Enhancing Outcomes of Low-Intensity Parenting Groups Through Sufficient Exemplar Training: A Randomized Control Trial.

Low-intensity parenting groups, such as the Triple P-Positive Parenting Program Discussion Groups, appear to be a cost-effective intervention for child conduct problems. Several studies evaluating a Triple P Discussion Group on disobedience found promising results for improving child and parent outcomes. However, a sufficient exemplar training approach that incorporates generalization promotion strategies may assist parents to more flexibly apply positive parenting principles to a broader range of child target behaviors and settings, leading to greater change. We compared the effects of sufficient exemplar training to an existing narrowly focused low-intensity intervention. Participants were 78 families with a 5-8 year-old child. Sufficient exemplar training resulted in more robust changes in child behavior and superior outcomes for mothers on measures of parenting behavior, parenting self-efficacy, mental health, and perceptions of partner support at post-intervention and 6-month follow-up. These results indicate that teaching sufficient exemplars may promote generalization leading to enhanced intervention outcomes.

Te Whanau Pou Toru: a Randomized Controlled Trial (RCT) of a Culturally Adapted Low-Intensity Variant of the Triple P-Positive Parenting Program for Indigenous Maori Families in New Zealand.

Evidence-based parenting support programs (EBPS) based on social learning and cognitive behavioral principles are effective in reducing conduct-related problems in a diverse range of cultural contexts. However, much less is known about their effects with indigenous families. A Collaborative Participation Adaptation Model (CPAM) was used to culturally adapt a low-intensity, two-session group variant of the Triple P-Positive Parenting Program for Maori parents of young children in New Zealand. CPAM involved collaborating closely with Maori tribal elders, practitioners as end-users, and parents as consumers through a participatory process to identify content and delivery process used in Triple P that would ensure that traditional Maori cultural values were incorporated. The culturally adapted program (Te Whanau Pou Toru) was then evaluated with 70 parents of 3-7-year-old children in a two-arm randomized clinical trial (intervention vs waitlist control). Results showed that parents in the intervention group reported significantly greater improvements in child behavior problems and reduced interparental conflict about child-rearing compared to parents in the control group at immediate post-intervention. These intervention effects were either maintained or improved further at follow-up assessment. At 6-month follow-up intervention-group parents reported significantly greater reductions in overreactive parenting practices and greater confidence in managing a range of difficult child behaviors than control parents. The culturally adapted program was associated with high levels of parental satisfaction. Findings are discussed in terms of making brief, effective, culturally adapted parenting support available to Maori families.

Relationships between parenting practices and perceptions of child behaviour among Korean immigrant mothers and fathers.

This study examined parenting styles and culturally-specific parenting practices of Korean immigrant mothers (N = 128) and fathers (N = 79) of children (ages 6-10) in New Zealand and the parenting predictors of child behaviour. Participants completed questionnaires on parenting styles and practices, and parental perceptions of child behaviour. Both parents indicated a high degree of devotion (Mo jeong) and involvement in care and education of their child with fathers were more likely than mothers to utilise shaming/love withdrawal and modesty encouragement. Results of regression analyses showed that there were some differences between mothers and fathers in the parenting predictors of child internalising and externalising behaviour problems and prosocial behaviour. Across the whole sample, there were contrasting relationships for authoritative parenting styles, devoted/involved parenting and modesty encouragement/shaming/non-reasoning parenting practices with child behaviour problems. Results indicated a blend of Western and Korean parenting practices were being utilised after settling in New Zealand.

Dealing with Disobedience: An Evaluation of a Brief Parenting Intervention for Young Children Showing Noncompliant Behavior Problems.

