Leiden Consortium Individual Development

Rationale and objective:

Most children develop well and find their way into society without many problems, but not all children manage to do so. These differences are related to a combination of the child’s disposition and the environment in which he or she is raised. However, children are not equally vulnerable to adverse rearing environments, and they do not equally profit from supportive environments. It is thus far unclear which children are most susceptible to the environment, and what the neurobiological mechanisms are of environmental influences on developmental outcomes. In the current study we aim to examine the effect of an interactive parenting intervention (VIPP-SD) on parental sensitivity and sensitive discipline, and on children’s behavioral control and social competence. Central questions are: Which children are most susceptible to the

environment, and what are the neurobiological

mechanisms of environmental influences on

developmental outcomes? In addition, which parents are

most susceptible to the intervention and what

neurobiological mechanisms are involved in intervention

effects on parenting behavior?



Study design:

This is an experimental longitudinal study during which families will be followed for six years. Every year, there will be a home visit or a lab visit, during which we will measure several biological, environmental and child characteristics. During two of the three lab visits, we will also measure brain activation using EEG or functional Magnetic Resonance Imaging (fMRI) while the children are performing a computerized decision-making task. We will use structural MRI and Diffusion Tensor Imaging (DTI) to measure underlying brain anatomical processes. The experimental group (40% of the study population, randomly selected) will receive an intervention between the second and third measurement (Video-feedback Intervention to Promote Positive Parenting and Sensitive Discipline [VIPP-SD]; Juffer et al., 2008). This intervention is focused on enhancing sensitive discipline parenting skills. To investigate neurobiological

mechanisms involved in intervention effects on parenting

behavior, a randomly selected sample of 100 parents will

be invited for two parent assessments, one before and

one after the condition.



Study population:

500 families with a healthy twin. Of these families, a

random selection of 100 primary caregivers will be

invited to participate in two separate parent assessments

at the laboratory in which only the primary caregiver

takes part. Of these 100 parents, 50 are randomized to the

intervention condition and 50 to the control condition.



Intervention (if applicable):

The experimental group will receive the VIPP-SD (Juffer et al., 2008), focused on the enhancement of sensitive disciplinary parenting skills. The control group will receive –within the same time frame and with the same frequency- phone calls of a researcher (placebo intervention). During these phone calls, the parents will answer questions about the development of their children.



Main study parameters/endpoints:

The effect of the intervention (VIPP-SD) on enhancement of parental sensitivity and sensitive discipline and on children’s behavioral control and social competence.

Twelve randomized controlled trials indicated the

effectiveness of the Video Feedback to Promote Positive

Parenting and Sensitive Discipline in different countries

(e.g., Juffer et al., 2008; Juffer & Steele, 2014). The

VIPP-SD helps parents to understand and interact with

their children in a sensitive way, also when discipline is

needed. However, the VIPP-SD may not be equally

effective with all families: Some parents and their

children may be more susceptible for the intervention

than others. Therefore, the central question of this study

is: What characterizes parents and children for whom the

intervention is most effective? It is expected that children

with a mildly compromised neonatal status, a reactive

temperament or a certain genetic make-up (i.e., specific

dopamine and serotonin related genotypes) are more

susceptible to the VIPP-SD related effects. A second

question concerns the mechanisms for change: What

factors cause the effects of the VIPP-SD, also on the long

term? It is hypothesized that changes in parenting

environment caused by the VIPP-SD have positive

effects on children’s hormone levels, especially those

related to stress responses. Also, it is expected that these

changes influence children’s brain response to aggression

provoking stimuli, presuming an improved prefrontal

regulation on emotional impulses from the limbic

system. In addition, mediating mechanisms of the

association between VIPP-SD and positive parenting

behavior are investigated. More specifically, parental

neurobiological factors (e.g. brain activity) will be

investigated as possible mediators of intervention effects

on parenting behavior.

In a longitudinal study families will be followed for six years. Every year, there will be either a home visit or a lab visit with additional ambulatory measurements. The design includes two pretests and four posttests. After the second pretest, the experimental group will receive the VIPP-SD (Juffer et al., 2008), focused on the enhancement of sensitive disciplinary parenting skills. The control group will receive –within the same time frame and with the same frequency- phone calls of a researcher (placebo intervention).

In addition, the subsample of 100 parents (50 control group and 50 experimental group) will be invited to the laboratory twice. The first assessment will take place two weeks before the start of the condition they are randomized to and the second assessment two weeks after finishing the condition they are allocated to.

The experimental group (40% of the study population, randomly selected) will receive an intervention between the second and third measurement, the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD; Juffer et al., 2008). This intervention is focused on enhancing sensitivity and sensitive disciplinary techniques of the primary caregiver. The original version of the intervention has been adapted for the use with twin families in the current study (VIPP-Twins).

Content of the intervention

For the VIPP program families are visited five times at home by an intervener. Every visit lasts for approximately one-and-a-half hours and the visits take place every 2 to 3 weeks. The parent and the children are videotaped during daily situations, such as playing together or mealtime. During the next visit, the video is reviewed with the parent. The intervener focusses on positive and successful interaction moments and shows when positive parenting is effective. The parent is explicitly acknowledged as the expert on her own child. The intervener uses a detailed protocol when discussing the video with the parent. The first four visits have their own themes with respect to sensitivity and sensitive discipline:

1. Exploration versus attachment behavior & Inductive discipline and distraction

2. ‘Speaking for the child’ & Positive reinforcement

3. Sensitivity chain & Sensitive time-out

4. Sharing emotions & Empathy for the child

The final session is a booster sessions, in which all themes are repeated.

Effectiveness

Twelve randomized controlled trials indicated the effectiveness of the VIPP-SD in a number of countries (for an overview, see Juffer et al., 2008; Juffer & Steele, 2014). These RCTs showed that the VIPP-SD enhanced parental sensitivity and decreased children’s externalizing problem behavior. No risks or adverse events were found. As a result, the VIPP-SD is one of the two parenting interventions that are indicated as with established effectiveness in the Database of Effective Youth Intervention from the Netherlands Youth Institute (see www.nji.nl).

Control group

Families in the control group will receive telephone calls from a research assistant during the same period and with the same frequency (placebo intervention). During these telephone calls, parents will be asked about the development of their twins.