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Parenting Programs

Introduction

In 2009, approximately 5 percent of U.S. children aged 4 through 17 were reported as having serious socioemotional or behavioral difficulties, and 21 percent of U.S. children in approximately the same age group were living in poverty.1 Emotional and behavioral health is important in building strong social relationships and realizing full academic potential.1, 2 Poverty has been associated with lifelong cognitive, behavioral, and socioemotional difficulties as well as fewer years in school and increased unemployment.1, 2 Parents and other caregivers play a central role in recognizing and ameliorating such risk factors. Interventions including parenting programs have shown both long-term efficacy and cost-effectiveness in promoting the successful transition of children into healthy, productive adults.2 Parenting programs for child behavior problems aim to help parents improve their relationship with their children and enhance their parenting skills to prevent and cope with challenging behavior.

This report focuses on the efficacy of parenting programs that include child or adolescent behavioral outcomes such as academic performance, conduct, delinquency, or peer relations. Some parenting programs are universal, while others are targeted to parents with specific problems such as mental health disorders, socioeconomic challenges, domestic violence, child maltreatment, or substance abuse.2 Parenting programs may also be targeted to reduce problem behavior in children with specific problems such as attention deficit disorder, delinquency, socioemotional challenges, or traumatic stress from child abuse or neglect.2 Parenting programs are often multifaceted, with components that include not only parents but also children, other family members, schools, and communities.2 The programs may take place in settings such as homes, schools, or clinics and may be delivered through classroom curricula, computer programs, or face-to-face contact with clinicians, counselors, teachers, or other professionals.2 Parenting programs may start as early as preconception and continue through adolescence.2

Search Strategy and Criteria

An extensive search was conducted for systematic reviews published between January 1, 2000, and May 18, 2012. The search was limited to the online catalog of the U.S. Government’s National Library of Medicine, PubMed (http://www.pubmed.gov) to ensure free access to abstracts and in some cases full-text articles. Systematic reviews reported in the context of guidelines, consensus statements, or studies were not the target of the search.

The strategy to conduct the search was as follows: “Parenting” [Mesh] AND (systematic[sb] OR Meta-Analysis[pt]) AND English[lang] AND "Humans"[MeSH Terms] AND "2000/01/01" [PDAT]: "2012/05/18" [PDAT]

Each part of the strategy is described below:

  1. Topics: The medical subject heading “parenting” used in the search is defined by PubMed as “performing the role of a parent by care-giving, nurturance, and protection of the child by a natural or substitute parent. The parent supports the child by exercising authority and through consistent, empathic, appropriate behavior in response to the child's needs.”
  2. Additional limits: Limits were used restricting the search to systematic reviews (with a separate designation for those containing meta-analyses) and articles published in English, focused on humans, and published no earlier than 2000. The search was further narrowed by hand to those reviews focusing on parenting programs that included child or adolescent behavioral outcomes.

Results

The literature search yielded a total of 11 systematic reviews. Of these, 9 included a meta-analysis (Reviews 1, 3–8, 10, and 11). The average number of studies included in the systematic reviews was 22 (range = 3–77; median = 15). Studies were conducted in the United States and internationally. Settings for the parenting interventions were not reported in all the included studies. The goal of the included interventions was to examine the efficacy of parenting programs on the behavior of children who were at risk for or displayed behavioral problems and on parents’ parenting skills and positive behavior (e.g., sensitivity, stress management, self-confidence). Although all the studies reported at least one or more outcome measures of child behavior, parental outcome measures were also reported in most of the reviews. Behavior problems were assessed exclusively in preschool-aged children (Reviews 1 and 7) and in school-aged children up to age 18 (Reviews 2, 3–6, and 8–11). Four of the reviews included parents of children and/or adolescents with a clinical diagnosis such as conduct disorder, oppositional defiant disorder, attention deficit disorder, attention deficit hyperactive disorder (ADHD), cerebral palsy, and conduct problems or delinquency (Reviews 3, 5, and 8–10). Two reviews focused on low-income families (Reviews 4 and 7), and one examined which parenting program components were effective in reducing early childhood behavior problems (Review 6). Overall, the parenting interventions had significant positive effects on child behavioral problems and parenting skills and behaviors.

Effects of Parenting Interventions by Population

Four reviews examined the effect of parenting interventions on parents of children diagnosed with ADHD or with early onset conduct disorder and ADHD symptoms (Reviews 3, 5, 8, and 11). Parenting interventions significantly improved behaviors in children with ADHD and improved parental mental health, parenting practices, and parenting skills. Parenting interventions significantly decreased the amount of time delinquent children and adolescents spent incarcerated and reduced the risk of arrests 1–3 years postintervention (Review 10). Parenting interventions for low-income or socially disadvantaged families revealed mixed results. Specifically, interventions that included video feedback (i.e., interventions that record parent-child interactions so the parent can observe his or her parenting behaviors) had positive effects on parent and child behaviors from low-income families (Review 4), while home-based interventions for socially disadvantaged families were not effective (Review 7). Research suggests that parenting interventions for parents of children with cerebral palsy are effective in improving parent and child behaviors (Review 9).

Effects of Parenting Interventions by Type

Two reviews examined the Positive Parenting Program (Triple P), which is a stepped-care program designed to prevent or treat behavioral, developmental, and emotional problems in children from birth to 16 years (Reviews 3 and 8). Triple P had a positive effect on parenting behavior and child behavior problems. The positive effects were maintained 6–12 months after the intervention. One review specifically examined behavioral and cognitive-behavioral parent programs (Review 5), which are interventions that teach parents how to reframe distorted cognitions and coach them in problem-solving and anger management. These types of interventions significantly reduced child conduct problems and negative parenting practices and significantly improved parental mental health.

In sum, parenting interventions produced significantly positive results in parenting behaviors and children’s behavioral problems across a diverse range of participants at risk for or displaying behavioral problems. However, moderators on the effect of parenting programs emerged such that larger long-term effects were found in studies with a higher percentage of girls and studies with children who have initial behavior problems in the clinical range (Review 3). Similarly, two reviews found interventions had larger effects on parental reports of child outcomes than independent observations (Reviews 1 and 8).

Systematic Reviews

Read the PDF for the descriptive information for each of the 11 systematic reviews.


1Federal Interagency Forum on Child and Family Statistics. (2011). America’s children: Key national indicators of well-being, 2011. Washington, DC: U.S. Government Printing Office. Retrieved from http://www.childstats.gov/pdf/ac2011/ac_11.pdf (PDF, 5.3MB)
2Substance Abuse and Mental Health Services Administration, Center for Mental Health Services. (2007). Promotion and prevention in mental health: Strengthening parenting and enhancing child resilience. HHS Publication No.CMHS-SVP-0175. Rockville, MD. Retrieved from http://store.samhsa.gov/shin/content//SVP07-0186/SVP07-0186.pdf (PDF, 1.3MB)