Rapid Responses to:

RESEARCH: Susan P Walker, Susan M Chang, Christine A Powell, Emily Simonoff, and Sally M Grantham-McGregor Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial BMJ 2006; 333: 472 [Abstract] [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Stratton, Supernanny and the State

Minoo Irani   (2 September 2006)

Stratton, Supernanny and the State 2 September 2006
Minoo Irani, Consultant Community Paediatrician Children's Services,Upton Hospital, Slough SL1 2BJ Send response to journal: Re: Stratton, Supernanny and the State	Another ‘real world’ study about the benefits of psychosocial stimulation in early childhood may lead readers to the inevitable conclusion that group based parenting programmes could mitigate the impact of socioeconomic adversity and environmental risk factors upon the psychosocial outcome of children when they reach adolescence and adulthood. Results of the study by Walker et al (1) would struggle to be generalisable to much of the Western child population. A selective sample of stunted children (unresponsive to dietary supplementation) from Kingston, Jamaica and identified by house to house survey of poor neighbourhoods introduces a strong selection bias. Randomisation with small numbers adds little comfort and majority of the effects on outcomes are only modest. Prevalence of emotional and behavioural disorders in children in the UK ranges between 10 and 20 % of the childhood population and is probably the most common reason for referral to some Community Child Health Services and most Child and Adolescent Mental Health Services. Offering parenting programmes to families with insurmountable socioeconomic difficulties is certainly therapeutic to many healthcare professionals, but often misses the point completely. The complex interplay of genetic, neurobiological and environmental risk factors in producing emotional and behavioural disorders in children and contributing towards criminality in adulthood is often predictable. It would, of course, be ideal if socioeconomic and biological adversities in families could be eliminated and all children offered an equal chance in life. Barring that, our options vary from using the Webster-Stratton (and similar parenting programmes) for prevention, the Supernanny approach when crisis point has been reached, or let the State intervene to ‘identify tomorrow’s potential troublemakers even before they are born’(2). We have had some success with the first two approaches; now let us give the third a fair chance. 1. Walker SP, Chang SM, Powell CA, Simonoff E, Grantham-McGregor SM. Effects of psychosocial stimulation and dietary supplementation in early childhood on psychosocial functioning in late adolescence: follow-up of randomised controlled trial. BMJ 2006; 333: 472-4 2. Blair to tackle ‘menace’ children. BBC News online: 31 August Competing interests: None declared