Sustained Effects of Incredible Years as a Preventive Intervention in Preschool Children with Conduct Problems

The present study evaluated preventive effects of the Incredible Years program for parents of preschool children who were at risk for a chronic pattern of conduct problems, in the Netherlands. In a matched control design, 72 parents of children with conduct problems received the Incredible Years program. These families (intervention group) were compared with 72 families who received care as usual (control group). Two years after termination of the intervention, it appeared that observed and selfrated parenting skills were significantly improved in the intervention group. Likewise, in this group, observed child conduct problems showed sustained intervention effects. The decrease in observed critical parenting mediated the decrease in observed child conduct problems over time. In addition, it appeared that parental influence increased over time.     

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.     

Effectiveness of Group Positive Parenting Program (Triple P) in Changing Child Behavior,Parenting Style,and Parental Adjustment: An Intervention Study in Japan

The purpose of this study is to investigate the effectiveness of a group-based family intervention program known as the Group Positive Parenting Program (Triple P), with families in Japan. Reductions in children’s behavioral problems, changes in dysfunctional parenting practices, and affects on parenting adjustment were examined. Participants of both the intervention and control groups (N = 91 and N = 24, respectively) were recruited from mothers visiting health clinics in Kawasaki City, Kanagawa. Intervention and control groups were assessed in terms of child behavior (Strength and Difficulty Questionnaire, SDQ), parenting style (Parenting Scale, PS), and parenting adjustment (Depression-Anxiety-Stress Scale, DASS; and Parenting Experience Survey, PES), both pre- and postintervention. A repeated measures multivariate analysis of variance was used to determine the intervention’s effects. The SDQ score for the conduct problems subscale indicated a significant intervention effect. In addition, the postintervention scores for all subscales of the PS, the DASS depression subscale and total scores, as well as ratings for perceived difficulty of parenting in the PES, were significantly reduced in the intervention group alone. The PES also revealed that confidence in parenting significantly increased only in the intervention group. Group Triple P is effective in decreasing child conduct problems, dysfunctional parenting practices, depression, anxiety, stress, and the perceived level of parenting difficulty, as well as in improving parenting confidence, among Japanese families.     

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.     

Treatment effectiveness of PMTO for children's behavior problems in Iceland: Assessing parenting practices in a randomized controlled trial

Findings are presented from an Icelandic randomized control trial (RCT) evaluating parent management training – Oregon model (PMTO?), a parent training intervention designed to improve parenting practices and reduce child behavior problems. In a prior report from this effectiveness study that focused on child outcomes, children in the PMTO condition showed greater reductions in reported child adjustment problems relative to the comparison group. The present report focuses on observed parenting practices as the targeted outcome, with risk by treatment moderators also tested. It was hypothesized that mothers assigned to the PMTO condition would show greater gains in pre‐post parenting practices relative to controls. The sample was recruited from five municipalities throughout Iceland and included 102 participating families of children with behavior problems. Cases were referred by community professionals and randomly assigned to either PMTO (n = 51) or community services usually offered (n = 51). Child age ranged from 5 to 12 years; 73% were boys. Contrary to expectations, findings showed no main effects for changes in maternal parenting. However, evaluation of risk by treatment moderators showed greater gains in parenting practices for mothers who increased in depressed mood within the PMTO group relative to their counterparts in the comparison group. This finding suggests that PMTO prevented the expected damaging effects of depression on maternal parenting. Failure to find hypothesized main effects may indicate that there were some unobserved factors regarding the measurement and a need to further adapt the global observational procedures to Icelandic culture.     

Early Parenting Intervention: Family Risk and First-time Parenting Related to Intervention Effectiveness

The effects of cumulative risk and parity on the effectiveness of a home based parenting intervention were tested in a randomized controlled trial with 237 families with 1- to 3-year-old children screened for high levels of externalizing behavior. The intervention was aimed at enhancing positive parenting and decreasing externalizing behaviors. The results showed that cumulative risk was not associated with either change in child externalizing behaviors or change in positive parenting. When intervention effectiveness was compared for primiparas (i.e., first-time mothers) versus multiparas (i.e., mothers with more than one child), we found that intervention mothers of first-born children displayed an increase in their use of positive discipline strategies as compared to first-time mothers in the control group, whereas a similar effect for multiparas was absent. Among multiparas we found an intervention effect on sensitivity, with control group mothers showing an increase in sensitivity, whereas the intervention group showed a constant level of sensitivity over time. These results suggest that parity may be a moderator of intervention effectiveness. Implications for investigating moderators of intervention effectiveness are discussed.     

