Skip to main content
Top
Published in: BMC Pediatrics 1/2014

Open Access 01-12-2014 | Research article

Primary Care Triple P for parents of NICU graduates with behavioral problems: a randomized, clinical trial using observations of parent–child interaction

Authors: Renske Schappin, Lex Wijnroks, Monica Uniken Venema, Barbara Wijnberg-Williams, Ravian Veenstra, Corine Koopman-Esseboom, Susanne Mulder-De Tollenaer, Ingeborg van der Tweel, Marian Jongmans

Published in: BMC Pediatrics | Issue 1/2014

Login to get access

Abstract

Background

Preterm-born or asphyxiated term-born children show more emotional and behavioral problems at preschool age than term-born children without a medical condition. It is uncertain whether parenting intervention programs aimed at the general population, are effective in this specific group. In earlier findings from the present trial, Primary Care Triple P was not effective in reducing parent-reported child behavioral problems. However, parenting programs claim to positively change child behavior through enhancement of the parent–child interaction. Therefore, we investigated whether Primary Care Triple P is effective in improving the quality of parent–child interaction and increasing the application of trained parenting skills in parents of preterm-born or asphyxiated term-born preschoolers with behavioral problems.

Methods

For this pragmatic, open randomized clinical trial, participants were recruited from a cohort of infants admitted to the neonatal intensive care units of two Dutch hospitals. Children aged 2–5 years, with a gestational age <32 weeks and/or birth weight <1500 g and children with a gestational age 37–42 weeks and perinatal asphyxia were included. After screening for a t-score ≥60 on the Child Behavior Checklist, children were randomly assigned to Primary Care Triple P (n = 34) or a wait-list control group (n = 33). Trial outcomes were the quality of parent–child interaction and the application of trained parenting skills, both scored from structured observation tasks.

Results

There was no effect of the intervention on either of the observational outcome measures at the 6-month trial endpoint.

Conclusions

Primary Care Triple P, is not effective in improving the quality of parent–child interaction nor does it increase the application of trained parenting skills in parents of preterm-born or asphyxiated term-born children with behavioral problems. Further research should focus on personalized care for these parents, with an emphasis on psychological support to reduce stress and promote self-regulation.

