Parenting and Prematurity: Understanding Parent Experience and Preferences for Support

Infants born very preterm are at risk of developmental and behavioural problems and their parents are at risk of psychological distress and compromised parenting. This study has two key aims: (1) to identify, from the parents’ own perspective, the unique aspects of parenting an infant born very preterm and (2) to assess parent preferences for support including opinions of a new, tailored parenting intervention, Prem Baby Positive Parenting Program (Triple P). A qualitative approach was taken with focus groups of 18 parents of infants born preterm and a thematic analysis conducted. Parents identified several unique aspects of parenting an infant born preterm including: difficulty coping with the stress of hospitalisation; institutionalisation to the hospital environment; a lack of preparation for the transition to parenthood; grief; isolation; getting into “bad parenting habits” of overnurturance and a lack of certainty about developmental expectations. Parents preferred parenting support that is tailored to parents of infants born preterm, has flexible delivery, enhances coping skills and the spousal relationship and is sensitive to the emotional context of parenting an infant born preterm. Understanding the experiences and the preferences of parents of infants born preterm is an important step in tailoring parenting interventions to fit their needs.     

Tuning in to Kids: an effectiveness trial of a parenting program targeting emotion socialization of preschoolers

This article reports on an effectiveness trial of the Tuning in to Kids (TIK) parenting program. TIK aims to improve emotion socialization practices in parents of preschool children; it is a universal prevention program that teaches parents the skills of emotion coaching and also targets parents' own emotion awareness and regulation. The present study followed a 2 × 2 (Treatment Condition × Time) design. One hundred twenty-eight parents of children ages 4.0-5.11 years were recruited from preschools and randomized into intervention and waitlist conditions. Parents in the intervention condition (n = 62) attended a six-session group parenting program delivered by community practitioners who followed intervention fidelity protocols. Parents and preschool teachers completed questionnaires twice during the preschool year: at preintervention and at follow-up (approximately 7 months later). Parents reported on their emotion socialization beliefs and practices, other parenting practices, and on child behavior. Teachers reported on child behavior (Social Competence and Anger-Aggression). Data were analyzed using multilevel modeling. At follow-up, compared to the control group, intervention parents were significantly less emotionally dismissive in their beliefs, less dismissive and more coaching in their practices in response to children's negative emotions, and more positively involved. Although there were improvements in both conditions over time for parent-reported child behavior and teacher-reported social competence, compared to the waitlist group, intervention parents reported a significantly greater reduction in number of behavior problems. This trial demonstrates the potential for community agencies and practitioners in real-world settings to deliver a new parenting program that targets emotional communication in parent-child relationships.     

Help when it's needed first: a controlled evaluation of brief, preventive behavioral family intervention in a primary care setting

This study evaluated the effects of a brief 3- to 4-session behavioral family intervention program for parents of preschool-aged children in a primary care setting, compared to parents in a wait-list control condition. Parents receiving the Primary Care Triple P-Positive Parenting Program intervention reported significantly lower levels of targeted child behavior problems, dysfunctional parenting, and reduced parental anxiety and stress in comparison to wait-listed parents at postassessment. These short-term effects were largely maintained at 6-month follow-up assessment of the intervention group. Implications of these findings for the prevention of behavioral and emotional problems in children are discussed.     

Relations between Parenting Stress,Parenting Style,and Child Executive Functioning for Children with ADHD or Autism

Relations among parenting stress, parenting style, and child executive functioning for children with disabilities are not easily teased apart. The current study explored these relations among 82 children and adolescents age 7–18: 21 with attention deficit/hyperactivity disorder, 33 with autism spectrum disorder, and 28 typically developing. Results indicated that children with attention deficit/hyperactivity disorder or autism spectrum disorder had more executive functioning deficits, and their parents reported more parenting stress and a greater use of permissive parenting, compared to typically developing children. In general, increased parenting stress was associated with greater use of authoritarian and permissive parenting styles, as well as more problems with behavior regulation for children. Authoritarian and permissive parenting styles were associated with poorer child executive functioning. Child diagnostic group (attention deficit/hyperactivity disorder, autism spectrum disorder, typically developing) moderated relations between parent stress and child functioning, and between parenting style and child functioning. Implications for intervention with families of children with disabilities are discussed.     

