Understanding Children
Six session program is showing strong results in shaping children’s behaviour
Freya Lucas
Mar 16, 2021
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A home-based parenting program, designed to prevent childhood behaviour challenges by working with children as young as 12 months of age, has shown strong results during its first public health trial.
Although contextualised to the home environment, the findings and structure of the program will be of interest to those in the early childhood education and care (ECEC) sector, not only for possible adaptation in service environments, but also for parents who are seeking support in guiding children’s behaviour.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.
How the program works
Known as the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD), the program 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 per cent for behaviour problems during standard healthcare assessments.
While “misbehaviour” is a normal part of toddlerhood, and not all of the children would necessarily have gone on to develop serious problems, all were 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).
Younger children
The trial was significant because all of the children involved were under two years of age - far younger than traditional interventions for behavioural challenges are made available. This, researchers say, suggests 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.
Addressing challenging behaviour in the younger years is important, they emphasised, given that children with enduring behaviour problems often experience many other difficulties as they grow up, including challenges with physical and mental health, education, and relationships.
"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," research assistant Beth Barker said.
Results
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.
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.
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, and was led by academics at the University of Cambridge and Imperial College London.
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