Efficacy of brief online parent management training for parents of children with externalizing behavior problems: a pilot randomized controlled trial

Parent Training for Children With or at Risk for Developmental Delay: The Role of Parental Homework Completion

ObjectivesWhile mindfulness-based parenting programs (MPPs) are increasingly popular for reducing child behavior problems, the evidence for the advantages of MPP over existing behavioral parent training is unclear. Existing systematic reviews have largely excluded the breadth of MPP protocols, including those that integrate behavioral skills components. Therefore, a scoping review was conducted to map the nature and extent of research on MPPs for parents of children aged 3 to 12 years with behavioral problems.MethodsPRISMA-ScR guidelines were used to conduct an encompassing peer literature review of cross-disciplinary databases. Studies were included if they reported mindfulness interventions for parents of children aged between 3 and 12 years with externalizing behavior problems and had an outcome measure of child behavioral problems that could be represented as an effect size. Randomized controlled trials as well as quasi-experimental, pre-post studies and unpublished dissertations were included.ResultsSixteen studies met the inclusion criteria (N = 1362). The majority of MPPs delivered mindfulness adapted to parenting based on the Bögels’ protocol within clinical settings. There was a dearth of fully integrated mindfulness and behavioral programs. MPPs generally produced pre-to-post-intervention improvements with small effect sizes across child behavior and parent style, stress, and mindfulness measures. Examining longer follow-up periods compared to pre-intervention, effects reached a moderate size across most outcome measures.ConclusionsMPPs continue to show promise in improving child behavior and parental mindfulness, well-being, and style. Further research is needed to determine how to best leverage the advantages of mindfulness in augmenting the well-established effectiveness of behavioral programs.

This study aims to explore the influence of paternal variables on outcome of behavioral parent training (BPT) in children with attention-deficit/hyperactivity disorder (ADHD). 83 referred, school-aged children with ADHD were randomly assigned to BPT plus ongoing routine clinical care (RCC) or RCC alone. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Moderator variables included paternal ADHD symptoms, depressive symptoms, and parenting self-efficacy. We conducted repeated measures analyses of variance (ANOVA) for all variables, and then analyzed the direction of interaction effects by repeated measures ANOVA in high and low scoring subgroups. Paternal ADHD symptoms and parenting self-efficacy played a moderating role in decreasing behavioral problems, but not in decreasing ADHD symptoms. Paternal depressive symptoms did not moderate either treatment outcome. BPT is most beneficial in reducing children's behavioral problems when their fathers have high levels of ADHD symptoms or high-parenting self-efficacy.

Preliminary empirical evidence supports the efficacy of digital parent management training (d-PMT) in the treatment of externalizing behavior problems in children. This study investigated the efficacy of a mobile-based self-directed d-PMT for parents of children aged 4–11 years with attention-deficit/hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD), and without pharmacological and/or behavioral therapy. Participants were randomized 1:1 to d-PMT (hiToco®) plus treatment as usual (TAU) or TAU only for 16 weeks. The primary outcome was a reduction of parent-rated externalizing problem behavior including symptoms of ADHD and ODD. Secondary outcomes included parent-rated ADHD symptoms only, ODD symptoms only, and functional impairment of the child as well as parenting behavior and family strain. Sixty-five participants were randomized to the dPMT + TAU group (n = 34) or the TAU group (n = 31). All children had a clinical diagnosis of ADHD; clinically diagnosed ODD was reported in 9 children (26.5%) in the d-PMT + TAU group and 13 children (42%) in the TAU group. The mean ± SD age of the children was 8.4 ± 1.7 years (69.2% boys). On average, participants used the program for 8 h in total. Regarding the primary outcome, significant treatment effects favoring the d-PMT + TAU group compared to the TAU group were observed at week 12 (W12) and W16 (Cohen’s d at W12: 0.74; at W16: 0.48). Post-hoc analyses showed that 50% of the children in the d-PMT + TAU group compared to 30% in the TAU group were reliably recovered or improved. Significant treatment effects in favor of the d-PMT + TAU group were also observed for all secondary variables. Our findings suggest that a mobile-based self-directed d-PMT for parents may play an important role in the multimodal treatment of children with ADHD in future clinical routine practice.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-025-02799-2.

To adapt problem-solving skills training (PSST) for parents of children receiving intensive pain rehabilitation and evaluate treatment feasibility, acceptability, and satisfaction. Using a prospective single-arm case series design, we evaluated the feasibility of delivering PSST to 26 parents (84.6% female) from one of three pediatric pain rehabilitation programs. Parents completed four to six sessions of PSST delivered during a 2-4-week period. A mixed-methods approach was used to assess treatment acceptability and satisfaction. We also assessed changes in parent mental health and behavior outcomes from pretreatment to immediate posttreatment and 3-month follow-up. Parents demonstrated excellent treatment adherence and rated the intervention as highly acceptable and satisfactory. Preliminary analyses indicated improvements in domains of mental health, parenting behaviors, health status, and problem-solving skills. Findings demonstrate the potential role of psychological interventions directed at reducing parent distress in the context of intensive pediatric pain rehabilitation.

