The Effectiveness of Parenting Programs

Method

A search of the Campbell Library was undertaken to identify systematic reviews of the effectiveness of parenting programs. All reviews of parenting programs were included irrespective of the focus of the review in terms of the target group, theoretical approach, or outcomes of interest. A narrative synthesis of the findings from each of the reviews is provided.

Results

The Campbell Collaboration has published six systematic reviews evaluating the effectiveness of various types of parenting programs. These reviews cover outcomes for children aged 0–3 years (Barlow & Parsons, 2005), early onset conduct disorder among children aged 3–12 years (Furlong et al., 2012), outcomes for both parents and children with attention-deficit hyperactivity disorder (ADHD; Zwi, Jones, Thorgaard, York, & Dennis, 2012), and outcomes for the children of particular subgroups of parents, such as those with intellectual disabilities (Coren, Hutchfield, Thomae, & Gustafsson, 2010) and teenage parents (Barlow et al., 2011). One review examined the effectiveness of parenting programs in improving the psychosocial functioning of parents only (Barlow, Smailagic, Huband, Roloff, & Bennett, 2012).

Barlow and Parsons (2005) examined the effectiveness of parenting programs in the primary and secondary prevention of behavior problems in children aged 0–3 years. Five studies were included in the review, with a total of 410 parents. Meta-analyses were conducted for both parent reports and independent assessments of children’s behavior. The result for parent reports shows a small benefit for the intervention group (short-term improvements in depression [SMD] −0.29, 95% confidence interval [CI] [−0.55, 0.02]), that was not statistically significant, and for independent observations of children’s behavior shows a moderate benefit for the intervention group that was statistically significant (SMD −0.54, 95% CI [−0.84, −0.23]). A meta-analysis of the follow-up data available from two studies shows a small benefit for the intervention group (SMD −0.24, 95% CI [−0.56, 0.09]) that was not statistically significant. Some heterogeneity in all of these analyses may be explained by differences in intervention content and duration.

The findings of this review provide mixed results and modest support for the use of group-based parenting programs to improve the emotional and behavioral adjustment of children under the age of 3 years. The authors suggest that there is insufficient evidence to reach any firm conclusions regarding the role that such programs might play in the primary prevention of behavior problems in young children. Furthermore, there is little information on the long-term effectiveness of these programs.

Furlong and colleagues (2012) examined the effectiveness of parenting programs in addressing early onset conduct disorder in children aged 3–12 years. This review identified 13 randomized controlled trials (RCTs) that met the inclusion criteria as well as two economic evaluations, including a total of 1,078 participants (646 in intervention groups; 432 in control groups). The results indicate that parent training reduced child conduct problems according to parent reports (SMD −0.53; 95% CI [−0.72, −0.34]) and independent assessments of outcome (SMD −0.44; 95% CI [−0.77, −0.11]). There were also consistent improvements favoring the intervention group for parental mental health assessments (SMD −0.36; 95% CI [−0.52, −0.20]), and positive parenting skills based on both parent reports (SMD −0.53; 95% CI [−0.90, −0.16]) and independent assessments (SMD −0.47; 95% CI [−0.65, −0.29]). Parent training also reduced negative or harsh parenting practices according to parent reports (SMD −0.77; 95% CI [−0.96, −0.59]) and independent assessments (SMD −0.42; 95% CI [−0.67, −0.16]). All of these results were statistically significant. There was also evidence of cost-effectiveness converted from data in the original studies using common currency and price year.

The authors conclude that “behavioural and cognitive-behavioural group-based parenting interventions are effective and cost-effective methods of improving child conduct problems, parental mental health and parenting skills in the short term” (Furlong et al., 2012, p. 8). They also suggest that “the cost of programme delivery was modest when compared with the long-term health, social, educational, and legal costs associated with childhood conduct problems” (Furlong et al., 2012, p. 8).

Zwi, Jones, Thorgaard, York, and Dennis (2012) examined the effectiveness of both individually delivered and group-based parenting programs, in improving outcomes for both parents and children with ADHD. A total of five studies including 284 participants met the inclusion criteria, all of which compared parent training with treatment as usual. The results show a small improvement in externalizing behavior (SMD −0.32; 95% CI [−0.83, 0.18]), which was not statistically significant, and in internalizing behavior (SMD −0.48; 95% CI [−0.84, −0.13]), which was statistically significant. The results also found improvements in parenting stress for the “child” domain (MD −10.52; 95% CI [−20.55, −0.48]) but not the “parent” domain (MD −7.54; 95% CI [−24.38, 9.30]). Variation in the strength and the consistency of results may be due to differences in intervention content and small sample sizes. No study reported data for academic achievement, adverse events, or parental understanding of ADHD.

The authors conclude that parent training may have a positive effect on the behavior of children with ADHD and may also be effective in reducing parental stress and enhancing parental confidence. However, they suggest that currently available data regarding ADHD-specific behaviors are inconclusive and that there is an absence of data regarding some outcomes such as school achievement and adverse effects.