Pilot Evaluation of the ACT Raising Safe Kids Program on Children’s Bullying Behavior

Research documents that parents play a critical role in the development and maintenance of behavior problems in children. Few bullying prevention programs, however, target children in early childhood or include a parenting component in spite of experts recommending that parent training in behavior management be addressed. Based upon these recommendations, the present study examines the relationship among parent characteristics (hostility, depression, and overall parenting skills) and child bullying and the effects of the American Psychological Association’s ACT Raising Safe Kids program on reducing early childhood bullying. The ACT-RSK program is a primary family violence and child physical abuse prevention program for parents of young children. Fifty-two parents/caregivers, representing children ages 4–10, completed the Brief Symptom Inventory, the ACT Parents Raising Safe Kids Scale, and Early Childhood Bullying Questionnaire (derived from the Child Behavior Checklist and Strengths and Difficulties Questionnaire). Twenty-five of these parents/caregivers were trained in effective parenting including nonviolent discipline, child development, anger management, social problem-solving skills, effects of violent media on children, and methods to protect children from exposure to violence through the ACT-RSK program. The remaining 27 parents/caregivers received treatment as usual. Results indicate decreased bullying in children whose parents completed the ACT-RSK program. Furthermore, of the parent characteristics assessed, parental hostility is the only significant parent predictor for child bullying. These findings suggest the efficacy of this brief intervention for preventing bullying.     

Parent-directed cognitive behavioral therapy for young anxious children: a pilot study

Anxiety in children age 8 years and above has been successfully treated with cognitive behavioral therapy (CBT). However, the efficacy of CBT for anxious children ages 4-7 years has not, to date, been fully investigated. This paper piloted a CBT intervention targeting child anxiety that was delivered exclusively to parents of 26 children with anxiety symptoms ages 4-7 years. The intervention consisted of four 2-hour group sessions of four to six parents (couples). These group sessions were followed by four individual telephone sessions, once per week across a 4-week period. The pre- and postintervention assessment involved measures of multiple constructs of child anxiety (anxiety symptoms, children's fears, behavioral inhibition, and internalizing symptoms) from multiple informants (parents, children, and teachers). Parents also reported parenting strategies they were likely to use to manage their children's anxiety pre- and postintervention. Results indicated a significant decrease in child anxiety and behavioral inhibition as reported by parents and teachers. Furthermore, mothers reported significant increases in their use of positive reinforcement, and modeling and reassurance, and a significant decrease in their use of reinforcement of dependency directly after treatment. Taken together, parent-directed CBT appears to be an effective approach for treating children ages 4-7 years with anxiety symptoms. Limitations of the current research are discussed.     

Parent stress and coping in relation to child ADHD severity and associated child disruptive behavior problems.

Examined parent role distress and coping in relation to childhood attention deficit hyperactivity disorder (ADHD) in mothers and fathers of 66 children age 7 to 11 (42 boys, 24 girls; mean age = 10.2). Parents of children with ADHD combined and inattentive subtypes expressed more role dissatisfaction than parents of control children. Parents of ADHD combined and inattentive type children did not differ significantly in levels of distress. For mothers, child inattention and oppositional-conduct problems but not hyperactivity contributed uniquely to role distress (dissatisfaction related to parenting or parenting performance). For fathers, parenting role distress was associated uniquely with child oppositional or aggressive behaviors but not with ADHD symptom severity. Parent coping by more use of positive reframing (thinking about problems as challenges that might be overcome) was associated with higher role satisfaction for both mothers and fathers. Community supports were associated with higher distress for mothers only.     

Parental Overprotection,Perceived Child Vulnerability,and Parenting Stress: A Cross-Illness Comparison

The current study sought to investigate differences in parenting capacity variables across four disease groups. Parents (N = 425), the majority of whom were mothers, of children with either cancer, asthma, Type 1 diabetes, or cystic fibrosis, completed measures of parental overprotection, perceived child vulnerability, and parenting stress. After controlling for significant demographic variables, parents of children with cystic fibrosis and asthma reported higher perceived child vulnerability than parents of children with either diabetes or cancer, while parents of children with asthma and diabetes reported higher parenting stress than parents of children with cancer or cystic fibrosis. No differences between disease groups were found for parental overprotection. The current study provides support for an illness-specific approach to understanding parenting capacity variables in the context of childhood chronic illnesses.     

Does parental mental health moderate the effect of a telephone and internet‐assisted remote parent training for disruptive 4‐year‐old children?

This study explores the moderators affecting the success of an Internet‐based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4‐year‐old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self‐reported parenting skills. The measures were completed at baseline, six and 12‐months follow‐up. The 232 families randomized to active treatment received 11 Internet‐based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45‐minute phone‐call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.     

Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change

Parent-centred interventions for childhood obesity aim to improve parents' skills and confidence in managing children's dietary and activity patterns, and in promoting a healthy lifestyle in their family. However, few studies assess changes in parenting over the course of treatment. This study describes the evaluation of a lifestyle-specific parenting program (Group Lifestyle Triple P) on multiple child and parent outcomes. One-hundred-and-one families with overweight and obese 4- to 11-year-old children participated in an intervention or waitlist control condition. The 12-week intervention was associated with significant reductions in child BMI z score and weight-related problem behaviour. At the end of the intervention, parents reported increased confidence in managing children's weight-related behaviour, and less frequent use of inconsistent or coercive parenting practices. All short-term intervention effects were maintained at one-year follow-up assessment, with additional improvements in child body size. The results support the efficacy of Group Lifestyle Triple P and suggest that parenting influences treatment outcomes. Further research is needed to evaluate the long-term effectiveness of the intervention and to elucidate the mechanisms of change.     

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity

This study examined the quality of parent–child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father–child communication, and less synchronous mother–child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.     

The Effectiveness of Mindfulness Training for Children with ADHD and Mindful Parenting for their Parents

This study evaluated the effectiveness of an 8-week mindfulness training for children aged 8–12 with ADHD and parallel mindful parenting training for their parents. Parents (N = 22) completed questionnaires on their child’s ADHD and ODD symptoms, their own ADHD symptoms, parenting stress, parental overreactivity, permissiveness and mindful awareness before, immediately after the 8-week training and at 8-week follow-up. Teachers reported on ADHD and ODD behavior of the child. A within-group waitlist was used to control for the effects of time and repeated measurement. Training was delivered in group format. There were no significant changes between wait-list and pre-test, except on the increase of teacher-rated ODD behavior. There was a significant reduction of parent-rated ADHD behavior of themselves and their child from pre-to posttest and from pre- to follow-up test. Further, there was a significant increase of mindful awareness from pre-to posttest and a significant reduction of parental stress and overreactivity from pre-to follow-up test. Teacher-ratings showed non-significant effects. Our study shows preliminary evidence for the effectiveness of mindfulness for children with ADHD and their parents, as rated by parents. However, in the absence of substantial effects on teacher-ratings, we cannot ascertain effects are due to specific treatment procedures.     

Validity of the parenting scale for parents of children with attention-deficit/hyperactivity disorder

The present study examined the validity of the parenting scale for parents of elementary school-aged children with attention-deficit/hyperactivity disorder (ADHD). Parents from 109 families with children who had been diagnosed with ADHD (106 mothers and 93 fathers) and from 70 families with non-problem children (69 mothers and 59 fathers) completed the parenting scale and reported on their children's behavior problems. Factor analyses revealed two interpretable factors for both mothers and fathers, corresponding to the overreactivity and laxness factors identified in previous studies of the parenting scale. Overreactivity and laxness scores were significantly higher for mothers and fathers of ADHD children than of non-ADHD children; this effect appeared to be accounted for by comorbid aggression and conduct problems among ADHD children. Results support the validity of the parenting scale for use with parents of ADHD children.     

Is the Triple P-Positive Parenting Program Acceptable to Parents from Culturally Diverse Backgrounds?

Behavioural parenting programs are an effective intervention for behavioural and emotional problems in children, however these programs have low utilisation rates by culturally diverse parents. We examined the cultural acceptability of program materials, preferences for delivery methods, and barriers to use of the Triple P-Positive Parenting Program. One hundred and thirty seven parents watched a video outlining the 17 strategies in Triple P and read through a tip sheet before completing a series of questionnaires. Results revealed that parents found the strategies highly acceptable, highly useful, were very likely to use the strategies and reported currently using the strategies often. They also rated the program materials as very culturally appropriate and identified group, seminar, television, and individual as the most preferred delivery methods. Parents identified location and timing of services, financial cost, and competing work commitments as the most frequently cited barriers to accessing a parenting intervention. The findings of this study suggest that elements of parenting programs may not be contributing to the low rates of access among culturally diverse parents. These findings highlight the need for more research addressing variables that may contribute to increasing culturally diverse parents’ access of behavioural parenting programs.     

Effects of parent and child characteristics on participation and outcome of an individualized booster parent intervention for children with externalizing behaviour

In this study, we examined whether a booster parent training, offered after a cognitive behavioural child intervention, is effective in reduction of aggressive behaviour and changes in parenting. A second aim was to identify parent and child characteristics that influence parental participation. Children (73% boys, 40% immigrants, mean age = 10.1 (.53)) were randomly assigned to the child (n = 97 children) or child and parent intervention (n = 94 children) condition. Results of both intention-to-treat and completers only analyses indicated no extra effects of the parent intervention for the total group. Parents who participated (47%) did not differ from non-participants in demographic characteristics. However, mother's perceived level of child's aggression at the end of the child intervention was of significant meaning for the decision to participate in the parent intervention. Participation seemed to interrupt the development of more aggressive behaviour and less appropriate parenting skills for those children in highest need and resulted in increased maternal involvement.     

