ACQ_Vol_11_no_3_2009

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ACQ Volume 11, Number 3 2009 179
Research updates
The Toddlers Without Tears study
Jordana Bayer
Price, & Wake, 2008). We believe that the Toddlers Without
Tears program needs to do more to support parents feeling
stressed and anxious with children who are showing early
signs of behaviour and emotional problems. Most parents
(85%) reported the parenting groups were useful and helpful
with their children; 89% said they would recommend the
program to other families (Hiscock et al., 2008).
A new study was funded for 2009–14 to improve the
program. In the new study more strategies have been
added for parents to manage feelings of stress and anxiety
and to practise new positive parenting skills to reduce early
behaviour and emotional difficulties. This new randomised
controlled trial involves nine different local government areas.
The trial will provide the Toddlers Without Tears parenting
groups as well as extra family support for those under most
stress. The new study aims to show whether early childhood
mental health problems can be prevented
more effectively and cost efficiently by offering
prevention universally (to all families), or
targeting prevention only to families at
highest risk (Mrazek & Haggerty, 1994).
References
Bayer, J.K., Hiscock, H., Morton-Allen, E.,
Ukoumunne, O.C., & Wake, M. (2007).
Prevention of mental health problems:
Rationale for a universal approach. Archives
of Disease in Childhood, 92, 34–38.
Bayer, J.K., Hiscock H., Ukoumunne,
O.C., Price A., & Wake, M. (2008).
Aetiology of early childhood mental health
problems: A population-level longitudinal study. Journal of
Child Psychology & Psychiatry, 49, 1166–1174.
Campbell, S. (1995). Behaviour problems in preschool children.
Journal of Child Psychology and Psychiatry, 36, 113–149.
Hiscock, H., Bayer, J.K., Price, A., Ukoumunne, O.C.,
Rogers, S., & Wake, M. (2008). Universal parenting
programme to prevent early child behavioural problems:
cluster randomised trial. British Medical Journal, 336,
318–321.
Hiscock, H., Bayer, J.K., & Wake, M. (2005). Preventing
toddler behaviour problems: Pilot evaluation of a universal
parenting program. International Journal of Mental Health
Promotion, 7, 52–58.
Mrazek, P.J., & Haggerty R.J. (1994). Reducing the risks
for mental disorders. Washington: National Academy Press.
Sawyer, M.G., Arney, F.M., Baghurst, P.A., et al. (2000).
The mental health of young people in Australia. Canberra:
Commonwealth Department of Health and Aged Care.
Behaviour and emotional
problems affect 1 in 7 Australian children
(Sawyer et al., 2000). These problems
include aggression, disobedience, anxiety,
social withdrawal and depression. Around
50% of preschool children’s problems
continue through the childhood years
(Campbell, 1995). The Toddlers Without
Tears program aims to prevent children from developing
behaviour and emotional problems (Hiscock, Bayer, & Wake,
2005). This program of research for young children’s mental
health, led by Dr Harriet Hiscock and Dr Jordana Bayer,
comprises a multidisciplinary team of psychologists,
paediatricians, a biostatistician and a health economist.1 This
research is supported by the Australian Research Council,
Australian Rotary Health, Equity Trustees, National Health
and Medical Research Council, and Telstra Community
Development Fund.
In 2004, 733 families with 7-month old babies enrolled in
Toddlers Without Tears across six Victorian local government
areas (Bayer, Hiscock, Morton-Allen, Ukoumunne, & Wake,
2007), representing 69% of all eligible babies at maternal
and child health centres in these areas. In 2005, half of the
families in each area were invited to parenting groups when
their children were 12 and 15 months old. In 2006, half of
these families were offered an extra parenting group when
their child was 2 years old. All parents in the study were
invited to fill out questionnaires at child ages 7, 12, 18, 24
and 36 months. Parents’ response rates have been high,
with 96% completing the questionnaire at 12 months, 92%
at 18 months, 89% at 24 months, and 80% at 36 months.
When all children turned 2 years old, results showed that
families who had been offered the parenting groups used
less harsh discipline with their young children (e.g., yelling
and smacking) compared to families who weren’t offered this
program. They also had a better understanding of what is
normal for young children’s behaviour (Hiscock, Bayer, Price,
Ukoumunne, Rogers, & Wake, 2008). However, we believe
this parenting program was too brief, because the parenting
benefits faded out by the time children turned 3, and the
program didn’t impact on child behaviour problems.
Evaluation of questionnaire data from infancy through to 3
years identified contributing factors to the development of
behaviour problems over time. Results showed that toddler
and preschool children were more likely to develop behaviour
problems in families where parents felt stressed, and used
yelling and smacking with young children. Children were more
likely to show early emotional problems when their parents
felt anxious or stressed too (Bayer, Hiscock, Ukoumunne,
Correspondence to:
Dr Jordana Bayer
Postdoctoral research fellow and clinical psychologist
Royal Children’s Hospital (Centre for Community Child Health) and
Murdoch Childrens Research Institute
Melbourne, Victoria
email:
website:
1 Toddlers Without Tears Team: Dr Harriet Hiscock, Dr Jordana
Bayer, Professor Melissa Wake, Dr Obioha Ukoumunne, Ms
Lisa Gold, Professor Daniel Shaw, Professor Ann Sanson, Ms
Anna Price, Ms Elise Morton Allen, Ms Megan Mathers, Ms
Kate Scalzo, Dr Susan Rogers. Participating institutions: Royal
Children’s Hospital (Centre for Community Child Health) and
Murdoch Childrens Research Institute (lead institutions), The
University of Melbourne Department of Paediatrics, University of
Pittsburgh USA, Victorian government agencies (DEECD, DHS,
MAV), Parenting Research Centre Victoria.
Jordana Bayer