Digital-based parent training (DPT) programs for parents of children with disruptive behaviors have been developed and tested in randomized trials. The aim of this study was to quantitatively assess the efficacy of these programs versus a control condition.
Methods:
We conducted a systematic review and random effects meta-analysis of peer-reviewed randomized studies comparing DPT targeting children with disruptive behaviors versus a control group (wait list or no treatment).
Results:
Altogether, seven studies (n = 718) were meta-analyzed. Compared to the control groups, DPT resulted in significantly greater improvement in child behavior (effect size [ES] = 0.44, 95% confidence interval [CI] = 0.21–0.66, studies = 7), parent behavior (ES = 0.41, 95% CI = 0.25–0.57, studies = 6), and parental confidence (ES = 0.36, 95% CI = 0.12–0.59, studies = 4). The improvement in child behavior was moderated by age group and severity of clinical presentation, which overlapped 100%. While DPT was superior to control conditions in studies of young children (mean age <7 years) with a clinical range of disruptive behaviors (ES = 0.61, 95% CI = 0.40–0.82, studies = 4), results were nonsignificant in studies of older children (mean age >11 years) with a nonclinical range of symptoms (ES = 0.21, 95% CI = −0.01 to 0.42, studies = 3). Analyses yielded similar results of higher ESs favoring studies of young children with clinical range disruptive behaviors for parent behavior and parental confidence, but the differences were not significant. Results further suggested that in studies of younger children, interactive programs (e.g., computerized programs) were more effective in improving child behavior compared to noninteractive programs (e.g., watching video clips) (p < 0.05).
Conclusion:
Although additional studies are needed, DPT holds promise as a potentially scalable evidence-based treatment of children with disruptive behaviors that can save human resources.
Get full access to this article
View all access options for this article.
References
1.
ArnoldDS, O'LearySG, WolffLS, AckerMM: The Parenting Scale: A measure of dysfunctional parenting in discipline situations. Psychol Assess, 5:137–144, 1993.
2.
BaumelA, MuenchF: Heuristic evaluation of Ehealth interventions: Establishing standards that relate to the therapeutic process perspective. JMIR Ment Health, 3:e5, 2016.
3.
BorensteinM, HedgesL, RothsteinH: Meta-analysis: Fixed effect vs. random effects. http://www.metaanalysis.com/downloads/Meta-analysis_fixed_effect_vs_random_effects_sv.pdf.2007.
4.
BorensteinM, HedgesLV, HigginsJPT, RothsteinHR (eds): When does it make sense to perform a meta‐analysis?. In: Introduction to Meta-Analysis. Hoboken (New Jersey), Wiley, 2009a, pp 357–364.
5.
BorensteinMH, HigginsL, RothsteinJ:. Introduction to Meta-Analysis. Hoboken (New Jersey), Wiley, 2009b.
6.
BreitensteinSM, GrossD, ChristophersenR: Digital delivery methods of parenting training interventions: A systematic review. Worldviews Evid Based Nurs, 11:168–176, 2014.
7.
CefaiJ, SmithD, PushakRE: Parenting wisely: Parent training via CD-ROM with an Australian sample. Child Fam Behav Ther, 32:17–33, 2010.
8.
ChorpitaBF, DaleidenEL, EbesutaniC, YoungJ, BeckerKD, NakamuraBJ, PhillipsL, WardA, LynchR, TrentL: Evidence‐based treatments for children and adolescents: An updated review of indicators of efficacy and effectiveness. Clin Psychol Sci Pract, 18:154–172, 2011.
9.
ComerJS, ChowC, ChanPT, Cooper-VinceC, WilsonLA: Psychosocial treatment efficacy for disruptive behavior problems in very young children: A meta-analytic examination. J Am Acad Child Adolesc Psychiatry, 52:26–36, 2013.
10.
CorrellCU, ManuP, OlshanskiyV, NapolitanoB, KaneJM, MalhotraAK: Cardiometabolic risk of second-generation antipsychotic medications during first-time use in children and adolescents. JAMA, 302:1765–1773, 2009.