Barlow and colleagues (2011) examined the effectiveness of individual- and group-based parenting programs in improving psychosocial outcomes for teenage parents and developmental outcomes for their children. They included eight studies with 513 participants, providing a total of 47 comparisons of outcome between intervention and control conditions. Nine meta-analyses were conducted using data from four studies in total (each meta-analysis included data from two studies). These were the only meta-analyses possible in this review due to diversity in both interventions and outcome measures. Four meta-analyses showed findings favoring the intervention group for the following outcomes: parent responsiveness to the child postintervention (SMD −0.91, 95% CI [−1.52, −0.30]); infant responsiveness to mother at follow-up (SMD −0.65, 95% CI [−1.25, −0.06]); and an overall measure of parent–child interactions postintervention (SMD −0.71, 95% CI [−1.31, −0.11]) and at follow-up (SMD −0.90, 95% CI [−1.51, −0.30]). All of the preceding results were statistically significant. The results of the remaining five meta-analyses were inconclusive; these comparisons related to four subscales measuring parenting attitudes to child rearing in the parental role and one to parent psychosocial outcomes. The numbers of participants for these comparisons were small and the results are heterogeneous, which may account for the absence of consistent findings. Participant numbers in all these studies were small, and the results while promising should be treated with caution.

The authors conclude that the findings are limited by variation across studies in the measures used, sample characteristics and interventions, and by the risk of bias within the included studies. Nevertheless, these studies provide some evidence that parenting programs may be effective in improving a number of aspects of parent–child interaction both in the short and long term.

Coren and colleagues (2010) examined the effectiveness of programs in improving the parenting of parents with intellectual disabilities. Only three RCTs were identified, and no meta-analysis was possible due to variation between the included studies. Results from the studies were therefore summarized using narrative. The included studies showed improved maternal–child interaction following a group-based parent training program and in parents knowledge of life-threatening emergencies, ability to recognize dangers and identify precautions, as well as smaller improvements in their ability to implement precautions, use medicines safely and recognize child illness and symptoms, and in child care and safety skills following individually delivered programs.

The authors conclude that these results appear promising in terms of parenting knowledge and skills, but further research is needed with this group of parents.

Barlow and colleagues (2012) examined the effectiveness of group-based parenting programs in improving parents’ psychosocial health. They included 48 studies (involving a total of 4,937 participants) that examined the effectiveness of three types of programs: behavioral, cognitive–behavioral, and multimodal. The results showed that that there were significant improvements in (SMD−0.17, 95% CI [−0.28, −0.07]), anxiety (SMD −0.22, 95% CI [−0.43, −0.01]), stress (SMD −0.29, 95% CI [−0.42, −0.15]), anger (SMD −0.60, 95% CI [−1.00, −0.20]), guilt (SMD −0.79, 95% CI [−1.18, −0.41]), confidence (SMD −0.34, 95% CI [−0.51, −0.17]), and satisfaction with the partner relationship (SMD −0.28, 95% CI [−0.47, −0.09]). All these preceding results were consistently positive and statistically significant. However, only the differences in stress and confidence were maintained at the 6-month follow-up, and none were significant at 1 year. There was no evidence of any effect on self-esteem (SMD −0.01, 95% CI [−0.45, 0.42]). None of the trials reported on aggression or adverse effects. There was limited data examining outcomes for fathers, as the studies included in the review were largely directed at mothers, and the trial investigators reported results that were mainly derived from the mothers. Data available for fathers showed short-term improvement in paternal stress (SMD −0.43, 95% CI [−0.79, −0.06]).

The authors conclude that these findings support the use of parenting programs to improve the short-term psychosocial well-being of parents but suggest that further input may be required to ensure that these results are maintained. They also suggest that more research is needed on potential benefits for fathers, the comparative effectiveness of different types of programs, along with the mechanisms by which such programs bring about improvements in parental psychosocial functioning.

Discussion and Application to Practice

Together, these reviews provide substantial evidence to show that parenting programs can be effective in improving aspects of parents’ psychosocial functioning (e.g., depression, anxiety, stress, anger, guilt, confidence, and satisfaction with the partner relationship) in the short term. Behavioral and cognitive–behavioral group-based parenting interventions have also been found to be cost-effective methods of improving child conduct problems, parental mental health, and parenting skills in the short term for parents of children aged 3–12 years (Furlong et al., 2012), although the evidence for effectiveness with parents of younger children is less comprehensive (Barlow et al., 2012).

There is also some evidence that parenting programs can improve parental stress and general child behavior in children with ADHD, but less evidence with regard to other important outcomes including ADHD-related behavioral achievement in school or parent knowledge of ADHD (Zwi et al., 2012).

The available evidence shows only short-term effectiveness, and a number of reviews have concluded that further input may be required to ensure that these results are maintained. The use of “top ups” to maintain the benefits of these interventions needs formal evaluation.

It is not clear whether parent training is better delivered in groups or individually and whether outcomes may vary by characteristics of the target group. The evidence with regard to the needs of specific groups of parents such as teenage parents and parents with intellectual disability looks promising, with some evidence of improved outcomes for both parent and children, but further research is still needed.

More research is needed to assess benefits for fathers, to examine the comparative effectiveness of different types of programs, and to identify the mechanisms by which such programs bring about improvements in parental functioning and outcomes for children. More studies are also are needed of the effectiveness of parenting programs for parents with particular needs (e.g., teenage parents and parents with intellectual disabilities), including parents of children with ADHD.