Parent Video Feedback Program Reduces Behavioral Problems In Children As Young As 12 Months

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A public health trial suggests that offering personalized support to children who show early signs of difficult behavior by as little as one year of age could significantly reduce the chances of worsening problems.

A home parenting program to prevent behavioral problems in children, which very exceptionally focuses on children when they are still toddlers and in some cases as young as 12 months old has been shown to be very effective during its first public health trial.

The six-session program is all about providing parents with carefully prepared feedback on how they can take advantage of the positive moments when they play and engage with their child using video clips of daily interactions, which are filmed by a healthcare professional during a visit to their home.

It has been tested in 300 families of children who had shown early signs of behavioral problems. Half of the families received the program in addition to routine medical support, while the other half received routine support alone. When assessed five months later, children whose families had access to the video feedback approach had significantly reduced behavior problems compared to those whose families did not.

All the children were only one or two years old: much younger than the age at which interventions for behavior problems are normally available. The results suggest that providing personalized support to parents at this early stage, if their children show early signs of difficult behavior, such as very frequent or intense temper tantrums or aggressive behavior, would significantly reduce the chances of these worsening. problems.

Children with persistent behavior problems often face many other challenges as they grow up: with physical and mental health, education, and relationships. Behavior problems currently affect 5-10% of all children.


A home parenting program to prevent behavioral problems in children, which very exceptionally focuses on children when they are still toddlers and in some cases as young as 12 months old has been shown to be very effective during its first public health trial. This animated short gives a brief overview of the research. Credit: Healthy Start, Happy Start

The trial – one of the very first ‘real-world’ tests of an intervention for challenging behaviors in children so young – was carried out by healthcare professionals in six NHS Trusts in England and funded by the National Institute for Health Research. This was part of a larger project called ‘Healthy Start, Happy Start’, which tests the video-based approach, led by academics from the University of Cambridge and Imperial College London.

Dr Christine O’Farrelly, Center for Play in Education, Development and Learning (PEDAL), Faculty of Education, University of Cambridge, said: “Often times when you move a program like this into a real setting of health services, you would expect to see a drop in its effectiveness compared to the research conditions. Instead, we saw a clear and striking change in children’s behavior. “

Beth Barker, research assistant at the PEDAL Center, said: “The fact that this program has been effective with children aged one or two represents a real opportunity to intervene early and protect against mental health problems. persistent. The sooner we can support them, the better we can improve their outcomes as they progress through childhood and into adulthood.

The program, known as the Video Feedback Intervention to Promote Positive Parenting and Sensitive Discipline (VIPP-SD), consists of six home visits, lasting approximately 90 minutes each.

Healthcare professionals film the family in everyday situations – like playing together or having a meal – and then analyze the content in depth. On the next visit, they review specific clips, highlighting often fleeting moments when parents and child seem to be “listening”. They discuss what made them successful, as well as any incidents where more difficult issues have arisen. This helps parents identify particular cues and signals from their children and respond in a way that helps their children feel understood and reinforces engagement and positive behaviors.

The 300 participating families all had children who scored in the top 20% for behavior problems on standard health care assessments. Misconduct is a normal part of early childhood, and not all children would necessarily have developed serious problems. All were, however, rated “at risk” because they exhibited difficult behaviors such as temper tantrums and rule violations more severely and more frequently than most. These are often the first symptoms of disruptive behavioral disorders and usually appear between 12 and 36 months.

The researchers used a variety of tools, mostly parent interviews, to assess each child’s behavior before trial, and again five months after. Each child was given a score based on the frequency and severity of difficult behaviors, including temper tantrums, “destructive” behaviors (such as deliberately breaking a toy or spilling a drink); resist rules and demands; and aggressive behavior (hitting or biting).

Between assessments, all 300 families received the routine health care available to them for the first symptoms of behavioral problems. Researchers describe this as “generally minimal” because there is currently no standard route of support for behavior problems in these young children. Only half of the families had access to the parenting program.

In the second assessment, five months later, children from families who received the additional support of video feedback scored significantly lower on all measures of behavior problems than those who received only routine care. .

The mean difference between the scores of the two groups was 2.03 points. Although the exact meaning of this varies depending on the specific issues presented by the child, researchers describe it as roughly equivalent to the difference between having temper tantrums every day and having tantrums once or twice. per week. Likewise, in the case of destructive behaviors, it represents the disparity between regularly throwing or breaking toys and other objects, and barely doing so.

Encouragingly, 95% of the participants persisted with the trial until its conclusion, suggesting that most families are able to accommodate the visits.

Paul Ramchandani, professor of play in education, development and learning at the University of Cambridge, said: “Providing this program in any health service would require an investment, but it can realistically be achieved. provided as part of routine care. This would benefit a group of children who are at risk of problems with education, behavior, future well-being and mental health. There is a chance here to invest early and mitigate those difficulties now, potentially avoiding longer term problems that are much worse. “

The results are reported in JAMA Pediatrics. The Healthy Start, Happy Start project is also examining other data from the project – including children’s assessments two years after the trial – which will be reported at a later date.

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