Brief Parenting Interventions for Children at Risk of Externalizing Behavior Problems: A Systematic Review

We systematically reviewed the evidence for the efficacy and effectiveness of brief parenting interventions, defined as <8 sessions in duration, in reducing child externalizing behaviors. While there is significant evidence to support the efficacy of parenting interventions of 8–12 sessions in duration, the public health benefit of these interventions is limited by low participation rates, high attrition rates and the lack of implementation by a wide range of practitioners. Brief parenting interventions have the potential to extend the reach and impact of parenting interventions and steer children away from a trajectory of life course persistent behavior problems. A search of four electronic databases was undertaken to identify RCTs conducted on brief parenting interventions. The primary outcome was child externalizing behaviors and secondary outcomes included parenting skills, parental self-efficacy, parental mental health and partner relationship functioning. The heterogeneity of included studies prevented a meta-analysis but characteristics of the studies were described. Nine papers summarising the results of eight studies with 836 families in five countries met inclusion criteria. All studies found significant improvements in parent-rated child externalizing behaviors, parenting skills and parenting self-efficacy, relative to control or comparison groups, with findings maintained at follow-up. Less consistent findings emerged for parental mental health and partner relationship functioning. This review provides initial evidence that brief parenting interventions may be sufficient to reduce child externalizing behavior problems for some families, however further research is needed.     

A Pilot Randomized Trial of an Online Parenting Skills Program for Pediatric Traumatic Brain Injury: Improvements in Parenting and Child Behavior

This pilot study examined changes in parenting skills and child behavior following participation in an online positive parenting skills program designed for young children with traumatic brain injury (TBI). Thirty-seven families with a child between 3 and 9 years of age who sustained a moderate to severe TBI were randomly assigned to one of two interventions: online parenting skills training (n = 20) or access to Internet resources on managing brain injury (n = 17). Parent–child interaction observations and parent ratings of child behavior were collected pre- and post-treatment. Generalized estimating equations and mixed models were used to examine changes in parenting skills and child behavior problems as well as the moderating role of family income on treatment response. Participants in the parenting skills group displayed significant improvements in observed positive parenting skills relative to participants in the Internet resource group. Income moderated improvements in parent ratings of child behavior, with participants in the low-income parenting skills group and high-income Internet resource group reporting the greatest improvements in behavior. This is the first randomized controlled trial examining online parenting skills training for families of young children with TBI. Improvements in positive parenting skills and child behavior support the utility of this intervention, particularly for families from lower socioeconomic backgrounds.     

Parenting as a Mechanism of Change in Psychosocial Treatment for Youth with ADHD,Predominantly Inattentive Presentation

We investigated whether parenting and child behavior improve following psychosocial treatment for Attention-Deficit/Hyperactivity Disorder, Predominantly Inattentive Presentation (ADHD-I) and whether parenting improvements mediate child outcomes. We analyzed data from a randomized clinical trial investigating the efficacy of a multicomponent psychosocial intervention (Child Life and Attention Skills, CLAS, n = 74) in comparison to Parent-Focused Treatment (PFT, n = 74) and treatment as usual (TAU, n = 51) for youth with ADHD-I (average child age = 8.6 years, range 7–11 years, 58 % boys). Child and parent/family functioning were assessed prior to treatment, immediately following treatment, and at follow-up into the subsequent school year using parent and teacher reports of inattention, organization, social skills, academic competency (teachers only), parenting daily hassles, and positive and negative parenting behaviors (parents only). Both treatment groups improved on negative parenting and home impairment, but only CLAS families also improved on positive parenting as well as academic impairment. Improvements in positive and negative parenting mediated treatment effects on child impairment independent of improvements in child inattention, implicating parenting as an important mechanism of change in psychosocial treatment for ADHD-I. Further, whereas parent-focused training produces improvements in negative parenting and impairment at home for children with ADHD-I, a multicomponent approach (incorporating child skills training and teacher consultation) more consistently produces improvements at school and in positive parenting, which may contribute to improvements in social skills into the next school year.     

Systematic Changes in Families Following Prevention Trials

A selective prevention design was applied to 238 recently separated families. Of these, 153 mothers randomly assigned to the experimental (E) group participated in 14 group sessions focused on Parent Management Treatment (PMT). Prior analyses showed that, over time, the group of families in the untreated group deteriorated in both parenting practices and in child outcomes. In keeping with the classic prevention pattern, families in the E group showed modest improvements in parenting and in child outcomes. Improvements in parenting were associated with significant reductions in problem behavior. The data showed that those mothers who improved their parenting skills during the first 12 months also showed significant reductions in maternal depression during that same interval. A cross-lagged panel analysis showed that a reduction in maternal depression during the first year of the study was a significant predictor of maintenance or improvements over the next 18 months. The findings are consistent with the concept of the family as a system.     

