Psychological Interventions Involving Parents

• Behavioural Parenting Interventions


  • Focused on the parents and involving them in the intervention process
  • Prior to the 1960s they used psychotherapy and psychodynamic approach to tackle disruptive behaviour in children
• Case of "Rusty"


  • Parents sought help for their son showing disruptive behaviours (climbing on roof, playing with matches)
• Boardman's idea


  1. Work with the parents to help them manage his behaviour, to change how they responded to the behaviour and upskill them, so they were able to be more evolved in the intervention process

  2. Led to decrease of disruptive behaviour in Rusty
• Parents deserve a vote of confidence


  Involve parents as coparticipants, cotherapists in interventions as this is more likely to lead to effective outcomes for parents and their children as it upskills them to manage the child's behaviour and gives them skills to generalise across multiple challenges
• Coercive Process Theory


  Based on the idea that behavioural problems develop through interactions with the child and the parent
• Coercive Process Theory


  1. Parent issues demand, child engages in challenging behaviour to try get out of complying

  2. Sometimes it works and the parent removes the demand, negatively reinforcing the behaviour

  3. Parent persists, child behaviour escalates and tries harder to escape the demand

  4. Parent responds with harsh discipline or inconsistently removes the task

  5. Child learns if they be more challenging, the demand stops

  6. Child observes and learns this is a way to resolve conflict and adopts those interactions more
• Psychologist has to try disrupting this process so that the cycle is broken. If it can be broken, the reinforcement doesn't happen we see change in the child.
• Parenting Programmes for Disruptive Child Behaviour

  • Recommended as first line treatment approach for children showing oppositional and externalising behaviours
  • Behaviours often emerge in very young children
  • Aimed at parents because children may not have the cognitive skill to recognise/understand their own cognitions/emotions
  • Parents can engage and apply the intervention with the children
  • Parents become 'co-therapists' and agents of change
• Triple P Parenting Programme


  • Aims to treat (but also prevent) behavioural problems in young children
  • Enhance family protective factors and reduce risk factors
• Triple P Parenting Programme


  1. Encourages positive interactions between parents and children

  2. Teaches parents an alternative to coercive parent behaviours (e.g. time-out, planned ignoring)

  3. Timeout- remove from situation, social interaction, fun etc. Period of time to not be receiving reinforcement

  4. Positive reinforcement of adaptive behaviour (e.g. token economy)

  5. Star reward chart after a desired behaviour that they can exchange for a reward

  6. Delivered over a 10-session programme

  7. Home or clinic observations allows parents to get feedback on their parenting and interactions with their child
• Enhanced Triple P


  • For families who have additional risk factors and adversity (e.g. parents becoming separated)
  • Communication to help parents communicate and manage the impact of separation in their child
• Randomised Controlled Trial (RCT)


  • Gold-standard way to assess whether an intervention is effective
  • Random allocation to intervention or control group
  • Assess outcomes of interest
• Bor, Sanders & Markie-Dadds (2002)


  • Compared the effectiveness of enhanced Triple P, Standard Triple P and a no treatment control group (waitlist control)
  • 87 families of children aged 3 years and elevated levels of disruptive behaviour and symptoms of inattention/hyperactivity randomised to different arms
  • Both standard and enhanced intervention led to reductions in parent-reported behaviour problems compared to the control group
  • Enhanced Triple P also led to reductions in observed negative child behaviour
• Meta-analysis


  • The most reliable evidence base for clinical practice and research
  • Calculate an overall (absolute) effect using data from existing studies
• Sanders et al., 2014


  • Combined data from 101 studies (62 RCTs) that have explored the effectiveness of the Triple P Parenting Programme
  • Overall, studies show all levels of triple P are effective for child behaviour problems (internalizing and externalizing)
  • Smaller effect sizes when looking at observed child behaviour compared to parent-report
  • Triple P is also effective for parenting practices, parenting satisfaction, and parenting efficacy
• As children get older, interventions may not be so parent-focussed as children get older. Child variables are important, but so are wider societal factors such as peers and wider community influences.
• Multisystemic Therapy


