Parent training works for child and adolescent mental health

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In a mental health context, parent training is the term used to describe manualised programmes of education, and psychoeducation, which are delivered to parents to help impact their children’s health and wellbeing.

These programmes employ common adult education techniques such as video clips, discussion activities, role-play and homework, and are commonly delivered to groups of parents in one or two hour weekly sessions, for periods from six weeks to a year.

Parent training is currently topical in research circles. A raft of systematic reviews have been published in this area over the past decade, and 2016 was particularly prolific. Teachers, nurses, social workers and psychologists, among others, are increasingly turning to parent training to offer more holistic responses to children’s problems.

Parent training has been covered here at Mental Elf before:

We assume that parenting styles, parenting skills and parental knowledge are key to parent and child health and wellbeing outcomes. The question addressed here is:

Is the ascendance of parent-training, in scope and volume, supported by efficacy evidence?

My objective in writing this piece was to provide a high-level overview of the state of efficacy research on parent training in general, which draws entirely on systematic reviews with meta-analysis.

Parent training can help people understand the role they can play in promoting good mental health, preventing mental health problems and working together with other professionals and services to support better psychological wellbeing.

Parent training can help people understand the role they can play in promoting good mental health, preventing mental health problems and working together with other professionals and services to support better psychological wellbeing.

Methods

To find published meta-analytic reviews on parent training I completed a scoping search of the Campbell and Cochrane collaboration online libraries by searching for the term ‘parent’ in review titles. I found 7 relevant reviews on these facilities. I then completed a more precise search, but still limited to manuscript titles, on Proquest’s Complete Collection platform. This facility simultaneously searches 19 relevant bibliographic databases. I used the following search formula: (systematic review OR meta) AND (parent AND training) NOT protocol. This produced 55 hits and a further 25 relevant reviews.

Results

ADHD

Parent training for … Review identifier (first author) Parent training (PT) review finding
Children with ADHD Zwi, 2011 Better quality research is needed
Children with or at risk of ADHD Rimestad, 2016 PT is partially effective
Disruptive behaviour in children with ADHD Lee, 2012 PT is effective

Autism

Autism Nevil, 2016 Findings offer tentative support

Difficulties in early years

Early conduct disorder Furlong, 2012 PT is effective
Early emotional and behavioural difficulties Barlow, 2016 Findings offer tentative support

Anti-social and disruptive behaviour

Children’s anti-social behaviour Piquero, 2008 PT is effective
Children’s disruptive behaviours (digital programmes) Baumel, 2016 Digital programmes hold promise
Children’s externalised disruptive behaviours Maughan, 2005 PT is effective
Children’s anti-social behaviour Serketich, 1996 Results support short-term effectiveness
Prevention of children’s anti-social behaviour Piquero, 2016 PT is effective
Disruptive behaviour in children with developmental disability Skotarczak, 2015 PT is effective
Children’s disruptive behaviour Michelson, 2013 PT is effective
Children’s disruptive behaviour Menting, 2013 PT is effective

Internalised problems

Children’s internalising problems Yap, 2016 PT is effective

Parenting skills (fathers)

Fathers’ parenting Fletcher, 2011 A much smaller effect in comparison to effects on Mothers’ parenting
Father involvement Lundahl, 2008 Fathers report fewer benefits than mothers; they should be encouraged to attend

Parenting skills

Foster parent training Solomon, 2016 Findings offer tentative support
The education of children with disabilities Tavil, 2013 These parent programmes predominantly focus on the management of children’s behaviour and living skills
Parents’ attitudes, behaviour and knowledge; children’s self-esteem Cedar, 1990 PT is effective
Parenting skills and children’s well-being Sougstad, 2010 PT is effective
Parenting skills, for parents with intellectual disability Coren, 2010

 

Findings offer tentative support
Psychosocial well-being of parents Barlow, 2014 PT is effective in the short-term
Psychosocial outcomes for teenage parents and children Barlow 2011 Findings offer tentative support

Children’s physical health challenges

Obesity in children Loveman, 2015 Findings offer tentative support

Preventing child abuse

Preventing child abuse Lundahl, 2006 PT is effective in the short-term
Treating abusive parents Barlow, 2006 Insufficient evidence available

