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Are self-directed parenting interventions sufficient for externalising behaviour problems in childhood? A systematic review and meta-analysis

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Abstract

Externalising behaviour in childhood is a prevalent problem in the field of child and adolescent mental health. Parenting interventions are widely accepted as efficacious treatment options for reducing externalising behaviour, yet practical and psychological barriers limit their accessibility. This review aims to establish the evidence base of self-directed (SD) parenting interventions for externalising behaviour problems. Electronic searches of PubMed, Web of Knowledge, Psychinfo, Embase and CENTRAL databases and manual searches of reference lists of relevant reviews identified randomised controlled trials and cluster randomised controlled trials examining the efficacy of SD interventions compared to no-treatment or active control groups. A random-effect meta-analysis estimated pooled standard mean difference (SMD) for SD interventions on measures of externalising child behaviour. Secondary analyses examined their effect on measures of parenting behaviour, parental stress and mood and parenting efficacy. Eleven eligible trials were included in the analyses. SD interventions had a large effect on parent report of externalising child behaviour (SMD = 1.01, 95 % CI: 0.77–1.24); although this effect was not upheld by analyses of observed child behaviour. Secondary analyses revealed effects of small to moderate magnitude on measures of parenting behaviour, parental mood and stress and parenting efficacy. An analysis comparing SD interventions with therapist-led parenting interventions revealed no significant difference on parent-reported measures of externalising child behaviour. SD interventions are associated with improvements in parental perception of externalising child behaviour and parental behaviour and well-being. Future research should further investigate the relative efficacy and cost-effectiveness of SD interventions compared to therapist-led interventions.

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Notes

  1. Lavigne et al.’s [37] active intervention arms were nurse-led and psychologist-led parenting intervention in primary care. Webster-Stratton et al.’s [28] active intervention arms were group discussion training (GD) and group discussion videotape modelling (GDVM). GD discussed the same topics as GDVM but did not receive videotape material for visual modelling of material.

References

  1. NICE (2013) Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management (CG158). National Institute for Health and Care Excellence, London

    Google Scholar 

  2. Barkley RA, Fischer M, Smallish L, Fletcher K (2006) Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry 45(2):192–202

    Article  PubMed  Google Scholar 

  3. Langley K, Fowler T, Ford T, Thapar AK, van den Bree M, Harold G, Owen MJ, O’Donovan MC, Thapar A (2010) Adolescent clinical outcomes for young people with attention-deficit hyperactivity disorder. Br J Psychiatry 196(3):235–240

    Article  PubMed  Google Scholar 

  4. Broidy LM, Nagin DS, Tremblay RE, Bates JE, Brame B, Dodge KA, Fergusson D, Horwood JL, Loeber R, Laird R (2003) Developmental trajectories of childhood disruptive behaviors and adolescent delinquency: a six-site, cross-national study. Dev Psychol 39(2):222

    Article  PubMed Central  PubMed  Google Scholar 

  5. Webster-Stratton C, Reid J (2010) The incredible years parents, teacher and children training series: a multifaceted treatment approach for young children with conduct disorders. In: Weisz JR, Kazdin AE (eds) Evidence-based psychotherapies for children and adolescents, 2nd edn. Guilford Press, New York, pp 194–210

    Google Scholar 

  6. Johnston C, Mash EJ (2001) Families of children with attention-deficit/hyperactivity disorder: review and recommendations for future research. Clin Child Fam Psychol Rev 4(3):183–207

    Article  CAS  PubMed  Google Scholar 

  7. Deault L (2010) A systematic review of parenting in relation to the development of co-morbidities and functional impairments in children with attention-deficit/hyperactivity disorder (ADHD). Child Psychiatry Hum Dev 41(2):168–192. doi:10.1007/s10578-009-0159-4

    Article  PubMed  Google Scholar 

  8. NICE (2008) Diagnosis and management of ADHD in children, young people and adults (National Clinical Practice Number 72). The British Psychological Society and the Royal College of Psychiatrists, London

