The Impact of Parent Empowerment in Children’s Mental Health Services on Parenting Stress

Emotional and behavioral (EB) problems in children are associated with increased perceptions of strain in parenting. Among children receiving services, parenting stress has been linked to initiating services for their children, and may strain the relationship between parent and child. In contrast, parental engagement and empowerment in services is an important quality indicator for positive treatment outcomes. However, no known studies have examined the association between parent empowerment in their child’s services and their perceptions of stress related to parenting a child with significant mental health needs. Further, no studies have explored whether empowerment moderates the relationship between the child’s symptoms and parental perceptions of stress. The current study examined the impact of child EB problems and parent empowerment on parenting stress. Among a sample of 525 parents of children receiving school-based services for disruptive behavior disorders, child EB problems significantly predicted parenting stress. Parent empowerment also correlated with lower parenting stress, as hypothesized. Although parent empowerment was not found to moderate the relationship between child symptomatology and parenting stress, the relationship between parent empowerment and parenting stress differed based on child gender and age. Parent empowerment was associated with lower parenting stress more for parents of females and younger children than for parents of males and older children.     

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.     

The Effect of Behavioral Family Intervention on Knowledge of Effective Parenting Strategies

There is a paucity of research considering the effect of behavioral family intervention (BFI) on parenting knowledge and the relative importance of both knowledge and parent confidence in reducing parenting dysfunction and problematic child behavior is unclear. In this study ninety-one parents (44 mothers, 47 fathers) of children aged 2–10?years completed an evidence-based BFI and were assessed at pre and post-intervention on knowledge of effective parenting strategies, parenting confidence, parent dysfunction, and reported intensity of externalised child behavior. Results showed that at pre-intervention parents higher in education (N?=?57) demonstrated greater knowledge than those lower in education (N?=?34). Relative to baseline, parents in both groups significantly improved their knowledge and confidence, reduced their dysfunction and reported less externalised child behavior. Effect sizes for the latter two variables were similar for both groups, however for parents higher in education the effect for confidence was larger than knowledge. Change in level of dysfunction explained the largest amount of unique variance in change to externalised child behavior. Results suggest that for optimal outcomes for parenting and child behavior management more knowledgeable parents may benefit from interventions that focus on practice and consolidation of already learned skills in order to increase confidence whereas for less knowledgeable parents the teaching of new skills and strategies, alongside increasing confidence, are important.     

Therapist Factors Matter: A Systematic Review of Parent Interventions Directed at Children’s Behavior Problems

The present review systematically explored research examining the relationship between therapist‐related factors and the outcomes of parent interventions directed at children’s behavior problems. A systematic search of the literature was conducted with online scientific databases, parenting programs, web sites, and bibliographic references of the selected articles, according to PRISMA guidelines. A total of 24 quantitative studies met the inclusion criteria. Although some methodological limitations were identified with respect to the measurement of therapist factors, the reviewed research strongly suggests that the therapist plays a critical role in parent interventions directed at behavior problems. In particular, many parent outcomes are found to be related to the parent–therapist alliance, the therapist’s fidelity to the intervention, specific therapist’s in‐session actions, and the therapist’s personal variables. The parent–therapist alliance and therapist fidelity to the intervention consistently relate to changes in parenting practices, and alliance additionally relates to fewer perceived barriers to participation in treatment, more treatment acceptability, and greater parenting satisfaction and self‐efficacy. In addition, specific in‐session therapist interpersonal actions relate to parents’ engagement and satisfaction, while both the therapist’s interpersonal actions and more active skills relate to parent change. Therapist’s personal variables have been scarcely or poorly studied to date, but the results found justify the need to develop further research in this area. In conclusion, more attention should be given to the role of the therapist when implementing parenting programs directed at behavior problems, and more and better research is needed that can overcome the methodological limitations identified.     

Father participation in behavioral parent training for ADHD: review and recommendations for increasing inclusion and engagement.