The study was a randomized controlled trial evaluating the efficacy of a brief and preventatively-focused parenting discussion group for dealing with disobedient behavior in preschool-aged children. Eighty-five parents with children aged between 3 and 5 years who were concerned about the noncompliant behavior of their child were recruited from Auckland, New Zealand and Brisbane, Australia. Compared to the waitlist control group (n = 40), parents in the intervention group (n = 45) reported greater improvements in disruptive child behavior, ineffective parenting practices and parenting confidence, as well as clinically significant improvements in child behavior and parenting. All of these effects were maintained at 6-month follow up. No group differences were found for parental wellbeing, inter-parental conflict and general relationship quality, although intervention parents reported improvements in parental wellbeing and inter-parental conflict at 6-month follow-up. The findings are discussed in terms of the implications for making brief and effective parenting support available to parents.

Erratum to: What are the Parenting Experiences of Fathers? The Use of Household Survey Data to Inform Decisions About the Delivery of Evidence-Based Parenting Interventions to Fathers.

CONFLICT OF INTEREST: The Triple P-Positive Parenting Program is owned by the University of Queensland (UQ). The University through its main technology transfer company UniQuest Pty Limited has licensed Triple P International Pty Ltd to disseminate the program worldwide. Royalties stemming from this dissemination activity are distributed to the Parenting and Family Support Centre, School of Psychology, UQ; Faculty of Health and Behavioural Sciences at UQ; and contributory authors. No author has any share or ownership in Triple P International Pty Ltd. Matthew Sanders is the founder and an author on various Triple P programs and a consultant to Triple P International.

A comparison of online versus workbook delivery of a self-help positive parenting program.

A noninferiority randomized trial design compared the efficacy of two self-help variants of the Triple P-Positive Parenting Program: an online version and a self-help workbook. We randomly assigned families of 193 children displaying early onset disruptive behavior difficulties to the online (N = 97) or workbook (N = 96) interventions. Parents completed questionnaire measures of child behavior, parenting, child maltreatment risk, personal adjustment and relationship quality at pre- and post-intervention and again at 6-month follow up. The short-term intervention effects of the Triple P Online program were not inferior to the workbook on the primary outcomes of disruptive child behavior and dysfunctional parenting as reported by both mothers and fathers. Both interventions were associated with significant and clinically meaningful declines from pre- to post-intervention in levels of disruptive child behavior, dysfunctional parenting styles, risk of child maltreatment, and inter-parental conflict on both mother and father report measures. Intervention effects were largely maintained at 6-month follow up, thus supporting the use of self-help parenting programs within a comprehensive population-based system of parenting support to reduce child maltreatment and behavioral problems in children.

Study protocol: evaluation of a parenting and stress management programme: a randomised controlled trial of Triple P Discussion Groups and Stress Control.

BACKGROUND: Children displaying psychosocial problems are at an increased risk of negative developmental outcomes. Parenting practices are closely linked with child development and behaviour, and parenting programmes have been recommended in the treatment of child psychosocial problems. However, parental mental health also needs to be addressed when delivering parenting programmes as it is linked with parenting practices, child outcomes, and treatment outcomes of parenting programmes. This paper describes the protocol of a study examining the effects of a combined intervention of a parenting programme and a cognitive behavioural intervention for mental health problems. METHODS/DESIGN: The effects of a combined intervention of Triple P Discussion Groups and Stress Control will be examined using a randomised controlled trial design. Parents with a child aged 3-8 years will be recruited to take part in the study. After obtaining informed consent and pre-intervention measures, participants will be randomly assigned to either an intervention or a waitlist condition. The two primary outcomes for this study are change in dysfunctional/ineffective parenting practices and change in symptoms of depression, anxiety, and stress. Secondary outcomes are child behaviour problems, parenting experiences, parental self-efficacy, family relationships, and positive parental mental health. Demographic information, participant satisfaction with the intervention, and treatment fidelity data will also be collected. Data will be collected at pre-intervention, mid-intervention, post-intervention, and 3-month follow-up. DISCUSSION: The aim of this paper is to describe the study protocol of a randomised controlled trial evaluating the effects of a combined intervention of Triple P Discussion Groups and Stress Control in comparison to a waitlist condition. This study is important because it will provide evidence about the effects of this combined intervention for parents with 3-8 year old children. The results of the study could be used to inform policy about parenting support and support for parents with mental health problems. TRIAL REGISTRATION: ClinicalTrial.gov: NCT01777724, UTN: U1111-1137-1053.

