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      Group-based parent training programmes for improving emotional and behavioural adjustment in young children

      1 , 2 , 3 , 4 , 5 , 6
      Cochrane Developmental, Psychosocial and Learning Problems Group
      Cochrane Database of Systematic Reviews
      Wiley

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          Abstract

          Emotional and behavioural problems in children are common. Research suggests that parenting has an important role to play in helping children to become well‐adjusted, and that the first few months and years are especially important. Parenting programmes may have a role to play in improving the emotional and behavioural adjustment of infants and toddlers, and this review examined their effectiveness with parents and carers of young children. 1. To establish whether group‐based parenting programmes are effective in improving the emotional and behavioural adjustment of young children (maximum mean age of three years and 11 months); and
 2. To assess whether parenting programmes are effective in the primary prevention of emotional and behavioural problems. In July 2015 we searched CENTRAL (the Cochrane Library), Ovid MEDLINE, Embase (Ovid), and 10 other databases. We also searched two trial registers and handsearched reference lists of included studies and relevant systematic reviews. Two reviewers independently assessed the records retrieved by the search. We included randomised controlled trials (RCTs) and quasi‐RCTs of group‐based parenting programmes that had used at least one standardised instrument to measure emotional and behavioural adjustment in children. One reviewer extracted data and a second reviewer checked the extracted data. We presented the results for each outcome in each study as standardised mean differences (SMDs) with 95% confidence intervals (CIs). Where appropriate, we combined the results in a meta‐analysis using a random‐effects model. We used the GRADE (Grades of Recommendations, Assessment, Development, and Evaluation) approach to assess the overall quality of the body of evidence for each outcome. We identified 22 RCTs and two quasi‐RCTs evaluating the effectiveness of group‐based parenting programmes in improving the emotional and behavioural adjustment of children aged up to three years and 11 months (maximum mean age three years 11 months). The total number of participants in the studies were 3161 parents and their young children. Eight studies were conducted in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the included studies were of behavioural, cognitive‐behavioural or videotape modelling parenting programmes. We judged 50% (or more) of the included studies to be at low risk for selection bias, detection bias (observer‐reported outcomes), attrition bias, selective reporting bias, and other bias. As it is not possible to blind participants and personnel to the type of intervention in these trials, we judged all studies to have high risk of performance bias. Also, there was a high risk of detection bias in the 20 studies that included parent‐reported outcomes. The results provide evidence that group‐based parenting programmes reduce overall emotional and behavioural problems (SMD ‐0.81, 95% CI ‐1.37 to ‐0.25; 5 studies, 280 participants, low quality evidence) based on total parent‐reported data assessed at postintervention. This result was not, however, maintained when two quasi‐RCTs were removed as part of a sensitivity analysis (SMD ‐0.67, 95% CI ‐1.43 to 0.09; 3 studies, 221 participants). The results of data from subscales show evidence of reduced total externalising problems (SMD ‐0.23, 95% CI ‐0.46 to ‐0.01; 8 studies, 989 participants, moderate quality evidence). Single study results show very low quality evidence of reductions in externalising problems hyperactivity‐inattention subscale (SMD ‐1.34; 95% CI ‐2.37 to ‐0.31; 19 participants), low quality evidence of no effect on total internalising problems (SMD 0.34; 95% CI ‐0.12 to 0.81; 73 participants), and very low quality evidence of an increase in social skills (SMD 3.59; 95% CI 2.42 to 4.76; 32 participants), based on parent‐reported data assessed at postintervention. Results for secondary outcomes, which were also measured using subscales, show an impact on parent‐child interaction in terms of reduced negative behaviour (SMD ‐0.22, 95% CI ‐0.39 to ‐0.06; 7 studies, 941 participants, moderate quality evidence), and improved positive behaviour (SMD 0.48, 95% CI 0.17 to 0.79; 4 studies, 173 participants, moderate quality evidence) as rated by independent observers postintervention. No further meta‐analyses were possible. Results of subgroup analyses show no evidence for treatment duration (seven weeks or less versus more than eight weeks) and inconclusive evidence for prevention versus treatment interventions. The findings of this review, which relate to the broad group of universal and at‐risk (targeted) children and parents, provide tentative support for the use of group‐based parenting programmes to improve the overall emotional and behavioural adjustment of children with a maximum mean age of three years and 11 months, in the short‐term. There is, however, a need for more research regarding the role that these programmes might play in the primary prevention of both emotional and behavioural problems, and their long‐term effectiveness. Group‐based parent training programmes for improving emotional and behavioural adjustment in young children Review question We wanted to know if group‐based parent training programmes are helpful in improving emotional and behavioural adjustment in young children. Background Emotional and behavioural problems are common among infants and toddlers and, for many children, these problems continue into their early school and teenage years as well. Parenting practices play an important role in how emotional and behavioural problems in children develop. Parent training programmes aimed at parents of infants and toddlers might help to prevent such problems before they start, as well as treat them after they are established. Study characteristics We searched the scientific literature for all randomised controlled trials (RCTs) and quasi‐RCTs published up to July 2015. RCTs are studies in which people are randomly allocated to treatment groups. Quasi‐RCTs are studies in which people receive treatment based on methods that are not strictly random such as date of birth, or their hospital record number, and the results of quasi‐RCTs are generally considered less trustworthy than those of RCTs. We found 24 trials (22 RCTs and two quasi‐RCTs) to include in our review. These studies included, in total, information from 3161 parents and their young children. Eight studies had been carried out in the USA, five in the UK, four in Canada, five in Australia, one in Mexico, and one in Peru. All of the studies looked at behavioural, cognitive‐behavioural or videotape modelling parenting programmes. Behavioural programmes are aimed at helping parents develop methods that will reduce bad behaviour, usually with the use of techniques such as praise or rewards. It also aims to help parents set limits that make sense. Cognitive‐behavioral skills allow parents think about behaviour patterns and focus on solutions. Programmes can use a variety of techniques; for example, videotape modelling programmes enable parents to learn by watching videotaped films of other parents implementing some of the techniques described above. Key results and quality of the evidence Some of the studies we found included people chosen specially because they were ‘at risk’ of behavioural problems, while others included parents and children without any specific risks. When we put all of the studies together, overall, we found that group‐based parenting programmes can improve the emotional and behavioural development of young children, although the quality of the evidence was, on the whole, low. Furthermore, our findings were not convincing when we removed two studies that used quasi‐randomised methods. Our findings also showed evidence of an improvement in externalising problems (these might include negative behaviours in children or young people that are directed towards the external environment such as anger, aggression or conflict with the law). However, the evidence for this, once again, came from studies that we rated as being of only moderate quality, and was only found for some parts of the outcome measure (known as a subscale). Results from single studies that could not be combined with other studies and that were of poor quality, on the whole, showed no impact on children’s internalising problems (e.g. depression and anxiety). However, there was some improvement on one subscale of a measure that focused on children’s hyperactivity‐inattention and another subscale that focused on social skills. There was moderate‐quality evidence that group‐based parenting programmes also improve the way in which parents and children interact, as measured by fewer negative behaviours. Our reasons for rating the quality of the evidence as low or moderate included: inconsistency in the findings from different studies (different studies yielded different results); unclear risk of bias (where it was not possible for us to assess the ways in which the included studies might be biased due to inadequate information); and small numbers of parents in the included studies. We believe more research is needed to be able to reach a firm conclusion about whether the effects we have found are short term only or whether they continue over time and therefore may be able to prevent future behavioural problems.

