Pediatric Practice Parenting Groups Prevent Behavior Problems

I found the paper heartening for a number of reasons:

1) A pediatrics journal published a paper focused on parenting.

2) It focused on parents being key in prevention.

3)  The research was done in actual practices, so it has practical implications.

4)  Lastly, the editor found the work so significant that he asked Martin Stein to write an editorial on the signficance of parenting skills groups. 

 The paper describes a randomized control trial conducted in 11 pediatric practices with 273 families with children two to four years of age, showing disruptive behavior, as assessed by a 20-item screening tool, the Infant Toddler Social-Emotional Assessment Scale.  Due to difficulties common to studies conducted in actual practice settings, only 150 of the families were successfully randomized into a treatment or a wait-listed control group, so the other 123 families comprised a non-randomized treatment group.  The two treatment groups participated in a 10-week program using the Incredible Years curriculum.

Parenting Assessment Outcomes

The study found strong impact with the parent self-report survey instruments. That is, in both treatment groups the parents reported that their parenting skills had significantly improved.   Parents in the two treatments groups also reported improved child behavior.   As we have discussed previously, self-report parenting instruments are not highly correlated with actual parenting practice.  Recognizing this problem, this research employed an observational assessment of parent-child interaction.   The results of the complete observational tool, as it was validated, showed no differences in parenting behavior between the control and the two treatment groups.  However, after considerable (and in my mind, questionable) manipulation of the observational parenting tool results, they were able to produce a statistically significant difference.  If one looks at the figure showing the results, one can reasonably question whether the differences in the highly manipulated data represent meaningful changes in parenting behavior at the post-treatment and follow-up time points, or for the child disruptive behavior at follow-up. 

An important lesson to be taken from this work is that parent report of their behavior in survey tools should not be interpreted as actual behavior.  This study and others have shown that what parents say they do and what they actually do can differ markedly.  If your aim is to show a change in what matters most to children, their parents behavior, you need to use a validated observational tool as proof.  In last week’s post we reported on a study that used a validated observational assessment, the Keys to Interactive Parenting Scale (KIPS), to assess parenting outcomes of home-based parenting interventions and showed large changes in just five sessions. 

Despite the technical problems with this study, we who are working to support parents in nurturing their children should feel buoyed for several reasons.  We should celebrate that:

1) the awareness of the importance of parenting quality in child health and development is growing among pediatricians,

2) the recognition of the important role of parenting in preventing problems is also growing, and

3) delivering parenting services through pediatric practices shows promise. 

This last factor is no small matter.  If more research can document the effectiveness of parenting services, then physicians can prescribe evidence-based interventions.  Where there is a physician’s prescription, payment follows. Thus, this has potential to become a means of paying for badly needed parenting services.  We can also applaud that this paper promotes moving from a focus on treatment to one of prevention.  Although, among physicians, pediatricians concentrate on wellness more than most others; might pediatric practices some day move from focusing on treating and preventing problems, to actively supporting all parents to nurture their children so they thrive and flourish?