A Randomized Controlled Trial of Group Stepping Stones Triple P: A Mixed‐Disability Trial

Stepping Stones Triple P (SSTP) is a parenting program designed for families of a child with a disability. The current study involved a randomized controlled trial of Group Stepping Stones Triple P (GSSTP) for a mixed‐disability group. Participants were 52 families of children diagnosed with an Autism Spectrum Disorder, Down syndrome, Cerebral Palsy, or an intellectual disability. The results demonstrated significant improvements in parent‐reported child behavior, parenting styles, parental satisfaction, and conflict about parenting. Results among participants were similar despite children's differing impairments. The intervention effect was maintained at 6‐month follow‐up. The results indicate that GSSTP is a promising intervention for a mixed‐disability group. Limitations of the study, along with areas for future research, are also discussed.     

Examining the Link Between Infant Attachment and Child Conduct Problems in Grade 1

Abtract  We examined the extent to which infant attachment status is directly related to child conduct problems 6 years later, and assessed the potential mediating roles of hostile parenting and maternal depression. The sample included 84 adolescent mothers and their children (45 girls, 39 boys). Infant attachment status was assessed using the Strange Situation when the study children were 1-year-old. Hostile parenting was coded during a parent–child interaction task when the study children were 4.5-years-old. Maternal depression was self-rated, also when the study children were 4.5-years-old, using the Beck Depression Inventory. Mothers reported child conduct problems at Grade 1 on the Child Behavior Checklist. Infant attachment status at 1 year of age was directly related to child conduct problems but not to hostile parenting or maternal depression. Neither hostile parenting nor maternal depression mediated the relationship between infant attachment status and child conduct problems. However, the pattern of relations differed by attachment security. For securely attached children, maternal depression, but not hostile parenting, was directly related to conduct problems. For insecurely attached children, hostile parenting, but not maternal depression, was directly related to child conduct problems. Implications for intervention and future research are discussed.     

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.     

Assessing Parenting Practices Through Parent-Report and Direct Observation During Parent-Training

The specific parenting domains measured by the Alabama Parenting Questionnaire (APQ) make it particularly relevant to interventions concerned with the modification of parenting practices. This study assessed the validity and clinical utility of parent reports on the APQ using observational data of parents and children (N=56, aged 4–8 years) participating in a parent training intervention for childhood conduct problems. Parent reports on the measure were found to converge well with observations of parents’ use of praise, and harsh/aversive parenting. APQ scores also reflected change in parenting practices across treatment, and were associated with clinical child outcomes. Comparisons of the five original APQ subscales with a three-factor empirically-derived form of the measure indicated greater support for the original subscales, which were found to be valid and clinically informative in the treatment of childhood conduct problems.     

Randomized Controlled Trial of a Family Intervention for Children Bullied by Peers

This study examined the effects of a family intervention on victimization and emotional distress of children bullied by peers. The intervention, Resilience Triple P, combined facilitative parenting and teaching children social and emotional skills relevant to developing strong peer relationships and addressing problems with peers. Facilitative parenting is parenting that supports the development of children’s peer relationship skills. A randomized controlled trial was conducted with 111 families who reported chronic bullying of children aged 6 to 12 years. Families were randomly allocated to either an immediate start to Resilience Triple P (RTP) or an assessment control (AC) condition. Assessments involving children, parents, teachers, and observational measures were conducted at 0 (pre), 3 (post) and 9 months follow-up. RTP families had significantly greater improvements than AC families on measures of victimization, child distress, child peer and family relationships, including teacher reports of overt victimization (d = 0.56), child internalizing feelings (d = 0.59), depressive symptoms (d = 0.56), child overt aggression towards peers (d = 0.51), acceptance by same sex and opposite sex peers (d = 0.46/ 0.60), and child liking school (d = 0.65). Families in both conditions showed significant improvements on most variables over time including child reports of bullying in the last week reducing to a near zero and indistinguishable from the normative sample. The intervention combining facilitative parenting and social and emotional skills training for children produced better results than the comparison assessment control condition. This study demonstrated that family interventions can reduce victimization and distress and strengthen school efforts to address bullying.     

