children when delivered in a routine health service context.