Office-based parent training reduces disruptive toddler behavior

Participation in parent training groups can effectively improve parenting practices and behavior in young children with disruptive behaviors, a randomized trial conducted at 11 diverse pediatric practices around Boston demonstrated.

Included in the trial were 150 parents (mostly mothers) of 2- to 4-year-old children who scored at the 80th percentile or higher on the Infant-Toddler Social-Emotional Assessment scale, which predicts disruptive behavior disorders. Investigators assigned half the parents to a parent training group (6 to 12 parents in a group); the other half were assigned to a waiting list, which served as the control group. An additional 123 parents were assigned to receive the intervention without a randomly selected comparison group.

The parent training, which was based on the Incredible Years program, encouraged proactive, nurturing parenting while discouraging harsh, punitive approaches. The groups, which met for 2 hours weekly for 10 weeks (usually in a pediatric office), relied on videotaped modeling, group discussion, role plays, and home practice tasks in 4 areas: play; praise and rewards; effective limit setting; and handling misbehavior. A clinical psychologist or social worker as well as a pediatric practice staff member led each group.

At the beginning and end of the trial, investigators used parental questionnaires, a parenting scale, childhood behavior inventory, and structured videotaped parent-child interactions to observe changes during the study period. Compared with baseline, both the randomized and nonrandomized intervention groups demonstrated or reported less negative parenting, fewer child disruptive behaviors, and fewer negative parent-child interactions both at the intervention’s conclusion and at the 12-month follow-up, whereas the control group showed less improvement (Perrin EC, et al. JAMA Pediatr. 2014;168[1]:16-24).

Commentary: This sounds great, especially if you have parents who will sign up and show up for a weekly 2-hour intervention. However, who will pay? Is the evidence strong enough that insurers, Medicaid, and other payers would pick up the tab to avoid costs associated with later poor school performance? Would school districts invest in the program to improve the school readiness of these high-risk children? -Michael Burke, MD

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. He is a physician contributing editor for Contemporary Pediatrics. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.