Day care study done by Rush nurses improve toddlers' behavior; Parents show improvement, too

March 12, 2000

A study of 268 parents with young children in 11 Chicago day-care centers serving low-income families found that using a parent training course can significantly help parents reduce the number of behavioral problems among their two and three-year-old children.

Deborah Gross, DNSc, RN, a professor at Rush University College of Nursing in Chicago and Wrenetha Julion, MS, MPH, RN doctoral student in the Rush University College of Nursing and co-project director on the study, presented their findings at the State of the Science Congress in Washington D.C. Parent training is a method for teaching positive parenting behaviors and preventing childhood behavior problems. Gross uses a 12-week parent training program that covers topics such as encouraging positive behavior in children, setting effective limits and managing misbehavior. In the study, parents met in groups run by two trained group leaders for 12 consecutive weeks. Each week, the parents viewed videotaped vignettes of parent and child models engaged in situations that many parents typically face at home. After each vignette, the tape is stopped and the group leader asks the parents for their opinions on how the parent handled the situation, how they could have improved, what the parent did well, and if they ever have situations like that at home with their children.

"We try to get parents to solve problems and encourage good behavior in their children and discourage negative behavior without getting into power struggles," Gross said.

Each of the 11 day-care centers was assigned to one of four experimental conditions. In some centers, the parents received only parent training. In a second set of centers, the parent training intervention was given only to the day-care teachers who were instructed to use the program principles in their classrooms and to teach the parents what they had learned. In a third set of centers, the intervention was given to both parents and teachers, but in separate groups. Finally, the fourth group of centers received no intervention for one year and then were given the parent training interventions.

"Parents who received the parent training intervention reported significantly less reliance on coercive discipline strategies (yelling, spanking, and hitting) than comparison group parents," Gross said. In addition, intervention parents were significantly less negative and directive with their children during play observations than comparison group parents.

Parent training also led to improvements in the children's behavior. Children of parents who completed parent training used significantly fewer aversive behaviors (whining, backtalking, non- compliance) with their parents during observations of parent-child interactions and had fewer behavior problems in their day care classrooms.

Improvements in the children's behavior were most apparent when children with very high behavior problem scores were compared with those of children without significant behavior problems.

Of children with very high behavior classroom problem scores at pre-intervention, 50 percent of the children in the parent-training group improved compared to only 24 percent of the children in the teacher training and non-intervention groups. Of children who demonstrated a high number of aversive behaviors during interactions with their parents before training, 100 percent of the children in the parent training conditions improved compared to only 50 percent of the children in the teacher training and non-intervention groups.

A total of 15 parent groups were held over the course of two years. Prior to the start of the parent groups, parents were interviewed by telephone about their decision to participate in the parent program, what they thought might change for their family as a result of participating in the program, and how important ten specific incentives were in their decision to participate. In addition, parents who dropped out of the study were interviewed about their decision and the reasons for it. These interviews showed that parents from low-income communities sign up for parent groups because they want to be better parents but many are forced to drop out because of competing demands on their time.

The findings of Gross and her research team hold much promise for assisting parents to effectively manage toddler behavior. Gross is currently following the families for one year post-intervention to learn whether the program continues to have positive effects long after the groups have ended. Gross received funding to do this study from the National Institute for Nursing Research.
Rush-Presbyterian-St. Luke's Medical Center includes the 809-bed Presbyterian-St. Luke's Hospital; 154-bed Johnston R. Bowman Health Center for the Elderly; Rush University (Rush Medical College, College of Nursing, College of Health Sciences and Graduate College); and seven Rush Institutes providing diagnosis, treatment and research into leading health problems. The medical center is the tertiary hub of the Rush System for Health, a comprehensive healthcare system capable of serving about three million people through its outpatient facilities and seven member hospitals.

Rush University Medical Center

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