RESUMEN
Individuals with Tourette syndrome (TS) have poorer quality of life (QoL) than their peers, yet factors contributing to poor QoL in this population remain unclear. Research to date has predominantly focused on the impact of tics and psychiatric symptoms on QoL in TS samples. The aim of this cross-sectional, multi-informant study was to identify psychosocial variables that may impact adolescent QoL in TS. Thirty-eight adolescents aged 13 to 17 with TS and 28 age-matched controls participated with a caregiver. No group differences were found on QoL, although the TS group reported reduced QoL compared to population normative data. In the TS group, reduced QoL was associated with lower self-esteem, poorer family functioning, higher stress, and greater depression and anxiety; QoL was unrelated to tic severity. In regression analyses, after adjusting for covariates, family functioning was the strongest predictor of QoL. These results emphasize the need to further explore the influence of psychosocial factors, particularly family functioning, on QoL in adolescents with TS.
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To prevent diseases, efforts are needed to determine how to address Adverse Childhood Experiences (ACEs), including parenting behaviors. The objective of this study, conducted in Nashville TN in 2017, was to initiate testing the psychometric properties of two new Adverse Childhood Experiences (ACEs) screening tools, the Quick Parenting Assessment (QPA) and Other Childhood Stressors (OCS). In a clinic serving low-income families, caregivers of children ages 2-10 completed assessments of parenting (QPA), other stressors (OCS), child behavior problems ((Strength and Difficulties Questionnaire (SDQ)), and Attitudes Toward Spanking (ATS). The QPA takes 1 min to complete and assesses for healthy and unhealthy parenting behaviors. Seventy-five percent of eligible participants completed the survey (N=558). A reduced 10-item QPA yielded a Cronbach's alpha of 0.79 and, in 4-10-year-olds, was associated with high SDQ conduct, hyperactivity, and total difficulties scores (r=0.44, 0.48, and 0.47; all p< 0.001). Children with QPAs of >4 were nine times more likely than those children with scores of ≤2 to have behavior problems (OR=8.93, 95% CI = 3.74-21.32). Elevated QPAs were associated with the ATS (r=0.47, p < .001). The OCS was also associated with high SDQ total difficulties scores (r=0.28, p< 0.001). Two pediatric ACEs screening tools, the QPA and the OCS, have promising psychometric properties. The findings suggest that parenting behaviors may play an outsized role in the pathogenesis of outcomes associated with ACEs. We discuss the clinical application of QPA at our institution and the theoretical potential for this instrument to reduce the rates of short- and long-term health problems.
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Experiencias Adversas de la Infancia , Responsabilidad Parental , Niño , Preescolar , Estado de Salud , Humanos , Psicometría , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To investigate age-related trends in physically aggressive behaviors in children before age 2 years. STUDY DESIGN: A normative US sample of 477 mothers of 6- to 24-month-old children reported on the frequency of 9 interpersonally directed aggressive child behaviors, and hurting animals, in the past month. RESULTS: Almost all (94%) of the children were reported to have engaged in physically aggressive behavior in the past month. Based on 2-part regression models, the prevalences of kicking (OR, 1.70; P = .023), pushing (OR, 3.22; P < .001), and swiping (OR, 1.78; P = .018) increased with years of age, but the prevalence of hair pulling decreased with age (OR, 0.55; P = .020). The prevalences of hitting and throwing increased initially, then plateaued at age 18-20 months, and then decreased (quadratic aOR, 0.13 and 0.16; P < .001 and .010, respectively). The frequencies of hitting (R2 = .05; P < .001) and throwing (R2 = .03; P = .030) increased, and the frequencies of hair pulling (R2 = .07; P < .001) and scratching (R2 = .02; P = .042) decreased with age (P values adjusted for false discovery rate). CONCLUSIONS: Physically aggressive behavior in the 6- to 24-month age range appears to be nearly ubiquitous. Most, but not all, forms of physical aggression increase with age. These results can guide pediatricians as they educate and counsel parents about their child's behavior in the first 2 years of life.
