Parent Education in Bangladeshi Families with Young Children of Diverse Abilities: Implementation of the Learning Through Play Calendar

Attachment theory

Attachment theory suggests that the nature of parent-child relationships in early childhood can inform interactions across the lifespan (Bowlby, Citation1988; Cassidy & Shaver, Citation2016). Attachment styles are either considered secure (confident in a parent’s availability, protection and comfort as a result of positive past experiences) or anxious (insecure, avoidant, or disorganized, and lacking trust in the parent’s likelihood based on varied past experiences; Cassidy & Shaver, Citation2016). The ideal secure attachment style is characterized by high levels of parental warmth and accessibility to the child. Parents can promote secure attachment through identifying and promptly responding to the child’s needs (Ainsworth et al., Citation1978; van der Voort, Juffer, et al., Citation2014; Wright & Edginton, Citation2016) and engaging affectionately in developmentally appropriate ways (Gerhardt, Citation2014). Attachment theory, criticized for its Western-centric perspective, often overlooks the rich diversity of emotional bonding across cultures. Chaudhary and Keller (Citation2017) highlight the theory’s bias toward maternal-centric caregiving, ignoring the varied childcare practices that are normative in other cultures, including Bangladesh. Allen (Citation2016) extends this critique by pointing out the theory’s narrow focus on maternal attachment, suggesting it fails to capture the broad spectrum of relationships and support systems essential for a child’s development. Despite these critiques, attachment theory’s capacity to explore and understand the complex dynamics of emotional connections across different cultures remains valuable, illustrating its adaptability and relevance in global contexts (Allen, Citation2016; Chaudhary & Keller, Citation2017).

Learning Through Play

The Learning Through Play (LTP) parent training intervention promotes positive parenting practices that help support the formation of a secure attachment relationship in the early years (Bevc, Citation2004). By educating parents on their child’s developmental needs and providing ideas for age-appropriate activities, the intervention enables parents to anticipate and promptly respond to their child’s needs, engage affectionately, and foster positive attitudes in their own parenting. Based in cognitive development (Piaget, Citation2013) and attachment (Bowlby, Citation1988) theories, LTP provides foundational knowledge on normative early childhood development and how parents can facilitate positive relationships from the start. First, parents participate in a four-hour group psychoeducational workshop. Facilitators, who are trained in the LTP intervention and corresponding theoretical framework, engage the parents in presentations, discussions, and activities to teach the material. Specific topics include child physical and cognitive development, effective communication strategies, understanding children’s emotions and behaviors, setting boundaries and discipline, promoting emotional intelligence, and building strong parent-child relationships. The workshop was designed to support parents in developmentally appropriate interactions with their children that would help facilitate a positive, secure relationship.

The second part of the intervention provides an opportunity for parents to practice at home what they learned in the workshop. Parents are given a pictorial calendar which depicts the stages of early childhood development using simple illustrations and few written words (Bevc, Citation2004). The calendar shows five domains of child development: (a) sense of self, (b) physical development, (c) relationships, (d) understanding and (e) communication (Evans & Ilfeld, Citation1982). For each domain, at sequential developmental stages from birth to age six, the calendar provides suggestions for play, learning, and attachment-promoting activities. Parents hang the calendar somewhere visible in their home and use it to help inform their interactions with their children at each developmental stage.

Systemic perspective

The Learning Through Play (LTP) intervention aims to support the interplay between parent-child relationships and broader contextual factors. Using attachment (Bowlby, Citation1988; Cassidy & Shaver, Citation2016) and ecological systems (Bronfenbrenner, Citation1979) frameworks, LTP addresses individual, familial, and societal influences on parenting practices. At the individual and family levels, LTP equips parents with tools to foster secure attachment and positive interactions (Ainsworth et al., Citation1978; van der Voort et al., Citation2014; Wright & Edginton, Citation2016). At the sociocultural level, LTP considers availability of resources, cultural norms around parenting to optimize implementation. This holistic perspective emphasizes the interconnectedness of systems in shaping parenting and child well-being.

LTP is uniquely able to support families in low-income settings due to its low funding and training requirements, and high accessibility to families regardless of literacy level (Knerr et al., Citation2013). This makes it an ideal candidate for low-resource countries such as Bangladesh. Bangladesh’s status as a low-resource country is underscored by several critical factors affecting early childhood development. Despite progress, a literacy rate of 74.7% among those aged 15 and above (Bangladesh Bureau of Statistics, Citation2019) highlights educational gaps that may hinder parental support for child learning. Limited digital access, with only 15% internet penetration (World Bank, Citation2020), and an under-resourced healthcare system, with a low density of healthcare professionals (WHO, Citation2020), reflect significant barriers to quality education and healthcare. Furthermore, 20.5% of the population living below the poverty line (UNDP, Citation2019) and restricted access to early childhood education (UNICEF, Citation2019) exacerbate these challenges. These factors collectively demand targeted interventions to improve outcomes in early childhood development within this context.

