This annual report - Taranaki District Health Board

state more than it cost) provided that it reduced the prevalence of conduct disorder by 7%or more and that therefore it would be a worthwhile use of limited health funds [473].Pathways Triple P (PTP) participants are identified by social services or by practitionersleading a less intensive Triple P Programme. They are likely to be using overly harsh orinappropriate discipline, have highly unrealistic expectations of their child’s behaviour,make inappropriate attributions about the intentions behind their child’s behaviour andhave difficult managing their own anger and moods. Pathways Triple P involves parentsattending between 10 and 12 weekly individual or group sessions at which they learn howto have appropriate expectations for their child’s behaviour, manage their own moods andanger, increase their self-efficacy as parents and better manage their child’s unwantedbehaviour.There is evidence for the effectiveness of PTP from two RCTs, one involving the parents of60 children (aged from four to ten) who had concerns about their relationship with theirchild [474] and one involving the parents of 98 children (aged 2 to seven) who were knownto child protection services [475]. In the trial involving the parents of the older children theparents who participated in PTP (compared to the wait-list group) were significantly morelikely to report improvements in their parenting practices, their confidence as parents, theirchild’s behaviour and the quality of parent child relationships, both immediately aftercompletion of the programme and three months later. The trial involving younger childrencompared parents who received PTP to a control group of parents who received astandard behavioural family intervention. Both groups of parent showed significantimprovements after intervention in their parenting practices, the parents’ attributions oftheir child’s behaviour and their child’s behaviour, both immediately after the interventionand six months later.Other interventionsOther interventions for young children which were evaluated by the National Academy ofParenting Research and given a 2-star rating are: The Anna Freud Centre Parent InfantProject, Family Transitions Triple P, Mellow Parenting, Parents as First Teachers andNoughts to Sixes – From Pram to Primary School [462].Postnatal Depression and Infant Mental HealthPost natal depression and its effects on mother-infant relationshipsPostnatal depression is relatively common, affecting around 13% of mothers [476]. Riskfactors commonly reported in published studies include a previous history of depression,depression during pregnancy, difficulties in the marital relationship, a lack of social supportand stressful life events. Probable risk factors, reported in some, but not all, studiesinclude family history of psychopathology, personality characteristics, single parenthood, adifficult birth experience and infant temperament [477].It appears that characteristics of the infant may contribute to maternal depression. Womenwho perceive their babies as being fussy or difficult to care for are more likely to bedepressed [477]. Disabled infants tend to provide fewer and less readable cues to theirmothers, show more withdrawal from or avoidance of social interactions, display morenegative affect and less positive affect and have difficulties in turn-taking during socialexchanges [478].There is considerable evidence that mother-infant interactions may be impaired if themother is suffering from postnatal depression and that the infant’s social, emotional andcognitive development may be harmed as a result, particularly if the depression isprolonged and/or there are adverse socio-economic circumstances [479]. Male babiesappear to be more vulnerable to the effects of maternal depression [480]. Depressedmothers have been observed to touch their infants less often, handle them more roughly,smile and talk to their child less often and coordinate their communication with their child’sless well than non-depressed mothers [481]. Studies on parenting practices have reportedthat mothers with postpartum depression are more likely to discontinue breastfeeding[482].In-Depth Topic: Mental Health Issues in Children - 388