Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis.

QUESTION: We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems. STUDY SELECTION AND ANALYSIS: We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years. EXCLUSION CRITERIA: studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs). FINDINGS: Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers. CONCLUSIONS: We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.

Communication Skills and Communicative Autonomy of Prelinguistic Deaf and Hard-of-Hearing Children: Application of a Video Feedback Intervention.

BACKGROUND AND AIM: Evidence on the efficacy of parenting interventions to support communication development in deaf and hard-of-hearing children is emerging. In previous research, we showed that parental participation in a video feedback-based intervention enhanced parental self-esteem and emotional availability to their deaf and hard-of-hearing children. This paper investigates the impact of the intervention on the development of the children's prelingual communication skills and autonomy. Evidence on the efficacy of parenting interventions to support communication development is warranted. METHODS: Sixteen hearing parents with a prelingual deaf and hard-of-hearing child (Mage = 2.05 years, SD = 1.77) were recruited by self-selection from pediatric audiological services and randomly stratified into intervention-first and waiting-list groups. Families completed three sessions of Video Interaction Guidance in their homes. Designed for maximal inclusion, the sample comprised children with complex developmental and social needs. The primary inclusion criterion was the child's prelingual status (<50 signed/spoken words), which was established using speech and language therapy reports. Child communicative autonomy was assessed from a 20 min free-play video recording using a gold standard measure for deaf and hard-of-hearing children (Tait) before and after the intervention. RESULTS: A Mann-Whitney U test indicated no significant difference between the two groups. The groups were collated, and a Wilcoxon signed-rank test with time (pre-/post-intervention) as a repeating variable was run. A significant increase in children's communicative autonomy (Z = -3.517, p < 0.0001, d = 0.62) and decrease in children's no-responses (Z = -3.111, p < 0.005, d = 0.55) were seen. There was no significant difference in the overall number of turn-taking between the parent and child, indicating differences in the quality of the parent-child interactions, not the quantity. CONCLUSION: This study adds to the emerging evidence for parenting interventions with deaf and hard-of-hearing children. We hypothesize that the video feedback intervention with its focus on emotional availability created space for the children to show increased communicative autonomy during parent-child interactions. Communicative autonomy is a long-term predictor of communication and linguistic development in deaf and hard-of-hearing children, and its conceptual underpinning makes it a good early measure of relational agency. Results can inform wider interventions that focus on the quantity of the parent-child communication.

Enhancing Parent-Child Communication and Parental Self-Esteem With a Video-Feedback Intervention: Outcomes With Prelingual Deaf and Hard-of-Hearing Children.

Evidence on best practice for optimizing communication with prelingual deaf and hard-of-hearing (DHH) children is lacking. This study examined the effect of a family-focused psychosocial video intervention program on parent-child communication in the context of childhood hearing loss. Fourteen hearing parents with a prelingual DHH child (Mage = 2 years 8 months) completed three sessions of video interaction guidance intervention. Families were assessed in spontaneous free play interactions at pre and postintervention using the Emotional Availability (EA) Scales. The Rosenberg Self-esteem Scale was also used to assess parental report of self-esteem. Compared with nontreatment baselines, increases were shown in the EA subscales: parental sensitivity, parental structuring, parental nonhostility, child responsiveness, and child involvement, and in reported self-esteem at postintervention. Video-feedback enhances communication in families with prelingual DHH children and encourages more connected parent-child interaction. The results raise implications regarding the focus of early intervention strategies for prelingual DHH children.

Video feedback intervention: a case series in the context of childhood hearing impairment.

BACKGROUND: Recent research shows that parental sensitivity can explain a significant and unique amount of growth in speech and language outcomes in children with cochlear implants. In this intervention study we explored the impact of an intervention designed to support parental sensitivity on children's communication development. AIMS: This study tests the effect of a complex intervention in the context of childhood hearing impairment using a case study design of three families. Propositions for each case were made using parental report of the child's development in an attempt to identify change in outcome measurements that were not likely to be due to general development in the child or a halo effect from the intervention. METHODS AND RESULTS: Multiple pre- and post-intervention measures were taken. Outcome measures were mother-child contingencies to vocal utterances, emotional availability and an assessment of early communication in the child. Results for each case showed that improvements in some outcome measurements were found after the intervention and were maintained at follow-up. CONCLUSIONS & IMPLICATIONS: Taking account of developmental change in intervention studies with children is challenging. Single-subject intervention studies can be designed to allow research interventions to be tailored to meet families' specific needs. Video interaction guidance may support pre-linguistic communicative development in children with hearing impairment.

Thin Slice Sampling of Video Footage for Mother/Child Interaction: Application to Single Cases.

The purpose was to test the reliability of short samples of parent/child interaction for use in single-subject research. Four variable pairs of mother/child behaviour were coded for seven mother/child play sessions. Each session lasted 20 min and 18 min of the session was behaviourally coded using frame-by-frame analysis. The co-occurrence of the mother/child behaviours within a given time window was computed and an odds ratio was calculated for the co-occurrence of the targeted behaviours. The play session was divided into shorter segments (3, 6 and 9 min) and odds ratios of the variable pairs from the shorter segments were compared to the odds ratios from the entire session. Segments of 3 and 6 min did not yield the same pattern of results as the entire session. In single-subject research, evidence of the reliability of the time segment for behavioural coding should be reported in the methods section of original research manuscripts.

The applicability of normalisation process theory to speech and language therapy: a review of qualitative research on a speech and language intervention.

BACKGROUND: The Bercow review found a high level of public dissatisfaction with speech and language services for children. Children with speech, language, and communication needs (SLCN) often have chronic complex conditions that require provision from health, education, and community services. Speech and language therapists are a small group of Allied Health Professionals with a specialist skill-set that equips them to work with children with SLCN. They work within and across the diverse range of public service providers. The aim of this review was to explore the applicability of Normalisation Process Theory (NPT) to the case of speech and language therapy. METHODS: A review of qualitative research on a successfully embedded speech and language therapy intervention was undertaken to test the applicability of NPT. The review focused on two of the collective action elements of NPT (relational integration and interaction workability) using all previously published qualitative data from both parents and practitioners' perspectives on the intervention. RESULTS: The synthesis of the data based on the Normalisation Process Model (NPM) uncovered strengths in the interpersonal processes between the practitioners and parents, and weaknesses in how the accountability of the intervention is distributed in the health system. CONCLUSIONS: The analysis based on the NPM uncovered interpersonal processes between the practitioners and parents that were likely to have given rise to successful implementation of the intervention. In previous qualitative research on this intervention where the Medical Research Council's guidance on developing a design for a complex intervention had been used as a framework, the interpersonal work within the intervention had emerged as a barrier to implementation of the intervention. It is suggested that the design of services for children and families needs to extend beyond the consideration of benefits and barriers to embrace the social processes that appear to afford success in embedding innovation in healthcare.