1
|
Fisher AP, Miley AE, Glazer S, Gies LM, Parikh NA, Lam L, Wade SL. Feasibility and acceptability of an online parenting intervention to address behaviour problems in moderately to extremely preterm pre-school and school-age children. Child Care Health Dev 2024; 50:e13209. [PMID: 38100158 DOI: 10.1111/cch.13209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 09/08/2023] [Accepted: 11/18/2023] [Indexed: 01/25/2024]
Abstract
BACKGROUND Preterm birth is associated with adverse mental health outcomes, including internalizing problems, social difficulties and inattention. Interventions are needed beyond infancy and toddlerhood to support children and their families. We examined the feasibility and acceptability of the I-InTERACT Preterm pilot study, an online parenting intervention for preterm children ages 3-8. METHOD Families participated in a weekly intervention comprised of seven sessions with online modules followed by videoconference coaching sessions with a therapist. Following completion of the study, caregivers completed a survey to assess their satisfaction and were asked to participate in a voluntary semi-structured interview to provide feedback. We anticipated greater than a 50% participation rate (enrollment feasibility) and 75% completion rate (adherence feasibility). We also hypothesized that at least 80% of participants would be satisfied with the intervention (acceptability). RESULTS Nineteen of 32 families (59%) enrolled in the study, suggesting adequate enrollment feasibility. Feasibility of programme completion (adherence) was lower than anticipated (59%). Regarding satisfaction, all caregivers agreed that the programme's information was relevant to them and their family. Nearly all participants (92%) indicated that they had a better understanding of the effects of preterm birth on behaviour, that they enjoyed the programme, that it met their expectations and that they recommend the programme to others. In qualitative interviews, caregivers expressed satisfaction with the content, skills they learned, and receiving direct coaching. Caregivers suggested improvements to increase intervention feasibility and skill implementation, including offering biweekly sessions and more hands-on coaching. CONCLUSION Our largely satisfactory acceptability rates suggest the value of and need for a parenting intervention for children born preterm past the initial period of early development. Future directions include modifying the intervention in response to caregiver feedback to improve recruitment, engagement and adherence.
Collapse
Affiliation(s)
- Allison P Fisher
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Aimee E Miley
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sandra Glazer
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Psychology, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lisa M Gies
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Nehal A Parikh
- Neurodevelopmental Disorders Prevention Center, Perinatal Institute, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Leo Lam
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Shari L Wade
- Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
- University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| |
Collapse
|
2
|
Patronick J, Glazer S, Sidol C, Parikh NA, Wade SL. Parenting Interventions Targeting Behavior for Children Born Preterm or Low Birth Weight: A Systematic Review. J Pediatr Psychol 2023; 48:676-687. [PMID: 37290433 DOI: 10.1093/jpepsy/jsad031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE To systematically review and summarize the outcomes of parenting interventions designed to improve child and/or parenting behavior for children born preterm and/or low birth weight (LBW). METHODS We conducted systematic searches of Embase, Scopus, PubMed, PsycInfo, and CINAHL in September 2021. We identified articles published at any time that describe the outcomes of parenting interventions targeting the child and/or parenting behavior of children born preterm/LBW and their caregivers. Two independent raters assessed the risk of bias using the Revised Cochrane Risk-of-Bias Tool. RESULTS Eight hundred sixteen titles and abstracts were screened, followed by 71 full-text articles, resulting in 24 eligible articles reporting on nine interventions with 1,676 participants. Eligible articles had an adequate risk of bias ratings. Sample characteristics, intervention components, and intervention effects were tabulated and described narratively by the intervention type. Preventative and treatment programs demonstrated positive intervention effects on externalizing behavior, parenting stress, and parenting behaviors, with mixed effects on internalizing behavior and emotion regulation. The few studies with longitudinal follow-up found little evidence of effects beyond 6 months postintervention. CONCLUSION Behavior problems in children born preterm/LBW may be modifiable, and interventions targeting parenting behavior are promising. However, existing interventions may not produce long-lasting changes and are not designed for children older than four. Existing treatment programs may require adaptation for the neurocognitive, medical, and family needs of children born preterm/LBW (e.g., processing speed deficits, post-traumatic stress). Interventions that account for theories of sustained change may promote long-term effectiveness and the developmental tailoring of parenting skills.
