Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

doi:10.1136/bmj.39451.609676.AE

BMJ 2008;336:318-321 (9 February), doi:10.1136/bmj.39451.609676.AE (published 31 January 2008)

Research

Universal parenting programme to prevent early childhood behavioural problems: cluster randomised trial

Harriet Hiscock, postdoctoral research fellow and paediatrician ¹^,2^,3, Jordana K Bayer, postdoctoral research fellow and clinical child psychologist ¹^,2^,3, Anna Price, research assistant¹^,3, Obioha C Ukoumunne, postdoctoral research fellow and statistician²^,3^,4, Susan Rogers, clinical research fellow ⁵, Melissa Wake, paediatrician and senior research fellow¹^,2^,3

¹ Centre for Community Child Health, Royal Children’s Hospital, Parkville VIC 3052, Australia, ² Department of Paediatrics, University of Melbourne, Parkville, ³ Murdoch Children’s Research Institute, Parkville, ⁴ Clinical Epidemiology and Biostatistics Unit, Royal Children’s Hospital, Parkville, ⁵ Parenting Research Centre, Carlton, VIC 3053

Correspondence to: H Hiscock harriet.hiscock{at}rch.org.au

Objective To determine whether a parenting programme, offereduniversally in primary care, can prevent behavioural problemsin children and improve parenting and maternal mental health.

Design Cluster randomised trial.

Setting 40 primary care nursing centres (clusters) in Victoria,Australia.

Participants 733 English speaking mothers of 8 month old childrensequentially recruited from well child appointments; 656 retainedat 24 months.

Intervention Structured three session programme at age 8-15months, co-led by well child providers and a parenting expert.The programme covered normal development and behaviour, strategiesto increase desired behaviour, and strategies to reduce unwantedbehaviour.

Main outcome measures Maternal report of child externalisingbehaviour (child behavior checklist 1 $1/2$ -5 year old), parenting(parent behavior checklist), and maternal mental health (depressionanxiety stress scales) at 18 and 24 months.

Results At 18 months, child behaviour and parenting scores weresimilar in the two groups. At 24 months, externalising scoresin the intervention and control groups were similar (mean 11.9(SD 7.2) v 12.9 (7.4)); however, on the parent behavior checklistsubscale scores, intervention group parents were less likelyto report harsh/abusive parenting (mean 38.9 (SD 7.7) v 40.5(8.8); adjusted mean difference –1.83, 95% confidenceinterval –3.12 to –0.55) and unreasonable expectationsof child development (40.9 (9.9) v 42.7 (9.6); –2.18,–3.74 to –0.62). Mean scores for nurturing parentingand maternal mental health were similar in the two groups atboth times.

Conclusions A universal parenting programme resulted in modestimprovement in parenting factors that predict behavioural problemsin children but did not reduce externalising behavioural problemsor affect maternal mental health at 2 years.

Trial registration ISRCTN 77531789.

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