The effectiveness of the Stepping Stones Triple P seminars for Korean families of a child with a developmental disability.

Background: Children with a developmental disability (DD) are more likely to develop behavioral problems. The Stepping Stones Triple P Positive Parenting Program (SSTP) for parents of children with a DD has demonstrated effectiveness for improving parenting practices and reducing child behavior problems. However, there is scant research in Asian countries and with less intensive SSTP interventions. Aim: This study examined the effectiveness of the SSTP seminars for Korean parents of a child with a DD. Methods: Parents were randomly assigned to an intervention group (n = 21) or a delayed intervention group (n = 17). Data was collected on child adjustment problems, parenting practices, parental adjustment, and family relationships from both groups at pre- and post-intervention, and from the intervention group at 4-month follow-up. Twelve parents provided post-intervention interview data. Results: A series of one-way Analysis of Covariance (ANCOVA) were used to examine differences between the intervention and delayed intervention groups at post-intervention. Significant short-term intervention effects were found for reductions in child behavior and emotional difficulties, and dysfunctional parenting practices. These improvements were maintained 4-months later by the intervention group. At post-intervention, inter-parental child-rearing conflict was reduced as a trend, with a moderate effect size. Interviews provided additional insights into the benefits gained from program participation. Conclusions: Findings, for parents within this study, contribute to the evidence base for the effectiveness of the SSTP seminars.

What are the parenting experiences of fathers? The use of household survey data to inform decisions about the delivery of evidence-based parenting interventions to fathers.

Participants were 933 fathers participating in a large-scale household survey of parenting practices in Queensland Australia. Although the majority of fathers reported having few problems with their children, a significant minority reported behavioral and emotional problems and 5% reported that their child showed a potentially problematic level of oppositional and defiant behavior. Reports of child problems were associated with fathers' levels of personal stress and socioeconomic disadvantage. Approximately half of all fathers reported the use of one or more coercive parenting strategies (shouting and yelling, hitting the child with their hand or with an object) with fathers' use of hitting being associated with child behavior difficulties. Fathers reported low rates of help seeking or participation in parenting courses, with socially disadvantaged fathers being less likely to complete parenting programs than other fathers. Implications for research on increasing fathers' participation rates in parenting programs are discussed and directions for future research highlighted.

An RCT of an Online Parenting Program for Parents of Preschool-Aged Children With ADHD Symptoms.

Objective: This randomized control trial evaluated the efficacy of an online self-help program in a sample of parents of preschoolers with ADHD symptoms. Method: Parents were randomly assigned to the intervention group (n = 27) or the delayed intervention group (n = 26). Child behavior measures were completed by mothers, fathers, and teachers, and parenting measures were completed by mothers. Results: Intent-to-treat analyses indicated significant post-intervention improvements in mother-rated child hyperactivity/inattention, restlessness/impulsivity, defiance/aggression, social functioning, and teacher-rated prosocial behavior, as well as significant improvements in maternal over-reactivity, verbosity, laxness, positive parenting, parenting satisfaction, self-efficacy, stress, and depression. At 6-month follow-up, effects were maintained for maternal over-reactivity and verbosity, parenting satisfaction and self-efficacy, and parental stress and depression. Conclusion: This study provides evidence for the effectiveness of an online self-help parenting program in reducing preschool inattentive behavior difficulties, and in increasing parenting competence, satisfaction in the parenting role, and maternal well-being.

Enhancing Father Engagement and Interparental Teamwork in an Evidence-Based Parenting Intervention: A Randomized-Controlled Trial of Outcomes and Processes.

