Article Text

PDF
A cognitive behavioural parenting intervention reduced conduct problems in children and improved parenting skill and confidence
  1. Linda O’Mara, RN, PhD
  1. McMaster University School of Nursing,
 Hamilton, Ontario, Canada

    Statistics from Altmetric.com

    
 
 Q Does a community based cognitive behavioural parenting intervention delivered by a voluntary sector organisation reduce conduct problems in clinically referred children and improve parenting skill and confidence?

    METHODS

    Embedded ImageDesign:

    randomised controlled trial.

    Embedded ImageAllocation:

    concealed.

    Embedded ImageBlinding:

    blinded {data collectors, researchers coding videotapes, and data analysts}.*

    Embedded ImageFollow up period:

    6 months.

    Embedded ImageSetting:

    9 sites (including community and family centres and church halls) in the UK.

    Embedded ImagePatients:

    76 families with children 2–9 years of age (74% boys) who were referred for conduct problems by primary healthcare workers, social workers, other professionals, or their own families and scored >10 on the Eyberg problem scale. Exclusion criteria were children with severe disabilities or in temporary care, drug addiction in parents, and previous participation in programmes by the Family Nurturing Network.

    Embedded ImageIntervention:

    Webster-Stratton’s Incredible Years parenting programme (n = 44) or a 6 month wait list (n = 32). The parenting intervention was delivered by trained leaders in weekly 2 hour group sessions of 10–12 parents for 14 weeks; child care was offered for that time period. Topics included parent-child play, praise, incentives, limit setting, problem solving, and discipline, and role play was used to find solutions and practise skills. Parents practised management strategies at home and received phone calls to encourage progress.

    Embedded ImageOutcomes:

    included child problem behaviour (36 item Eyberg Child Behaviour Inventory and video taped observations of parent-child interactions). Secondary outcomes included self reported parenting skill (30 item scale) and competence (16 item scale) and observed negative parenting (eg, hit, yell, rude, or threaten) and positive parenting (eg, praise, positive and proactive discipline).

    Embedded ImagePatient follow up:

    82% (intention to treat analysis).

    MAIN RESULTS

    At 6 months, children in the parenting intervention group had greater improvements on the Eyberg Inventory and greater reductions in observed negative behaviours than those in the wait list group (table). Parents in the intervention group had greater improvements than the wait list group on the parenting and competence scales and on observed positive and negative parenting strategies (table).

    Parenting intervention v wait list for behaviour problems in children

    CONCLUSION

    A community based cognitive behavioural parenting intervention delivered by a voluntary sector organisation reduced conduct problems in clinically referred children and improved parenting skill, confidence, and behaviour.

    Commentary

    Conduct disorder problems in children are an important health and social issue. There is clear evidence that such problems can be treated with cognitive behavioural parenting interventions.1 The study by Gardner et al adds to our knowledge about the value of parent intervention programmes delivered by community based voluntary organisations. The careful attention to detail has resulted in a well conducted study and thus confidence in the findings. Although the mental health of parents did not improve, the intervention improved parenting behaviours and attitudes. Further analysis showed that this, in turn, led to improved behaviour in children.

    However, there are some limitations. The first is the number of families referred to the Family Nurturing Network who were unwilling to participate in the study: only 72% of eligible families agreed to participate. Secondly, although changes in the intervention group were maintained at 18 month follow up, there was no follow up for the control group; so, although not ideal, the changes were encouraging.

    Practitioners considering acting on the results of this promising community based programme would need to consider the trade-off between costs and potential effectiveness in their settings. Likely costs include the specialised training for group leaders and the operating costs of the programme. In addition, it is suggested that parenting programmes should screen for coexisting psychiatric conditions in potential users because 30% of participants in a study by Scott et al had co-existing psychiatric diagnoses.2 Treatment of coexisting mental health problems might further benefit the parenting programme and outcomes in children.

    View Abstract

    Footnotes

    • * Information provided by author.

    • For correspondence: Dr F Gardner, Oxford, UK. frances.gardner{at}socres.ox.ac.uk

    • Source of funding: Esmee Fairbairn Foundation.

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    References