Collapse
Affiliation(s)
- Jamie Patronick
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Sandra Glazer
- Department of Psychology, University of Cincinnati, USA
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Craig Sidol
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
| | - Nehal A Parikh
- The Perinatal Institute, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| | - Shari L Wade
- Division of Physical Medicine and Rehabilitation, Cincinnati Children's Hospital Medical Center, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, USA
| |
Collapse
|
3
|
The Efficacy of Parent Training Interventions for Disruptive Behavior Disorders in Treating Untargeted Comorbid Internalizing Symptoms in Children and Adolescents: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:542-552. [PMID: 33991282 PMCID: PMC8324591 DOI: 10.1007/s10567-021-00349-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 11/17/2022]
Abstract
Disruptive behavior disorders (DBDs) are among the primary reasons for child and youth referrals to mental health services and are linked to poor adult outcomes including antisocial behavior disorder. Research indicates a high incidence of internalizing problems in those with DBDs and those who have DBDs with cooccurring internalizing problems may have more severe later outcomes. Interventions targeted at internalizing symptoms have been found to also reduce comorbid externalizing problems. The impact of treatments for DBDs on comorbid internalizing disorders is not known. Databases PsycINFO, EMBASE and MEDLINE were systematically searched based on the Cochrane guidelines for systematic reviews. Records were independently reviewed by two reviewers. 12 papers were deemed eligible. A quality assessment of the selected studies was conducted independently by both reviewers. The 12 studies included 1334 young people with a mean age of 5 years. The parent training interventions assessed were the Incredible Years (6/12 studies), Triple-P (5/12) and Tuning In To Kids (1/12). 11 of the 12 studies reported significant reductions in primary externalizing behavior problems and DBDs. 7 studies reported significant reductions in internalizing symptoms. Mechanisms of change, clinical implications and directions for future research are discussed.
Collapse
|
4
|
Girabent-Farrés M, Jimenez-Gónzalez A, Romero-Galisteo RP, Amor-Barbosa M, Bagur-Calafat C. Effects of early intervention on parenting stress after preterm birth: A meta-analysis. Child Care Health Dev 2021; 47:400-410. [PMID: 33559337 DOI: 10.1111/cch.12853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 12/18/2020] [Accepted: 02/03/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Preterm infants have a higher risk of development disorders. Prematurity can be considered a source of stress, in both children and their parents, due to the high number of interventions that they require. Early intervention (EI) programmes have shown to have a positive influence on the neurodevelopment of children with neurological risk. On the other hand, parenting stress has a negative influence on the development of any child. This systematic review aimed to identify the effect of EI programmes on decreasing parenting stress suffered by parents of preterm babies. METHODS Systematic review and meta-analysis of experimental studies in accordance with the PRISMA declaration guidelines were applied in this work. RESULTS Fifteen randomized clinical trials were included whose methodological quality was assessed using the PEDro scale. Stress data extraction was meta-analysed using the inverse variance method in a random effects model. Statistical heterogeneity was assessed with the I2 heterogeneity statistic. The domains most commonly reported in the trials were the childcare-related stress (Child Domain), personal discomfort (Parent Domain) and computation of both (Total Stress). The results showed significant (P < 0,05) and clinically relevant differences in favour of the EI programme group at 18 months and 5 years. CONCLUSIONS This review found moderate to strong evidence of the impact of EI programmes on the reduction of parenting stress in parents of preterm babies. These findings offer useful insights regarding the delivery of current support and the development of future family interventions. Finally, recommendations are provided for future intervention evaluation studies in this area.
Collapse
Affiliation(s)
- Montserrat Girabent-Farrés
- Department of Physiotherapy, School of Health Sciences, TecnoCampus-Pompeu Fabra University, Barcelona, Spain
| | | | | | - Marta Amor-Barbosa
- Physiotherapy Department, Universitat Internacional de Catalunya, Barcelona, Spain
| | | |
Collapse
|
5
|
Wilson P, Marryat L, Thompson L, Coyne J, Allerhand M. Readers and service commissioners require clear financial disclosures: Comment on innovation, research integrity, and change: A conflict of interest management framework for program developers (Sanders et al., 2019). AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Philip Wilson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, UK,
| | - Louise Marryat
- SMC Research Centre, University of Edinburgh, Edinburgh, Scotland, UK,
| | - Lucy Thompson
- Centre for Rural Health, University of Aberdeen, Inverness, Scotland, UK,
| | - James Coyne
- University Medical Center, University of Groningen, Groningen, Netherlands,
| | - Michael Allerhand
- School of Mathematics, University of Edinburgh, Edinburgh, Scotland, UK,
| |
Collapse
|
6
|
Smith JD, Cruden GH, Rojas LM, Van Ryzin M, Fu E, Davis MM, Landsverk J, Brown CH. Parenting Interventions in Pediatric Primary Care: A Systematic Review. Pediatrics 2020; 146:e20193548. [PMID: 32581000 PMCID: PMC7329253 DOI: 10.1542/peds.2019-3548] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2020] [Indexed: 01/13/2023] Open
Abstract
CONTEXT More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.