Parent training with high-risk immigrant chinese families: a pilot group randomized trial yielding practice-based evidence

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families. Parents were eligible for intervention if they were Chinese-speaking immigrants referred from schools, community clinics, or child protective services with concerns about parenting or child behavior problems. Retention and engagement were high with 83% of families attending 10 or more sessions. Results revealed that the treatment was efficacious in reducing negative discipline, increasing positive parenting, and decreasing child externalizing and internalizing problems. Treatment effects were larger among families with higher levels of baseline behavior problems and lower levels of parenting stress. Further augmentation of PT to address immigrant parent stress may be warranted. Qualitative impressions from group leaders suggested that slower pacing and increased rehearsal of skills may improve efficacy for immigrant parents unfamiliar with skills introduced in PT.     

African American Single Mothers and Children in Context: A Review of Studies on Risk and Resilience

This paper presents a comprehensive review of research linking single-parent family structure to parenting processes, maternal well-being, and child developmental outcomes among African Americans. The approaches used to study these families, related methodological and conceptual concerns, and the factors linked to maternal well-being, effective parenting processes, family functioning, and child outcomes are addressed. Much work remains to be done on conceptualizing and assessing parenting processes among African Americans in general and single African American mothers in particular. Researchers must examine more carefully the circumstances that foster or impede successful parenting among these mothers. Studies also are needed to disentangle the interactions between economic stress and parenting behavior and to determine the extent to which the findings can be applied to middle-income single African American parents.     

Program for the Education and Enrichment of Relational Skills: Parental Outcomes With an ADHD Sample

The goal of the current study was to examine the effect of the Program for the Education and Enrichment of Relational Skills (PEERS®), a 14-week parent-assisted friendship-building program for adolescents with ADHD, on parental functioning, quality of the parent-adolescent relationship, and family functioning. Participants included 25 parents of adolescents with ADHD. Families completed PEERS®. Measures of parenting stress, parental efficacy, parent-adolescent communication, parent-adolescent involvement, causal attributions for negative social interactions, and family chaos were completed by parents at pre- and post-treatment. Parents demonstrated statistically significant improvements in parenting stress and parent-adolescent communication and marginally statistically significant improvement in parental efficacy. Parents also demonstrated reliable change in parenting stress, parent-adolescent communication, parent-adolescent involvement, and family chaos. Overall, these findings demonstrate the benefit of PEERS® at improving parental functioning, quality of the parent-adolescent relationship, and family functioning for families of adolescents with ADHD.     

Role of maternal functioning and parenting skills in adolescent functioning following parental divorce

While divorce has been associated with impaired child functioning, the mechanisms within the divorce process leading to such an outcome have rarely been examined. The following hypothesis was examined: Divorce is associated with poor parental adjustment or disrupts parenting behavior, or both, which leads to poor adolescent functioning. Subjects were 121 and 93 young adolescents from intact and recently divorced families, respectively, and their mothers and teachers. Mothers completed measures assessing parental conflict and depression, observers coded parenting skills during a mother-adolescent interaction, and teachers completed measures assessing adolescent functioning. Although the magnitude of differences was not large, analyses of variance indicated that the divorced sample was functioning poorer than the married sample on all measures except interparental conflict. Path analysis suggested that parental functioning and parenting skills play a role in adolescent functioning following divorce.     

The Integration of a Family Systems Approach for Understanding Youth Obesity,Physical Activity,and Dietary Programs

Rates of overweight in youth have reached epidemic proportions and are associated with adverse health outcomes. Family-based programs have been widely used to treat overweight in youth. However, few programs incorporate a theoretical framework for studying a family systems approach in relation to youth health behavior change. Therefore, this review provides a family systems theory framework for evaluating family-level variables in weight loss, physical activity, and dietary approaches in youth. Studies were reviewed and effect sizes were calculated for interventions that manipulated the family system, including components that targeted parenting styles, parenting skills, or family functioning, or which had novel approaches for including the family. Twenty-one weight loss interventions were identified, and 25 interventions related to physical activity and/or diet were identified. Overall, family-based treatment programs that incorporated training for authoritative parenting styles, parenting skills, or child management, and family functioning had positive effects on youth weight loss. Programs to improve physical activity and dietary behaviors that targeted the family system also demonstrated improvements in youth health behaviors; however, direct effects of parent-targeted programming is not clear. Both treatment and prevention programs would benefit from evaluating family functioning and parenting styles as possible mediators of intervention outcomes. Recommendations are provided to guide the development of future family-based obesity prevention and treatment programs for youth.     