The current study

The early childhood phase is formative for parents as they foster secure attachment and anchor themselves in the context of their child’s development. Few studies have looked at the usefulness of attachment-based interventions for families with exceptional children. Additionally, though research on parenting interventions has historically been concentrated in developed countries (Knerr et al., Citation2013; Mejia et al., Citation2012), the past decade has seen increased exploration of parent education interventions in low- and middle-income countries (Jeong et al., Citation2018; Tinajero et al., Citation2016). While many established parenting interventions foster positive parenting skills (e.g. Triple P (Sanders, Citation2014) and Incredible Years (Webster-Stratton, Citation2014)), there remains a need for culturally adaptable, resource-sensitive tools for wider dissemination. Thus far, LTP has demonstrated a wide range of effectiveness through implementation in over 25 diverse countries, including Pakistan (Husain et al., Citation2017), Nigeria (Jidong et al., Citation2021), the Caribbean (Jidong et al., Citation2022), Kenya (Notiar et al., Citation2021), and refugee communities in the United States (Kaptan et al., Citation2023).

Given the potential utility of the LTP calendar for the development of parenting training programs in Bangladesh, the current study was conducted with three specific objectives: (1) to adapt an LTP calendar-based parenting training program aimed at enhancing Bangladeshi parents’ knowledge, attitudes, and skills in parenting; (2) to evaluate the effectiveness of this training program; and (3) to determine the relative effectiveness of the training in supporting parents of exceptional children as compared to parents of typically developing children. Although the LTP calendar focuses on typical development and does not include education on exceptionalities, we hypothesized that the LTP calendar-based parenting training program would still contribute positively to parents’ knowledge, attitudes, and skill sets in supporting their typically developing children as well as children with special needs.

Design

The study utilized a mixed quasi-experimental design. The within-group variable was the phase (pretest vs. posttest), and the between-group variable was the parent category (parents of typically developing children vs. parents of children with exceptional needs). The quasi-experimental nature of the study implied that the parent categories were preexisting (i.e., participants were not randomly assigned to groups). The same scales were employed in both the pretest and posttest phases. Ethical approval for the study was obtained from the Department of Education and Counseling Psychology Ethics Committee at the University of Dhaka, Bangladesh (reference number DECP/05/2018). Written informed consent was obtained from all participants before collecting data. The study adhered to the ethical guidelines outlined in the World Medical Association’s Declaration of Helsinki throughout its duration.

Setting

The research was conducted in Dhaka, the capital of Bangladesh, comprising two distinct administrative entities: Dhaka South City Corporation and Dhaka North City Corporation. Socio-economic disparities between Dhaka North and Dhaka South are evident, characterized by variations in land use, housing conditions, and access to healthcare (Razzaque et al., Citation2020; Sharmeen & Houston, Citation2019; Sowgat & Roy, Citation2022). Therefore, gathering data from both areas was crucial to assess the diversity within the middle class and identify socioeconomic differences between the two regions. The data collection process was facilitated by workshops held in schools that granted permission to utilize their facilities.

Participants

The study’s sample consisted of purposive and conveniently selected 28 participants: 16 parents (comprising nine mothers and seven fathers) of typically developing children and 12 parents (comprising eight mothers and four fathers) of children with exceptional needs, including learning challenges, developmental delays, and autism spectrum conditions. Parents were eligible for inclusion if they had at least one child aged 0 to 6 years. Due to scheduling constraints, only one parent per child could participate in the study. The majority of the participants identified themselves as belonging to middle-class socioeconomic backgrounds.

LTP calendar-based parenting training program

The LTP Calendar-Based Parenting Training Program, adapted for Bangladeshi parents, began with a four-hour psychoeducational workshop on early childhood development. The workshop was facilitated by professionals trained in the LTP intervention and theory. They held bachelor’s and master’s degrees in educational psychology and received training in Learning Through Play from a specialized educator. Facilitators received a three-month training program covering instruction in both the intervention methodology and attachment theory, aligning closely with the program’s theoretical framework. In addition to receiving psychoeducation, parents were oriented to the LTP calendar, a visual intended to be displayed in their homes. The calendar illustrated developmental milestones and various activities parents could undertake to support their child and strengthen the parent-child relationship.

The LTP Parent Training Program for Bangladeshi parents was customized to align with local customs and language. It included activities tailored to each domain, including (a) self-recognition practices with local toys for a sense of self, (b) traditional fabric play for physical development, (c) family games for relationship development, (d) local environment exploration for cognitive development, and (e) stories and simple conversations in Bengali language for development of both verbal and non-verbal skills. These activities were designed to suit Bangladeshi family structures and norms from birth to age six. All adaptations were made in pursuit of enhanced program effectiveness and stronger parent-child connections within the Bangladeshi cultural context.

Measures

Procedure

The procedural framework began with formal approval from school authorities and pretest evaluations of knowledge, attitudes, and skills. To initiate the intervention, participants engaged in a four-hour psychoeducational workshop to lay the foundation for the LTP calendar. Then, participants implemented the LTP calendar in their homes for two weeks. Post-test measurements captured knowledge, attitude, and ability changes, with participants marking relevant options.

