137 Short-term outcomes and six-month follow-up of BEAR 6 development when there is no suitable intervention possible (Snijder et al., 2021). This hypothesis is supported by our observation that fewer children were referred by WBCs in the control group (4 out of 9) compared to those in the BEAR group (7 out of 10). Another limitation of this study is the insufficient statistical power and the relatively high percentage of missing data, particularly in the questionnaires. The missing data can be attributed to our diverse sample, which included a substantial number of parents from different cultural backgrounds. While this diversity is a strength, as most studies have primarily populations from a dominant racial or ethnic group (Hamptom & Rodriguez, 2022), it also posed challenges in collecting follow-up data (i.e. unanticipated language barriers or cultural barriers). We attempted to enhance statistical power by imputing missing data and conducting sensitivity analyses on the complete cases to verify our findings. The results, except for fluency and connectedness, were consistent across these analyses. The differences between the imputed data and complete cases may be due to the possibility that the complete cases represent a selective subgroup of parents and children, though this remains speculative. Additionally, no correction for multiple testing was applied, as this study is the first to investigate the effects of BEAR and can therefore be considered exploratory. The last limitation of the study is that the observations from the JERI and BOSCC are based on parent-child interaction and that the parents are not an experimental fixed factor since they have been part of the intervention. Specifically, for our experimental group, there might be a bias at our T1 and T2 video measurements, due to the interventionist being the assessor of the JERI and BOSCC. Since data are coded by a separate team of trained observers who are not part of the intervention and are unaware of treatment allocation, we aimed to minimize this possible bias. In conclusion, findings from the current study provide some support for BEAR as a promising pre-emptive intervention for young children with a neurodevelopmental vulnerability and their parents. Parents seem to benefit primarily from the intervention through the enhancement of their parental skills while direct effects on the child’s behaviors were absent. Longitudinal assessments are essential to evaluate the long-term impact of the BEAR intervention and to assess its sustainability over time. Also, dose – response questions are important to incorporate in future studies as well as questions regarding acceptability and parental satisfaction with BEAR.
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