Meta-meta-analysis on the effectiveness of parent-based interventions for the treatment of child externalizing behavior problems

Abstract

ObjectiveThe aim of this study is to perform the first meta-meta-analysis on the effectiveness of parent-based interventions for children with externalizing behavior problems. Even though parent-based interventions are considered as effective treatments the effects reported in meta-analyses are heterogeneous and the implementation in clinical practice is suboptimal. Recapitulative valid effect predictions are required to close the still existing gap between research findings and clinical practice. The meta-meta-analytic results on changes in child behavior shall result in a clear signal for clinical practice.MethodsThis meta-meta-analysis encompasses 26 meta-analyses identified via search in electronic databases (PsycINFO, Medline, PubMed). Meta-analyses had to report effects of parent-based interventions on child behavior and focus on children under the age of 13 years with externalizing behavior problems in a clinical setting. Analyses were based on random-effects models. To combine results, the effect estimates of the meta-analyses were transformed to SMD and weighted to correct for primary study overlap. The meta-meta-analysis is registered on PROSPERO, registration number CRD42016036486 and was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA).ResultsThe results indicate a significant moderate overall effect for child behavior (SMD = 0.46) as well as for parent reports (SMD = 0.51) and observational data (SMD = 0.62). Further analyses focusing on child externalizing behavior yielded significant and moderate effects (SMD = 0.45). All effects remained stable to follow-up. Considerable heterogeneity was observed within results.ConclusionParent-based interventions are shown to be effective in improving behavior in children with externalizing behavior problems, as assessed using parent reports and observational measures. The present results should encourage health care providers to apply evidence-based parent-based interventions.

Nurturing Family Environments for Children: Compassion-Focused Parenting as a Form of Parenting Intervention

“…Importantly, although current evidence indicates the positive impact of EBPPs, intervention models can still be improved, as other researchers in parenting also suggest [20,21]. As our understanding of the scientific processes involved in physiology and emotional functioning increases, so must our models of parenting interventions [25]. Most EBPPs, as mentioned earlier, were developed in the 1970s, where social learning theory and behavioural approaches to child and family functioning were the focus of improving parenting style and child outcomes [22].…”

“…There are a range of parenting programs shown to be effective at reducing coercive parenting practices and reducing child problem behaviour [25]. For example, the Triple P-Positive Parenting Program [26,27], and the Incredible Years Program [28], are two examples of programs that have had a significant impact on parenting practices and reductions in child behavior problems.…”

“…That is, the parasympathetic system is not activated in order to downregulate threat processing, and this can lead to a heightened fear or anxiety towards affiliative behaviours [29,30]. Moreover, punitive parenting practices (e.g., over-reactive anger, criticism), particularly when children are joyful and loud, can also lead to a classically conditioned response for the individual, where positive emotions (e.g., joy, happiness) are paired with some form of punishment (e.g., being yelled at or physically hit in order to quiet down) [25]. Gilbert [37] proposes that in therapy, individuals can become quite fearful of positivity, kindness, and compassion from their therapist, as it can activate conditioned memories of loneliness, vulnerability, or shame [37].…”

“…Compassion-focused parenting is the application of CFT in a parenting context. Currently, parenting interventions are 'technique' oriented, aimed at reducing problematic behaviour [25], and are not grounded in the understanding of physiology and emotional function from an evolutionary perspective [37,45,46]. My premise is that many of the techniques in EBPPs will remain the same (e.g., attention and praise), but the model of how to facilitate positive parent-child relationships will shift to focus on evolved caring motivational systems and affiliative emotion processing, which requires an understanding of the evolved processes involved in parent-offspring caring and physiological regulating systems.…”

“…Thus, the inclusion of the three circle model of emotion regulation in EBPPs will enable parents to understand the function of evolved emotion systems, so that they can gain insight into 'what sits behind' the interactions with their children and parenting partners (e.g., spouse, grandparent). The benefit of including the three circle model is that it will also enable a de-shaming and de-blaming process to occur for parents, as they begin to understand how they did not design the brain and body to function in that way [25]. In so doing, this process can start to facilitate a greater motivation for parents to take responsibility for how their affect regulation systems function in order to help their children's social-emotional development.…”