In a mental health context, parent training is the term used to describe manualised programmes of education, and psychoeducation, which are delivered to parents to help impact their children’s health and wellbeing.

These programmes employ common adult education techniques such as video clips, discussion activities, role-play and homework, and are commonly delivered to groups of parents in one or two hour weekly sessions, for periods from six weeks to a year.

Parent training is currently topical in research circles. A raft of systematic reviews have been published in this area over the past decade, and 2016 was particularly prolific. Teachers, nurses, social workers and psychologists, among others, are increasingly turning to parent training to offer more holistic responses to children’s problems.

Parent training has been covered here at Mental Elf before:

• David Steele (Steele, 2016) reviewed a randomised controlled trial of a parent training programme for adolescent anorexia. On this occasion parent training was not shown to have a significant effect
• Fiona Warner-Gale (Warner-Gale, 2014) brought our attention to a meta-analysis carried out on the Incredible Years Parent Training programme (arguably a flagship parent-training intervention), which described quite convincing evidence of efficacy
• John Baker (Baker, 2014) reported on a Cochrane review of parent training for parent’s mental health, which found evidence to support short-term efficacy.

We assume that parenting styles, parenting skills and parental knowledge are key to parent and child health and wellbeing outcomes. The question addressed here is:

Is the ascendance of parent-training, in scope and volume, supported by efficacy evidence?

My objective in writing this piece was to provide a high-level overview of the state of efficacy research on parent training in general, which draws entirely on systematic reviews with meta-analysis.

Methods

To find published meta-analytic reviews on parent training I completed a scoping search of the Campbell and Cochrane collaboration online libraries by searching for the term ‘parent’ in review titles. I found 7 relevant reviews on these facilities. I then completed a more precise search, but still limited to manuscript titles, on Proquest’s Complete Collection platform. This facility simultaneously searches 19 relevant bibliographic databases. I used the following search formula: (systematic review OR meta) AND (parent AND training) NOT protocol. This produced 55 hits and a further 25 relevant reviews.

Results

ADHD

Parent training for …	Review identifier (first author)	Parent training (PT) review finding
Children with ADHD	Zwi, 2011	Better quality research is needed
Children with or at risk of ADHD	Rimestad, 2016	PT is partially effective
Disruptive behaviour in children with ADHD	Lee, 2012	PT is effective

Autism

Autism

Nevil, 2016

Findings offer tentative support

Difficulties in early years

Early conduct disorder	Furlong, 2012	PT is effective
Early emotional and behavioural difficulties	Barlow, 2016	Findings offer tentative support

Anti-social and disruptive behaviour

Children’s anti-social behaviour	Piquero, 2008	PT is effective
Children’s disruptive behaviours (digital programmes)	Baumel, 2016	Digital programmes hold promise
Children’s externalised disruptive behaviours	Maughan, 2005	PT is effective
Children’s anti-social behaviour	Serketich, 1996	Results support short-term effectiveness
Prevention of children’s anti-social behaviour	Piquero, 2016	PT is effective
Disruptive behaviour in children with developmental disability	Skotarczak, 2015	PT is effective
Children’s disruptive behaviour	Michelson, 2013	PT is effective
Children’s disruptive behaviour	Menting, 2013	PT is effective

Internalised problems

Children’s internalising problems

Yap, 2016

PT is effective

Parenting skills (fathers)

Fathers’ parenting	Fletcher, 2011	A much smaller effect in comparison to effects on Mothers’ parenting
Father involvement	Lundahl, 2008	Fathers report fewer benefits than mothers; they should be encouraged to attend

Parenting skills

Foster parent training	Solomon, 2016	Findings offer tentative support
The education of children with disabilities	Tavil, 2013	These parent programmes predominantly focus on the management of children’s behaviour and living skills
Parents’ attitudes, behaviour and knowledge; children’s self-esteem	Cedar, 1990	PT is effective
Parenting skills and children’s well-being	Sougstad, 2010	PT is effective
Parenting skills, for parents with intellectual disability	Coren, 2010	Findings offer tentative support
Psychosocial well-being of parents	Barlow, 2014	PT is effective in the short-term
Psychosocial outcomes for teenage parents and children	Barlow 2011	Findings offer tentative support

