Spotlight: managing child behaviour

Introduction What is the appeal of 1-2-3 Magic? Evidence-based programme1-2-3 MagicReferences

Introduction

Many healthcare professionals are also parents themselves and know only too well that all children can have bad behaviour €˜peaks’ €“ which can sometimes simply the result of over-tiredness. However, when problem behaviours start to become the default parent-child relationship, it is perhaps time to consider a parent education intervention to help both parent/caregiver and child in addressing the challenge. 1-2-3 Magic is one such programme that has, through its proven success, become one of the leading programmes of its type in America¹ and has been embraced by many NHS professionals in the UK.

The programme’s ability to support across the spectrum of behavioural disorders is also demonstrated by the ADHD Information Services’ (ADDISS) endorsement of the programme for parents, teachers and carers of children with ADHD.²

For a child, behavioural disorders (persistent disruptive, deceptive and aggressive behaviours) can highlight a risk for greater problems in adult life.³ Evidence shows there can be a significant impact on a child’s social and educational development and a greater risk of social, physical and mental health problems in adult life.³

What is the appeal of 1-2-3 Magic?

Firstly, as a healthcare professional, anything with the word €˜magic’ probably creates a healthy degree of cynicism. But of course, the programme name was created with the consumer in mind. The available peer-reviewed evidence quickly dispels any myth that this behaviour management programme has no substance.

The added benefit with 1-2-3 Magic, given its proven success, is that it is easy for the parent to learn and they can start applying the techniques as soon as they learn them. It is also easy to remember for both the caregiver and the child. For the commissioner and provider the programme is a low-cost intervention that is easy to deliver in the community through group sessions, as well as in the home setting.

For a child, behavioural disorders (persistent disruptive, deceptive and aggressive behaviours) can highlight a risk for greater problems in adult life

The programme was developed by American psychologist Thomas Phelan, using his clinical experience working with children with clinically diagnosed behavioural issues and his personal parenting insights.⁴ Developed for managing bad behaviour peaks in children from 2 to 12 years, 1-2-3 Magic is a €˜parent-in-charge’ intervention that aims to eliminate arguing, shouting and physical punishment. The principles are based on establishing the role of parenting consisting of three tasks:

• Controlling unacceptable behaviour (arguing, aggression, whinging and tantrums)
• Encouraging good behaviours (eating properly, completing tasks, homework, fulfilling promises, respecting others)
• Strengthening the parent-child relationship (active listening, shared fun, praise and reward).

Coaching of parents should be delivered by 1-2-3 Magic trained practitioners and it is recommended that it is delivered as three, two-hour workshops, each held a week apart. This scheduling is important to embed the learnings in manageable sections, whilst providing the opportunity for new techniques to be put into practice and personal experiences to be discussed in the following session.

Group sessions also allow parents the opportunity to learn and build confidence from the successful personal experiences of others and provides the comfort of knowing the challenges they face are not unique. Although there is evidence in randomised controlled trials that a DVD of the programme alone delivers a significant reduction in child problem behaviours,⁴ group sessions supplement this learning by allowing participants to explore any specific challenges they face in the practical day-to-day implementation.

The strategies employed as part of the programme are not necessarily unfamiliar to many parents. It is how they are employed, and the consistency, which are pivotal to the programme’s success. Essentially, parents are encouraged to stay calm and divide behaviours into €˜stop’ behaviours (for example back chat, aggression) and €˜start’ behaviours (for example, politeness and attentiveness). The 1,2,3 of the programme name comes from a simple counting regimen that €˜warns’ the child, and provides stages for correction, before they face a €˜Time Out’. €˜Start’ behaviour techniques involve positive reinforcements.

The strategies employed as part of the programme are not necessarily unfamiliar to many parents

Evidence-based programme

There is a plethora of evidence from across the world for the successful outcomes of this specific parenting programme. Many institutions have conducted their own audits to evaluate outcomes and there have also been randomised controlled trials published. Some of those published are summarised here:

The 1-2-3 Magic parenting program and its effect on child problem behaviours and dysfunctional parenting: A randomized controlled trial⁵

This RCT evaluated DVD and Emotion-coaching (EC) versions of the 1-2-3 Magic programme. Ninety-two participants with 2-12 year-old children were randomised in to the following three groups: DVD (n=31), EC (n=31) or control (n=30). The results were observed after three months and two years. Both interventions showed significant decreases in child problem behaviours, dysfunctional parenting, parental depression and parental stress compared to control group. At two years, for the EC group, effects were maintained on the main outcome variables.