Research on parenting has generally focused on mothers, with fathers' parenting approaches and interventions for fathers being relatively less studied. To investigate the involvement of fathers in behavioral parent training (BPT), the literature on BPT for attention-deficit/hyperactivity disorder (ADHD) was reviewed. A systematic review of this literature (N = 32) indicated that the majority of research studies are composed of mothers as participants in treatment and raters of outcome (87% of reviewed studies did not include information on father-related outcomes). Present barriers to father participation in BPT (e.g., content of classes, characteristics of fathers) are discussed. Strategies for increasing father participation are offered and include establishing the expectation that fathers will be involved in treatment at initial clinical contacts, collecting treatment-related information from both parents, conducting BPT classes that focus on issues of direct relevance to fathers, and integrating parent-child interactions in recreational settings into BPT programs.     

Self-Reported Parenting of Clinic-Referred and Non-referred Mexican American Mothers of Young Children

Behavioral parent training (BPT) interventions for child behavior problems have been based on decades of research that demonstrate links between particular parent behaviors and child externalizing problems. However, the majority of this research has been conducted with European-American (EA) families, and less is known about whether these findings can be generalized to Mexican Americans (MAs). In the current study, we investigated self-reported parenting practices that have been associated with externalizing behavior problems among EA families (harsh parenting, inconsistency, and low parental warmth), to determine if those practices can also differentiate MA mothers whose young children have clinically significant behavior problems from MA mothers whose children do not have behavior problems. Participants were 115 MA families with young children, 58 with a child with clinically significant behavior problems and 57 with a child in the normal range for such problems. Results indicated that MA mothers whose children have behavior problems self-reported significantly less warmth and consistency and more harsh parenting compared to parents whose children’s behavior was in the normal range. These findings indicate that parenting behaviors that are associated with externalizing behavior problems among EA families are associated with the same problems among MA families with young children, suggesting that parent training interventions designed to target these behaviors are also likely to be relevant to MA families with children in this age range. However, findings also indicate that parenting behaviors differ depending on acculturation level, suggesting that BPT programs must respond to variation in normative parenting practices for MA families.     

How Couple- and Parenting-Focused Programs Affect Child Behavioral Problems: A Randomized Controlled Trial

The significance of enhancing parenting skills to reduce child maladjustment is well-established and supports the important role of evidence-based parenting programs. However, the notion that parenting should be the exclusive focus for enhancing child behavior is necessarily limiting. Evidence is growing that relationship-oriented treatments may be another powerful approach to improve child adjustment, albeit the underlying effects in couple- versus parenting-focused programs have been subject to limited study. The aim of this RCT was to compare the treatment effects of (1) a couple-focused program (the Couples Coping Enhancement Training) to (2) a parenting training (Triple P) and (3) a control group on children’s behavioral problems in 150 couples. The parents’ perceptions of relationship quality, parenting behavior, and child’s behavioral problems were assessed by means of questionnaires completed prior to and 2 weeks after the end of the treatment. Multi-group path analyses revealed that in mothers’ perception the couple-focused program reduced child behavioral problems by enhancing the relationship quality whereas improved parenting mediated the benefits in the parenting training. In fathers’ evaluations the couple-focused program reduced dysfunctional parenting which largely accounted for the benefits in child adjustment. The dearth of research on child outcomes in couple-focused intervention studies is a striking gap that should be overcome. It is a promising field because of its evident potential to foster the health of many children.     

The link between child temperament and low-income mothers’ and fathers’ parenting

Numerous studies have shown that children's temperamental characteristics impact the quality and quantity of parent–child interactions. However, these studies have largely focused on middle-class samples, have not compared multiple domains of parenting across mothers and fathers, and have not considered the possibility of nonlinear associations between temperament and parenting. The present study addresses these gaps by examining the potentially nonlinear role of two temperamental characteristics—negative emotionality and sociability—in predicting the quality and quantity of low-income mothers’ and fathers’ parenting. Data were drawn from the Early Head Start Research and Evaluation Project, a study of low-income children and families. Results indicated that whereas parenting quality was somewhat impaired when children were temperamentally vulnerable (low sociability, high negativity), parents increased parenting quantity with the same vulnerable children. There was some evidence that parents were most reactive to children who scored either very high or very low on negative emotionality and sociability in both parenting domains. Patterns also suggest that mothers were more reactive to sociability, and fathers to negative emotionality.     