Trial registration

Netherlands National Trial Register NTR2179. Registered 26 January 2010.
Appendix
Available only for authorised users
Literature
1.
go back to reference Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS: Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002, 288: 728-737. 10.1001/jama.288.6.728.CrossRefPubMed Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJS: Cognitive and behavioral outcomes of school-aged children who were born preterm: a meta-analysis. JAMA. 2002, 288: 728-737. 10.1001/jama.288.6.728.CrossRefPubMed
2.
go back to reference Van Handel M, Swaab H, De Vries LS, Jongmans MJ: Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007, 166: 645-654. 10.1007/s00431-007-0437-8.CrossRefPubMedPubMedCentral Van Handel M, Swaab H, De Vries LS, Jongmans MJ: Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007, 166: 645-654. 10.1007/s00431-007-0437-8.CrossRefPubMedPubMedCentral
3.
go back to reference Gray RF, Indurkhya A, McCormick MC: Prevalence, stability, and predictors of clinically significant behavior problems in low birth weight children at 3, 5, and 8 years of age. Pediatrics. 2004, 114: 736-743. 10.1542/peds.2003-1150-L.CrossRefPubMed Gray RF, Indurkhya A, McCormick MC: Prevalence, stability, and predictors of clinically significant behavior problems in low birth weight children at 3, 5, and 8 years of age. Pediatrics. 2004, 114: 736-743. 10.1542/peds.2003-1150-L.CrossRefPubMed
4.
go back to reference Miles MS, Holditch-Davis D: Parenting the prematurely born child: pathways of influence. Semin Perinatol. 1997, 21: 254-266. 10.1016/S0146-0005(97)80067-5.CrossRefPubMed Miles MS, Holditch-Davis D: Parenting the prematurely born child: pathways of influence. Semin Perinatol. 1997, 21: 254-266. 10.1016/S0146-0005(97)80067-5.CrossRefPubMed
5.
go back to reference Miles MS, Holditch-Davis D: Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children. J Pediatr Nurs. 1995, 10: 243-253. 10.1016/S0882-5963(05)80021-1.CrossRefPubMed Miles MS, Holditch-Davis D: Compensatory parenting: how mothers describe parenting their 3-year-old, prematurely born children. J Pediatr Nurs. 1995, 10: 243-253. 10.1016/S0882-5963(05)80021-1.CrossRefPubMed
6.
go back to reference De Ocampo AC, Macias MM, Saylor CF, Katikaneni LD: Caretaker perception of child vulnerability predicts behavior problems in NICU graduates. Child Psychiatry Hum Dev. 2003, 34: 83-96. 10.1023/A:1027384306827.CrossRefPubMed De Ocampo AC, Macias MM, Saylor CF, Katikaneni LD: Caretaker perception of child vulnerability predicts behavior problems in NICU graduates. Child Psychiatry Hum Dev. 2003, 34: 83-96. 10.1023/A:1027384306827.CrossRefPubMed
7.
go back to reference Campbell SB: Behavior Problems in Preschool Children: Clinical and Developmental Issues. 2006, The Guilford Press, New York, NY, 2 Campbell SB: Behavior Problems in Preschool Children: Clinical and Developmental Issues. 2006, The Guilford Press, New York, NY, 2
8.
go back to reference Clark CAC, Woodward LJ, Horwood LJ, Moor S: Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences. Child Dev. 2008, 79: 1444-1462. 10.1111/j.1467-8624.2008.01198.x.CrossRefPubMed Clark CAC, Woodward LJ, Horwood LJ, Moor S: Development of emotional and behavioral regulation in children born extremely preterm and very preterm: biological and social influences. Child Dev. 2008, 79: 1444-1462. 10.1111/j.1467-8624.2008.01198.x.CrossRefPubMed
9.
go back to reference Evans T, Whittingham K, Sanders MR, Colditz P, Boyd RN: Are parenting interventions effective in improving the relationship between mothers and their preterm infants?. Infant Behav Dev. 2014, 37: 131-154. 10.1016/j.infbeh.2013.12.009.CrossRefPubMed Evans T, Whittingham K, Sanders MR, Colditz P, Boyd RN: Are parenting interventions effective in improving the relationship between mothers and their preterm infants?. Infant Behav Dev. 2014, 37: 131-154. 10.1016/j.infbeh.2013.12.009.CrossRefPubMed
10.
go back to reference Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M: Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013, 13: S10-10.1186/1471-2393-13-S1-S10.CrossRefPubMedPubMedCentral Benzies KM, Magill-Evans JE, Hayden KA, Ballantyne M: Key components of early intervention programs for preterm infants and their parents: a systematic review and meta-analysis. BMC Pregnancy Childbirth. 2013, 13: S10-10.1186/1471-2393-13-S1-S10.CrossRefPubMedPubMedCentral
11.
