There is a home – based parenting program to prevent childhood behavioral problems, which typically target children when they are still children and, in some cases, just 12 months old, on to be extremely successful in his first public health test.
The six-session program involves carefully providing feedback to parents on how they can build on positive moments when playing and communicating with the audience. their child uses video clips of daily interactions, which are filmed by a health professional while they visit their home.
It was tested by 300 families of children who had shown early signs of behavioral problems. Half of the families received the program alongside routine health care support, and the other half received routine support on their own. When evaluated five months later, the children who had access to the video feedback approach had significantly lower behavioral problems compared to those who did not have families.
All children had only one or two: much younger than the age at which interventions for behavioral problems are usually available. The findings suggest that appropriate parental support at this early stage would be provided if their children show early signs of challenging behavior – such as frequent or intense tantrums, or behavior. aggressive – would greatly reduce the chances of these problems getting worse.
Children with chronic behavioral problems often experience many other problems as they grow up: with physical and mental health, education, and relationships. Behavioral problems currently affect 5% to 10% of children.
The trial – one of the first ever ‘real in the world’ trials of an intervention for challenging behavior in such young children – was made by health professionals at six NHS Trusts in England and Wales. funded by the National Institute for Health Research. It was part of a wider project called ‘Healthy Start, Happy Start’, which is piloting the video-based approach, led by academics at Cambridge University and Imperial College London.
Dr Christine O’Farrelly, of the Center for Play in Education, Development and Learning (PEDAL), Faculty of Education, University of Cambridge, said: “Often, as soon as you move a program like this to a real health service setting, you would expect You would see a reduction in voltage in efficiency compared to research settings. Instead, we have seen a clear and dramatic change in children ‘s behavior. “
The fact that this program was effective with children aged just one or two represents a real opportunity for early intervention and protection against enduring mental health problems. The earlier we can support them, the better we can do to improve their outcomes as they progress through childhood and into adult life. “
Beth Barker, Research Assistant, PEDAL Center
The program, called Video Feedback Intervention to Encourage Positive Parenting and Sensitive Control (VIPP-SD), is delivered over six home visits, each lasting approximately 90 minutes.
Health professionals film the family in everyday situations – such as playing together, or getting food – and then do an in-depth review of the content. During the next visit, they review specific snippets, highlighting frequent moments when the parents and child appear to be ‘in tune’. They talk about what made them successful, as well as any incidents where things got more challenging. This helps parents to recognize specific signs and symptoms from their children and respond in a way that helps their children feel understood and reinforces positive communication and behavior.
The 300 participating families that scored within the top 20% for behavioral problems at standard health care assessments had children. Misconduct is a normal part of a child, and not all children would have gone on to develop serious problems. But they were all seen as ‘at risk’ because they exhibited challenging behaviors like tantrums and breaking rules worse and more often than most. These are often early signs of anxiety behavior disorders and usually appear at the age of 12 to 36 months.
The researchers used a variety of tools, most notably interviews with parents, to assess each child’s behavior before the test, and again five months later. Each child received a score based on the frequency and severity of challenging behaviors including tantrums, ‘destructive’ behaviors (such as deliberately breaking a toy or spilling a drink); opposition to rules and applications; and aggressive behavior (hitting or biting).
Between assessments, all 300 families received the usual health care available to them for early signs of behavioral problems. The researchers describe this as ‘usually very small’, as there is no standard support pathway for behavioral problems in such young children. Only half of the families accessed the parenting program.
In the second evaluation, five months later, children from families who received the additional video feedback support received significantly lower for all measures of behavioral problems than those who received only routine care.
The average difference between the scores of the two groups was at 2.03 points. While the true meaning of this varied according to the specific difficulties the child presents with, the researchers say it is roughly equal to the difference between having tantrums. every day, and getting tantrums once or twice a week. Similarly, in the case of destructive behavior, it represents the difference between regularly throwing or breaking toys and other objects, and hardly does so at all.
Encouragingly, 95% of participants followed the trial to the conclusion, suggesting that most families will be able to take the walks.
Paul Ramchandani, Professor of Play in Education, Development and Learning at Cambridge University, said: “Delivering this program in any health service would require investment, but can be delivered in reality as part of routine care. It would be beneficial for a group of children at risk to progress with problems with education, behavior, future well-being and mental health.This is an opportunity here to invest early and reduce these problems now, a could prevent long – term problems 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 later.