Do Parents Benefit From Help When Completing a Self-Guided Parenting Program Online? A Randomized Controlled Trial Comparing Triple P Online With and Without Telephone Support

In response to recent increases in the dissemination of Web-based parenting supports, an important consideration is whether the core benefits of self-directed participation in online parenting interventions are counterbalanced by issues such as high dropout and noncompletion rates commonly reported within the Internet intervention literature. This study outlines a randomized controlled trial of Triple P Online, a Web-based variant of the Triple P—Positive Parenting Program, delivered with varied levels of support scaffolding. Participants were 183 parents of children between 1 and 8 years of age with concerns about their child’s behavior and at least one area of disadvantage or family difficulty. Participants were randomized to self-directed Triple P Online, telephone-supported Triple P Online, or a wait-list control. Primary outcomes measured at baseline, postintervention, and 5-month follow-up were negative parenting styles and child behavior problems. Secondary outcomes included parent confidence, anger, and adjustment; relationship quality; program engagement; and parent satisfaction. Self-directed participants showed short-term treatment effects, including reductions in overall negative parenting and frequency of child behavior problems, while practitioner support led to greater improvements in negative parenting and intensity of difficult child behaviors. Participants in the supported condition were also more likely to complete modules and reported greater program satisfaction. At follow-up, 50% of outcomes for the self-directed condition were significantly better than the control, while 94% of outcomes were significantly better than the control in the practitioner-supported condition. Although self-directed online approaches to parenting intervention are promising, this research highlights how minimal support can improve effective engagement and enhance outcomes for families.     

A Confidant Support and Problem Solving Model of Divorced Fathers’ Parenting

This study tested a hypothesized social interaction learning (SIL) model of confidant support and paternal parenting. The latent growth curve analysis employed 230 recently divorced fathers, of which 177 enrolled support confidants, to test confidant support as a predictor of problem solving outcomes and problem solving outcomes as predictors of change in fathers’ parenting. Fathers’ parenting was hypothesized to predict growth in child behavior. Observational measures of support behaviors and problem solving outcomes were obtained from structured discussions of personal and parenting issues faced by the fathers. Findings replicated and extended prior cross‐sectional studies with divorced mothers and their confidants. Confidant support predicted better problem solving outcomes, problem solving predicted more effective parenting, and parenting in turn predicted growth in children's reduced total problem behavior T scores over 18 months. Supporting a homophily perspective, fathers’ antisociality was associated with confidant antisociality but only fathers’ antisociality influenced the support process model. Intervention implications are discussed regarding SIL parent training and social support.     

Parenting Stress through the Lens of Different Clinical Groups: a Systematic Review & Meta-Analysis

Research has demonstrated an association between parenting stress and child behavior problems, and suggested levels of parenting stress are higher among parents of children at risk for behavior problems, such as those with autism and developmental delay (ASD/DD). The goal of the present study was to conduct a systematic review of parenting stress and child behavior problems among different clinical groups (i.e., ASD/DD, chronic illness, with or at-risk for behavioral and/or mood disorders). We also examined demographic and methodological variables as moderators and differences in overall levels of parenting stress between the clinical groups. This systematic review documents a link between parenting stress and child behavior problems with an emphasis on externalizing behavior. One-hundred thirty-three studies were included for quantitative analysis. Parenting stress was more strongly related to child externalizing (weighted ES r = 0.57, d = 1.39) than internalizing (weighted ES r = 0.37, d = 0.79) problems. Moderation analyses indicated that the association between parenting stress and behavior problems was stronger among studies which had mostly male and clinic-recruited samples. Overall, parenting stress levels were higher for parents of children with ASD/DD compared to parents of children from other clinical groups. Findings document the association between parenting stress and child behavior problems and highlight the importance of assessing parenting stress as part of routine care and throughout behavioral intervention programs, especially for groups of children at high risk for behavior problems, such as children with ASD/DD, in order to identify support for both the parent(s) and child.     