Statistical analysis

Given the ordinal nature of the data, non-parametric tests were utilized for analysis (Field, Citation2018). The Wilcoxon signed-rank test was employed to determine whether the workshop significantly increased participants’ knowledge, attitudes, and skills in parenting (Haynes, Citation2013). The Mann – Whitney U test was used to evaluate the efficacy of the workshop by comparing the change scores (posttest minus pretest) in parenting knowledge, attitudes, and skills between parents of typically developing children and parents of children with exceptional needs. The analysis was conducted using IBM SPSS Statistics 28.

Parents of typically developing children

Parents of children with exceptionalities

Comparing the parents

Limitations

The intervention is rooted in attachment theory, but it is crucial to recognize that its origins lie in Western, Anglo-centric ideas, which may not comprehensively encompass the wide range of cultural norms and values prevalent in global cultures (Morelli et al., Citation2018). This constraint compels us to acknowledge the possibility of a lack of harmony between the intervention and the cultural milieu in which it is implemented. Despite the diligent incorporation of cultural sensitivity in its execution (Maciel et al., Citation2023), the intervention’s compatibility with diverse cultural frameworks may vary, thereby impacting its efficacy in some contexts.

Furthermore, it is imperative to recognize attachment theory’s applicability or lack thereof within the cultural context of Bangladesh. The theory provides insights into parent-child relationships, but its relevance in cultural contexts that differ from its Western roots warrants additional investigation. In this setting, the intervention was presented as a means to lay the foundation for mutually satisfying parent-child relationships during the early years; attachment-specific terminology was not used.

Implications for practice

The low cost and personnel requirements for the LTP calendar, combined with the positive effects in both normative and exceptional families, make this intervention promising for widespread use. Understanding and improving parenting through this targeted training contributes to academic research and practical applications in parental education and child development. The study’s findings emphasize the critical role of tailored parenting interventions for therapists working with parents, especially those of exceptional children. By acknowledging the unique challenges faced by these parents, such as stigma and heightened stress, therapists can advocate for targeted support and resources. Understanding the variability in parenting experiences underscores the need for personalized approaches, enabling therapists to adapt strategies to individual family contexts. Ultimately, by incorporating these insights into clinical practice, therapists can empower parents, promote positive parenting practices, and support the healthy development of children in diverse family settings.

Implications for research

To build upon the findings and limitations of this study, future research could stratify by age groups rather than the wide span of birth to six years old. By conducting separate analyses for age groups (e.g. infancy, toddlerhood, and preschool), researchers could pinpoint aspects of interventions such as LTP that support the changing dynamics of parent-child relationships during early childhood. These analyses could be strengthened through the use of externally validated measurement tools.

Increasing the sample size within each age group would increase power and improve external validity. The current study’s sample size of 28 participants, encompassing parents of typically developing children and parents of children with exceptional needs, presents limitations in terms of generalizability. However, as Anderson and Glebova (Citation2022) discussed, small-sample research offers unique advantages in clinical research, including the ability to provide in-depth insights into specific phenomena and the feasibility of conducting studies with limited resources. While Roessner (Citation2014) highlights the benefits of larger samples for generalizability in child and adolescent psychiatric research, it’s also important to recognize small studies’ value in exploring nuanced, case-specific questions and piloting innovative interventions. Future studies could benefit from balancing the depth of small-sample studies with the breadth of larger sample sizes to enhance the specificity and generalizability of research findings.

The intervention timeframe, which includes a four-hour workshop and a subsequent two-week home practice period, was deliberately chosen to test its initial feasibility and effectiveness given the limited resources and to suit the scheduling needs of families in Bangladesh. Shorter interventions present practical benefits, such as reduced costs and potentially higher retention rates. However, shorter intervention timeframes can also inhibit long-term efficacy (Berger et al., Citation2009).

Evidence on the efficacy of brief interventions in parenting and early childhood development is varied. Some research indicates that short-term interventions can lead to notable improvements in parenting knowledge and attitudes (Anderson & Glebova, Citation2022; Furlong et al., Citation2012), whereas other studies advocate for extended durations to ensure deeper learning and sustainable behavioral changes (Sanders et al., Citation2014). This inconsistency underscores the importance of additional research to determine the ideal length of parenting programs, especially in settings like Bangladesh, where limited resources and accessibility issues challenge program implementation. Future research should consider varying the lengths of programs systematically to pinpoint the most effective duration that maximizes benefits for both parents and children over short and long terms.

Future studies may also explore the specific content and delivery methods that contributed to positive changes for Bangladeshi. For example, adjusting the guidance in each developmental stage, specific to various needs, while keeping the simple, intuitive calendar framework could provide more targeted support to families with exceptional children. Finally, longitudinal assessments could evaluate the long-term sustainability of these positive changes, informing ongoing support and development initiatives. These efforts would help inform ongoing research and attachment-based parenting intervention that is culturally and developmentally appropriate for the populations it serves.