Patterns of Parental Adherence and the Association to Child and Parenting Outcomes Following a Multicomponent School-Home Intervention for Youth With ADHD

The goal of the present study was to evaluate the role of parent adherence in the Collaborative Life Skills (CLS) program, a multicomponent school-home intervention, for predicting child and parenting outcomes. A sample of 129 children (63% male; M age = 8.22, SD = 1.10; grades 2–5) with attention-deficit/hyperactivity disorder (ADHD) and their parents participated in CLS, which included 10 weekly behavioral parent training group sessions. Each week, parents provided information on their CLS skill use between sessions (at home) as part of the intervention. Outcome measures included parent and teacher ratings of child behavior and parenting at post-intervention and 6 months follow-up. Growth mixture models examining weekly parent skill use trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes including parent-rated child behavior, teacher-rated academic competence, and positive parenting behaviors. Fifty-two percent of parents displayed moderate skill use throughout the intervention, whereas the remaining parents had either low (20%) or high (28%) initial levels of use but demonstrated high skill utilization by the middle of the intervention. Results highlight the importance of examining individual differences in parents between session strategy use for behavioral parent training interventions targeting child and parenting outcomes.     

Asian-Indian Parents’ Attributions About the Causes of Child Behavior: A Replication and Extension With Parents From Chennai,India

Using hypothetical vignettes, 152 parents of children 10–17 years old living in Chennai, India, made attributions about whether the origins of 2 positive and 2 negative behaviors performed by their own child or another child were due to the child's personality or the situation, or to parenting or nonparenting influences based on the frequency, intensity, and cross-situational consistency of the behavior. Parents attributed the positive behaviors of all children to the personality of the child and to parenting. Parents attributed negative behavior of their own children to situational influences and nonparenting effects, but attributed the negative behavior of other children to their personality and to parenting, a pattern that enhances and reinforces parent self-esteem. Results were discussed in terms of the self-serving bias and the actor–observer bias, cognitive distortions that protect and enhance parents’ views of themselves and their children.     

Exploration of Mechanisms behind Changes after Participation in a Parenting Intervention: A Qualitative Study in a Low‐Resource Setting

Parenting interventions are effective for preventing psychological difficulties in children. However, their active ingredients have not been comprehensively explored. How do they work? What are the mechanisms operating behind changes? In 2012, a randomized controlled trial of a parenting intervention was conducted in low‐resource communities of Panama. Effects on child behavioral difficulties, parental stress, and parenting practices were large in the short and long term. This was an ideal opportunity to explore potential mechanisms operating behind effects found in this low‐resource setting. Twenty‐five parents were interviewed. Data were analyzed through an inductive semantic thematic analysis. Three themes emerged from the data: (a) psychological mechanisms behind changes, (b) behavioral changes in parent, and (c) changes in the children. Parents described that the intervention triggered changes in emotion regulation, self‐efficacy, and problem solving. Parents also reported behavioral changes such as praising their children more often, who in turn seemed more responsible and better at following instructions. The study offers participant‐driven insight into potential pathways of change after participation in this parenting intervention, pathways that are often overlooked in quantitative studies. Future studies should further explore these pathways, through mediator and moderator analyses, and determine how much is shared across interventions and across different cultural settings.     

Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents' interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents' preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents' ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3-6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents' ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.     

Adaptation of parent-child interaction therapy for Puerto Rican families: a preliminary study

This study examines how parent-child interaction therapy (PCIT) was adapted for Puerto Rican parents of children aged 4-6 with hyperactivity and other significant behavior problems. Four steps were followed: (1) translation and preliminary adaptation of the treatment manual, (2) application of the treatment to 9 families as part of an exploratory study using repeated measures, (3) treatment revision and refinement, and (4) in-depth interviews with parents (n=15) and clinical psychologists (n=5) from Puerto Rico who provided feedback on treatment process and components. Throughout this process, cultural elements and modifications were recommended to be incorporated into the treatment protocol. Both quantitative and qualitative results suggest that PCIT seems to be an acceptable intervention for this population, with some minor changes. Parents reported a high level of satisfaction, a significant reduction in children's externalizing behavior problems, and reduction of parenting stress and improvement in their parenting practices. Psychologists also evaluated positively the treatment protocol and recommended its use. Results from this study may inform clinicians and researchers who work with Latino families about relevant issues to be considered to promote their participation in behavioral family interventions and to enhance their acceptability and effectiveness.