This study examined the outcomes and process in a positive parenting program adapted to enhance father engagement and teamwork. A randomized control trial of the Group Triple P Program with additional father-relevant content was conducted with 42 families of children with conduct problems aged between 3 to 8years. Families were allocated to either the intervention or waitlist condition. Assessments of child behavior, self- and partner-reported parenting, and the interparental relationship were conducted at T1 (pre), T2 (post), and T3 (6-month follow-up). Observations were used to examine fathers' and mothers' unique and shared contributions to group process during participation in parenting group sessions. Following program completion (T2) intervention group fathers and mothers reported significantly fewer child behavior problems, dysfunctional parenting practices, and interparental conflict about child-rearing than waitlist parents. Intervention group mothers also reported increased parenting confidence and rated their partners as showing significantly fewer dysfunctional parenting practices. Intervention effects were maintained at 6-month follow-up. Observational data showed that fathers and mothers made similar contributions during the group sessions. The most frequent types of contributions were asking questions and sharing information with other parents about implementing parenting strategies. The key differences between parents were fathers' more frequent use of humor and mothers' more frequent sharing of personal stories and reporting co-parenting cooperation. The levels of session attendance and program satisfaction were high for both fathers and mothers. Findings highlight the potential benefits of efforts to engage both fathers and mothers for program adherence, satisfaction, and effectiveness.

Early parent-child relations and family functioning of preschool boys with pervasive hyperactivity.

This study examined the quality of parent-child relationships and family functioning of preschool children with early onset hyperactivity by comparing a community sample of 33 pervasively hyperactive preschool boys with a comparison sample of 34 boys. Mothers and children were assessed at home on a range of interview, parent questionnaire, and observational measures of parenting and family functioning. Results of the study showed that higher rates of reported lax disciplinary practices, less efficient parental coping, lower rates of father-child communication, and less synchronous mother-child interactions were significantly associated with hyperactivity following statistical adjustment for the effects of conduct problems and other confounding factors. The best parenting predictor of hyperactivity was maternal coping. The present findings suggest that the way in which parents interact with their preschool children may make a unique contribution to the development and ongoing behavioral difficulties experienced by children with pervasive hyperactivity. Findings also highlight the importance of considering the role of fathers in the behavioral development of boys with early tendencies to hyperactive and distractible behavior problems.

Predicting success in an online parenting intervention: the role of child, parent, and family factors.

The present study involved an examination of the extent to which a wide range of child, parent, family, and program-related factors predicted child behavior and parenting outcomes after participation in an 8-session online version of the Triple P-Positive Parenting Program. Participants were mothers and fathers of 97 children aged between 3 and 8 years displaying elevated levels of disruptive behavior problems. For both mothers and fathers, poorer child behavior outcomes at postintervention were predicted by the number of sessions of the intervention completed by the family. For mothers, postintervention child behavior was also predicted by the quality of the mother-child relationship at baseline; for fathers, baseline child behavior severity was an additional predictor. Mothers' postintervention ineffective parenting was predicted by session completion and preintervention levels of ineffective parenting, whereas the only predictor of fathers' ineffective parenting at postintervention was preintervention levels of ineffective parenting. Socioeconomic risk, parental adjustment, and father participation in the intervention were not significant predictors of mother- or father-reported treatment outcomes. The implications of the findings for the provision of online parenting support are discussed.

Predictors of boys' ADHD symptoms from early to middle childhood: the role of father-child and mother-child interactions.

This prospective 3 year longitudinal study investigated preschool paternal and maternal parenting predictors of Attention-Deficit/Hyperactivity Disorder(ADHD) in a community sample of 93 school-age boys. Participants were recruited on the basis of inattention-hyperactivity at age 4 and fathers and mothers were observed interacting with their sons. Teachers, fathers, and mothers reported children's ADHD symptoms and impairment. Results from dimensional analysis showed that less observed paternal sensitivity and maternal positive regard predicted higher levels of inattentiveness in middle childhood, and that intrusive paternal behavior was predictive of hyperactive-impulsive behavior at school. In categorical analysis, less maternal warmth and sensitivity were predictive of later ADHD. These predictions held after statistical adjustment for the effects of preschool ADHD behaviors and conduct problems. At follow-up, parents of boys with ADHD reported more negative child-parent relationship perceptions than comparison parents. Findings highlight the importance of examining responsive parenting behaviors of both fathers and mothers in relation to multi-informant ratings of ADHD symptoms.