Impact of a Kentucky Maternal, Infant, and Early Childhood Home-Visitation Program on Parental Risk Factors

As public health organizations continue to implement maternal and child health home-visitation programs, more evaluation of these efforts is needed, particularly as it relates to improving parental behaviors. The purpose of our study was to assess the impact of families’ participation in a home-visitation program offered by a central Kentucky health department on parental risk factors. A family social worker or nurse interviewed parents pre-intervention, completing a Parent Survey which assessed multiple parental risk factors associated with negative health and well-being and to calculate a total risk score. Upon exiting the program, parents are re-interviewed to document improvements, review progress and accomplished goals, plan for transitional services, and calculate a new risk score. As of December 2010, 64 families had completed the home-visitation program and had pre- and post-risk scores available for analysis. Based on paired-sample t tests, there was a statistically significant difference in total mean risk scores among both mothers and fathers from pre to post. The McNemar–Bowker test also revealed statistically different scores for four of the six risk factors for mothers and fathers pre- and post-home-visitation: lifestyle behaviors and mental health, coping skills and support systems, stresses, and anger management skills. Findings suggest that families who were deemed at-risk for adverse pregnancy and child health outcomes benefit from participation in the home-visitation program. Programs designed to promote positive pregnancy outcomes and child development may benefit from providing social support, fostering parental knowledge, skill development and problem solving, insuring proper medical care, and connecting parents with community resources.     

Coalitions and Family Problem Solving with Preadolescents in Referred,At-Risk,and Comparison Families

This study tested the hypothesis that the mother-father coalition, parent-child coalitions, and parental warmth expressed toward the child are associated with family problem solving in families with a preadolescent child referred for treatment of behavior problems (n = 30 ), families with a child at-risk for conduct disorder (n = 68 ), and a sample of comparison families (n = 90 ). Referred and at-risk families displayed less effective problem solving. A regression analysis, which controlled for gender of the child, family structure, family income, marital satisfaction, and severity of child problems, showed that strong parental coalitions were linked to low levels of family problem solving in at-risk and referred families. Parent-child coalitions had little apparent impact while parental warmth was highly correlated with better family problem solving. The results may be interpreted as evidence for a tendency for parents in at-risk and referred families to “scapegoat” a preadolescent during family problem-solving sessions. This may undermine progress on family problem solutions and may complicate family-based prevention and treatment programs that use family problem-solving sessions.     

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.     

The contribution of parenting practices in a risk and resiliency model of children's adjustment

A risk and resiliency model of children's adjustment was evaluated, with a focus on the relationship of parenting practices to risk and protective factors. Risk factors included family stress, family conflict, parent psychopathology and low socio‐economic status. Protective factors included family cohesion, family social support and family moral– religious orientation. The research hypothesis was that parenting practices would have a direct effect on child outcomes, as well as a moderating effect on the relationship between risk and protective factors and child outcomes. Three different outcomes were utilized: disruptive behaviour disorders, adaptive emotional functioning and school achievement. Participants were 80 children aged 6–12 years and their mothers. Hierarchical regression analyses suggested that the combination of family risk and protection and parenting practices was highly predictive of child functioning for both disruptive externalizing behaviours and positive emotional adaptation. It was found that negative family factors were more highly associated with negative child outcomes, whereas positive family factors were more highly associated with positive child outcomes. Family risk factors and poor parenting primarily accounted for the variance in externalizing child behaviours. Alternately, family protective factors and positive parenting primarily accounted for the variance in child adaptive behaviours. Parenting practices had a direct effect on child outcomes, but was not a strong moderator of the relationship between risk and protection factors and child outcomes.     

Protective Factors for Depression Among African American Children of Predominantly Low-Income Mothers with Depression

Maternal depression has a deleterious impact on child psychological outcomes, including depression symptoms. However, there is limited research on the protective factors for these children and even less for African Americans. The purpose of the study is to examine the effects of positive parenting skills on child depression and the potential protective effects of social skills and kinship support among African American children whose mothers are depressed and low-income. African American mothers (n = 77) with a past year diagnosis of a depressive disorder and one of their children (ages 8–14) completed self-report measures of positive parenting skills, social skills, kinship support, and depression in a cross-sectional design. Regression analyses demonstrated that there was a significant interaction effect of positive parenting skills and child social skills on child depression symptoms. Specifically, parent report of child social skills was negatively associated with child depression symptoms for children exposed to poorer parenting skills; however, this association was not significant for children exposed to more positive and involved parenting. Kinship support did not show a moderating effect, although greater maternal depression severity was correlated with more child-reported kinship support. The study findings have implications for developing interventions for families with maternal depression. In particular, parenting and child social skills are potential areas for intervention to prevent depression among African American youth.     