11.
DerSimonianR, LairdN: Meta-analysis in clinical trials. Control Clin Trials, 7:177–188, 1986.
12.
EggerHL, AngoldA: Common emotional and behavioral disorders in preschool children: Presentation, nosology, and epidemiology. J Child Psychol Psychiatry, 47:313–337, 2006.
13.
EnebrinkP, HögströmJ, ForsterM, GhaderiA: Internet-based parent management training: A randomized controlled study. Behav Res Ther, 50:240–249, 2012.
14.
EybergSM, NelsonMM, BoggsSR: Evidence-based psychosocial treatments for children and adolescents with disruptive behavior. J Clin Child Adolesc Psychol, 37:215–237, 2008.
15.
EybergSM, RobinsonEA: Conduct problem behavior: Standardization of a behavioral rating. J Clin Child Adolesc Psychol, 12:347–354, 1983.
16.
GallingB, RoldánA, NielsenRE, NielsenJ, GerhardT, CarbonM, StubbsB, VancampfortD, De HertM, OlfsonM: Type 2 diabetes mellitus in youth exposed to antipsychotics: A systematic review and meta-analysis. JAMA Psychiatry, 73:247–259, 2016.
17.
GordonDA, StanarCR: Lessons learned from the dissemination of Parenting Wisely, a parent training CD-ROM. Cogn Behav Pract, 10:312–323, 2003.
18.
GortmakerSL, WalkerDK, WeitzmanM, SobolAM: Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents. Pediatrics, 85:267–276, 1990.
19.
HedgesLV, OlkinI: Statistical Method for Meta-Analysis. London, Academic Press, 2014.
20.
HigginsJP, AltmanDG, GøtzschePC, JüniP, MoherD, OxmanAD, SavovićJ, SchulzKF, WeeksL, SterneJA: The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ, 343:d5928, 2011.
21.
HigginsJP, ThompsonSG: Quantifying heterogeneity in a meta-analysis. Stat Med, 21:1539–1558, 2002.
22.
IrvineAB, GelattVA, HammondM, SeeleyJR: A randomized study of internet parent training accessed from community technology centers. Prev Sci, 16:597–608, 2015a.
23.
IrvineAB, RussellH, ManocchiaM, MinoDE, GlassenTC, MorganR, GauJM, BirneyAJ, AryDV: Mobile-Web app to self-manage low back pain: Randomized controlled trial. J Med Internet Res, 17:e1, 2015b.
24.
JohnstonC, MashEJ: A measure of parenting satisfaction and efficacy. J Clin Child Psychol, 18:167–175, 1989.
25.
JonesDJ, ForehandR, CuellarJ, KincaidC, ParentJ, FentonN, GoodrumN: Harnessing innovative technologies to advance children's mental health: Behavioral parent training as an example. Clin Psychol Rev, 33:241–252, 2013.
26.
KacirCD, GordonDA: Parenting adolescents wisely: The effectiveness of an interactive videodisk parent training program in Appalachia. Child Fam Behav Ther, 21:1–22, 2000.
27.
KazdinAE, BlaseSL: Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspect Psychol Sci, 6:21–37, 2011.
28.
KazdinAE, RabbittSM: Novel models for delivering mental health services and reducing the burdens of mental illness. Clin Psychol Sci, 2013. DOI: 10.1177/2167702612463566.
29.
KlingÅ, ForsterM, SundellK, MelinL: A randomized controlled effectiveness trial of parent management training with varying degrees of therapist support. Behav Ther, 41:530–542, 2010.
30.
KnappP, ChaitA, PappadopulosE, CrystalS, JensenPS: Treatment of maladaptive aggression in youth: CERT guidelines I. Engagement, assessment, and management. Pediatrics, 129:e1562–e1576, 2012.
31.