Collapse
Affiliation(s)
- Justin D Smith
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois;
| | | | - Lourdes M Rojas
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, Miami, Florida
| | | | - Emily Fu
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew M Davis
- Division of Academic General Pediatrics, Stanley Manne Children's Research Institute, Ann and Robert H. Lurie Children's Hospital of Chicago and Departments of Pediatrics, Medicine, Medical Social Sciences, and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - C Hendricks Brown
- Center for Prevention Implementation Methodology for Drug Abuse and HIV and Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| |
Collapse
|
7
|
Gonçalves JL, Fuertes M, Alves MJ, Antunes S, Almeida AR, Casimiro R, Santos M. Maternal pre and perinatal experiences with their full-term, preterm and very preterm newborns. BMC Pregnancy Childbirth 2020; 20:276. [PMID: 32375667 PMCID: PMC7204281 DOI: 10.1186/s12884-020-02934-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/13/2020] [Indexed: 01/07/2023] Open
Abstract
Background Mothers’ reports about pregnancy, maternity and their experiences during the perinatal period have been associated with infants’ later quality of attachment and development. Yet, there has been little research with mothers of very preterm newborns. This study aimed to explore mothers’ experiences related to pregnancy, premature birth, relationship with the newborn, and future perspectives, and to compare them in the context of distinct infants’ at-birth-risk conditions. Methods A semi-structured interview was conducted with women after birth, within the first 72 h of the newborn’s life. A total of 150 women participated and were divided in three groups: (1) 50 mothers of full-term newborns (Gestational Age (GA) ≥ 37 weeks; FT), (2) 50 mothers of preterm newborns (GA 32–36 weeks; PT) and (3) 50 mothers of very preterm newborns (GA < 32 weeks; VPT). Results Mothers of full-term infants responded more often that their children were calm and that they did not expect difficulties in taking care of and providing for the baby. Mothers of preterm newborns although having planned and accepted well the pregnancy (with no mixed or ambivalent feelings about it) and while being optimistic about their competence to take care of the baby, mentioned feeling frightened because of the unexpected occurrence of a premature birth and its associated risks. Mothers of very preterm newborns reported more negative and distressful feelings while showing more difficulties in anticipating the experience of caring for their babies. Conclusion The results indicate that Health Care Systems and Neonatal Care Policy should provide differentiated psychological support and responses to mothers, babies and families, taking into account the newborns’ GA and neonatal risk factors.
Collapse
Affiliation(s)
- Joana L Gonçalves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Marina Fuertes
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Maria João Alves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Sandra Antunes
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Ana Rita Almeida
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Rute Casimiro
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Margarida Santos
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal.,Faculty of Psychology and Education Sciences, University of Lisbon, Lisbon, Portugal
| |
Collapse
|
8
|
Neel MLM, Stark AR, Maitre NL. Parenting style impacts cognitive and behavioural outcomes of former preterm infants: A systematic review. Child Care Health Dev 2018; 44:507-515. [PMID: 29575031 PMCID: PMC6005730 DOI: 10.1111/cch.12561] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 01/12/2018] [Accepted: 01/30/2018] [Indexed: 11/30/2022]
Abstract
We sought to evaluate published evidence in aggregate regarding the impact of parenting style on the cognitive and behavioural outcomes of former preterm infants. We searched 5 databases using germane MeSH terms. Parenting style was defined as any descriptor of parenting using ≥2 dimensions on published parenting axes. We evaluated studies for quality of evidence and strength of recommendations using standardized tools and categorized summative recommendations by parenting axis and child outcome. Twenty-seven articles met our inclusion criteria. Parental responsivity is the only parenting axis strongly associated with both improved child cognition and behaviour. Parental demandingness is associated only with improved child cognition, and parental warmth and rejection are associated only with child behaviour. Parental coercion is not associated with subsequent child outcomes. Parental responsivity may be essential in optimizing neurodevelopment in former preterm infants. More targeted studies are needed to inform this relationship and identify opportunities for intervention.