Developing the couple perspective in parenting support: evaluation of a service initiative for vulnerable families

The importance of the relationship between parents is frequently underestimated by those designing and developing services to support parents in bringing up their children. Instead, the primary focus of recent family support initiatives in the United Kingdom has been on improving parenting skills. This article describes the outcomes of a project designed to maximize the effectiveness of parenting support to vulnerable families through sensitizing the workforce of a community‐based adult mental health agency to take account of the parental couple in providing postnatal support groups, parenting workshops and relationship counselling. Evaluating outcomes from these services suggests that a couple orientation adds significant value to the effectiveness of parenting support.     

Cultural differences in the relationship between parenting and children's behavior

Parent and teacher data for 14,990 children from the National Longitudinal Survey of Children and Youth were used in multilevel analyses to examine the relationship between ethnicity, children's aggression and emotional problems, and parenting. Using parent and teacher report, relationships between ethnicity and child behavior were present but modest. The association between parental harshness and child aggression differed between ethnic groups and across informants. Using teacher report of outcomes, parental harshness was positively related to child aggression in European Canadian families but negatively related in South Asian Canadian families. For all ethnic groups, parental harshness was positively related to children's aggression when parent report of outcomes was used, but relationships varied in strength across ethnic groups. The relationship of parental harshness with child emotional problems did not differ across groups, irrespective of informant. The results are discussed within the context of an ecological model of parenting.     

Long-term effects from a randomized trial of two public health preventive interventions for parental depression.

This article presents long-term effects of a randomized trial evaluating 2 standardized, manual-based prevention strategies for families with parental mood disorder: informational lectures and a brief, clinician-based approach including child assessment and a family meeting. A sample of 105 families, in which at least 1 parent suffered from a mood disorder and at least 1 nondepressed child was within the 8- to 15-year age range, was recruited. Parents and children were assessed separately at baseline and every 9 to 12 months thereafter on behavioral functioning, psychopathology, and response to intervention. Both interventions produced sustained effects through the 6th assessment point, approximately 4.5 years after enrollment, with relatively small sample loss of families (<14%). Clinician-based families had significantly more gains in parental child-related behaviors and attitudes and in child-reported understanding of parental disorder. Child and parent family functioning increased for both groups and internalizing symptoms decreased for both groups, with no significant group differences. These findings demonstrate that brief, family-centered preventive interventions for parental depression may contribute to long-term, sustained improvements in family functioning.     

PARENTAL CHILDHOOD ADVERSITY,DEPRESSIVE SYMPTOMS,AND PARENTING QUALITY: EFFECTS ON TODDLER SELF‐REGULATION IN CHILD WELFARE SERVICES INVOLVED FAMILIES

Parents who are involved with child welfare services (CWSI) often have a history of childhood adversity and depressive symptoms. Both affect parenting quality, which in turn influences child adaptive functioning. We tested a model of the relations between parental depression and child regulatory outcomes first proposed by K. Lyons‐Ruth, R. Wolfe, A. Lyubchik, and R. Steingard (2002). We hypothesized that both parental depression and parenting quality mediate the effects of parental early adversity on offspring regulatory outcomes. Participants were 123 CWSI parents and their toddlers assessed three times over a period of 6 months. At Time 1, parents reported on their childhood adversity and current depressive symptoms. At Time 2, parents’ sensitivity to their child's distress and nondistress cues was rated from a videotaped teaching task. At Time 3, observers rated children's emotional regulation, orientation/engagement, and secure base behavior. The results of a path model partly supported the hypotheses. Parent childhood adversity was associated with current depressive symptoms, which in turn related to parent sensitivity to child distress, but not nondistress. Sensitivity to distress also predicted secure base behavior. Depression directly predicted orientation/engagement, also predicted by sensitivity to nondistress. Sensitivity to distress predicted emotion regulation and orientation/engagement. Results are discussed in terms of intervention approaches for CWSI families.     

Very Young Child Well-being in Military Families: A Snapshot

Since the September 11th attacks on the U.S., more than 2 million children have experienced parental deployment during their early years, with potentially lasting impact. When a parent is deployed, a number of factors may affect the well-being of the service member and his/her family. One parental factor—posttraumatic stress disorder or distress—might be particularly powerful in its effect on young children and the family system. We analyzed baseline data from an intervention development project which focused on supporting military families with very young children during post-deployment. The purpose of this research is to understand the relationships between parental mental health status, parenting stress, couple functioning, and young child well-being. The effects of mental health status of home-front and service member parents and the role of couple functioning on parent–child interactions and behavioral problems of young children were examined in a sample of military families during the post-deployment period. Findings suggest that service member posttraumatic stress symptoms are associated with higher parental report of child behavior problems. Higher quality of the couple relationship appears to lessen the impact of parental posttraumatic stress but is not related to parent perceptions of child behavior concerns. Implications for future research with military families are discussed.