go back to reference Koldewijn K, Wolf MJ, Van Wassenaer A, Meijssen D, Van Sonderen L, Van Baar A, Beelen A, Nollet F, Kok J: The infant behavioral assessment and intervention program for very low birth weight infants at 6 months corrected age. J Pediatr. 2009, 154: 33-38. 10.1016/j.jpeds.2008.07.039.CrossRefPubMed Koldewijn K, Wolf MJ, Van Wassenaer A, Meijssen D, Van Sonderen L, Van Baar A, Beelen A, Nollet F, Kok J: The infant behavioral assessment and intervention program for very low birth weight infants at 6 months corrected age. J Pediatr. 2009, 154: 33-38. 10.1016/j.jpeds.2008.07.039.CrossRefPubMed
12.
go back to reference Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB: A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics. 2006, 118: e9-e19. 10.1542/peds.2005-1491.CrossRefPubMed Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB: A randomized, controlled trial of the effectiveness of an early-intervention program in reducing parenting stress after preterm birth. Pediatrics. 2006, 118: e9-e19. 10.1542/peds.2005-1491.CrossRefPubMed
13.
go back to reference Van Hus JW, Jeukens-Visser M, Koldewijn K, Geldof CJ, Kok JH, Nollet F, Van Wassenaer-Leemhuis AG: Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age. J Pediatr. 2013, 162: 1112-1119. 10.1016/j.jpeds.2012.11.078.CrossRefPubMed Van Hus JW, Jeukens-Visser M, Koldewijn K, Geldof CJ, Kok JH, Nollet F, Van Wassenaer-Leemhuis AG: Sustained developmental effects of the infant behavioral assessment and intervention program in very low birth weight infants at 5.5 years corrected age. J Pediatr. 2013, 162: 1112-1119. 10.1016/j.jpeds.2012.11.078.CrossRefPubMed
14.
go back to reference Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB: A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev. 2008, 84: 201-209. 10.1016/j.earlhumdev.2007.07.003.CrossRefPubMed Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB: A randomized controlled trial of an early intervention program in low birth weight children: outcome at 2 years. Early Hum Dev. 2008, 84: 201-209. 10.1016/j.earlhumdev.2007.07.003.CrossRefPubMed
15.
go back to reference Newnham CA, Milgrom J, Skouteris H: Effectiveness of a modified mother-infant transaction program on outcomes for preterm infants from 3 to 24 months of age. Infant Behav Dev. 2009, 32: 17-26. 10.1016/j.infbeh.2008.09.004.CrossRefPubMed Newnham CA, Milgrom J, Skouteris H: Effectiveness of a modified mother-infant transaction program on outcomes for preterm infants from 3 to 24 months of age. Infant Behav Dev. 2009, 32: 17-26. 10.1016/j.infbeh.2008.09.004.CrossRefPubMed
16.
go back to reference Verkerk G, Jeukens-Visser M, Houtzager B, Koldewijn K, Van Wassenaer A, Nollet F, Kok J: The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age. Early Hum Dev. 2012, 88: 699-705. 10.1016/j.earlhumdev.2012.02.004.CrossRefPubMed Verkerk G, Jeukens-Visser M, Houtzager B, Koldewijn K, Van Wassenaer A, Nollet F, Kok J: The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age. Early Hum Dev. 2012, 88: 699-705. 10.1016/j.earlhumdev.2012.02.004.CrossRefPubMed
17.
go back to reference Spittle AJ, Treyvaud K, Doyle LW, Roberts G, Lee KJ, Inder TE, Cheong JLY, Hunt RW, Newnham CA, Anderson PJ: Early emergence of behavior and social-emotional problems in very preterm infants. J Am Acad Child Adolesc Psychiatry. 2009, 48: 909-918. 10.1097/CHI.0b013e3181af8235.CrossRefPubMed Spittle AJ, Treyvaud K, Doyle LW, Roberts G, Lee KJ, Inder TE, Cheong JLY, Hunt RW, Newnham CA, Anderson PJ: Early emergence of behavior and social-emotional problems in very preterm infants. J Am Acad Child Adolesc Psychiatry. 2009, 48: 909-918. 10.1097/CHI.0b013e3181af8235.CrossRefPubMed
18.
go back to reference Sanders MR, Markie-Dadds C, Turner KMT: Theoretical, scientific and clinical foundations of the triple P-positive parenting program: a population approach to the promotion of parenting competence. Parent Res Pract Monogr. 2003, 1: 1-21. Sanders MR, Markie-Dadds C, Turner KMT: Theoretical, scientific and clinical foundations of the triple P-positive parenting program: a population approach to the promotion of parenting competence. Parent Res Pract Monogr. 2003, 1: 1-21.
19.
go back to reference Schappin R, Wijnroks L, Uniken Venema M, Wijnberg-Williams B, Veenstra R, Koopman-Esseboom C, Mulder-De Tollenaer S, Van der Tweel I, Jongmans M: Brief parenting intervention for parents of NICU graduates: a randomized, clinical trial of Primary Care Triple P. BMC Pediatr. 2013, 13: 69-10.1186/1471-2431-13-69.CrossRefPubMedPubMedCentral Schappin R, Wijnroks L, Uniken Venema M, Wijnberg-Williams B, Veenstra R, Koopman-Esseboom C, Mulder-De Tollenaer S, Van der Tweel I, Jongmans M: Brief parenting intervention for parents of NICU graduates: a randomized, clinical trial of Primary Care Triple P. BMC Pediatr. 2013, 13: 69-10.1186/1471-2431-13-69.CrossRefPubMedPubMedCentral
