Primary Care Triple P for parents of NICU graduates with behavioral problems: a randomized, clinical trial using observations of parent–child interaction

BACKGROUND Preterm-born or asphyxiated term-born children show more emotional and behavioral problems at preschool age than term-born children without a medical condition. It is uncertain whether parenting intervention programs aimed at the general population, are effective in this specific group. In earlier findings from the present trial, Primary Care Triple P was not effective in reducing parent-reported child behavioral problems. However, parenting programs claim to positively change child behavior through enhancement of the parent-child interaction. Therefore, we investigated whether Primary Care Triple P is effective in improving the quality of parent-child interaction and increasing the application of trained parenting skills in parents of preterm-born or asphyxiated term-born preschoolers with behavioral problems. METHODS For this pragmatic, open randomized clinical trial, participants were recruited from a cohort of infants admitted to the neonatal intensive care units of two Dutch hospitals. Children aged 2-5 years, with a gestational age <32 weeks and/or birth weight <1500 g and children with a gestational age 37-42 weeks and perinatal asphyxia were included. After screening for a t-score ≥60 on the Child Behavior Checklist, children were randomly assigned to Primary Care Triple P (n = 34) or a wait-list control group (n = 33). Trial outcomes were the quality of parent-child interaction and the application of trained parenting skills, both scored from structured observation tasks. RESULTS There was no effect of the intervention on either of the observational outcome measures at the 6-month trial endpoint. CONCLUSIONS Primary Care Triple P, is not effective in improving the quality of parent-child interaction nor does it increase the application of trained parenting skills in parents of preterm-born or asphyxiated term-born children with behavioral problems. Further research should focus on personalized care for these parents, with an emphasis on psychological support to reduce stress and promote self-regulation. TRIAL REGISTRATION Netherlands National Trial Register NTR2179 . Registered 26 January 2010.