1. A primary care pediatric intervention that promotes parental involvement through reading aloud and play demonstrated sustained improvement in childhood behavioral outcomes in children.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Primary care interventions that promote parenting skills can be used as tools to improve poverty-related disparities in social-emotional development. However, prior research on this subject has been focused on children with diagnoses such as ADHD, rather than on more general populations. In this study, researchers took a randomized, controlled approach to assessing a primary care-based intervention of parent-child interaction through reading aloud and play. The primary care practice was located in a low-income area. Families randomly assigned to the intervention, the Video Interaction Project (VIP), were found to have improved developmental outcomes as measured by a standardized behavior assessment tool. Specifically, children in the VIP program from ages 0-3 years improved in hyperactivity, as well as attention, and externalizing behaviors compared to control children who received no intervention. These improvements were sustained 1.5 years after the completion of the initial program. While this study was limited by attrition, the findings are strengthened by the study’s reduced risk of bias due to the factorial randomized control trial design. This study’s results suggest that primary care-based parenting interventions could have significant developmental benefits to high-risk pediatric populations.
In-Depth [randomized controlled trial]: In this factorial, randomized controlled trial, researchers recruited mother and infant dyads through the Bellevue Hospital Center with random assignment to the intervention (VIP), control, or another intervention called Building Blocks during the postpartum period. When the children were 3 years of age, the dyads assigned first to control or VIP were then randomized again to another VIP intervention or to control. The Building Blocks group was not included in this study’s analysis. Parental behavior ratings using the validated, Behavior Assessment System for Children (scales for Aggression, Hyperactivity, Social Skills and Externalizing Behavior) were collected over the 4.5 years following initial enrollment. In analysis of the sustained impact of the VIP program, VIP from age 0-3 years was associated with reductions in Attention problems (d = -0.251, p=0.03), Hyperactivity (d= -0.031, p=0.02), and Externalizing (d= -0.24, p=0.02) at age 4.5 years. In analysis of early impacts of VIP from ages 3-5 years, VIP was associated with reductions in Aggression (d = -0.22, p=0.01), Externalizing (d =-0.26, p=0.01), and near significance for Hyperactivity (d= -0.26, p=0.05). In analyzing dose and trajectory impacts of the intervention, a near-significant trend was noted of potentiation of VIP at both ages 0-3 and 3-5, with an age X VIP 0-3 X VIP 3-5 interaction effect p = 0.062.
1 Cohen’s d, is a statistical measure of effect size, and expresses the standardized difference between two means, with the difference of the means of the groups divided by a pooled standard deviation. See: Sawilowsky, S (2009). “New effect size rules of thumb”. Journal of Modern Applied Statistical Methods. 8 (2): 467–474.
2 This interaction effect was calculated through a multi-level model, a linear regression model that specifically included the interaction term reported, among other terms.
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