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Agresión , Conducta Infantil , Factores de Edad , Preescolar , Femenino , Humanos , Lactante , Masculino , Prevalencia , Valores de Referencia , Estados UnidosRESUMEN
Objectives Inappropriate discipline such as harsh physical punishment is a social determinant of health. The objective was to determine if a brief parent training intervention that teaches discipline strategies is culturally sensitive. Methods English or Spanish-speaking parents of 1-5 year old children viewed a multimedia program that teaches appropriate discipline strategies. The intervention, Play Nicely, was viewed in the exam room before the physician's visit. Parents viewed 4 of 20 discipline strategies of their choosing; the average viewing time was 7 min. Results Of 204 parents eligible to participate, 197 (96 %) completed the study; 41 % were Black, 31 % were White, and 21 % were Hispanic. At least 80 % of parents from each racial/ethnic group reported that the program built their confidence to care for their child, addressed their family needs, explained things in a way they could understand, respected their family values, and was sensitive to their personal beliefs. Overall, 80 % of parents reported that the program answered individual questions. One parent (0.5 %) reported that the program did not respect her family values. Conclusions for Practice Discipline education can be integrated into the pediatric primary care clinic in a way that is family-centered and culturally sensitive for the majority of parents. The results have implications for the development and implementation of population-based parenting programs and the primary prevention of child abuse and violence.
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Maltrato a los Niños/prevención & control , Asistencia Sanitaria Culturalmente Competente/métodos , Responsabilidad Parental/psicología , Padres/educación , Instituciones Académicas/ética , Adulto , Población Negra/etnología , Población Negra/psicología , Maltrato a los Niños/psicología , Conducta Infantil , Preescolar , Asistencia Sanitaria Culturalmente Competente/normas , Femenino , Hispánicos o Latinos/psicología , Humanos , Lactante , Masculino , New York , Atención Primaria de Salud/métodos , Enseñanza/normas , Población Blanca/etnología , Población Blanca/psicologíaRESUMEN
Parents (N = 599) of 6-month-old to 10-year-old children were given a handbook intervention that educates about healthy discipline in a pediatric clinic serving low-income families in Nashville, Tennessee. A research assistant spent approximately 1 minute introducing the intervention. A total of 440 parents (73.4%) responded to a follow-up survey 2 to 4 months later. Most parents (88%) who completed the follow-up survey had read at least part of the handbook. Of parents who received the handbook, 63% reported that the handbook helped them discipline their children. Half of parents reported specific changes they made because of the handbook. The most frequently reported changes were more talking/explaining/communicating (25%), more redirecting (7.8%), more patience/listening (6.0%), less anger/yelling (10.8%), and less spanking (7.5%). 42% of parents reported that they shared the handbook with other caregivers, friends, relatives, and children. A brief clinic intervention improves parents' discipline practices and reaches other caregivers.
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Rates of traditional bullying have remained stable (30%) but rates of cyberbullying are increasing rapidly (46% of youth). There are significant long-term physical and mental health consequences of bullying especially for vulnerable youth. Multi-component school-based prevention programs that include caring adults, positive school climate, and supportive services for involved youth can effectively reduce bullying. While bullying has emerged as a legitimate concern, studies of surviving perpetrators to date suggest bullying is not the most significant risk factor of mass school shootings. Pediatricians play a critical role in identification, intervention, awareness, and advocacy.
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Acoso Escolar , Víctimas de Crimen , Ciberacoso , Adulto , Adolescente , Humanos , Estudiantes/psicología , Violencia/prevención & control , Acoso Escolar/prevención & controlRESUMEN
OBJECTIVE: to describe the translation, cross-cultural adaptation and validity process of the "Play Nicely Program: The Healthy Discipline Handbook" for use in Brazil. METHODS: a methodological study that followed the translation, back-translation, expert committee assessment, and pre-test steps. The Content Validity Index (CVI) was calculated for both the judge population and the pre-test population. Four translators, seven expert judges in the field of child health and thirty participants in the pre-test, including parents, teachers and healthcare professionals, participated in the study. RESULTS: in experts' analysis (98.4%), a value of 100% of adequate assessments was obtained, and in the target population's analysis (89.5%), there were 100% of adequate assessments. In both analyses, suggested adaptations were made. CONCLUSIOS: cross-cultural adaptation and content validity into Brazilian Portuguese of the "Play Nicely Program: The Healthy Discipline Handbook" were considered adequate for application in the target population.