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            Studied the effectiveness of parent and teacher training as a selective prevention program for 272 Head Start mothers and their 4-year-old children and 61 Head Start teachers. Fourteen Head Start centers (34 classrooms) were randomly assigned to (a) an experimental condition in which parents, teachers, and family service workers participated in the prevention program (Incredible Years) or (b) a control condition consisting of the regular Head Start program. Assessments included teacher and parent reports of child behavior and independent observations at home and at school. Construct scores combining observational and report data were calculated for negative and positive parenting style, parent-teacher bonding, child conduct problems at home and at school, and teacher classroom management style. Following the 12-session weekly program, experimental mothers had significantly lower negative parenting and significantly higher positive parenting scores than control mothers. Parent-teacher bonding was significantly higher for experimental than for control mothers. Experimental children showed significantly fewer conduct problems at school than control children. Children of mothers who attended 6 or more intervention sessions showed significantly fewer conduct problems at home than control children. Children who were the "highest risk" at baseline (high rates of noncompliant and aggressive behavior) showed more clinically significant reductions in these behaviors than high-risk control children. After training, experimental teachers showed significantly better classroom management skills than control teachers. One year later the experimental effects were maintained for parents who attended more than 6 groups. The clinically significant reductions in behavior problems for the highest risk experimental children were also maintained. Implications of this prevention program as a strategy for reducing risk factors leading to delinquency by promoting social competence, school readiness, and reducing conduct problems are discussed.
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              A behavior rating scale for the preschool child.

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                Author and article information

                Journal
                Cochrane Database of Systematic Reviews
                Wiley
                14651858
                August 01 2016
                Affiliations
                [1 ]University of Warwick; Division of Mental Health and Wellbeing, Warwick Medical School; Gibbett Hill Road Coventry UK CV4 7LF
                [2 ]Enhance Reviews Ltd; Central Office, Cobweb buildings The Lane, Lyford Wantage UK OX12 0EE
                [3 ]Cochrane; Cochrane Response; St Albans House 57-59 Haymarket London UK SW1Y 4QX
                [4 ]Center for Child and Adolescent Mental Health, Eastern and Southern Norway; Box 4623 Nydalen Oslo Norway 0405
                [5 ]University of Plymouth; Centre for Mathematical Sciences, School of Computing, Electronics and Mathematics; Plymouth UK
                [6 ]Coventry University; Centre for Technology Enabled Health Research (CTEHR); Priory Street Coventry UK CV1 5FB
                Article
                10.1002/14651858.CD003680.pub3
                6797064
                27478983
                4d7c44b2-7d55-432c-a6cf-4c640c4d0b6d
                © 2016
                History

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