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:
- David Steele (Steele, 2016) reviewed a randomised controlled trial of a parent training programme for adolescent anorexia. On this occasion parent training was not shown to have a significant effect
- Fiona Warner-Gale (Warner-Gale, 2014) brought our attention to a meta-analysis carried out on the Incredible Years Parent Training programme (arguably a flagship parent-training intervention), which described quite convincing evidence of efficacy
- John Baker (Baker, 2014) reported on a Cochrane review of parent training for parent’s mental health, which found evidence to support short-term efficacy.
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.
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.
|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||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|
|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|
|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|
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.
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Baumel, A., Pawar, A., Kane, J. M., & Correll, C. U. (2016). Digital Parent Training for Children with Disruptive Behaviors: Systematic Review and Meta-Analysis of Randomized Trials. Journal of Child and Adolescent Psychopharmacology, 26(8), 740-749.
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Coren, E., Hutchfield, J., Thomae, M., & Gustafsson, C. (2010). Parent training support for intellectually disabled parents. Cochrane Database of Systematic Reviews(6). doi:10.1002/14651858.CD007987.pub2
Crone, R. M., & Mehta, S. S. (2016). Parent Training on Generalized Use of Behavior Analytic Strategies for Decreasing the Problem Behavior of Children with Autism Spectrum Disorder: A Data-Based Case Study. Education and Treatment of Children, 39(1), 64-94.
De Voogd, E., Wiers, R., Prins, P., de Jong, P., Boendermaker, W., Zwitser, R., & Salemink, E. (2016). Online attentional bias modification training targeting anxiety and depression in unselected adolescents: Short-and long-term effects of a randomized controlled trial. Behaviour Research and Therapy, 87, 11-22.
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Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S. M., & Donnelly, M. (2012). Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database of Systematic Reviews(2). doi:10.1002/14651858.CD008225.pub2
Kaminski, J. W., Valle, L. A., Filene, J. H., & Boyle, C. L. (2008). A meta-analytic review of components associated with parent training program effectiveness. Journal of Abnormal Child Psychology, 36(4), 567-589.
Langford, A., Laws, K. (2014). Psychotherapy trials should report the side effects of treatment. The Mental Elf.
Lee, P.-c., Niew, W.-i., Yang, H.-j., Chen, V. C.-h., & Lin, K.-c. (2012). A Meta-Analysis of Behavioral Parent Training for Children with Attention Deficit Hyperactivity Disorder. Research in Developmental Disabilities: A Multidisciplinary Journal, 33(6), 2040-2049.
Littell, J. H. (2005). Lessons from a systematic review of effects of multisystemic therapy. Children and Youth Services Review, 27(4), 445-463.
Loveman, E., Al-Khudairy, L., Johnson, R. E., Robertson, W., Colquitt, J. L., Mead, E. L., . . . Rees, K. (2015). Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database of Systematic Reviews(12). doi:10.1002/14651858.CD012008
Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: moderators and follow-up effects. Clinical Psychology Review, 26(1), 86-104.
Lundahl, B. W., Nimer, J., & Parsons, B. (2006). Preventing Child Abuse: A Meta-Analysis of Parent Training Programs. Research on Social Work Practice, 16(3), 251-262.
Lundahl, B. W., Tollefson, D., Risser, H., & Lovejoy, C. M. (2008). A Meta-Analysis of Father Involvement in Parent Training. Research on Social Work Practice, 18(2), 97-106.
Maughan, D. R., Christiansen, E., Jenson, W. R., Olympia, D., & Clark, E. (2005). Behavioral Parent Training as a Treatment for Externalizing Behaviors and Disruptive Behavior Disorders: A Meta-Analysis. School Psychology Review, 34(3), 267-286.
Menting, A. T. A., Orobio de Castro, B., & Matthys, W. (2013). Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: a meta-analytic review. Clinical Psychology Review, 33(8), 901-913. doi:http://dx.doi.org/10.1016/j.cpr.2013.07.006
Michelson, D., Davenport, C., Dretzke, J., Barlow, J., & Day, C. (2013). Do evidence-based interventions work when tested in the “real world?” A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clinical Child and Family Psychology Review, 16(1), 18-34.
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Rimestad, M. L., Lambek, R., Zacher Christiansen, H., & Hougaard, E. (2016). Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. Journal of attention disorders.
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