Early intervention for preschoolers with behaviour problems: Preliminary findings for the Exploring Together Preschool Program
Kate Reid
Psychologist, Private Practice, Euroa VIC
Lyn Littlefield
Victorian Parenting Centre, Melbourne VIC
Sabine W Hammond
School of Psychology, Australian Catholic University, Melbourne VIC
PP: 015 - 029
Abstract
There is increasing recognition of the need for early intervention into behavioural problems in preschool aged children (3-6 years) to prevent long-term adverse outcomes. This paper reports on the Exploring Together Preschool Program (ETPP), an innovative, developmental theory based, early intervention program, aimed at preschoolers referred with behaviour problems who are at risk of developing ongoing mental health problems.
ETPP is a multifaceted group program comprising parent behaviour management training, parent-child interaction therapy, and children's social problem-solving training. Seven groups comprising 37 preschoolers and one of their parents referred from clinical and community settings participated in the 10-week program.
Results indicate that children's behaviour problems reduced clinically and significantly from pre- to post-program whilst social skills improved significantly. Parenting practices and parents' satisfaction with their role also improved significantly. Improvements were mostly maintained at 6-month follow-up. Developmental theory suggests that these changes will help prevent behaviour problems from developing into long-term, enduring mental health problems.
The study provides preliminary evidence that ETPP is a theoretically and developmentally sound, comprehensive intervention for Australian families with preschool aged children who show early signs of mental health problems.
Keywords
early intervention, behavioural problems, emotional problems, children, preschool, parents, parenting, evaluation, program evaluation
Article Text
The promotion of mental health is critical in early childhood. Behavioural and relationship problems cause significant impairment for many preschool aged children and can be precursors for long-term antisocial behaviours and mental health problems (Campbell, 2002; Campbell & Ewing, 1990; Gagnon, Craig, Tremblay et al., 1995; White, Moffitt, Earls et al., 1990). Behaviours such as temper tantrums, yelling, fighting, and refusal to comply with instructions can interfere with the child's functioning at home and with their peers (Kazdin, 1995). Problems such as aggressive, oppositional, defiant, and disruptive behaviours can be severe, persistent, and frequent enough to warrant clinical attention or diagnoses (Dadds, 1997; Keenan & Wakschlag, 2004; Lavigne, Cicchetti, Gibbons et al., 2001; McMahon & Wells, 1998).
Some preschool aged children also exhibit internalising problems such as anxiety (Dadds, Spence, Holland et al., 1997) and shyness and withdrawal from peers (Spence & Donovan, 1998). Children may also have interpersonal relationship problems including deficits in core social and problem-solving skills (Shure, 2001; Spivack & Shure, 1989) as well as attachment difficulties with parents (Bowlby, 1998; Greenberg, Speltz & DeKlyen, 1993).
Without intervention, all of these problems may become more serious and more entrenched (Campbell, 2002; Fergusson, Horwood & Lynskey, 1995; Richman, Stevenson & Graham, 1982; Speltz, McClellan, DeKlyen & Jones, 1999). Given that children at risk of developing long-term problems can be identified at preschool age (Mesman & Koot, 2001; Pierce, Ewing & Campbell, 1999; Shaw, Owens, Giovannelli & Winslow, 2001) and that the developmental pathways for these problems in childhood and adolescence are well known (Loeber, 1990; Mesman, Bongers & Koot, 2001) it is imperative to intervene as early as possible. Research has shown that if treated early, problems at preschool age can be prevented from developing into full-scale, severe, long-term mental health problems (Brestan & Eyberg, 1998; Kazdin, 1998; Smart, Richardson, Sanson et al., 2005).
Across the range of interventions for mental health problems, early intervention programs for individuals with early signs of disorder have been highlighted as crucial and effective strategies to prevent full-scale mental health problems from developing (Mrazek & Haggerty, 1994 cited in Commonwealth Department of Health and Aged Care, 2000). The period around the transition to school has been identified as a particularly effective time to intervene (Vassallo, Smart, Sanson et al., 2002). Overseas prevention and intervention programs targeting preschoolers and their parents are being developed and are increasingly available (e.g., Brotman, Klein, Kamboukos et al., 2003; Kamps, Tankersley & Ellis, 2000; Reid, Webster-Stratton & Hammond, 2003, 2007). However, Australian programs (e.g., Havighurst, Harley & Prior, 2004; Markie-Dadds & Sanders, 2006) are generally aimed at parents only, without the opportunity for children to directly learn and develop new skills. The greatest emphasis of current research is placed on universal prevention programs targeting all parents (McTaggart & Sanders, 2003; Sanders, 2003; Turner & Sanders, 2006; Zubrick, Ward, Silburn et al., 2005). It is appropriate for the field to develop universal, preventative programs as well as more targeted interventions. Sanders and colleagues (e.g., Turner & Sanders, 2006) provide evidence for a stepped approach to prevention and early intervention and have generated several well-established parenting interventions for various populations (e.g., Bor, Sanders & Markie-Dadds, 2002; Roberts, Mazzucchelli, Studman & Sanders, 2006; Rogers, Cann, Cameron et al., 2003; Sanders, Pidgeon, Gravestock et al., 2004). A comprehensive step beyond Sanders' 5-Step model would include children's skills-based components and/or parent-child direct interaction components within a family intervention program. In Australia, there are few comprehensive parent and child intervention programs for preschool children who are already showing signs of behavioural disturbance. A recent Victorian government initiative targets children in early primary school years and includes separate parent and child groups but no interactive component (Corboy & McDonald, 2007).
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