An Analysis of Training, Generalization, and Maintenance Effects of Primary Care Triple P for Parents of Preschool-Aged Children with Disruptive Behavior

  • Cynthia L. Boyle
  • Matthew R. SandersEmail author
  • John R. Lutzker
  • Ronald J. Prinz
  • Cheri Shapiro
  • Daniel J. Whitaker
Original Article


A brief primary care intervention for parents of preschool-aged children with disruptive behavior was assessed using a multiple probe design. Primary Care Triple P, a four session behavioral intervention was sequentially introduced within a multiple probe format to each of 9 families to a total of 10 children aged between 3 and 7 years (males = 4, females = 6). Independent observations of parent-child interaction in the home revealed that the intervention was associated with lower levels of child disruptive behavior both in a target training setting and in various generalization settings. Parent report data also confirmed there were significant reductions in intensity and frequency of disruptive behavior, an increase in task specific parental self-efficacy, improved scores on the Parent Experience Survey, and high levels of consumer satisfaction. All short-term intervention effects were maintained at four-month follow-up. Implications for the delivery of brief interventions to prevent conduct problems are discussed.


Primary care Triple P Single case Parent training Child problem behavior Child disruptive behavior 



The research described in this paper was supported by grants U17/CCU422317 and 1R18CE001340 to Prinz and Sanders from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.


