Objective: To determine whether a structured program of parent anticipatory guidance ‘Toddlers Without Tears’, delivered in universal primary care, can prevent preschool child behaviour problems.
Design: Cluster randomised controlled trial.
Setting/participants: 40 primary care nursing centres (clusters) in metropolitan Melbourne, Australia. 733 English-speaking mothers of 6-7 month old infants consecutively recruited from well-child appointments; 589 (80%) retained at age 3 years.
Intervention: Parenting program from age 8-15 months, with two group sessions co-led by well-child providers and a parenting expert. The program addressed normal behaviour development, and offered strategies to increase desired and reduce unwanted behaviour. While 93% of intervention parents received at least some of the program, only 49% completed all components.
Control: Usual primary care.
Main outcome measures: Maternal report of child externalising behaviour (Child Behaviour Checklist), parenting (Parent Behaviour Checklist) and maternal mental health (Depression Anxiety Stress Scales) when children were aged 3 years.
Results: Behaviour scores in the intervention and control groups were similar (mean (sd)) 11.4 (7.1) versus 12.4 (7.6); adjusted mean difference -0.8, 95% CI: -2.2 to 0.6, p = 0.26). On the parenting subscale scores, intervention parents reported fewer unreasonable expectations of child development (37.3 (10.9) versus 39.9 (10.2), adjusted mean difference -3.1, 95% CI: -4.9 to -1.4, p = 0.001). Mean scores for harsh/abusive and nurturing parenting, and maternal mental health, were similar between the two groups.
Conclusions: A brief universal parenting program in primary care is insufficient to prevent development of preschool externalising problems. A new population trial targeting more intensive prevention to distressed parents with toddler behaviour problems is now under way, aiming to prevent both externalising and internalising problems before school entry.
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