Maternal-Related Predictors of Self-Regulation Among Low-Income Youth

The association between self-regulation and various adaptive outcomes has become a topic of growing interest to researchers. Yet, there is not much research on predictors of self-regulation in children. Using a cross-sectional design and an array of psychometrically sound scales and measures from multiple informants, this study examined whether maternal characteristics, namely maternal mental health, substance abuse, parenting practices, and child monitoring predicted self-regulation in children. Participants included a culturally diverse group of 155 youths (ages 8–17) and their mothers, all of whom were part of a larger investigation of low-income families in a mid-sized Northeastern city in the United States. Results showed that maternal substance abuse, parenting practices and parental monitoring independently predicted children’s self-regulation, accounting for 23% of the variance. Additional analyses indicated that parenting practices may partly mediate the effect of maternal mental health on children’s self-regulation. Implications for intervention and practice, especially those aimed to mitigate the detrimental effects of maternal mental health problems on children’s self-regulation, are discussed. Further research, both longitudinal and experimental, is warranted in order to extend this line of investigation.     

Changing Parent’s Mindfulness,Child Management Skills and Relationship Quality With Their Youth: Results From a Randomized Pilot Intervention Trial

We evaluated the efficacy of a mindful parenting program for changing parents’ mindfulness, child management practices, and relationships with their early adolescent youth and tested whether changes in parents’ mindfulness mediated changes in other domains. We conducted a pilot randomized trial with 65 families and tested an adapted version of the Strengthening Families Program: For Parent and Youth 10–14 that infused mindfulness principles and practices against the original program and a delayed intervention control group. Results of pre-post analyses of mother and youth-report data showed that the mindful parenting program generally demonstrated comparable effects to the original program on measures of child management practices and stronger effects on measures of mindful parenting and parent–youth relationship qualities. Moreover, mediation analyses indicated that the mindful parenting program operated indirectly on the quality of parent–youth relationships through changes in mindful parenting. Overall, the findings suggest that infusing mindful parenting activities into existing empirically validated parenting programs can enhance their effects on family risk and protection during the transition to adolescence.     

An evaluation of a behavioural parenting intervention for parents of gifted children

Parents of gifted children identify a need for tailored parenting support, and gifted children have unique requirements and vulnerabilities. The aim of this study was to assess the efficacy of a tailored behavioural parenting intervention, for enhancing the parenting skills of parents of gifted children and to assess the effect of these changes on the behavioural and emotional adjustment of their gifted child. A randomised controlled trial of tailored Group Triple P – Positive Parenting Program was conducted with 75 parents of children identified as gifted. Results indicated significant intervention effects for the number and frequency of parent reported child behaviour problems, as well as hyperactivity in the intervention group, relative to a waitlist control. Parents also reported significant improvements in their own parenting style, including less permissiveness, harshness, and verbosity when disciplining their child. No intervention effects were evident for teacher reports, except for a trend in relation to hyperactivity. This study demonstrated that a tailored behavioural parenting intervention is effective and acceptable for parents of gifted children, and thus has clinical implications for the delivery of parenting interventions for this population.     

Leveraging Healthcare to Promote Responsive Parenting: Impacts of the Video Interaction Project on Parenting Stress

We sought to determine impacts of a pediatric primary care intervention, the Video Interaction Project, on 3-year trajectories of parenting stress related to parent–child interactions in low socioeconomic status families. A randomized controlled trial was conducted, with random assignment to one of two interventions Video Interaction Project (VIP); Building Blocks or control. As part of VIP, dyads attended one-on-one sessions with an interventionist who facilitated interactions in play and shared reading through review of videotaped parent–child interactions made on primary care visit days; learning materials and parenting pamphlets were also provided to facilitate parent–child interactions at home. Parenting stress related to parent–child interactions was assessed for VIP and Control groups at 6, 14, 24, and 36 months using the Parent–Child Dysfunctional Interaction subscale of the Parenting Stress Index—Short Form, with 378 dyads (84 %) assessed at least once. Group differences emerged at 6 months with VIP associated with lower parenting stress at three of four ages considered cross-sectionally and an 17.7 % reduction in parenting stress overall during the study period based on multi-level modeling. No age by group interaction was observed, indicating persistence of early VIP impacts. Results indicated that VIP, a preventive intervention targeting parent–child interactions, is associated with decreased parenting stress. Results therefore support the expansion of pediatric interventions such as VIP as part of a broad public health strategy to address poverty-related disparities in school-readiness.     