Moderators of efficacy

Programme adaptations for ethnicity Van Mourik, 2016 Ethnically sensitive programmes are more effective
Programme component efficacy Kaminski, 2008 Key components are reported as: increasing positive interaction; emotional communication skills; time-out training; consistency training; and focus on practice
Moderators and follow-up effects Lundahl, 2006 Economically disadvantaged families benefit less. Disadvantaged parents benefit more from a one-to-one format
The moderating effect of socioeconomic status Leijten, 2013 Maintenance of treatment gains is harder for disadvantage families
Predictors of parent training efficacy Reyno, 2006 Socioeconomic status and maternal mental health are key predictors
Behavioural and cognitive-behavioural group-based parenting interventions are effective at improving child conduct problems, parental mental health and parenting skills in the short term, in the parents of children aged 3-12.

Behavioural and cognitive-behavioural group-based parenting interventions are effective at improving child conduct problems, parental mental health and parenting skills in the short term, in the parents of children aged 3-12.

Discussion

I would acknowledge that the term ‘parent-training’, used here, belies the variability of educative programmes used with parents. From those which are dominated by instruction and a presentation format, to those which mirror CBT programmes.

I would also acknowledge that treatment integrity is a challenge in programme delivery, and that the role individual training facilitators play in the efficacy of any given programme is significant.

However, considering the currency of the research reported in the table above, and the wide range of children’s difficulties targeted, it could be argued that practitioners who work with children and adolescents, are increasingly turning to educative work with parents.

I believe it’s also safe to assume that parent training has become an evidence-based practice, with a credibility that places it alongside pharmacological and psychotherapeutic responses to children’s difficulties. While it is difficult to see how parent-training will lead to a harmful effect, it was interesting that three of the reviews listed above reported that the non-measurement of adverse effects was a methodological shortfall in primary studies. This aligns with another recent Mental Elf blog which calls for greater scrutiny of side effects in psychotherapy (Langford and Laws, 2014).

While the same caution should be exercised with parent-training, and further evaluation is prudent, it is hard not to get enthusiastic about what it has to offer in the field of children’s health and social care. Parent training can be delivered to parents simultaneously, in groups. The fact that online versions and adjuncts are increasingly available (for example Crone & Mehta, 2016; De Voogd et al., 2016; and Snodgrass et al., 2016) creates further economy. I would suggest that parent-training should be viewed as a low-risk and efficient tool. At the very least it should be viewed as an important complement to the pharmacological and psychotherapeutic treatment of children’s health problems, and worthy of wider implementation.

The review of parent-training with abusive parents (Barlow et al., 2006) failed to offer support. There also appears to be less convincing evidence of efficacy with fathers (Fletcher et al., 2011; B. W. Lundahl et al., 2008). These findings align with evidence from other areas in which programme participants are not always self-motivated to take part: systematic reviews of educative and psychotherapeutic programmes with partner-violence perpetrators (Akoensi, Koehler, Lösel, & Humphreys, 2012) and offenders (Woodhouse et al., 2016).

Going forward, research that helps us to understand how motivation measures interact with efficacy in parent training would be useful. As the evidence base stands, parent training programme developers are minded to make particular provision for disadvantaged parents, different ethnicities, fathers and the sustainability of any gains from treatment.

More research is needed to assess benefits for fathers, examine the comparative effectiveness of different types of programmes, and identify the mechanisms by which such programmes bring about improvements in parental functioning and outcomes for children.

More research is needed to assess benefits for fathers, examine the comparative effectiveness of different types of programmes, and identify the mechanisms by which such programmes bring about improvements in parental functioning and outcomes for children.

Links

Other references

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Baker, J. (2014). Do parent training programmes improve the health of parents? The Mental Elf.

Barlow J. (2016) Effects of Parenting Programmes: A Review of Six Campbell Systematic Reviews. Campbell Collaboration Policy Brief no.1 (PDF). May 2016.

Barlow, J., Johnston, I., Kendrick, D., Polnay, L., & Stewart-Brown, S. (2006). Individual and group-based parenting programmes for the treatment of physical child abuse and neglect. Cochrane Database of Systematic Reviews(3). doi:10.1002/14651858.CD005463.pub2

Barlow, J., Smailagic, N., Bennett, C., Huband, N., Jones, H., & Coren, E. (2011). Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children. Cochrane Database of Systematic Reviews(3). doi:10.1002/14651858.CD002964.pub2

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