Children’s physical health challenges

Obesity in children

Loveman, 2015

Findings offer tentative support

Preventing child abuse

Preventing child abuse	Lundahl, 2006	PT is effective in the short-term
Treating abusive parents	Barlow, 2006	Insufficient evidence available

Moderators of efficacy

Programme adaptations for ethnicity	Van Mourik, 2016	Ethnically sensitive programmes are more effective
Programme component efficacy	Kaminski, 2008	Key components are reported as: increasing positive interaction; emotional communication skills; time-out training; consistency training; and focus on practice
Moderators and follow-up effects	Lundahl, 2006	Economically disadvantaged families benefit less. Disadvantaged parents benefit more from a one-to-one format
The moderating effect of socioeconomic status	Leijten, 2013	Maintenance of treatment gains is harder for disadvantage families
Predictors of parent training efficacy	Reyno, 2006	Socioeconomic status and maternal mental health are key predictors

Discussion

I would acknowledge that the term ‘parent-training’, used here, belies the variability of educative programmes used with parents. From those which are dominated by instruction and a presentation format, to those which mirror CBT programmes.

I would also acknowledge that treatment integrity is a challenge in programme delivery, and that the role individual training facilitators play in the efficacy of any given programme is significant.

However, considering the currency of the research reported in the table above, and the wide range of children’s difficulties targeted, it could be argued that practitioners who work with children and adolescents, are increasingly turning to educative work with parents.

I believe it’s also safe to assume that parent training has become an evidence-based practice, with a credibility that places it alongside pharmacological and psychotherapeutic responses to children’s difficulties. While it is difficult to see how parent-training will lead to a harmful effect, it was interesting that three of the reviews listed above reported that the non-measurement of adverse effects was a methodological shortfall in primary studies. This aligns with another recent Mental Elf blog which calls for greater scrutiny of side effects in psychotherapy (Langford and Laws, 2014).

While the same caution should be exercised with parent-training, and further evaluation is prudent, it is hard not to get enthusiastic about what it has to offer in the field of children’s health and social care. Parent training can be delivered to parents simultaneously, in groups. The fact that online versions and adjuncts are increasingly available (for example Crone & Mehta, 2016; De Voogd et al., 2016; and Snodgrass et al., 2016) creates further economy. I would suggest that parent-training should be viewed as a low-risk and efficient tool. At the very least it should be viewed as an important complement to the pharmacological and psychotherapeutic treatment of children’s health problems, and worthy of wider implementation.

The review of parent-training with abusive parents (Barlow et al., 2006) failed to offer support. There also appears to be less convincing evidence of efficacy with fathers (Fletcher et al., 2011; B. W. Lundahl et al., 2008). These findings align with evidence from other areas in which programme participants are not always self-motivated to take part: systematic reviews of educative and psychotherapeutic programmes with partner-violence perpetrators (Akoensi, Koehler, Lösel, & Humphreys, 2012) and offenders (Woodhouse et al., 2016).

Going forward, research that helps us to understand how motivation measures interact with efficacy in parent training would be useful. As the evidence base stands, parent training programme developers are minded to make particular provision for disadvantaged parents, different ethnicities, fathers and the sustainability of any gains from treatment.

Links

Other references

Akoensi, T. D., Koehler, J. A., Lösel, F., & Humphreys, D. K. (2012). Domestic violence perpetrator programs in Europe, Part II: a systematic review of the state of evidence. International Journal of Offender Therapy and Comparative Criminology.

Baker, J. (2014). Do parent training programmes improve the health of parents? The Mental Elf.