LiberatiA, AltmanDG, TetzlaffJ, MulrowC, GøtzschePC, IoannidisJP, ClarkeM, DevereauxP, KleijnenJ, MoherD: The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med, 151:W-65–W-94, 2009.
32.
LoeberR, GreenSM, KeenanK, LaheyBB: Which boys will fare worse? Early predictors of the onset of conduct disorder in a six-year longitudinal study. J Am Acad Child Adolesc Psychiatry, 34:499–509, 1995.
33.
LundahlB, RisserHJ, LovejoyMC: A meta-analysis of parent training: Moderators and follow-up effects. Clin Psychol Rev, 26:86–104, 2006.
34.
MaayanL, CorrellCU: Weight gain and metabolic risks associated with antipsychotic medications in children and adolescents. J Child Adolesc Psychopharmacol, 21:517–535, 2011.
35.
MerikangasKR, NakamuraEF, KesslerRC: Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci, 11:7–20, 2009.
36.
MorawskaA, TometzkiH, SandersMR: An evaluation of the efficacy of a triple P-positive parenting program podcast series. J Dev Behav Pediatr, 35:128–137, 2014.
37.
OlfsonM, BlancoC, LiuS-M, WangS, CorrellCU: National trends in the office-based treatment of children, adolescents, and adults with antipsychotics. Arch Gen Psychiatry, 69:1247–1256, 2012.
38.
OlfsonM, BlancoC, WangS, LajeG, CorrellCU: National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry, 71:81–90, 2014.
39.
PhelanTW: 1-2-3 Magic: Effective Discipline for Children 2–12. ParentMagic, Inc., Glen Ellyn (Illinois); (2010).
40.
Porzig-DrummondR, StevensonRJ, StevensonC: Preliminary evaluation of a self-directed video-based 1-2-3 Magic parenting program: A randomized controlled trial. Behav Res Ther, 66:32–42, 2015.
41.
APA Publications and Communications Board Working Group on Journal Article Reporting Standards: Reporting standards for research in psychology: Why do we need them?. What might they be? Am Psychol, 63:839–851, 2008.
42.
RobinsonKA, DickersinK: Development of a highly sensitive search strategy for the retrieval of reports of controlled trials using PubMed. Int J Epidemiol, 31:150–153, 2002.
43.
RosatoNS, CorrellCU, PappadopulosE, ChaitA, CrystalS, JensenPS: Treatment of maladaptive aggression in youth: CERT guidelines II. Treatments and ongoing management. Pediatrics, 129:e1577–e1586, 2012.
44.
SandersMR. Triple P-Positive Parenting Program: Towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clin Child Fam Psychol Rev, 2:71–90, 1999.
45.
SandersMR, BakerS, TurnerKM: A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems. Behav Res Ther, 50:675–684, 2012.
46.
SandersMR, WoolleyM: The relationship between maternal self‐efficacy and parenting practices: Implications for parent training. Child Care Health Dev, 31:65–73, 2005.
47.
SegalD, ChenPY, GordonDA, KacirCD, GylysJ: Development and evaluation of a parenting intervention program: Integration of scientific and practical approaches. Int J Hum Comput Interact, 15:453–467, 2003.
48.
SouranderA: Challenges in children's enrolment to psychosocial services. Eur Child Adolesc Psychiatry, 24:361–363, 2015.
49.
Webster-StrattonC, KolpacoffM, HollinsworthT: Self-administered videotape therapy for families with conduct-problem children: Comparison with two cost-effective treatments and a control group. J Consult Clin Psychol, 56:558, 1988.
50.
WilsonDB, LipseyMW: The role of method in treatment effectiveness research: Evidence from meta-analysis. Psychol Methods, 6:413–429, 2001.
51.
ZisserA, EybergS: Parent-child interaction therapy and the treatment of disruptive behavior disorders. In: Evidence-Based Psychotherapies for Children and Adolescents. WeiszJR, and KazdinAE, eds. New York, Guilford Press, 2010, pp. 179–193.
