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The Incredible Years® in Pediatric Settings

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.

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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).

Ellen PerrinThis 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).

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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.

Please don’t hesitate to contact us for more information about the Incredible Years® Programs and/or this recent research!

Click this link to read the full article!

If you are interested in learning more about The Incredible Years programs, click this link to go to our website.

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.


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Building Blocks for Reading with CARE with Babies

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Written by: Carolyn Webster-Stratton, Ph.D.

Did you know that there is a connection between how much you talk to your baby and his or her later reading abilities and school success?

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Studies (e.g., Hart & Risley) have shown that by 18 months, children from low-income families hear significantly fewer words in their homes than children from higher income families. One recent study from Stanford University showed that by their 3rd year, low-income children have heard 30 million fewer words than higher income children (full article can be found here). If this language exposure gap continues, by the time these children get to kindergarten they will need remediation because they are already far behind in the language and school readiness skills needed for school success. Since early vocabulary is connected to later success in reading comprehension, this language gap presents a barrier to these children’s future academic learning achievement. It was also found that TV talk not only didn’t help, but it was a barrier.

Often these parents just don’t know that it is important to talk more to their babies. The good news is that randomized control group studies show that programs such as the Incredible Years® Baby, Toddler, and Preschool Parent Series result in improvements in children’s social and emotional language skills and school readiness.  It has been shown that low income parents can successfully learn to focus their attention and learn to talk more to their babies and children using descriptive commenting, persistence, and social and emotion coaching language during child-directed play and reading interactions.

See these studies:

Preventing Conduct Problems and Improving School Readiness: Evaluation of the Incredible Years Teacher and Child Training Programs in High-Risk Schools

Preventing Conduct Problems, Promoting Social Competence: A Parent and Teacher Training Partnership in Head Start

Halting the Development of Conduct Problems in Head Start Children: The Effects of Parent Training

Here are some tips to building your baby’s language vocabulary through reading interactions. This is not about flash cards, use of Ipads or computers, or memorization of words. Rather it is about loving, child-directed conversations while reading books, playing with your child, or engaging in everyday routines. And yes, you must turn off your mobile phone 🙂

Building Blocks for Reading with CARE with Babies

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c_blockComment, point to and describe objects, colors, emotions, sounds and actions of pictures in touch-and-feel books. You don’t need to read the actual words in the book, just point to and talk about the pictures using your native language.  For example, “Teddy’s nose is yellow. Baby is hungry. The train is slowing down.” Allow your baby to touch the book and even to put it in his/her mouth.

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a_blockAct enthusiastic using physical dramatizations and sound effect.  For example, “that is a bird, he goes chirp chirp.” (Use your hands to make a chirp sign). Use a melodious voice varying the pace, phrasing, voice rhythm and pitch of your words.  Pause between sounds or vocalizations to allow your baby to respond.

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Respond with smiles, encouragement, eye contact, cuddling and delight to your baby’s smiles, body signals and pointing movements; follow what your baby is looking at and be child-directed in what you respond to.

 

e_blockExpand on your baby’s sounds.  If your baby says a syllable such as “la la” or “da da,” mirror or repeat the sound. Or, if your baby says “ball,” repeat the word and add a descriptor such as the color or shape of the ball.  “Yes, that’s a big, red ball!” If you have other children, read what they like while you are holding your baby. Let them read to your baby and imitate your baby’s sounds. Start reading at any page and make up your own stories or sing while you are looking at the book.

Remember:

• Be sure your baby’s head is supported and you are both sitting in a comfortable chair.  You might use a pillow or a sling to support your baby so that your hands are free.

• Read in a quiet place. Turn off any competing noises such as TV, stereo, or radio; this will also prevent overstimulation or stress.

•  There will be variability in individual baby’s interest in books, so don’t worry if your baby does not seem intently interested or starts crying.  Respond to your baby’s cues.  If (s)he seems fussy or uninterested in the book, try changing your tone or reading a different book.  If these new strategies do not engage him/her, then stop trying to read, and do another soothing activity with your baby. Try again later.

For more information, see the Incredible Years® Parents and Babies Program, and the book, Incredible Babies: Ways to Promote Your Baby’s Social, Emotional and Language Development by Carolyn Webster-Stratton.

Next week, we will bring you part 2 of this 3 part series: Reading with CARE for Toddlers.

References

Hart, Betty & Risley, Todd R.American parenting of language-learning children: Persisting differences in family-child interactions observed in natural home environments. Developmental Psychology, Vol 28(6), Nov 1992, 1096-1105. doi: 10.1037/0012-1649.28.6.1096
Fernald, A., Marchman, V. A. and Weisleder, A. (2013), SES differences in language processing skill and vocabulary are evident at 18 months. Developmental Science, 16: 234–248. doi: 10.1111/desc.12019
Reid, J. M., Webster-Stratton, C., Baydar, N. 2004. Halting the Development of Conduct Problems in Head Start Children: The Effects of Parent Training. Journal of Clinical Child and Adolescent Psychology. Vol.33(2) 279-291.
Webster-Stratton, C., Reid, M. J., University of WA, & Stoolmiller, M. 2008. Preventing Conduct Problems and Improving School Readiness: Evaluation of The Incredible Years Teacher and Child Training Programs in High-Risk Schools. Journal of Child Psychology and Psychiatry. 49 (5), 471-488.
Webster-Stratton, C., Reid, M. J. & Hammond, M. School of Nursing, University of Washington. Preventing Conduct Problems, Promoting Social Competence: A Parent and Teacher Training Partnership in Head Start. Journal of Clinical Child Psychology. Copyright 2001 by Lawrence Erlbaum Associates, Inc.
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