Barlow J. (2016) Effects of Parenting Programmes: A Review of Six Campbell Systematic Reviews. Campbell Collaboration Policy Brief no.1 (PDF). May 2016.

Barlow, J., Johnston, I., Kendrick, D., Polnay, L., & Stewart-Brown, S. (2006). Individual and group-based parenting programmes for the treatment of physical child abuse and neglect. Cochrane Database of Systematic Reviews(3). doi:10.1002/14651858.CD005463.pub2

Barlow, J., Smailagic, N., Bennett, C., Huband, N., Jones, H., & Coren, E. (2011). Individual and group based parenting programmes for improving psychosocial outcomes for teenage parents and their children. Cochrane Database of Systematic Reviews(3). doi:10.1002/14651858.CD002964.pub2

Barlow, J., Smailagic, N., Huband, N., Roloff, V., & Bennett, C. (2014). Group‐based parent training programmes for improving parental psychosocial health. The cochrane library.

Baumel, A., Pawar, A., Kane, J. M., & Correll, C. U. (2016). Digital Parent Training for Children with Disruptive Behaviors: Systematic Review and Meta-Analysis of Randomized Trials. Journal of Child and Adolescent Psychopharmacology, 26(8), 740-749.

Cedar, B., & Levant, R. F. (1990). A Meta-Analysis of the Effects of Parent Effectiveness Training. The American Journal of Family Therapy, 18(4), 375-384.

Coren, E., Hutchfield, J., Thomae, M., & Gustafsson, C. (2010). Parent training support for intellectually disabled parents. Cochrane Database of Systematic Reviews(6). doi:10.1002/14651858.CD007987.pub2

Crone, R. M., & Mehta, S. S. (2016). Parent Training on Generalized Use of Behavior Analytic Strategies for Decreasing the Problem Behavior of Children with Autism Spectrum Disorder: A Data-Based Case Study. Education and Treatment of Children, 39(1), 64-94.

De Voogd, E., Wiers, R., Prins, P., de Jong, P., Boendermaker, W., Zwitser, R., & Salemink, E. (2016). Online attentional bias modification training targeting anxiety and depression in unselected adolescents: Short-and long-term effects of a randomized controlled trial. Behaviour Research and Therapy, 87, 11-22.

Fletcher, R., Freeman, E., & Matthey, S. (2011). THE IMPACT OF BEHAVIOURAL PARENT TRAINING ON FATHERS’ PARENTING: A META-ANALYSIS OF THE TRIPLE P-POSITIVE PARENTING PROGRAM. Fathering, 9(3), 291-312.

Furlong, M., McGilloway, S., Bywater, T., Hutchings, J., Smith, S. M., & 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 of Systematic Reviews(2). doi:10.1002/14651858.CD008225.pub2

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Littell, J. H. (2005). Lessons from a systematic review of effects of multisystemic therapy. Children and Youth Services Review, 27(4), 445-463.

Loveman, E., Al-Khudairy, L., Johnson, R. E., Robertson, W., Colquitt, J. L., Mead, E. L., . . . Rees, K. (2015). Parent-only interventions for childhood overweight or obesity in children aged 5 to 11 years. Cochrane Database of Systematic Reviews(12). doi:10.1002/14651858.CD012008

Lundahl, B., Risser, H. J., & Lovejoy, M. C. (2006). A meta-analysis of parent training: moderators and follow-up effects. Clinical Psychology Review, 26(1), 86-104.

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Menting, A. T. A., Orobio de Castro, B., & Matthys, W. (2013). Effectiveness of the Incredible Years parent training to modify disruptive and prosocial child behavior: a meta-analytic review. Clinical Psychology Review, 33(8), 901-913. doi:http://dx.doi.org/10.1016/j.cpr.2013.07.006

Michelson, D., Davenport, C., Dretzke, J., Barlow, J., & Day, C. (2013). Do evidence-based interventions work when tested in the “real world?” A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clinical Child and Family Psychology Review, 16(1), 18-34.

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