20.
go back to reference Crisante L: Training in parent consultation skills for primary care practitioners in early intervention in the pre-school context. Aust e-J Adv Ment Health. 2003, 2: 1-10. 10.5172/jamh.2.1.1.CrossRef Crisante L: Training in parent consultation skills for primary care practitioners in early intervention in the pre-school context. Aust e-J Adv Ment Health. 2003, 2: 1-10. 10.5172/jamh.2.1.1.CrossRef
21.
go back to reference Turner KMT, Sanders MR: Help when it’s needed first: a controlled evaluation of a brief, preventive behavioral family intervention in a primary care setting. Behav Ther. 2006, 37: 131-142. 10.1016/j.beth.2005.05.004.CrossRefPubMed Turner KMT, Sanders MR: Help when it’s needed first: a controlled evaluation of a brief, preventive behavioral family intervention in a primary care setting. Behav Ther. 2006, 37: 131-142. 10.1016/j.beth.2005.05.004.CrossRefPubMed
22.
go back to reference Wilson P, Rush R, Hussey S, Puckering C, Sim F, Allely CS, Doku P, McConnachie A, Gillberg C: How evidence-based is an ‘evidence-based parenting program’? a PRISMA systematic review and meta-analysis of triple P. BMC Med. 2012, 10: 130-10.1186/1741-7015-10-130.CrossRefPubMedPubMedCentral Wilson P, Rush R, Hussey S, Puckering C, Sim F, Allely CS, Doku P, McConnachie A, Gillberg C: How evidence-based is an ‘evidence-based parenting program’? a PRISMA systematic review and meta-analysis of triple P. BMC Med. 2012, 10: 130-10.1186/1741-7015-10-130.CrossRefPubMedPubMedCentral
23.
go back to reference Sanders MR, Kirby JN, Tellegen CL, Day JJ: The triple P-positive parenting program: a systematic review and meta-analysis of a multi-level system of parenting support. Clin Psychol Rev. 2014, 34: 337-357. 10.1016/j.cpr.2014.04.003.CrossRefPubMed Sanders MR, Kirby JN, Tellegen CL, Day JJ: The triple P-positive parenting program: a systematic review and meta-analysis of a multi-level system of parenting support. Clin Psychol Rev. 2014, 34: 337-357. 10.1016/j.cpr.2014.04.003.CrossRefPubMed
24.
go back to reference Sanders MR, Waugh L, Tully L, Hynes K: The Revised Family Observation Schedule. 1996, Parenting and Family Support Centre, Brisbane, Australia, 3 Sanders MR, Waugh L, Tully L, Hynes K: The Revised Family Observation Schedule. 1996, Parenting and Family Support Centre, Brisbane, Australia, 3
25.
go back to reference Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH: Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008, 50: 744-750. 10.1111/j.1469-8749.2008.03089.x.CrossRefPubMed Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH: Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008, 50: 744-750. 10.1111/j.1469-8749.2008.03089.x.CrossRefPubMed
26.
go back to reference Achenbach TM, Rescorla LA: Manual for the ASEBA School-Age Forms & Profiles. 2000, University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT Achenbach TM, Rescorla LA: Manual for the ASEBA School-Age Forms & Profiles. 2000, University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT
27.
go back to reference Turner KMT, Sanders MR, Markie-Dadds C: Practitioner’s Manual for Primary Care Triple P. 2007, Australian Academic Press, Brisbane, Australia Turner KMT, Sanders MR, Markie-Dadds C: Practitioner’s Manual for Primary Care Triple P. 2007, Australian Academic Press, Brisbane, Australia
28.
go back to reference National Institute of Child Health and Human Development Early Child Care Research Network: Child care and mother-child interaction in the first three years of life. Dev Psychol. 1999, 35: 1399-1413. 10.1037/0012-1649.35.6.1399.CrossRef National Institute of Child Health and Human Development Early Child Care Research Network: Child care and mother-child interaction in the first three years of life. Dev Psychol. 1999, 35: 1399-1413. 10.1037/0012-1649.35.6.1399.CrossRef
29.
go back to reference Institute of Child Health and Human Development Early Child Care Research Network: Coding Manual, 36-Month Mother-Child Structured Interaction Qualitative Rating Scales. 1993, National Institute of Child Health and Human Development, Bethesda, MD Institute of Child Health and Human Development Early Child Care Research Network: Coding Manual, 36-Month Mother-Child Structured Interaction Qualitative Rating Scales. 1993, National Institute of Child Health and Human Development, Bethesda, MD