Brief Psychoeducational Parenting Program: An Evaluation and 1-Year Follow-up⁶

A total of 222 primary caregivers were randomised to an intervention group or control. The intervention comprised three weekly group sessions and a 1-month booster. These groups contained 7/8 parents. The aim of this intervention was to support effective discipline and reduce parent-child conflict. At the end of the 3-month evaluation period, 89 participants were considered to have completed the intervention and 93 the control. The sample comprised mainly middle-class, educated parents and there was no significant difference in demographics between the two study groups. All participants from the intervention group were sent a written questionnaire after a year to assess whether the gains were maintained. Twenty-five responded.

The parents who received the 1-2-3 Magic intervention reported significantly greater improvement in parenting practices and significantly greater reduction in child problem behaviour. Of the subset who completed the 1-year questionnaire, the gains in positive parenting behaviour were maintained. The authors noted that the low dropout rate suggested that the programme was acceptable to parents of young children and concluded: €˜This brief intervention programme may be a useful first intervention for parents of young children with behaviour problems, as it seems both acceptable and reasonably effective.

Evaluation of the 1-2-3 Magic and Emotion Coaching Parenting Program delivered in an Australian Community Setting⁷

With mental health problems in Australian communities a target health issue, and recognising that the emotional and behavioural risk factors for these problems develop in childhood, the University of Queensland evaluated 1-2-3 Magic as an easy-to-understand intervention that could be delivered outside of the main well-resourced clinics. Forty-eight foster carers and forty-six biological parents were enrolled within the community support setting. Assessment data was collected at three time points. The first two were prior to the intervention and the third, nine weeks following commencement of the intervention.

Caregivers completed questionnaires assessing parent emotion socialisation practices (emotion coaching vs emotion dismissing parenting style), parent emotional competence, parent psychosocial adjustment, childrearing attitudes that have the potential for child abuse and parent-reported child emotional and behavioural difficulties. The intervention comprised of three emotion-coaching sessions. All participants completed the three sessions. At post-intervention follow-up both foster and biological parent group reported significant improvements across all parent-reported child and adult outcomes.

Audit as evidence: the effectiveness of €˜123 Magic’ programmes⁸

Seventy-four parents attending 1-2-3 Magic parenting programmes across Hertfordshire over a 19 month period were audited using TOPSE, a self-efficacy measure looking at distinct dimensions of parenting: emotion and affection; play and enjoyment; empathy and understanding; control; discipline and boundaries; pressures; self-acceptance; learning and knowledge.

The audit identified significant increases in mean scores across all scales. The authors recognised that this demonstrated increase in self-efficacy during the programme is important as previous studies suggest that parents who are more confident in their ability are most likely to be more competent in nurturing and developing their children into healthy and confident young adults.

The evidence that supports 1-2-3 Magic can provide the healthcare professional with confidence that when delivered in the appropriate way, by those trained in the discipline, significant changes in parenting confidence and child behaviour improvements can be achieved.^5-8

 

 

References

1. 1-2-3 Magic. Available at https://www.123magic.com/ [Last accessed September 2018]
2. ADHD Information Service. Available at http://www.addiss.co.uk/ [Last accessed September 2018]
3. Scott S. Advances in Psychiatric Treatment 2008. 14:61-70
4. Phelan T. 1-2-3 Magic. Sourcebooks 6th ed. 2016. ISBN-13:978-1-4926-2988-7
5. Porzig-Drummond R. et al. J. Brat 2014. 58:52-84
6. Bradley SJ. et al. J. Am. Acad. Child Adolesc. Psychiatry 2003. 42(10):1171-1178
7. King, P. Evaluation of the 1-2-3 Magic and Emotion Coaching Parenting Program Delivered in an Australian Community Setting 2012. Available at: http://espace.library.uq.edu.au/view/UQ:270257 [Last accessed September 2018]
8. Bloomfield L, Kendall S. Community Practitioner 2010. 83(1):26-29.

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Charlotte Coombes Licensed 1-2-3 Magic practitioner