  1. 1.
    Patterson G (1982) A social learning approach to family intervention: III. Coercive family process. Castalia, EugeneGoogle Scholar
  2. 2.
    Kazdin A (1991) Effectiveness of psychotherapy with children and adolescents. J Consult Clin Psyc 59:785–798CrossRefGoogle Scholar
  3. 3.
    McMahon R, Wells K (1998) Conduct problems. In: Barkley R (ed) Treatment of childhood disorders, 2nd edn. The Guilford Press, New York, pp 111–207Google Scholar
  4. 4.
    Patterson G, Reid J, Dishion T (1992) Antisocial boys. Castalia, EugeneGoogle Scholar
  5. 5.
    Sanders M, Tully L, Baade P, Lynch M, Heywood A, Pollard G, Youlden D (1999) A survey of parenting practices in Queensland: implications for mental health promotion. Health Promot J Aust 9:112–121Google Scholar
  6. 6.
    Zubrick S, Ward K, Silburn S, Lawrence D, Williams A, Blair E, Robertson D, Sanders M (2005) Prevention of child behavior problems through universal implementation of a group behavioral family intervention. Prev Sci 6:287–304CrossRefPubMedGoogle Scholar
  7. 7.
    Sanders M (2008) The Triple P-Positive Parenting Program as a public health approach to strengthening parenting. J Fam Psychol 22(4):506–517CrossRefPubMedGoogle Scholar
  8. 8.
    Taylor T, Biglan A (1998) Behavioral family interventions for improving child-rearing: a review of the literature for clinicians and policy makers. Clin Child Fam Psych 1:41–60CrossRefGoogle Scholar
  9. 9.
    Sanders M, Turner K, Markie-Dadds C (2002) The development and dissemination of the Triple P-Positive Parenting Program: a multilevel, evidence-based system of parenting and family support. Prev Sci 3:173–189CrossRefPubMedGoogle Scholar
  10. 10.
    de Graaf I, Speetjens P, Smit F, de Wolff M, Tavecchio L (2009) Effectiveness of the Triple P Positive Parenting Program on parenting: a meta-analysis. Fam Relat 57:553–566CrossRefGoogle Scholar
  11. 11.
    de Graaf I, Speetjens P, Smit F, de Wolff M, Tavecchio L (2008) Effectiveness of the Triple P Positive Parenting Program on behavioral problems in children: a meta-analysis. Behav Modif 32(5):714–735CrossRefPubMedGoogle Scholar
  12. 12.
    Nowak C, Heinrichs N (2008) A comprehensive meta-analysis of Triple P-Positive Parenting Program using hierarchical linear modeling: effectiveness and moderating variables. Clin Child Fam Psych 11:114–144CrossRefGoogle Scholar
  13. 13.
    Thomas R, Zimmer-Gembeck M (2007) Behavioral outcomes of parent-child interaction therapy and Triple P-Positive Parenting Program: a review and meta-analysis. J Abnorm Child Psyc 35:475–495CrossRefGoogle Scholar
  14. 14.
    Turner K, Sanders M (2006) Help when it’s needed first: a controlled evaluation of brief, preventive behavioral family intervention in a primary care setting. Behav Ther 37(2):131–142CrossRefPubMedGoogle Scholar
  15. 15.
    Bower P, Garralda E, Kramer T, Harrington R, Sibbald B (2001) The treatment of child and adolescent mental health problems in primary care: a systematic review. Fam Pract 18:373–382CrossRefPubMedGoogle Scholar
  16. 16.
    Giel R, Koeter M, Ormel J (1990) Detection and referral of primary-care patients with mental health problems: the second and third filter. In: Goldberg D, Tantam D (eds) The public health impact of mental disorder. Hogrefe and Huber, Toronto, pp 25–34Google Scholar
  17. 17.
    Vasquez-Barquero J (1990) Mental health in primary care settings. In: Goldberg D, Tantam D (eds) The public health impact of mental disorder. Hogrefe and Huber, Toronto, pp 35–44Google Scholar
  18. 18.
    Nicholson J, French M, Oldenberg B, Connelly L (1997) Evaluation of the mental health service in rural and remote South West Queensland: final report for the Southern Queensland rural division of general practice. Queensland University of Technology, BrisbaneGoogle Scholar
  19. 19.
    Sanders M, Dadds M (1982) The effects of planned activities and child management procedures in parent training: an analysis of setting generality. Behav Ther 13:452–461CrossRefGoogle Scholar
  20. 20.
    Sanders M, Glynn T (1981) Training parents in behavioral self-management: an analysis of generalization and maintenance. J Appl Behav Anal 14:223–237CrossRefPubMedGoogle Scholar
  21. 21.
    Sanders M, Christensen A (1985) A comparison of the effects of child management and planned activities training in five parenting environments. J Abnorm Child Psych 13(1):101–117CrossRefGoogle Scholar
  22. 22.
    Huynen K, Lutzker J, Bigelow K, Touchette P (1996) Planned activities training for mothers of children with developmental disabilities: community generalization and follow-up. Behav Modif 20:406–427CrossRefPubMedGoogle Scholar
  23. 23.
    Powers S, Roberts M (1995) Simulation training with parents of oppositional children: preliminary findings. J Clin Child Psychol 24(1):89–97CrossRefGoogle Scholar
  24. 24.
    Sanders M, James J (1983) The modification of parent behavior: a review of generalization and maintenance. Behav Modif 7(1):3–27CrossRefPubMedGoogle Scholar
  25. 25.
    Stokes T, Baer D (1977) An implicit technology of generalization. J Appl Behav Anal 10(2):349–367CrossRefPubMedGoogle Scholar
  26. 26.
    Eyberg S, Pincus D (1999) Eyberg child behavior inventory and Sutter-Eyberg student behavior inventory—revised: professional manual. Psychological Assessment Resources, OdessaGoogle Scholar
  27. 27.
    Turner K, Sanders M, Markie-Dadds C (1999) Practitioner’s manual for primary care Triple P. Families International Publishing, BrisbaneGoogle Scholar
  28. 28.
    Turner K, Markie-Dadds C, Sanders M (1999) Consultation flip chart for primary care Triple P. Families International Publishing, BrisbaneGoogle Scholar
  29. 29.
    Sanders M, Markie-Dadds C, Turner K (1996) Positive parenting. Families International Publishing, BrisbaneGoogle Scholar
  30. 30.
    Turner K, Markie-Dadds C, Sanders M (1996) Triple P tip sheet series for toddlers. Families International Publishing, BrisbaneGoogle Scholar
  31. 31.
    Turner K, Markie-Dadds C, Sanders M (1996) Triple P tip sheet series for preschoolers. Families International Publishing, BrisbaneGoogle Scholar
  32. 32.
    Sanders M, Markie-Dadds C, Turner K (1996) Every parent’s survival guide [Videotape and booklet]. Families International, BrisbaneGoogle Scholar
  33. 33.
    Horner R, Baer D (1978) Multiple-probe technique: a variation of the multiple baseline. J Appl Behav Anal 11(1):189–196CrossRefPubMedGoogle Scholar
  34. 34.
    Sanders M, Waugh L, Tully L, Hynes K (1996) The revised family observation schedule, 3rd ed. Parenting and Family Support Centre, The University of Queensland, BrisbaneGoogle Scholar
  35. 35.
    Sanders M, Woolley M (2005) The relationship between maternal self-efficacy and parenting practices: implications for parent training. Child Care Hlth Dev 31(1):65–73Google Scholar
  36. 36.
    Garton A, Zubrick S, Silburn S (1995) The Western Australian survey: a pilot study. Aust NZ J Psychiat 29(1):48–57CrossRefGoogle Scholar
  37. 37.
    Eyberg S (1993) Consumer satisfaction measures for assessing parent training programs. In: Van de Creek L, Knapp S, Jackson T (eds) Innovations in clinical practice: a source book. Professional Resource Press, Sarasota, pp 377–382Google Scholar
  38. 38.
    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 Psych 68:624–640CrossRefGoogle Scholar
  39. 39.
    Prinz R, Sanders M, Shapiro C, Whitaker D, Lutzker J (2009) Population-based prevention of child maltreatment: the US Triple P system population trial. Prev Sci 10(1):1–12CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Cynthia L. Boyle
    • 1
  • Matthew R. Sanders
    • 2
    Email author
  • John R. Lutzker
    • 3
  • Ronald J. Prinz
    • 4
  • Cheri Shapiro
    • 4
  • Daniel J. Whitaker
    • 3
  1. 1.Center for Behavioral Sciences, Inc.LawrenceUSA
  2. 2.Parenting and Family Support CenterThe University of QueenslandBrisbaneAustralia
  3. 3.Georgia State UniversityAtlantaUSA
  4. 4.University of South CarolinaColumbiaUSA

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