ACQ_Vol_11_no_3_2009

Research updates

The Toddlers Without Tears study Jordana Bayer

Price, & Wake, 2008). We believe that the Toddlers Without Tears program needs to do more to support parents feeling stressed and anxious with children who are showing early signs of behaviour and emotional problems. Most parents (85%) reported the parenting groups were useful and helpful with their children; 89% said they would recommend the program to other families (Hiscock et al., 2008). A new study was funded for 2009–14 to improve the program. In the new study more strategies have been added for parents to manage feelings of stress and anxiety and to practise new positive parenting skills to reduce early behaviour and emotional difficulties. This new randomised controlled trial involves nine different local government areas. The trial will provide the Toddlers Without Tears parenting groups as well as extra family support for those under most stress. The new study aims to show whether early childhood Bayer, J.K., Hiscock, H., Morton-Allen, E., Ukoumunne, O.C., & Wake, M. (2007). Prevention of mental health problems: Rationale for a universal approach. Archives of Disease in Childhood , 92 , 34–38. Bayer, J.K., Hiscock H., Ukoumunne, O.C., Price A., & Wake, M. (2008). Aetiology of early childhood mental health problems: A population-level longitudinal study. Journal of Child Psychology & Psychiatry , 49 , 1166–1174. Campbell, S. (1995). Behaviour problems in preschool children. Journal of Child Psychology and Psychiatry , 36 , 113–149. Hiscock, H., Bayer, J.K., Price, A., Ukoumunne, O.C., Rogers, S., & Wake, M. (2008). Universal parenting programme to prevent early child behavioural problems: cluster randomised trial. British Medical Journal , 336 , 318–321. Hiscock, H., Bayer, J.K., & Wake, M. (2005). Preventing toddler behaviour problems: Pilot evaluation of a universal parenting program. International Journal of Mental Health Promotion , 7 , 52–58. Mrazek, P.J., & Haggerty R.J. (1994). Reducing the risks for mental disorders . Washington: National Academy Press. Sawyer, M.G., Arney, F.M., Baghurst, P.A., et al. (2000). The mental health of young people in Australia . Canberra: Commonwealth Department of Health and Aged Care. Correspondence to: Dr Jordana Bayer Postdoctoral research fellow and clinical psychologist Royal Children’s Hospital (Centre for Community Child Health) and Murdoch Childrens Research Institute Melbourne, Victoria email: jordana.bayer@mcri.edu.au website: http://www.rch.org.au/ccch/research.cfm?doc_id=10631 mental health problems can be prevented more effectively and cost efficiently by offering prevention universally (to all families), or targeting prevention only to families at highest risk (Mrazek & Haggerty, 1994). References

Behaviour and emotional problems affect 1 in 7 Australian children (Sawyer et al., 2000). These problems include aggression, disobedience, anxiety, social withdrawal and depression. Around 50% of preschool children’s problems continue through the childhood years (Campbell, 1995). The Toddlers Without

Tears program aims to prevent children from developing behaviour and emotional problems (Hiscock, Bayer, & Wake, 2005). This program of research for young children’s mental health, led by Dr Harriet Hiscock and Dr Jordana Bayer, comprises a multidisciplinary team of psychologists, paediatricians, a biostatistician and a health economist. 1 This research is supported by the Australian Research Council, Australian Rotary Health, Equity Trustees, National Health and Medical Research Council, and Telstra Community Development Fund. In 2004, 733 families with 7-month old babies enrolled in Toddlers Without Tears across six Victorian local government areas (Bayer, Hiscock, Morton-Allen, Ukoumunne, & Wake, 2007), representing 69% of all eligible babies at maternal and child health centres in these areas. In 2005, half of the families in each area were invited to parenting groups when their children were 12 and 15 months old. In 2006, half of these families were offered an extra parenting group when their child was 2 years old. All parents in the study were invited to fill out questionnaires at child ages 7, 12, 18, 24 and 36 months. Parents’ response rates have been high, with 96% completing the questionnaire at 12 months, 92% at 18 months, 89% at 24 months, and 80% at 36 months. When all children turned 2 years old, results showed that families who had been offered the parenting groups used less harsh discipline with their young children (e.g., yelling and smacking) compared to families who weren’t offered this program. They also had a better understanding of what is normal for young children’s behaviour (Hiscock, Bayer, Price, Ukoumunne, Rogers, & Wake, 2008). However, we believe this parenting program was too brief, because the parenting benefits faded out by the time children turned 3, and the program didn’t impact on child behaviour problems. Evaluation of questionnaire data from infancy through to 3 years identified contributing factors to the development of behaviour problems over time. Results showed that toddler and preschool children were more likely to develop behaviour problems in families where parents felt stressed, and used yelling and smacking with young children. Children were more likely to show early emotional problems when their parents felt anxious or stressed too (Bayer, Hiscock, Ukoumunne, 1 Toddlers Without Tears Team: Dr Harriet Hiscock, Dr Jordana Bayer, Professor Melissa Wake, Dr Obioha Ukoumunne, Ms Lisa Gold, Professor Daniel Shaw, Professor Ann Sanson, Ms Anna Price, Ms Elise Morton Allen, Ms Megan Mathers, Ms Kate Scalzo, Dr Susan Rogers. Participating institutions: Royal Children’s Hospital (Centre for Community Child Health) and Murdoch Childrens Research Institute (lead institutions), The University of Melbourne Department of Paediatrics, University of Pittsburgh USA, Victorian government agencies (DEECD, DHS, MAV), Parenting Research Centre Victoria.

Jordana Bayer

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ACQ Volume 11, Number 3 2009

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