    Google Scholar 

  9. Fabiano GA, Chacko A, Pelham WE Jr, Robb J, Walker KS, Wymbs F, Sastry AL, Flammer L, Keenan JK, Visweswaraiah H, Shulman S, Herbst L, Pirvics L (2009) A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder. Behav Ther 40(2):190–204. doi:10.1016/j.beth.2008.05.002

    Article  PubMed  Google Scholar 

  10. Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M (2012) Behavioural and cognitive-behavioural group-based parenting programmes for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev 2:CD008225. doi:10.1002/14651858.CD008225.pub2

  11. Prinz RJ, Sanders MR (2007) Adopting a population-level approach to parenting and family support interventions. Clin Psychol Rev 27(6):739–749

    Article  PubMed  Google Scholar 

  12. Enebrink P, Hogstrom J, Forster M, Ghaderi A (2012) Internet-based parent management training: a randomized controlled study. Behav Res Ther 50(4):240–249. doi:10.1016/j.brat.2012.01.006

    Article  PubMed  Google Scholar 

  13. Baker CN, Arnold DH, Meagher S (2011) Enrollment and attendance in a parent training prevention program for conduct problems. Prev Sci 12(2):126–138

    Article  PubMed  Google Scholar 

  14. Owens PL, Hoagwood K, Horwitz SM, Leaf PJ, Poduska JM, Kellam SG, Ialongo NS (2002) Barriers to children’s mental health services. J Am Acad Child Adolesc Psychiatry 41(6):731–738

    Article  PubMed  Google Scholar 

  15. Elgar FJ, McGrath PJ (2003) Self-administered psychosocial treatments for children and families. J Clin Psychol 59(3):321–339

    Article  PubMed  Google Scholar 

  16. Montgomery P, Bjornstad G, Dennis J (2006) Media-based behavioural treatments for behavioural problems in children. Cochrane Database Syst Rev(1):CD002206. doi:10.1002/14651858.CD002206.pub3

  17. Nieuwboer CC, Fukkink RG, Hermanns J (2013) Online Programs as Tools to Improve Parenting: A meta-analytic review. Children and Youth Services Review

  18. Barlow J, Smailagic N, Huband N, Roloff V, Bennett C (2012) Group-based parent training programmes for improving parental psychosocial health. Cochrane Database Systematic Reviews 6. doi:10.1002/14651858.CD002020.pub3

  19. White JL, Moffitt TE, Earls F, Robins L, Silva PA (1990) How early can we tell? Predictors of childhood conduct disorder and adolescent delinquency. Criminology 28(4):507–535

    Article  Google Scholar 

  20. Nicholson J, Sanders M (1999) Randomized controlled trial of behavioral family intervention for the treatment of child behavior problems in stepfamilies. J Divorce Remarriage 30(3–4):1–23

    Article  Google Scholar 

  21. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJM, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  22. Sonuga-Barke E, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, Stevenson J, Danckaerts M, van der Oord S, Dopfner M, Dittmann RW, Simonoff E, Zuddas A, Banaschewski T, Buitelaar J, Coghill D, Hollis C, Konofal E, Lecendreux M, Wong IC, Sergeant J (2013) Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 170(3):275–289. doi:10.1176/appi.ajp.2012.12070991

    Article  PubMed  Google Scholar 

  23. Bloch MH, Qawasmi A (2011) Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry 50(10):991–1000

    Article  PubMed Central  PubMed  Google Scholar 

  24. Eyberg SM, Boggs SR, Reynolds LA (1980) Eyberg child behavior inventory. University of Oregon Health Sciences Center

  25. Achenbach TM (1991) Manual for the child behavior checklist/4-18 and 1991 profile. University of Vermont Department of Psychiatry Burlington

