Article
Early Intervention in Pediatrics Offices for Emerging Disruptive Behavior in Toddlers

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Abstract

Background

This study provides preliminary data about a parenting intervention for families of preschoolers with early attention deficit hyperactivity disorder/oppositional defiant disorder symptoms carried out in two diverse primary care pediatric offices.

Method

Parents of toddlers completed behavioral screening questionnaires at well-child visits. Eligible parents participated in a 10-week parenting education group using the Incredible Years program. Mothers completed several outcome measures at three time points: before participating in the group, immediately after the group ended, and 6 months thereafter. These measures assessed changes in parenting practices, parenting stress, and child symptoms. Parent and provider satisfaction also were assessed.

Results

Mothers reported improvements in parenting skills and a decrease in stress. They also reported a decrease in child aggression and an increase in compliance. Mothers and providers reported high levels of satisfaction.

Conclusions

Results support the benefits and feasibility of providing parenting education groups to parents of toddlers in pediatric practice settings.

Section snippets

Participants

The study was conducted at two sites. The primary site was a 10-provider practice (eight pediatricians and two nurse practitioners) located in a small city in central Massachusetts that serves families from a wide range of socioeconomic status. During a 7-month period, 620 children between the ages of two and three years were scheduled for well-child visits. Of these, 55% (n = 341) completed screening questionnaires and 17% (n = 59) met our criteria for elevated ADHD/ODD symptoms. Forty-three

Parent Outcomes

Mothers reported high levels of satisfaction with the program. All mothers who completed the Parent Satisfaction Questionnaire at the end of the 10 sessions (n = 19) reported that their overall feeling about the program was “positive” or “very positive.” Seventy-nine percent (n = 15) reported being “satisfied” or “greatly satisfied” with their child's progress, and 100% of mothers reported that they would “recommend” or “strongly recommend” the program to a friend. Furthermore, 94% (n = 18)

Discussion

The Report of the Surgeon General's Conference on Children's Mental Health (Department of Health and Human Services Administration, 1999) has cited the prevention of mental health problems among youths as a national priority. We have described a combined screening and parenting education program, PREP, that is consistent with this priority. PREP was designed to capitalize on the multiple opportunities for observation and conversation between pediatricians, nurse practitioners, and parents

Conclusions

This study contributes initial data about the efficacy and feasibility of PREP in two diverse pediatric offices. Despite the promising nature of these findings, it is important to note that the results are preliminary and that this pilot study is not a true test of the long-term viability of PREP. Although the project took place in a real-world community setting, several supports were in place to maximize the program's success. The group leaders were a trained nurse practitioner and

Jannette McMenamy, Associate Professor, Department of Behavioral Sciences, Fitchburg State College, Fitchburg, MA.

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    Jannette McMenamy, Associate Professor, Department of Behavioral Sciences, Fitchburg State College, Fitchburg, MA.

    R. Christopher Sheldrick, Assistant Professor, Division of Developmental-Behavioral Pediatrics, The Floating Hospital for Children, Tufts University School of Medicine, Boston, MA.

    Ellen C. Perrin, Professor, Division of Developmental-Behavioral Pediatrics, The Floating Hospital for Children, Tufts University School of Medicine, Boston, MA.

    Conflicts of interest: None to report.

    This project was funded by grant 1R21 MH068035-01 from the National Institute of Mental Health and by The Commonwealth Foundation.

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