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Comparación Transcultural , Estado de Salud , Niño , Humanos , Brasil , Encuestas y Cuestionarios , Traducciones , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To assess US pediatricians' preparedness, motivation, and barriers related to educating parents about corporal punishment (CP) and effective child discipline. METHODS: A random sample of 1500 pediatricians was drawn from a nationwide database in the United States. A self-administered questionnaire was sent via mail in 2016. The response rate (53%; n = 787) was maximized via repeated survey mailings and use of cash incentives. RESULTS: The majority of respondents were White (69%), female (59%) and were members of the American Academy of Pediatrics (85%). Most pediatricians felt somewhat prepared to advise parents about child discipline, particularly CP, and perceived their colleagues to be slightly less prepared than themselves. Although most (72%) respondents believed it was "extremely/very" likely that parents valued their advice about child discipline, only 36% believed parents were "extremely/very" likely to follow their advice. Most respondents were highly motivated to participate in activities designed to change norms regarding CP. The most common strategy pediatricians identified for improving child behavior was being consistent with rules (71%). Perceived barriers to providing child discipline advice to parents included lack of time (90%), lack of insurance reimbursement (48%), and lack of training and educational resources (47%). CONCLUSIONS: Pediatricians are a key source of professional advice for parents about how to discipline children safely. Given this, along with strong approval and use of CP in the United States and its harm for children, the current findings suggest a strong need for pediatricians to receive additional training on how to advise parents about child discipline along with removal of barriers to providing such advice.
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Motivación , Castigo , Niño , Crianza del Niño , Femenino , Humanos , Padres , Pediatras , Estados UnidosRESUMEN
Ninety-six parents in a preschool and pediatric clinic participated in a randomized study of a brief parenting intervention. The Attitudes Toward Spanking (ATS) scale was measured at baseline, and, on average, 4 months postintervention. Higher ATS scores are correlated with increased use of physical punishment. In the intervention group, there was a 2.7-point decrease in the ATS score at follow-up compared with baseline (P = 0.01). There was no decrease in the ATS in the control group. Brief interventions may shift parental attitudes toward using less physical punishment and have implications for improving anticipatory guidance within primary care and early education.
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Relaciones Padres-Hijo , Responsabilidad Parental , Padres/psicología , Castigo/psicología , Adulto , Niño , Preescolar , Femenino , Grupos Focales , Estudios de Seguimiento , Humanos , Masculino , Pediatría , Encuestas y CuestionariosRESUMEN
Participants were parents of children less than 7 years of age who presented with their child for a well child visit. Viewed in the waiting room, the intervention was Play Nicely, which teaches childhood aggression management skills. A total of 138 parents were invited to view the program; 57 (41%) accepted (voluntary group). A second group of 35 parents viewed the program as part of the clinic visit (required group); all 35 (100%) accepted. There were no differences between the groups in the proportion of parents who were pleased that the program was offered by their pediatrician (100%) and the proportion who felt more comfortable managing aggression after the viewing experience (94%). Approximately 75% of both groups reported an increased willingness to discuss child behavior and discipline strategies with their pediatrician. These findings have implications for how providers can more routinely introduce educational material into the well child visit that relates to childhood aggression, discipline, and violence prevention.
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Agresión , Padres/educación , Padres/psicología , Psicología Infantil , Violencia/prevención & control , Adulto , Preescolar , Femenino , Humanos , Masculino , Pediatría , Factores SocioeconómicosRESUMEN
There were 65 third-year medical students and 59 pediatric residents who participated. The intervention was a 40-minute multimedia program that teaches how to counsel parents about childhood aggression. Comparing pre- and 2-month postintervention data, there was an increase in the proportion of medical students (11% pre vs 92% post; P < .001) and residents (3% pre vs 95% post; P < .001) who felt that their ability to counsel parents about hurtful behavior was high or very high. Compared with baseline, a higher proportion of trainees at the 2-month follow-up recommended redirecting (11% pre vs 69% post; P < .001), promoting empathy (13% pre vs 42% post; P < .001), and not using physical punishment (25% pre vs 50% post; P < .001). A brief, independently viewed curriculum addition expanded the repertoire of health care trainees related to counseling parents about childhood aggression. These findings have implications for violence prevention.