Collapse
Affiliation(s)
- Mary Lauren M. Neel
- Neonatal-Perinatal Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, , 615-322-3476
| | - Ann R. Stark
- Department of Pediatrics; Fellowship Program Director, Neonatal-Perinatal Medicine, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Vanderbilt University Medical Center, , 615-322-3475
| | - Nathalie L. Maitre
- Department of Pediatrics; Principal Investigator, Center for Perinatal Research; Director, NICU Follow-Up Programs, Nationwide Children’s Hospital and the Ohio State University, , 614-722-4559
| |
Collapse
|
9
|
Schappin R, Wijnroks L, Uniken Venema M, Jongmans M. Exploring predictors of change in behavioral problems over a 1-year period in preterm born preschoolers. Infant Behav Dev 2018; 50:98-106. [DOI: 10.1016/j.infbeh.2017.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 10/24/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
|
10
|
Marryat L, Thompson L, Wilson P. No evidence of whole population mental health impact of the Triple P parenting programme: findings from a routine dataset. BMC Pediatr 2017; 17:40. [PMID: 28143454 PMCID: PMC5282654 DOI: 10.1186/s12887-017-0800-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 01/25/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The Triple P parenting programme has been reported to improve child mental health at population level, but it consumes substantial resources. Previous published work has suggested improvements in whole population scores in the Strengths and Difficulties Questionnaire (SDQ) Total Difficulties Scale among samples of children following introduction of the programme. This paper aims to explore whether Triple P had an impact on child mental health problems using routinely collected data over 6 years before and during the implementation of the multilevel Triple P programme in Glasgow City. METHODS Annual monitoring of teacher-rated SDQ Total Difficulties Scale scores among children in their pre-school year in Glasgow City. RESULTS No significant or consistent changes in SDQ Total Difficulties Scale scores were seen during or after the implementation of Triple P programme on a whole population level. CONCLUSION Triple P in Glasgow City appears to have had no impact on early child mental health problems over a 6 year period. The Triple P programme, implemented on a whole population level, is unlikely to produce measurable benefits in terms of child mental health.
Collapse
Affiliation(s)
- Louise Marryat
- The Scottish Collaboration for Public Health Research and Policy, University of Edinburgh, 20 West Richmond Street, Edinburgh, EH8 9DX UK
- Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ UK
| | - Lucy Thompson
- Institute of Health and Wellbeing, University of Glasgow, Caledonia House, Royal Hospital for Sick Children, Yorkhill, Glasgow, G3 8SJ UK
- Centre for Rural Health, University of Aberdeen, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| | - Philip Wilson
- Centre for Rural Health, University of Aberdeen, Centre for Health Sciences, Old Perth Road, Inverness, IV2 3JH UK
| |
Collapse
|
11
|
Cluxton-Keller F, Riley AW, Noazin S, Umoren MV. Clinical Effectiveness of Family Therapeutic Interventions Embedded in General Pediatric Primary Care Settings for Parental Mental Health: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2016; 18:395-412. [PMID: 26377209 DOI: 10.1007/s10567-015-0190-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this systematic review and meta-analysis was to synthesize the available evidence on embedded family therapy interventions in pediatrics and impacts on parental mental health and family functioning outcomes. The Cochrane Collaboration guidelines for systematic reviews and meta-analysis were used for this study. Six electronic databases were searched for randomized controlled trials and cluster randomized trials. The Cochrane Collaboration's Risk of Bias Tool and GRADE system were used to rate the quality of evidence of the included studies. The primary outcomes included parental distress, parental depressive symptoms, and dysfunctional parent-child interaction. Fixed effects models showed statistically significant reductions in parental distress at 6-month and 12-month post-intervention in favor of the intervention group. Family therapy model, intervention level, delivery modality, and dosage moderated intervention impacts on parental distress. Fixed effects models showed statistically significant reductions in parental depressive symptoms and in dysfunctional parent-child interaction in favor of the intervention group. Family therapy interventions can be successfully embedded in general pediatric primary care, and intended outcomes are achieved in this setting. Recommendations for future research and implications for policy development are discussed.
