Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Abstract

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic review and network meta-analysis

“…Hypothesised potential mechanisms could include parents’ withdrawal from other self-help or community support in usual care and reduced self-efficacy (in line with our secondary outcome findings). We also found less beneficial effects of early parenting interventions than previous meta-analyses, with both fewer interventions being identified as effective and effect sizes being smaller 49. However, in this NMA, we included several unpublished results which may have corrected for previous publication bias present in the literature.…”

Healing Together: A Narrative Review on How Psychiatric Treatment for Parental Depression Impacts Children

“…Parenting and parent–child interactions significantly impact the persistence of internalizing and externalizing behaviors in childhood, and these behaviors can subsequently result in difficulties with mental health, academics, and employment [ 39 ] in adolescence and adulthood. Importantly, a parent’s mental health influences the quality of parenting and parent–child relationships.…”

“…Given that the large majority of the literature on parenting interventions’ impact on children’s externalizing and internalizing symptoms focuses on behavioral interventions, an extensive systematic review and meta-analysis focused on data for Attachment- and Emotion-Focused (AE) parenting interventions [ 39 ] which aim to focus on the parent–child relationship. The authors highlight that though behavioral parent training [BPT] is effective in particular at reducing externalizing symptoms, there remains an estimated 25–33% of children for which the intervention is not effective.…”

“…The authors highlight that though behavioral parent training [BPT] is effective in particular at reducing externalizing symptoms, there remains an estimated 25–33% of children for which the intervention is not effective. Importantly, it is noted that the parent’s mental health has been demonstrated as a moderator for this outcome [ 39 ], which underscores the utility of treating parents’ psychiatric needs alongside parenting interventions. The review found that improvements in the child’s externalizing behaviors were mediated by parental sensitivity, and the improvements in internalizing behaviors were mediated by parental emotion socialization [ 39 ].…”

Analysis of the mental health status of hospital staff during the COVID-19 pandemic

“…Symptom Checklist 90 (SCL-90) is a 90-item neuropsychological assessment tool which is frequently used both domestically and abroad [16]. This scale is the most frequently used screening scale for the examination of mental disorders and psychological disorders and has good reliability and validity [17,18].…”