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Agresión/psicología , Consejo , Educación de Postgrado en Medicina/métodos , Educación de Pregrado en Medicina/métodos , Padres/psicología , Pediatría/educación , Violencia/prevención & control , Distribución de Chi-Cuadrado , Niño , Evaluación Educacional , Femenino , Humanos , Internado y Residencia , Masculino , MultimediaRESUMEN
English- and Spanish-speaking parents of 1- to 5-year-old children were invited to view 5-10 minutes of parent training program, "Play Nicely," as part of the well-child checkup. Key measures were parents' plans to change how they discipline and, if they planned to use less spanking, how the program worked in their situation. Of 197 parents who participated, 128 (65.0%) planned to change how they discipline. Nineteen parents (9.6%) reported that they planned to spank less. The most common reasons for parents to plan to spank less were that the program taught other discipline options (12/19, 63.2%) and that the program taught that spanking was not recommended as a form of discipline (6/19, 31.6%). The majority of parents report that the program works because it offers alternatives to spanking. This study has implications for the development of parent training programs and the primary prevention of child abuse, violence, and other health problems.
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Protección a la Infancia , Consejo Dirigido/organización & administración , Relaciones Padres-Hijo , Padres/educación , Abuso Físico/prevención & control , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Medición de Riesgo , Estados UnidosRESUMEN
OBJECTIVE: To assess United States pediatricians' attitudes, beliefs, and perceived professional injunctive norms regarding spanking. METHOD: A self-administered questionnaire was mailed to a nationwide random sample of 1500 pediatricians in the US, drawn from a database maintained by IMS Health. Four survey mailings were conducted and cash incentives of up to $20 were provided. The response rate was 53% (N = 787). RESULTS: Most respondents were members of the American Academy of Pediatrics (85%), had been practicing physicians for 15 years or more (66%), and were white (69%) and female (59%). All US regions were represented. About 3-quarters of pediatricians did not support the use of spanking, and most perceived that their colleagues did not support its use either. Pediatricians who were male, black, and/or sometimes spanked as children had more positive attitudes toward spanking and expected more positive outcomes from spanking than their counterparts. Nearly 80% of pediatricians never or seldom expected positive outcomes from spanking, and a majority (64%) expected negative outcomes some of the time. CONCLUSION: The majority of pediatricians in the US do not support the use of spanking with children and are aware of the empirical evidence linking spanking with increased risk of poor health outcomes for children. Pediatricians are a key, trusted professional source in advising parents about child discipline. These findings suggest that most pediatricians will discourage the use of spanking with children, which over time could reduce its use and associated harms in the population. This is of clinical relevance because, despite strong and consistent evidence of the harms that spanking raises for children, spanking is still broadly accepted and practiced in the US.
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Actitud del Personal de Salud , Crianza del Niño , Pediatras/estadística & datos numéricos , Castigo , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados UnidosRESUMEN
ABSTRACT Objective: to describe the translation, cross-cultural adaptation and validity process of the "Play Nicely Program: The Healthy Discipline Handbook" for use in Brazil. Methods: a methodological study that followed the translation, back-translation, expert committee assessment, and pre-test steps. The Content Validity Index (CVI) was calculated for both the judge population and the pre-test population. Four translators, seven expert judges in the field of child health and thirty participants in the pre-test, including parents, teachers and healthcare professionals, participated in the study. Results: in experts' analysis (98.4%), a value of 100% of adequate assessments was obtained, and in the target population's analysis (89.5%), there were 100% of adequate assessments. In both analyses, suggested adaptations were made. Conclusios: cross-cultural adaptation and content validity into Brazilian Portuguese of the "Play Nicely Program: The Healthy Discipline Handbook" were considered adequate for application in the target population.
