Study
Bagner and colleagues (2016) conducted a randomized controlled trial to examine the effect of the Infant Behavior Program on infants’ observed compliance, activity/impulsivity, aggression/defiance, and internalizing problems, and on parenting skills, after 6 months following the program.
The participants were 60 mothers and their 12- to 15-month-old infants who were recruited at a large hospital-based pediatric primary care clinic providing care to underserved families. To be eligible for inclusion, the primary caregiver (who was the mother in all cases) was required to 1) rate their infant above the 75th percentile on the problem scale of the Brief Infant–Toddler Social and Emotional Assessment (a screener of infant behavior problems), and 2) speak and understand English or Spanish. To ensure the ability to learn intervention skills, the mother was required have an IQ score at or above 70 on the two-subtest (vocabulary and matrix reasoning) version of the Wechsler Abbreviated Scale of Intelligence for those speaking English, or an average standard score at or above 4 on the vocabulary and matrix reasoning subtests of the Escala de Inteligencia Wechsler Para Adultos–Third Edition for those completing the screening and assessment in Spanish. Major infant sensory impairments (e.g., deafness, blindness) or motor impairments that significantly impaired mobility, as well as current child protection services involvement, were exclusion criteria, although no families were excluded based on these criteria.
The 60 families were randomized using a computer-generated random numbers list to the Infant Behavior Program intervention (n = 31), or a standard care control group (n = 29). Families completed a baseline assessment in their home and were informed of their group status at that time. Data were collected from the primary caregiver (in this case, the biological mother) although other caregivers were encouraged to participate in the intervention. A post-assessment was conducted 2 months after the baseline, and follow-up assessments were conducted 3 and 6 months after the post assessment. The CrimeSolutions review of this study focused on the results at the 6-month follow-up.
Several measures were used to assess the outcomes of interest. The Infant–Toddler Social and Emotional Assessment—a 166-item, nationally standardized questionnaire designed to assess behavioral problems in 12- to 36-month-olds—was used to assess infant behavior problems at all assessment points. Scores were reported on two subscales of the externalizing domain—activity/impulsivity (6 items) and aggression/defiance (12 items)—and the 30-item internalizing scale. Additionally, baseline scores on the compliance subscale (8 items) were used as a covariate when examining group differences in observed infant compliance at the 6-month follow-up. The Dyadic Parent–Child Interaction Coding System–Third Edition was used to assess observed parent and infant behaviors. Specifically, mother “do” skills (i.e., praises, behavior descriptions, and reflections) and “don’t” skills (i.e., questions, commands, and negative talk) were coded at all assessments. The percent of “do” skills was equal to the number of “do” skills divided by the total number of parent verbalizations (including neutral talk), and the percent of “don’t” skills was equal to the number of “don’t” skills divided by the total number of parent verbalizations. Infant compliance (defined as the number of times the infant complied with maternal commands divided by the total number of maternal commands presenting an opportunity to comply) was coded during a cleanup situation at the 6-month follow-up assessment when all infants were at least 18 months old to ensure the task was developmentally appropriate.
Infants in the intervention group were 58 percent male, they were an average age of 13.7 months old, and 97 percent were minority status. At baseline, infants in the intervention group had a mean score of 22.0 on the Brief Infant–Toddler Social and Emotional Assessment. Mothers in the intervention group were an average of 30.0 years old, 94 percent were minority status, 55 percent were English speaking, 65 percent were high school graduates or less, and 58 percent were below the poverty line. At baseline, mothers in the intervention group had a mean IQ T-Score (combined between the Vocabulary and Matrix Reasoning subtests) of 47.2. Infants in the standard care control group were 52 percent male, they were an average of 13.2 months old, and 100 percent were minority status. At baseline, infants in the control group had a mean score of 18.4 on the Brief Infant–Toddler Social and Emotional Assessment. Mothers in the control group were an average of 29.1 years old, 97 percent were minority status, 31 percent were English speaking, 76 percent were high school graduates or less, and 63 percent were below the poverty line. At baseline, mothers in the control group had a mean IQ T-Score of 45.4. There were no statistically significant differences between the treatment and control groups on any demographic characteristics or outcomes of interest at baseline.
Mixed-effects regression models were used to analyze the effect of the intervention on infant and parent outcomes. For continuous variables (infant activity/impulsivity, aggression/defiance, and internalizing), linear mixed models were used; for proportions (parent “do” and “don’t” skills), generalized linear logistic mixed models were used. For each model, the effects of time, intervention group, and the time by group interaction were included. A logistic regression analysis of covariance model was used to examine infant compliance and included a baseline outcome value for infant compliance (parent report on the Infant–Toddler Social and Emotional Assessment compliance subscale), intervention group, and the baseline by group interaction. All models included the mother’s age, education, ethnicity, and language as covariates. No subgroup analysis was conducted.
Study
Heflin and colleagues (2020) used the study sample from Study 1 (Bagner et al. 2016) to examine the effect of the Infant Behavior Program on observed frequency of aggressive behaviors and global ratings of aggression in infants ages 12 to 15 months, and on parenting skills, at post-intervention and at a 6-month follow-up. The procedures were the same as described in Study 1 above. Sixty families were randomized to the Infant Behavior Program intervention group (n = 30), who received the intervention, or to the standard pediatric primary care control group (n = 28).
Five aggressive frequency behaviors in infants were coded using the System for Coding Early Physical Aggression: 1) socially appropriate aggression (usually directed at objects, but fulfills the goals of the task), 2) aggressive intent (must have visible force, but with no evaluation of intent to harm), 3) game playing (actions, such as knocking over a tower of blocks), 4) temper tantrums (forceful contact with ground), and 5) banging toys together (repetitive banging with force). These five behaviors were observed and coded during 10 minutes of infant-led play, and were combined for a total aggressive frequency behavior score. Each child was also rated on a scale from 1 (unaggressive) to 4 (severely aggressive) based on the Global Aggression Rating Scale. Levels of behaviorally based parenting skills were observed and measured over a 5-minute period using the Dyadic Parent–Child Interaction Coding System. Parent codes were categorized into behaviorally based “do” skills and “don’t” skills.
At baseline, infants in the intervention group had an average total observed aggression score of 7.4 and an average Global Aggression Rating Scale score of 1.7. Mothers in the intervention group used on average 4.4 “do” skills and 24.8 “don’t” skills at baseline. Infants in the control group had an average total observed aggression score of 6.3 and an average Global Aggression Rating Scale score of 1.9. Mothers in the control group used on average 4.0 “do” skills and 23.0 “don’t” skills at baseline. There were no statistically significant baseline differences on either demographic or outcome variables between families in the intervention and control groups.
Linear mixed models were used to examine the effect of the intervention on the observed frequency of aggressive behaviors and global aggression rating scores over a continuous time variable. The effect of the intervention on levels of behaviorally based parenting skills at post-intervention (controlling for parenting skills at baseline) were also examined. No subgroup analysis was conducted.
