Helping Our Toddlers, Developing Our Children's Skills (HOT DOCS): A Parenting Intervention to Prevent and Address Challenging Behavior in Young Children

By Williams, Jillian L.; Armstrong, Kathleen H. et al. | Journal of Early Childhood and Infant Psychology, Annual 2010 | Go to article overview

Helping Our Toddlers, Developing Our Children's Skills (HOT DOCS): A Parenting Intervention to Prevent and Address Challenging Behavior in Young Children


Williams, Jillian L., Armstrong, Kathleen H., Agazzi, Heather, Bradley-Klug, Kathy L., Journal of Early Childhood and Infant Psychology


After nearly three decades of cross-disciplinary research, professionals in the fields of psychology, education, and medicine are no longer surprised that their client lists, student rosters, and appointment schedules are filled with young children displaying challenging behaviors. The most commonly cited challenging behaviors in young children (between the ages of 2 and 7 years old) include sleeping difficulties, mealtime and feeding issues, toilet training, temper tantrums, aggression, sibling rivalry, and noncompliance. Recent research has shown that approximately 15-25% of all typically developing preschool children have chronic levels of behavior problems that fall within the mild to moderate range (Campbell, 1995; Keenan & Wakschlag, 2000; Knapp, Ammen, Arstein-Kerslake, Poulson, & Mastergeorge, 2007; Lavigne et al., 1996). Even greater are prevalence rates of chronic behavior problems for minority children and/or children in low-income families, with estimates reaching up to 35% (Gross et al., 2003; Webster-Stratton, 1998).

The long-term outcomes associated with early-onset challenging behavior in young children have been well-documented (Coie & Dodge, 1998; Dishion, French, & Patterson, 1995; Kazdin, 1995; Reid, 1993; Tremblay 2000). In general, the earlier the problem behavior develops the more stable and intense the associated negative outcomes are over time. Dishion and colleagues found that early-appearing behavior problems in a child's preschool career are the single best predictor of delinquency in adolescence, gang membership, and adult incarceration. Other researchers have identified similarly poor long-term outcomes related to academic and school performance. Kazdin (1993) and Tremblay (2000) concluded from their research that preschoolers with challenging behaviors are at a greater risk of experiencing school failure than typically developing children.

In response to research demonstrating the rapid and enduring increase in the prevalence rates of young children with challenging behavior and the associated negative long-term outcomes, professionals across disciplines have developed a variety of interventions to help prevent and treat these behaviors. Behavioral parent training delivered in a group format is one such intervention, which has been shown to be both an effective and economical treatment to empower parents to prevent and address challenging behavior in young children (Lundahl, Risser, & Lovejoy, 2006; Maughan, Christiansen, Jenson, Olympia, & Clark, 2005; Nelson, 1995; Sandall & Ostrosky, 1999; Smith & Fox, 2003).

Despite the available evidence supporting the effectiveness of early intervention, there is a lack of services, resources, and empirically-supported interventions available to caregivers of young children displaying challenging behavior (Kazdin & Kendall, 1998; Knitzer, 2007; Walker et al., 1998). Based on the abundance of research supporting the primary role of parents and caregivers in young children's emotional and behavioral development, it follows that the most logical target for prevention and early intervention efforts would be improving caregiving skills and enhancing the caregiver-child relationship (Knitzer). Thus, group-based parent training would be an economical and ecologically-based system for providing children and families with the knowledge, skills, and support they need to prevent and correct challenging behaviors (Smagner & Sullivan, 2005). The ability of one child care professional to simultaneously meet the needs of multiple families and children at once dramatically increases the efficiency of limited resources, professionals, and funding sources.

Historically, one of the major theories guiding the inquiry into chronic behavior problems in young children was Skinner's (1953) theory of behaviorism. At its foundation, behaviorism postulates that all behavior is observable and functional. …

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