  26. DuPaul GJ, Anastopoulos AD, Power TJ, Reid R, Ikeda MJ, McGoey KE (1998) Parent ratings of attention-deficit/hyperactivity disorder symptoms: factor structure and normative data. J Psychopathol Behav Assess 20(1):83–102

    Article  Google Scholar 

  27. Webster-Stratton C (1990) Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children. J Abnorm Child Psychol 18(5):479–492

    Article  CAS  PubMed  Google Scholar 

  28. Webster-Stratton C, Kolpacoff M, Hollinsworth T (1988) Self-administered videotape therapy for families with conduct-problem children: comparison with two cost-effective treatments and a control group. J Consult Clin Psychol 56(4):558

    Article  CAS  PubMed  Google Scholar 

  29. Sanders M, Markie-Dadds C, Tully L, Bor W (2000) The triple P-positive parenting program: a comparison of enhanced, standard, and self-directed behavioral family intervention for parents of children with early onset conduct problems. J Consult Clin Psychol 68(4):624

    Article  CAS  PubMed  Google Scholar 

  30. Connell S, Sanders M, Markie-Dadds C (1997) Self-directed behavioral family intervention for parents of oppositional children in rural and remote areas. Behav Modif 21(4):379–408

    Article  CAS  PubMed  Google Scholar 

  31. Goldberg D (1982) General Health Questionnaire Manual NFER, Windsor

  32. Abidin RR (1990) Parenting Stress Index (PSI). Pediatric Psychology Press, Charlottesville

  33. Johnston C, Mash EJ (1989) A measure of parenting satisfaction and efficacy. J Clin Child Psychol 18(2):167–175

    Article  Google Scholar 

  34. Arnold DS, O’Leary SG, Wolff LS, Acker MM (1993) The parenting scale: a measure of dysfunctional parenting in discipline situations. Psychol Assess 5(2):137

    Article  Google Scholar 

  35. Lovibond PF, Lovibond SH (1995) The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther 33(3):335–343

    Article  CAS  PubMed  Google Scholar 

  36. Kierfeld F, Ise E, Hanisch C, Gortz-Dorten A, Dopfner M (2013) Effectiveness of telephone-assisted parent-administered behavioural family intervention for preschool children with externalizing problem behaviour: a randomized controlled trial. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-013-0397-7

    PubMed  Google Scholar 

  37. Lavigne JV, Lebailly SA, Gouze KR, Cicchetti C, Pochyly J, Arend R, Jessup BW, Binns HJ (2008) Treating oppositional defiant disorder in primary care: a comparison of three models. J Pediatr Psychol 33(5):449–461. doi:10.1093/jpepsy/jsm074

    Article  PubMed  Google Scholar 

  38. Cochrane Collaboration (2012) Review Manager (RevMan). 5.2 edn. The Nordic Cochrane Centre, Copenhagen

  39. Morris SB (2008) Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods 11(2):364–386

    Article  Google Scholar 

  40. Cochrane Collaboration (2008) Cochrane handbook for systematic reviews of interventions, vol 5. Wiley Online Library

  41. Sterne JA, Sutton AJ, Ioannidis JP, Terrin N, Jones DR, Lau J, Carpenter J, Rucker G, Harbord RM, Schmid CH, Tetzlaff J, Deeks JJ, Peters J, Macaskill P, Schwarzer G, Duval S, Altman DG, Moher D, Higgins JP (2011) Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ (Clinical research ed) 343:d4002. doi:10.1136/bmj.d4002

    Article  Google Scholar 

  42. Markie-Dadds C, Sanders M (2006) A controlled evaluation of an enhanced self-directed behavioural family intervention for parents of children with conduct problems in rural and remote areas. Behav Change 23(1):55–72

    Article  Google Scholar 

  43. Daley D, O’Brien M (2013) A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-013-0396-8

    PubMed  Google Scholar 

  44. Burke JD, Pardini DA, Loeber R (2008) Reciprocal relationships between parenting behavior and disruptive psychopathology from childhood through adolescence. J Abnorm Child Psychol 36(5):679–692

