title: Primary Care Triple P for parents of NICU graduates with behavioral problems: a randomized, clinical trial using observations of parent-child interaction.
abstract: 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.
  
  
  BACKGROUND
  Netherlands National Trial Register NTR2179 . Registered 26 January 2010.
authors.affiliation: Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. r.schappin@umcutrecht.nl.
authors.forename: Renske
authors.initials: R
authors.lastname: Schappin
authors.affiliation: Department of Child, Family and Education Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands. a.wijnroks@uu.nl.
authors.forename: Lex
authors.initials: L
authors.lastname: Wijnroks
authors.affiliation: Department of Medical Psychology and Social Work, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. m.unikenvenema@umcutrecht.nl.
authors.forename: Monica
authors.initials: M
authors.lastname: Uniken Venema
authors.affiliation: Department of Medical Psychology, Isala Clinics, Zwolle, The Netherlands. b.j.wijnberg@isala.nl.
authors.forename: Barbara
authors.initials: B
authors.lastname: Wijnberg-Williams
authors.affiliation: Department of Medical Psychology, Isala Clinics, Zwolle, The Netherlands. r.r.veenstra@isala.nl.
authors.forename: Ravian
authors.initials: R
authors.lastname: Veenstra
authors.affiliation: Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. c.koopman@umcutrecht.nl.
authors.forename: Corine
authors.initials: C
authors.lastname: Koopman-Esseboom
authors.affiliation: Department of Neonatology, Isala Clinics, Zwolle, The Netherlands. s.m.mulder@isala.nl.
authors.forename: Susanne
authors.initials: S
authors.lastname: Mulder-De Tollenaer
authors.affiliation: Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands. i.vandertweel@umcutrecht.nl.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: van der Tweel
authors.affiliation: Department of Child, Family and Education Studies, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands. m.j.jongmans@uu.nl.|Department of Neonatology, Wilhelmina Children's Hospital, UMC Utrecht, Utrecht, The Netherlands. m.j.jongmans@uu.nl.
authors.forename: Marian
authors.initials: M
authors.lastname: Jongmans
mesh_terms: D000328:Adult; D001238:Asphyxia Neonatorum / Q000150:complications* / Q000628:therapy; D002653:Child Behavior Disorders / Q000209:etiology / Q000628:therapy*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007234:Infant, Premature; D007235:Infant, Premature, Diseases; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D010287:Parent-Child Relations; D016487:Parenting; D011320:Primary Health Care / Q000379:methods*