  Address multiple risk factors
• Attention Deficit Hyperactivity Disorder (ADHD)


  • Persistent pattern of inattention and/or hyperactivity/impulsivity at rates higher than would be expected for child's developmental level
  • Occurs before age 12
  • Pervasive across settings like home and school
• Cognitive Factors in ADHD


  • Executive function deficits have been implicated in externalizing behaviour problems in children (Impulsivity, working memory and cognitive flexibility)
  • Some children with ADHD display differences in reward processing (Preference for smaller, immediate rewards over larger later rewards and display greater sensitivity to social rewards)
• New Forest Parenting Programme

  • A specialised intervention for parents of young children with attention deficit hyperactivity disorder (ADHD)
  • Builds on approaches used in traditional behavioural parenting interventions
  • Targets parent-child processes involved in the development of attention and self-organising skills to try address some difficulties associated with executive function difficulties and let them skills to regulate behaviour in various situations
  • 8 sessions (1 hour) delivered by a trained therapist to parents in their home
• New Forest Parenting Programme


  1. Children with ADHD have difficulty maintaining their attention on day-to-day tasks

  2. They may be struggling to keep up with the instructions that the parents are giving them, hold the info in their working memory and execute them. Perceived as non-compliance or difficult behaviour.

  3. The programme helps parents to come up with ways to help children complete day to day tasks

  4. Develop checklist so they can go through the steps

  5. Visual representation helpful for them

  6. They may also have problems with short term memory

  7. Programme includes ideas for games that help to develop their STM

  8. Scoping - find out child's current ability

  9. Extending - what the next step to extend their skills

  10. Scaffolding - learning of the skills through the games and procedures

  11. Consolidation - looking for opportunities to practise skills in the real world
• The New Forest Parenting Programme

  • Parents were randomised to receive NFPP (n=20), no treatment (n=30) or to a parent support and counselling group (n=28)
  • At the end of the intervention, NFPP was associated with improvements in ADHD symptoms (observed and clinical interview)
  • Parent well-being also improved following intervention
• Both NFPP and HNC (Helping the Noncompliant Child) led to reductions in parent-reported ADHD symptoms, but no superior effect of NFPP. NFPP did not show superior effects for parent behaviour or parent stress.
• ADHD is a chronic disorder so the difficulties are developed early and may not be that straightforward to change the processes. Cognitive Training in ADHD may be needed to more intensively target the underlying cognitive processes.
• Anxiety Interventions for Children


  • Parent behaviour has been less of a focus in models of childhood anxiety
  • The main treatment for anxiety in youth is Cognitive Behavioural Therapy (CBT)
  • Generally, lots of evidence to support CBT as a treatment in childhood anxiety
  • Evidence of long-term effects of CBT
  • However, parents may still be important. Parental Involvement in anxiety interventions for children is much more variable.
• Components of CBT with children


  1. Monitoring - Monitoring in situations to help children identify and label their feelings

  2. Cognitive Restructuring - Help reappraise evidence for maladaptive thoughts and teach new more adaptive thought processes

  3. Exposure - Reduce anxiety maintaining avoidance, graded exposure to gradually build up

  4. Skills Development - Help to develop skills which may underlie anxiety
• How parents might be involved


  • When parents look fearful, the child can pick up on this and become fearful themselves
  • Help parents reduce amount of modelling they are doing of anxiety in front of child
  • Parental cognitions might impact the way that children start to think about situations
  • Some parents are too overprotective over their children, limiting the child's opportunities to face their fears
• Silk et al, 2013


  • Bought child and parent together. Asked child to give a speech for 1.5 mins, then an optional additional speech. Children were more likely to do the optional speech if their parent gave them encouragement. Parents of anxious children are less likely to encourage their children to do the optional speech.
• Lebowitz et al, 2020


  • Individual CBT with child. Supporting Parent for Anxious Child Emotions (SPACE) - supportive responses to child anxiety, reduce accommodation and avoidance, how to communicate to child, how to deal with child responses. No difference was found in these two.
• A meta-analysis of existing CBT intervention trials for childhood anxiety found exposure is an important component of intervention. Gradually build up until comfortable at the level they are working on.