Collapse
Affiliation(s)
| | - Anne W Riley
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sassan Noazin
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
12
|
Barlow J, Bergman H, Kornør H, Wei Y, Bennett C. Group-based parent training programmes for improving emotional and behavioural adjustment in young children. Cochrane Database Syst Rev 2016; 2016:CD003680. [PMID: 27478983 PMCID: PMC6797064 DOI: 10.1002/14651858.cd003680.pub3] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well-adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children. OBJECTIVES 1. To establish whether group-based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems. SEARCH METHODS In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi-RCTs of group-based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children. DATA COLLECTION AND ANALYSIS One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta-analysis using a random-effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome. MAIN RESULTS We identified 22 RCTs and two quasi-RCTs evaluating the effectiveness of group-based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months).The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive-behavioural or videotape modelling parenting programmes.We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer-reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent-reported outcomes.The results provide evidence that group-based parenting programmes reduce overall emotional and behavioural problems (SMD -0.81, 95% CI -1.37 to -0.25; 5 studies, 280 participants, low quality evidence) based on total parent-reported data assessed at postintervention. This result was not, however, maintained when two quasi-RCTs were removed as part of a sensitivity analysis (SMD -0.67, 95% CI -1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD -0.23, 95% CI -0.46 to -0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity-inattention subscale (SMD -1.34; 95% CI -2.37 to -0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI -0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent-reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent-child interaction in terms of reduced negative behaviour (SMD -0.22, 95% CI -0.39 to -0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta-analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions. AUTHORS' CONCLUSIONS The findings of this review, which relate to the broad group of universal and at-risk (targeted) children and parents, provide tentative support for the use of group-based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short-term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long-term effectiveness.
Collapse
Affiliation(s)
- Jane Barlow
- University of OxfordDepartment of Social Policy and InterventionBarnett House32 Wellington SquareOxfordUKOX1 2ER
| | - Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Hege Kornør
- Norwegian Institute of Public HealthDivision of Health ServicesPO box 222 Skøyen0213 OsloNorway
| | - Yinghui Wei
- University of PlymouthCentre for Mathematical Sciences, School of Engineering, Computing and MathematicsPlymouthUK
| | - Cathy Bennett
- Coventry UniversityCentre for Innovative Research Across the Life Course (CIRAL)Richard Crossman BuildingGosford StreetCoventryUKCV1 5FB
| | | |
Collapse
|
13
|
Schappin R, Wijnroks L, Uniken Venema M, Wijnberg-Williams B, Veenstra R, Koopman-Esseboom C, Mulder-De Tollenaer S, van der Tweel I, Jongmans M. Primary Care Triple P for parents of NICU graduates with behavioral problems: a randomized, clinical trial using observations of parent-child interaction. BMC Pediatr 2014; 14:305. [PMID: 25495747 PMCID: PMC4273431 DOI: 10.1186/s12887-014-0305-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/02/2014] [Indexed: 11/16/2022] Open
Abstract
Background Preterm-born or asphyxiated term-born children show more emotional and behavioral problems at preschool age than term-born children without a medical condition. It is uncertain whether parenting intervention programs aimed at the general population, are effective in this specific group. In earlier findings from the present trial, Primary Care Triple P was not effective in reducing parent-reported child behavioral problems. However, parenting programs claim to positively change child behavior through enhancement of the parent–child interaction. Therefore, we investigated whether Primary Care Triple P is effective in improving the quality of parent–child interaction and increasing the application of trained parenting skills in parents of preterm-born or asphyxiated term-born preschoolers with behavioral problems. Methods For this pragmatic, open randomized clinical trial, participants were recruited from a cohort of infants admitted to the neonatal intensive care units of two Dutch hospitals. Children aged 2–5 years, with a gestational age <32 weeks and/or birth weight <1500 g and children with a gestational age 37–42 weeks and perinatal asphyxia were included. After screening for a t-score ≥60 on the Child Behavior Checklist, children were randomly assigned to Primary Care Triple P (n = 34) or a wait-list control group (n = 33). Trial outcomes were the quality of parent–child interaction and the application of trained parenting skills, both scored from structured observation tasks. Results There was no effect of the intervention on either of the observational outcome measures at the 6-month trial endpoint. Conclusions Primary Care Triple P, is not effective in improving the quality of parent–child interaction nor does it increase the application of trained parenting skills in parents of preterm-born or asphyxiated term-born children with behavioral problems. Further research should focus on personalized care for these parents, with an emphasis on psychological support to reduce stress and promote self-regulation. Trial registration Netherlands National Trial Register NTR2179. Registered 26 January 2010. Electronic supplementary material The online version of this article (doi:10.1186/s12887-014-0305-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Renske Schappin
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
| | - Lex Wijnroks
- Department of Child, Family and Education Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Monica Uniken Venema
- Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
| | | | - Ravian Veenstra
- Department of Medical Psychology, Isala Clinics, Zwolle, The Netherlands.
| | - Corine Koopman-Esseboom
- Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
| | | | - Ingeborg van der Tweel
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands.
| | - Marian Jongmans
- Department of Child, Family and Education Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands. .,Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands.
| |
Collapse
|