RESUMEN Objetivo: desarrollar el proceso de traducción, adaptación transcultural y validación del "Play Nicely Program: The Healthy Discipline Handbook" para uso en Brasil. Métodos: estudio metodológico, siguiendo las etapas de traducción, retrotraducción, evaluación por el comité de jueces y preprueba. Se calculó el Índice de Validez de Contenido (IVC) tanto para la población de jueces como para la población previa a la prueba. Población de estudio: cuatro traductores, siete jueces expertos en el área de salud infantil y treinta participantes en la preprueba con padres, docentes y profesionales de la salud. Resultados: en el análisis de los especialistas (98,4%), se obtuvo un valor de 100% de valoraciones adecuadas y, en el análisis de la población objetivo (89,5%), Se totalizó el 100% de las evaluaciones adecuadas. En ambos análisis, se realizaron adaptaciones sugeridas. Conclusiones: la adaptación transcultural y la validación de contenido para el portugués brasileño del "Play Nicely Program: The Healthy Discipline Handbook" se consideraron adecuadas para su aplicación en la población objetivo.
RESUMO Objetivo: desenvolver o processo de tradução, adaptação transcultural e validação do "Play Nicely Program: The Healthy Discipline Handbook" para uso no Brasil. Métodos: estudo metodológico, seguindo as etapas de tradução, retrotradução, avaliação do comitê de juízes e pré-teste. Foi calculado o Índice de Validade de Conteúdo (IVC) tanto para a população de juízes quanto para a população do pré-teste. População do estudo: quatro tradutores, sete juízes especialistas na área de saúde da criança e trinta participantes no pré-teste com pais, professores e profissionais da saúde. Resultados: na análise dos especialistas (98,4%), obteve-se valor de 100% de avaliações adequadas e, na análise da população-alvo (89,5%), totalizaram-se 100% de avaliações adequadas. Em ambas análises, foram realizadas adaptações sugeridas. Conclusão: a adaptação transcultural e a validação de conteúdo para o português do Brasil do "Play Nicely Program: The Healthy Discipline Handbook" foram consideradas adequadas para a aplicação na população-alvo.
RESUMEN
Participants were parents of 1- to 7-year-old children presenting to a pediatric clinic. The intervention was Play Nicely, 2nd edition, a multimedia educational program that teaches childhood aggression management skills. On average, parents viewed 10 to 15 min in clinic. The average age of the 89 participants was 30 years; 49% were African American, 29% were married, and 12% had a college education. Preintervention, 90% of parents stated that they felt very comfortable managing aggression. Postintervention, 90% of parents planned to change how they discipline their own child. More than 90% had at least one positive comment about the program; there were no negative comments. A brief intervention that addresses childhood aggression is embraced by a relatively diverse group of parents who viewed it during their children's primary care visit. Parents' prior comfort level with managing aggression should not be used to screen who might benefit. The program has implications for violence prevention.
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Agresión , Conducta Infantil , Responsabilidad Parental , Violencia/prevención & control , Adulto , Niño , Preescolar , Consejo , Femenino , Humanos , Lactante , Masculino , PadresRESUMEN
Persistent early childhood aggression is a strong predictor of violence later in life. To determine how well general pediatricians counsel parents regarding aggression management strategies, responses to open-ended questions and endorsements of specific aggression management strategies, among 27 pediatricians were evaluated. Sixteen (59%) screened regularly for aggression and 23 (85%) counseled (rather than referred) if there were parental concerns. Pediatricians were most likely to spontaneously recommend time-outs (85%) and verbal reprimands (78%) and much less likely to recommend other strategies such as redirecting (26%, p < 0.01) and promoting empathy (22%, p < 0.001). Pediatricians did endorse other aggression management strategies, however, when specifically asked about them. Pediatricians appear to take a limited approach to counseling parents of children with hurtful behavior. To increase health care providers' role in violence prevention, more systematic efforts are needed to increase rates of screening for early childhood aggression and to broaden the scope of how pediatricians counsel parents.
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Agresión , Consejo/normas , Pediatría/normas , Pautas de la Práctica en Medicina , Violencia/prevención & control , Adulto , Factores de Edad , Niño , Conducta Infantil , Preescolar , Consejo/tendencias , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pediatría/tendencias , Relaciones Médico-Paciente , Pautas de la Práctica en Medicina/tendencias , Prevalencia , Probabilidad , Calidad de la Atención de Salud , Reproducibilidad de los Resultados , Medición de Riesgo , Factores Sexuales , Encuestas y CuestionariosRESUMEN
Participants were 65 parents of 6- to 18-month-old children presenting for a well child checkup between September 2002 and February 2003 to one of two private pediatric offices. The intervention was a 30-minute multimedia program, Play Nicely, viewed at home, which teaches the basics in childhood aggression management. One year after intervention, parents were asked, "Do you feel that the CD program was helpful in managing aggressive behavior in your child?" Most (65%) parents who watched the program agreed that it helped them manage aggression with their own child (strongly agree, 31%; agree, 34%; uncertain, 28%; disagree, 7%; and strongly disagree, 0%). An inexpensive, brief, independently viewed, multimedia program helps parents manage aggression in their young children as long as 1 year after receiving it from their pediatrician. An easily implemented intervention may contribute to violence prevention efforts.