30.
go back to reference Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159-174. 10.2307/2529310.CrossRefPubMed Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics. 1977, 33: 159-174. 10.2307/2529310.CrossRefPubMed
32.
go back to reference Corp IBM: IBM SPSS Statistics for Windows, Volume Version 20. 2011, Armonk, NY, IBM Corp Corp IBM: IBM SPSS Statistics for Windows, Volume Version 20. 2011, Armonk, NY, IBM Corp
33.
go back to reference Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J: Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA. 1999, 281: 799-805. 10.1001/jama.281.9.799.CrossRefPubMed Singer LT, Salvator A, Guo S, Collin M, Lilien L, Baley J: Maternal psychological distress and parenting stress after the birth of a very low-birth-weight infant. JAMA. 1999, 281: 799-805. 10.1001/jama.281.9.799.CrossRefPubMed
34.
go back to reference Schappin R, Wijnroks L, Uniken Venema MMAT, Jongmans MJ: Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One. 2013, 8: e54992-10.1371/journal.pone.0054992.CrossRefPubMedPubMedCentral Schappin R, Wijnroks L, Uniken Venema MMAT, Jongmans MJ: Rethinking stress in parents of preterm infants: a meta-analysis. PLoS One. 2013, 8: e54992-10.1371/journal.pone.0054992.CrossRefPubMedPubMedCentral
35.
go back to reference Wijnroks L: Maternal recollected anxiety and mother-infant interaction in preterm infants. Infant Ment Health J. 1999, 20: 393-409. 10.1002/(SICI)1097-0355(199924)20:4<393::AID-IMHJ3>3.0.CO;2-I.CrossRef Wijnroks L: Maternal recollected anxiety and mother-infant interaction in preterm infants. Infant Ment Health J. 1999, 20: 393-409. 10.1002/(SICI)1097-0355(199924)20:4<393::AID-IMHJ3>3.0.CO;2-I.CrossRef
36.
go back to reference Huhtala M, Korja R, Lehtonen L, Haataja L, Lapinleimu H, Rautava R, Group PS: Parental psychological well-being and behavioral outcome of very low birth weight infants at 3 years. Pediatrics. 2012, 129: e937-e944. 10.1542/peds.2011-2411.CrossRefPubMed Huhtala M, Korja R, Lehtonen L, Haataja L, Lapinleimu H, Rautava R, Group PS: Parental psychological well-being and behavioral outcome of very low birth weight infants at 3 years. Pediatrics. 2012, 129: e937-e944. 10.1542/peds.2011-2411.CrossRefPubMed
37.
go back to reference Poehlmann J, Schwichtenberg AJM, Shlafer RJ, Hahn E, Bianchi JP, Warner R: Emerging self-regulation in toddlers born preterm or low birth weight: differential susceptibility to parenting?. Dev Psychopathol. 2011, 23: 177-193. 10.1017/S0954579410000726.CrossRefPubMedPubMedCentral Poehlmann J, Schwichtenberg AJM, Shlafer RJ, Hahn E, Bianchi JP, Warner R: Emerging self-regulation in toddlers born preterm or low birth weight: differential susceptibility to parenting?. Dev Psychopathol. 2011, 23: 177-193. 10.1017/S0954579410000726.CrossRefPubMedPubMedCentral
38.
go back to reference Westrupp EM, Mensah FK, Giallo R, Cooklin A, Nicholson JM: Mental health in low-to-moderate risk preterm, low birth weight, and small for gestational age children at 4 to 5 years: the role of early maternal parenting. J Am Acad Child Adolesc Psychiatry. 2012, 51: 313-323. 10.1016/j.jaac.2011.12.004.CrossRefPubMed Westrupp EM, Mensah FK, Giallo R, Cooklin A, Nicholson JM: Mental health in low-to-moderate risk preterm, low birth weight, and small for gestational age children at 4 to 5 years: the role of early maternal parenting. J Am Acad Child Adolesc Psychiatry. 2012, 51: 313-323. 10.1016/j.jaac.2011.12.004.CrossRefPubMed
39.
go back to reference Finch BK: Socioeconomic gradients and low birth-weight: empiciral and policy considerations. Health Serv Res. 2003, 38: 1819-1841. 10.1111/j.1475-6773.2003.00204.x.CrossRefPubMedPubMedCentral Finch BK: Socioeconomic gradients and low birth-weight: empiciral and policy considerations. Health Serv Res. 2003, 38: 1819-1841. 10.1111/j.1475-6773.2003.00204.x.CrossRefPubMedPubMedCentral
Metadata
Title
Primary Care Triple P for parents of NICU graduates with behavioral problems: a randomized, clinical trial using observations of parent–child interaction
Authors
Renske Schappin
Lex Wijnroks
Monica Uniken Venema
Barbara Wijnberg-Williams
Ravian Veenstra
Corine Koopman-Esseboom
Susanne Mulder-De Tollenaer
Ingeborg van der Tweel
Marian Jongmans
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2014
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-014-0305-4

Other articles of this Issue 1/2014

BMC Pediatrics 1/2014 Go to the issue