For this aphorism to be true, early behavioural problems must be linked to enduring and stable patterns of maladaptation. Children with externalising behaviours both at school and at home are at greater risk for substance abuse, arrest and risky sexual behaviour in mid-adolescence than children with these behavioural problems in only one setting.6 One study found that 60–80% of children with clinical levels of child behavioural problems in early childhood show continued social and academic problems later in childhood.7 Conversely, this means that 20–40% of these children improve by late childhood. Again, the evidence talks about risks, rather than the certainties that this aphorism would suggest.
While early behavioural problems do not guarantee problems in later life, many parents are confused about how to ‘parent’. What is ‘the right way’? Indeed, behavioural problems in early childhood represent the greatest proportion of referrals to paediatricians8 and child psychologists.9 Therefore, the other question that this aphorism raises is: Does intervening early in the course of these problems alter child development outcomes? Is parenting ‘learn-able’?
Of all the modifiable variables, parenting has the most potential to impact a child’s development before the age of 7 years. For example, even decades later, a young child with a warm, involved, responsive parent is likely to parent their own child similarly10 and, further, parents good at responding to a child’s distress help a child regulate negative affect.11 At 7 years old, this could be seen in how a child manages their disappointment after receiving an unfortunate gift from Grandma – smiling sweetly and saying thank you – or crying. On the other hand, the absence of positive parent–child interactions has been shown to be associated with increased child behavioural problems.12 As well as externalising problems, maternal hostility and physical discipline have been associated with child-internalising symptoms (eg. some anxiety and feelings of hopelessness).13 But, even in the case of physical discipline, warm and responsive parenting can buffer these negative outcomes.13
A majority of parents with children with behavioural problems benefit from attending a parenting course, whether it reaffirms their current behaviour management strategies, enables them to normalise their experiences with other parents, or learn new and effective skills. However, parenting interventions provided early in the course of behavioural problems generally have better outcomes than those provided later.14,15 It may be easier to change one or two years of maladaptive behaviour than eight or nine. But evidence for universal parenting interventions (parenting courses provided to parents whose children do not have behavioural problems) is equivocal.16
To intervene early in child behavioural problems, evidence-based intervention programs known collectively as Parent Management Training (PMT) have been shown to be effective in both the research and ‘real-world’ settings.17 Three of the most widely researched evidence-based PMT interventions available in Australia are Triple P (Positive Parenting Program; www.triplep.net/glo-en/home), the Incredible Years (IY; www.incredibleyears.com/) and Parent–Child Interaction Therapy (PCIT; www.pcit.org/). Each has evidence for reducing child behavioural problems in the short-term for children between the ages of 4 and 6 years.
Most children survive childhood and enter adulthood without marked psychological disorders or criminal histories. But history and prior experience remain important in their continued development: ‘Experience creates the child, but, at the same time, the child creates experience, through seeking, reacting to, and interpreting the world in individual ways.’2 If the aphorism held true for all, then there would be no point in psychological interventions after the age of 7 years. Indeed, the whole principle of lifelong learning, which is so central to our professional identities, would be a waste of effort. Fortunately we strive to be serene enough to accept the inevitable, courageous enough to act on changeable circumstance and now, thanks to evidence-based practice, we are wise enough to know we can.
General information about the availability of local parenting courses can be found at www.parentingrc.org.au and http://raisingchildren.net.au/
Competing interests: None.
Provenance and peer review: Commissioned; not peer reviewed.