Parenting NICU graduates

This thesis reflects the results of our randomized, clinical trial on the effectiveness of a generic parenting intervention named Primary Care Triple P. We investigated whether Primary Care Triple P reduced emotional and behavioral problems in preterm-born and asphyxiated term-born preschoolers. The rationale for this study was that approximately 20% of preterm-born and asphyxiated term-born preschoolers have emotional and behavioral problems, which is twice as much as healthy, term born preschoolers.1,2 Furthermore, preterm birth and perinatal asphyxia are the two most common causes for admission to a neonatal intensive care unit (NICU), and therefore affect a large population of children and parents.3 It has been found that parenting NICU graduates may differ from parenting healthy, term-born children, which could indicate that specific parenting programs may be necessary.4 However, when problem behavior develops in NICU graduates, parents are usually referred to generic parenting intervention programs, since there are currently no standardized and evidence based interventions that are specifically designed to reduce emotional and behavioral problems in these children. Although generic parenting programs are available and many have been reported to be effective in the general population, it is currently not known whether these programs are also effective in preterm-born and asphyxiated term-born preschoolers. We investigated the effectiveness of a generic parenting program – Primary Care Triple P – on parent-reported emotional and behavioral problems, teacher-reported emotional and behavioral problems, parenting stress, the quality of observed parent-child interaction, observations of trained parenting skills, parenting styles, and parent perceived child vulnerability. During the screening phase of our randomized clinical trial, we found that parents of NICU graduates reported less stress than we had expected based on our clinical impressions. To investigate this finding, we conducted a meta-analysis on parental stress in parents of preterm-born children. Furthermore, after the results of our randomized controlled trial were analyzed, we explored predictors of short-term changes in emotional and behavioral problems in preterm-born children, to identify modifiable predictors that could provide a foundation for future interventions.