More than Just the Breadwinner: The Effects of Fathers' Parenting Stress on Children's Language and Cognitive Development

Despite numerous studies on parenting stress suggesting negative influences on parent–child interactions and children's development, the majority of these studies focus on mothers' parenting stress with little or no acknowledgement of fathers. Using data from the National Early Head Start Research and Evaluation Project, this study examined (i) the effects of fathers' parenting stress during toddlerhood on children's language and cognitive outcomes when children are 3 years old (ii) whether the effects of fathers' parenting stress on children's language and cognitive development vary by child gender? Results from mixed linear models showed fathers' parenting stress predicted children's lower cognitive scores, but there were no gender differences in the effects of fathers' parenting stress on children's cognitive outcomes. In the language domain, boys, not girls, were found to be more susceptible to the effects of fathers' parenting stress. These findings indicated that fathers, in addition to mothers, should be included in early parenting research and interventions. Copyright © 2016 John Wiley & Sons, Ltd.     

Attention-Deficit/Hyperactivity Disorder Symptoms in Mothers and Fathers: Family Level Interactions in Relation to Parenting

Previous studies linking parent ADHD symptoms to parenting have typically focused on each parent individually. To provide a broader understanding of family context, in this study, levels of inattention and hyperactivity-impulsivity in mothers and fathers were examined, both individually and in combination, in relation to negative parenting and child-rearing disagreements. Two-parent families of 5 to 13 year old boys (126 with ADHD and 53 typically developing) participated. Parents reported their own ADHD symptoms and their perceptions of child-rearing disagreements. Parenting was measured using self-, partner-, and child-reports as well as observations. Controlling for child ADHD symptoms, inattention symptoms in fathers predicted parenting difficulties. For mothers, inattention symptoms were linked to parenting problems only when fathers also had high levels of inattention. In contrast, parenting was most problematic for both mothers and fathers in families in which fathers had higher and mothers had lower levels hyperactivity-impulsivity symptoms. These results remained essentially unchanged when child externalizing behavior and mother depression and hostility were controlled, but father depression reduced the significance of some interactions. The results highlight the importance of the match between father and mother levels of symptoms, and point to differential relations of parenting to inattention and hyperactivity-impulsivity symptoms in parents.     

Development and initial validation of the comprehensive early childhood parenting questionnaire (CECPAQ) for parents of 1–4 year-olds

Parenting is a multifaceted task and the way in which parents fulfill this task plays an important role in children’s growth and development, especially in early childhood. Conceptualization and assessment of parenting behavior is elementary for research on child and family development and would fill a gap in clinical work, as there is a lack of questionnaires simultaneously assessing multiple parenting behaviors specific for early childhood. Therefore the Comprehensive Early Childhood Parenting Questionnaire (CECPAQ) was designed; a parent report measure of commonly occurring behaviors in five domains of parenting (i.e., support, stimulation, structure, harsh discipline, and positive discipline) central to early childhood. Data were collected from 1139 mothers and 526 fathers of 1–4 year-old children. Confirmatory factor analysis confirmed a five-factor structure (composed of 54 items). The five parenting domains were found to have good internal consistency and temporal stability. Preliminary evidence of validity of the CECPAQ was demonstrated by moderate relationships with measures of parental stress and child problem behavior. It is concluded that the CECPAQ is a promising measure of self-perceived parenting behavior for parents of 1–4 year-old children.     

Facilitated Parent-child Groups as Family Support: A Systematic Literature Review of Supported Playgroup Studies

Supported playgroups are community-based services that provide low intensity family support, through regular group sessions for parents and their young children. Led by a playgroup facilitator, the program aims to enrich children’s early learning, enhance positive parenting behaviors, provide social connections for parents, and enable access to other community services. Despite high community acceptance and government investment, little is known about the extent to which such services are effective. This paper reports findings from a systematic review of research on supported playgroups and their effectiveness to improve child, parent, and community outcomes. Thirty-four studies were included, of which 28 were conducted in Australia. Programs targeted a diverse range of families who were considered socially disadvantaged. Seven studies employed experimental or quasi-experimental designs from which reliable evidence for effectiveness could be established. A high proportion of studies were qualitative and included action research, case studies, or ethnographies. A range of qualitative and quantitative measures were used to assess child, parent, and community outcomes. While findings suggested that supported playgroup programs were highly valued by parents and other stakeholders, rigorous evidence of effectiveness for achieving desired improvements in child outcomes or parenting behavior was rare and limited by low quality study designs. More explicit theories of change about how different types of supported playgroup programs can meet diverse family needs are required. Such theories of change would provide directions for specific content and delivery approaches that could address and improve different child and parent outcomes targeted to specific populations of attending families.     

