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Teaching Parenting Skills At Doctor Visits Helps Children's Behavior

As researchers have come to understand how poverty and its stresses influence children's brain development, they've begun untangling how that can lead to increased behavior problems and learning difficulties for disadvantaged kids.

Rather than trying treat those problems, NYU child development specialists Adriana Weisleder and Alan Mendelsohn want to head them off.

They say they've found a way: Working with low-income parents when they bring babies and young children to the pediatrician. They've been able to reduce key obstacles to learning like hyperactivity and difficulty paying attention, according to research published Wednesday in the journal Pediatrics.

The researchers recruited mothers with newborns to participate in the study and divided them into three groups. One group received standard pediatric care, which includes some basic coaching on reading to kids. The second went home with books, toys and informational pamphlets, and the third worked with a trained child development professional for about 30 minutes before or after each checkup. The specialist filmed each mother and child reading or playing together for a few minutes, talked to the mother about the positive things she did with her child and sent her home with the video.

At 3 years old, 50 percent fewer children in the video interaction group who were most at risk showed signs of hyperactivity compared to those who got standard pediatric care. The results were positive, though less remarkable, for the video group as a whole.

Improving a child's ability to focus, regulate behavior and cooperate with other kids can help a child learn. "If a child is controlling their behavior, not overreacting and paying attention, they will be taking in more information from learning activities," says early childhood expert Susan Landry, director of the Children's Learning Institute, who wasn't involved in the study. "All those things help in the classroom to be a better student."

The results show that a relatively cheap form of intervention works, the researchers say, and could be used reach a big swath of the population, including families who are often hard to reach because parents work multiple jobs or phones get disconnected.

By using pediatric checkups as a way to engage parents, the researchers say they could reach every child without burdening parents with additional transportation or logistical demands. "We're leveraging the relationship they already have with the pediatric clinic," Weisleder says.

While home visits to provide this sort of one-on-one behavioral training can cost between $1,500 and $10,000 per child per year (models vary widely), the video program costs around $200. David Willis, director of the federal Health Resources and Services Administration's Early Childhood Home Visiting Program, notes that the home visit program is far more intensive than the NYU video method, with families getting between 25 and 30 visits per year. Each lasts at least an hour.

"The families we serve are some of the most challenged families in country," Willis says. Home visits are an important resource for them, but he estimates the program only reaches 1 to 3 percent of families who could benefit from it. "To simultaneously have this [video interaction] program that's likewise focused on promoting positive parenting and brain development in the youngest families is really significant," he says.

Landry thinks the video intervention could be embedded into almost any type of pediatric setting for very little cost. "That's something all of us have been searching for, "she says. Her team at the University of Texas Health Science Center at Houston is working to make home visits by child development specialists more affordable by giving parents iPads so they can work remotely with experts.

The findings don't just apply to disadvantaged families. As a pediatrician, the first advice Mendelsohn gives families when kids have behavior problems is not to think about discipline, rather about positive steps.

"Can you start to pay attention to your child when your child is being good?" he asks. Negative interactions can turn into a cascade, he says, in which parents feel worse about themselves, which influences kids negatively, which ultimately makes things even harder for parents. "Kids misbehave because it's their job," he says. "It's our job to be able to help them learn and regulate their behavior."

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