Associations between Positive Parenting Practices and Child Externalizing Behavior in Underserved Latino Immigrant Families

This study examined whether five specific parenting practices (i.e., monitoring, discipline, skill encouragement, problem solving, and positive involvement) were associated with reduced child externalizing behaviors among a sample of Latino immigrant families. It utilized baseline data from 83 Latino couples with children participating in a larger randomized controlled trial of a culturally adapted parenting intervention. Results reveal that monitoring, discipline, skill encouragement, and problem solving each made independent contributions to the prediction of child externalizing behavior, although not all in the expected direction. Further analyses examining mothers and fathers separately suggest that mother‐reported monitoring and father‐reported discipline practices uniquely contributed to these findings. These results may have important implications for prevention and clinical intervention efforts with Latino immigrant families, including the cultural adaptation and implementation of parenting interventions with this underserved population.     

Stepping Stones Triple P: An RCT of a Parenting Program with Parents of a Child Diagnosed with an Autism Spectrum Disorder

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, Clinical Child and Family Psychology Review 2:71–90, 1999; Sanders, Journal of Consulting and Clinical Psychology 68:624–640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, Journal of Clinical Child and Adolescent Psychology, 35(2):180–193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.     

Understanding Parent Participation in a Going-to-Scale Implementation Trial of the Early Risers Conduct Problems Prevention Program

We examined parent participation in the context of a going-to-scale implementation trial of the evidence-based, multi-component Early Risers conduct problems prevention program. In this study we examine the participation of parents in two parent/family-focused components of Early Risers that were delivered over 2 years across 21 rural school sites with 155 primarily Caucasian families. One component is a standardized “Parent Skills” curriculum delivered at participating schools and the second component delivers “Family Support” via tailored case management services through school and non-school site contacts. The study examines predictors of parent participation for each parent-focused component using multilevel modeling analyses. Previous research is extended by examining parent participation within the context of a going-to-scale trial and by looking at a broader array of child/parent/family and implementation context predictors. Parent participation in Parent Skills is predicted by higher level of parent’s frustration in parent–child relationships, while their participation in Family Support is related to lower family income. Implementers with higher previous work experience with children/families and lower education levels, as well as those manifesting more extroverted and less agreeable personality characteristics, elicit more participation in Parent Skills. Greater participation in Family Support is also predicted by lower levels of implementer neuroticism. Finally, implementers who achieve higher quality of delivery fidelity have greater participation in Parent Skills and a lower level of adherence fidelity predicts more participation in Family Support. The results are discussed within the context of going-to-scale service provision and in terms of implications for future prevention efforts.     

Randomized prevention trial for early conduct problems: effects on proactive parenting and links to toddler disruptive behavior.

Despite knowledge of early pathways to conduct problems, few preventive interventions are specifically designed to modify disruptive behavior in toddlerhood. One potential prevention target is proactive and positive parenting, which is associated with reduced risk of conduct problems in preschoolers. This randomized trial with 120 low-income 2-year-old boys examined whether a brief family-centered intervention that reduces disruptive behavior (D. Shaw, T. Dishion, L. Supplee, F. Gardner, & K. Arnds, 2006) also leads to increases in proactive and positive parenting. It also explored whether change in parenting predicts change in disruptive behavior. In the intervention group, proactive and positive parenting skills increased among parents of 3-year-olds. Change in proactive and positive parenting of 2- to 3-year-old toddlers correlated with change in child disruptive behavior, although the mediation effect of positive parenting was of only borderline significance. Findings suggest that even within a brief and multifaceted preventive intervention, change in proactive parenting skills contributes modestly but significantly to change in child problem behavior.     

Responsiveness in Interactions of Mothers and Sons with ADHD: Relations to Maternal and Child Characteristics

We observed mother–child interactions, at baseline, in 136 families of 7–10-year-old boys with attention-deficit/hyperactivity disorder (ADHD) who were part of a large clinical trial, the Multimodal Treatment Study of Children with ADHD. Independent coders rated stylistic aspects of maternal behavior and factor analyses revealed a responsiveness factor that included overall responsiveness and sensitivity to the child, warmth and acceptance, and appropriate control. We examined relations between maternal responsiveness and (a) maternal depressive symptoms and maternal childhood ADHD symptoms, and (b) boys' ADHD and conduct problem symptoms. Controlling for all other variables, maternal responsiveness displayed a unique negative association with mother-reported child conduct problems, but not with child ADHD symptoms, and also was negatively related to maternal depressive symptoms. We discuss the unique association between mother-reported child conduct problems and parenting, and note the utility of studying parenting style in families of children with ADHD. We describe the results within the framework of a transactional model.