Improving Parenting Skills for Families of Young Children in Primary Care Pediatric Settings: A Randomized Clinical Trial

Disruptive behavior disorders such as Attention Deficient/Hyperactivity Disorder and Oppositional Defiant Disorder are common and stable throughout childhood. These disorders cause long-term morbidity but benefit from early intervention. While symptoms are often evident before preschool, few children receive appropriate treatment during this period. Group parent training such as the Incredible Years has been shown to be effective in improving parenting strategies and reducing children’s disruptive behaviors. Because they already monitor young children’s behavior and development, primary care pediatricians are in a good position to intervene early when indicated.

The goal of this project was to demonstrate the feasibility and benefits of introducing preventive parent education into a new context:  the primary care pediatric office.  We designed a randomized controlled trial with 11 diverse pediatric practice groups in Eastern Massachusetts.  Screening for early evidence of disruptive behavior was accomplished at the 2 and 3 year old well child visits using a parent report instrument created from longitudinal data about early symptoms of school-age diagnoses of ADHD and ODD.  Parents who acknowledged significant disruptive behavior were invited to participate in the project, and were randomly assigned to receive the intervention within one month or one year later.

Two members of the staff of each pediatric office were trained to deliver the Incredible Years parenting intervention.  Ten weekly parent groups were co-led by one of these staff members and a research staff psychologist.  Two hundred seventy-three parents participated in parenting groups and in outcome assessments prior to and immediately after the intervention, and 12 months later.  Primary outcomes were (1) Eyberg Child Behavior Scale and (2) Parenting Scale completed by parents; and (3) standardized scoring of videotaped child-parent interactions.  As a result of slower-than-expected enrollment in some practices, some parents were assigned to receive intervention without a comparison group.

Compared to the wait list group, greater improvement was observed in all primary outcome measures in both intervention groups (p<.05), both immediately after the intervention and 1 year later. No differences were observed between the randomized and the non-randomized intervention groups.

In summary, self-reports and structured observations provided evidence of improvements in parenting practices and child disruptive behaviors that were attributable to participation in Incredible Years groups. This study demonstrates the feasibility and effectiveness of parent training groups conducted in pediatric office settings to reduce disruptive behavior in toddlers.