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Agresión , Conducta del Lactante , Multimedia , Responsabilidad Parental , Padres , Adulto , CD-ROM , Estudios de Seguimiento , Humanos , Lactante , Relaciones Padres-Hijo , Padres/educación , Pediatría , Consultorios Médicos , Evaluación de Programas y Proyectos de Salud , Tennessee , Violencia/prevención & controlRESUMEN
A pre-post knowledge test using alternate forms was used to determine if a multimedia violence prevention program can increase knowledge about management of childhood aggression. The participants were pediatric residents and childcare workers who attended lectures about aggression management in young children. The intervention was a presentation of a 30 minute CD-ROM program, Play Nicely, which teaches how to manage aggression in young children ages 1 to 7 years. A pretest and posttest multiple-choice knowledge assessment that focused on the program's most important recommendations was administered. Childcare workers and pediatric residents had significantly increased knowledge scores after viewing the CD-ROM demonstration (F=6.8, p = 0.01). Childcare workers' scores improved by 2.6 points (p< 0.001) and residents' scores by 3.8 points (p< 0.001). A relatively short CD-ROM can improve knowledge about how to manage aggression in young children, indicating its usefulness as a violence prevention resource.
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Agresión , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Multimedia , Violencia/prevención & control , Actitud del Personal de Salud , Niño , Conducta Infantil , Guarderías Infantiles , Preescolar , Estudios de Cohortes , Intervalos de Confianza , Femenino , Humanos , Internado y Residencia , Masculino , Pediatría/educación , Probabilidad , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Sensibilidad y Especificidad , Materiales de EnseñanzaRESUMEN
BACKGROUND: Participants were consecutive English or Spanish speaking parents of 1- to 5-year-old children presenting for a well-child visit. Parents viewed a 5- to 10-minute intervention that teaches appropriate discipline strategies. The participation rate was 99% (129/130). Thirty-six percent (46/129) reported they had a discussion about discipline with their pediatrician. Of the parents who had a discussion, 93% (43/46) agreed or strongly agreed that the intervention program helped with a discussion about discipline. One hundred percent (19/19) of Hispanic parents reported that the program was helpful compared with 86% (12/14) of Black parents and 91% (10/11) of White parents. Parents' qualitative responses revealed that the intervention helped by facilitating communication with their physician and/or by providing information. Brief interventions, integrated into the primary care visit can help parents have discussions about discipline with their physician. The results have implications for improving pediatric primary care services, violence prevention, and child abuse prevention.
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Maltrato a los Niños/prevención & control , Crianza del Niño/psicología , Educación no Profesional/métodos , Pediatría/métodos , Atención Primaria de Salud/métodos , Evaluación de Programas y Proyectos de Salud , Población Negra/psicología , Población Negra/estadística & datos numéricos , Conducta Infantil/psicología , Preescolar , Consejo/métodos , Femenino , Hispánicos o Latinos/psicología , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Lactante , Masculino , Responsabilidad Parental , Padres/psicología , Tennessee , Población Blanca/psicología , Población Blanca/estadística & datos numéricosRESUMEN
The objective of this study is to describe feedback on a multimedia violence prevention program. Professionals and laypersons provided feedback regarding a multimedia CD program by completing an anonymous form. Feedback was obtained from 66% of participants (314). In general, participants felt more comfortable managing childhood aggression after the program (p<0.001). Pediatric residents felt more comfortable counseling parents (p<0.001). Approximately 90% of participants would either strongly or very strongly recommend the program to others. Multimedia programs can increase comfort level with managing childhood aggression, suggesting that they hold promise for use as adjunctive violence prevention tools.