A cost-effectiveness evaluation of parent training

Outcomes from a parenting program that was modified to reduce costs and a wait-list control condition were compared. Costs were reduced by over 50%. Sixty-six parents participated. Treatment parents reported significantly greater improvements in child behavior problems, parent attitudes, and satisfaction with family relationships when compared to untreated controls. These effects were maintained at three months follow-up. Outcomes for 35 of the children in the sample who had clinically significant behavior problems before treatment were also examined separately. The difference between clinical recovery rates, i.e., movement from the clinical to normal range during treatment, for control and treatment children was not statistically significant. Limitations of the current study and suggestions for future 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.     

Postpartum Depression in Mothers and Fathers: The Role of Parenting Efficacy Expectations During the Transition to Parenthood

Research demonstrates that belief in one’s effectiveness as a parent (parenting efficacy) is linked to numerous positive outcomes for new parents. Conversely, the perceived inability to meet expectations is associated with negative mental health consequences for mothers and fathers. In the present paper we examine the impact of parenting efficacy expectations on the mental health statuses of new parents. Using three waves of data spanning from the prenatal period to the 4-months postpartum period from a sample of 150 first-time mothers and fathers in the Midwestern United States, we find that parenting efficacy is negatively associated with postpartum depression (PPD) for both mothers and fathers throughout the transition period. We also find that mothers and fathers whose parenting efficacy experiences were more negative than expected reported higher levels of PPD at 1-month postpartum. This effect dissipates for mothers, but not fathers, by 4-months postpartum, suggesting differences in the experiences of mothers and fathers during this transition. We conclude that research on the transition to parenthood should continue to include fathers in an effort to better understand the mental health consequences of becoming a parent for the first time, as well as enhance interventions designed to assist couples experiencing this important transition.     

An Effectiveness Open Trial of Internet-Delivered Parent Training for Young Children With Conduct Problems Living in Regional and Rural Australia

There is accumulating evidence for the efficacy of online parent management training (PMT) programs to improve conduct problems in young children, and findings have been used to support the potential of online programs to close the research-to-practice gap in underserved rural settings. However, to date, no study has evaluated the effectiveness of online PMT under real-world conditions; that is, delivered by community practitioners as part of services-as-usual to families residing in rural communities. This has resulted in a critical lack of evidence supporting the capacity of online PMT to ameliorate actual geographical disparities in service accessibility. Accordingly, the current study evaluated effectiveness and engagement outcomes of Internet-delivered Parent-Child Interaction Therapy (I-PCIT) delivered from a community-based early childhood clinic to rural consumers. Participants were 27 mothers and their 1.5- to 4-year-old child with conduct problems (M age = 3.02, SD = 0.73) living in regional and rural New South Wales, Australia. Parent-rated and observed child conduct problems and observed parenting behaviors were assessed pre and post I-PCIT, and treatment attrition, parental satisfaction with treatment, and homework compliance provided indicators of treatment engagement. Results of linear mixed and marginal models indicated that I-PCIT produced significant improvements in parent-reported and observed child conduct problems and observed parenting behaviors, with “small” to “very large” effect sizes (ds = 0.3-1.4). Treatment retention was adequate (63%), and treatment-completing parents reported high treatment satisfaction and good homework compliance. Findings provide preliminary evidence for the real world effectiveness of I-PCIT, supporting its capacity to narrow the research-to-practice gap. Findings suggest a role for I-PCIT in a stepped care model of remote treatment for childhood conduct problems in Australia.