    Article  PubMed Central  PubMed  Google Scholar 

  45. Duncombe ME, Havighurst SS, Holland KA, Frankling EJ (2012) The contribution of parenting practices and parent emotion factors in children at risk for disruptive behavior disorders. Child Psychiatry Hum Dev 43(5):715–733

    Article  PubMed  Google Scholar 

  46. Keown L (2011) Fathering and mothering of preschool boys with hyperactivity. Int J Behav Dev 35(2):161–168. doi:10.1177/0165025410380982

    Article  Google Scholar 

  47. Cohen J (1988) Statistical power analysis for the behavioural sciences. Erlbaum Hillsdale, NJ

  48. Goodman SH, Gotlib IH (1999) Risk for psychopathology in the children of depressed mothers: a developmental model for understanding mechanisms of transmission. Psychol Rev 106(3):458–490

    Article  CAS  PubMed  Google Scholar 

  49. Shaw DS, Keenan K, Vondra JI (1994) Developmental precursors of externalizing behavior: ages 1 to 3. Dev Psychol 30(3):355

    Article  Google Scholar 

  50. Owens EB, Hinshaw SP, Kraemer HC, Arnold LE, Abikoff HB, Cantwell DP, Conners CK, Elliott G, Greenhill LL, Hechtman L, Hoza B, Jensen PS, March JS, Newcorn JH, Pelham WE, Severe JB, Swanson JM, Vitiello B, Wells KC, Wigal T (2003) Which treatment for whom for ADHD? Moderators of treatment response in the MTA. J Consult Clin Psychol 71(3):540–552

    Article  PubMed  Google Scholar 

  51. van den Hoofdakker BJ, Nauta MH, van der Veen-Mulders L, Sytema S, Emmelkamp PMG, Minderaa RB, Hoekstra PJ (2010) Behavioral parent training as an adjunct to routine care in children with attention-deficit/hyperactivity disorder: moderators of treatment response. J Pediatr Psychol 35(3):317–326. doi:10.1093/jpepsy/jsp060

    Article  PubMed  Google Scholar 

  52. Markie-Dadds C, Sanders M (2006) Self-directed Triple P (Positive Parenting Program) for mothers with children at-risk of developing conduct problems. Behav Cognit Psychother 34(3):259–275

    Article  Google Scholar 

  53. Sanders MR, Baker S, Turner KM (2012) A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems. Behav Res Ther 50(11):675–684. doi:10.1016/j.brat.2012.07.004

    Article  PubMed  Google Scholar 

  54. Keown LJ (2012) Predictors of boys’ ADHD symptoms from early to middle childhood: the role of father-child and mother-child interactions. J Abnorm Child Psychol 40(4):569–581. doi:10.1007/s10802-011-9586-3

    Article  PubMed  Google Scholar 

  55. Addis ME, Mahalik JR (2003) Men, masculinity, and the contexts of help seeking. Am Psychol 58(1):5

    Article  PubMed  Google Scholar 

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Acknowledgments

JT and KS are partially funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for Nottinghamshire, Derbyshire, Lincolnshire and JT is partly funded by the Institute of Mental Health at the University of Nottingham.

Conflict of interest

Professor Daley has served as a speaker or adviser for or received funding or travel support from Eli Lilly, Janssen-Cilag, UCB, and Shire. Professor Daley has also been involved in the development, implementation, and evaluation of the New Forest Parenting Programme for children with ADHD and has received royalties from sales of a New Forest Parent Training self-help book.

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Correspondence to David Daley.

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Tarver, J., Daley, D., Lockwood, J. et al. Are self-directed parenting interventions sufficient for externalising behaviour problems in childhood? A systematic review and meta-analysis. Eur Child Adolesc Psychiatry 23, 1123–1137 (2014). https://doi.org/10.1007/s00787-014-0556-5

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