Parents of children with autism spectrum disorder (ASD) experience significant stress and caregiving burden and urgently require targeted psychological support and parenting guidance. Integrating acceptance and commitment therapy (ACT) into the World Health Organization's caregiver skills training has demonstrated good feasibility, acceptability, and potential benefits in addressing these parents' unmet psychological and informational needs; however, its effectiveness remains unexplored. To evaluate the effectiveness of an evidence-based ACT-based parenting program on parental stress and that of other health outcomes on parents and their children with ASD immediately and 6 months after intervention. This randomized clinical trial using the intention-to-treat principle was conducted across 7 government-designated rehabilitation institutions in Shenzhen, China, from February 18, 2024, to January 20, 2025. Participants were adult parents serving as the primary caregivers of their children with ASD (aged 3-9 years). Participants were randomly allocated in a 1:1 ratio to either an intervention group or a control group using block randomization. Participants in the intervention group received usual care plus an 8-week, group-format ACT-based parenting program, while the control group received usual care only. Parental stress was the primary outcome, assessed by the Chinese version of the Parenting Stress Index-Short Form. Secondary outcomes included parental depressive symptoms, anxiety, psychological flexibility, and parenting competence and children's emotional and behavioral problems. Among 154 parents (mean [SD] age, 36.55 [4.92] years; 135 [87.66%] mothers) caring for children with ASD (mean [SD] age, 5.69 [1.75] years; 118 [76.62%] boys), 77 participants were randomized to the ACT-based intervention group and 77 were randomized to the control group. Those in the intervention group reported significantly greater improvements in parental stress (group × time effect, β = -2.04 [95% CI, -3.51 to -0.57]; P = .007), psychological flexibility (β = 1.12 [95% CI, 0.29 to 1.95]; P = .008), and parenting competence (β = 2.45 [95% CI, 0.53 to 4.36]; P = .01) and children's emotional and behavioral problems (β = -1.16 [95% CI, -2.26 to -0.05]; P = .04) during the 6-month follow-up. Significant effects on parental depressive symptoms (β = -1.61 [95% CI, -3.12 to -0.10]; P = .04) and anxiety (β = -1.62 [95% CI, -2.81 to -0.44]; P = .007) were observed in the ACT-based intervention group immediately post intervention. In this randomized clinical trial of an ACT-based parenting program, the intervention was effective in helping parents manage their stress in caregiving and the emotions and behaviors of their children with ASD, underscoring the need for future studies among more diverse populations globally. ChiCTR Identifier: 2400080472.

Early behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD. To evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD. A randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories. Internet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU). Observational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups. The sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27). Results of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families. ClinicalTrials.gov Identifier: NCT03260816.

Parent training (PT) is an effective intervention for improving children's behavioral problems and enhancing parental mental health in those caring for children with developmental disabilities (DD). Recent studies report the effectiveness of online PT (ON-PT). ON-PT encompasses both the on-demand type and the real-time type, which involves real-time online group PT delivered through web conferencing systems. However, the efficacy of the on-demand type has been established through comparisons with face-to-face PT (F2F-PT), whereas the real-time type of ON-PT has been assessed exclusively in single-arm studies, underscoring the need for comparative analyses with F2F-PT to validate its effectiveness. This study aims to compare the effectiveness of the real-time type of ON-PT and F2F-PT for parents of children with DD using a retrospective study design. The analysis included data from 13 parent-child pairs in the F2F-PT and 27 parent-child pairs in the ON-PT. Assessment scales included parental depression and stress, evaluated using the Beck Depression Inventory-Second Edition (BDI-II) and Parenting Stress Index (PSI), respectively, as well as children's behavioral problems, measured with the Eyberg Child Behavior Inventory (ECBI). A two-way repeated-measures ANOVA assessed the impact of different PT delivery methods and time on the outcome variables. Attendance and dropout rates were similar between ON-PT (82%, 18.7%) and F2F-PT (80.3%, 18.1%). A two-way repeated-measures ANOVA showed that the interaction effect was marginally significant for PSI (p = 0.066) and statistically significant for both the child domain of PSI (p = 0.049) and ECBI (p = 0.013). Simple main effects analysis indicated that pre-test mean scores for PSI (p < 0.001), the child domain of PSI (p = 0.001), and ECBI (p = 0.002) were significantly higher than post-test scores in the ON-PT compared with the F2F-PT. Furthermore, although a higher proportion of participants in the ON-PT were within the clinical range of ECBI at the pre-test (70.4%) compared to the F2F-PT, this proportion decreased to 44.4% at the post-test. This study suggests that ON-PT may be as effective as or potentially more effective than F2F-PT. The adoption of online formats should be considered for families facing challenges, as ON-PT may improve children's behavioral problems and reduce parental stress. Nonetheless, the retrospective study design warrants caution in interpreting the findings, and a future study with a prospective, rigorous validation design will be essential to effectively compare the effectiveness of ON-PT and F2F-PT.

The current pilot study was a quasi-experimental examination of the impact of father involvement in parent training among 44 families with a young child who presented with elevated externalizing behavior problems and developmental delay. All families were offered to receive Parent-Child Interaction Therapy (PCIT), an evidence-based parent-training intervention, at a hospital-based outpatient clinic. Single-mother families were significantly more likely to drop out of treatment than two-parent families. Of the families that completed treatment, children from families in which a father participated in treatment had lower levels of parent-reported externalizing behavior problems than children from single-mother families and children from two-parent families in which the father did not participate in treatment. Additionally, children from father-involved families were significantly more compliant during a cleanup task than children from single-mother families following treatment. The current study is consistent with the limited research examining father involvement in parent training and extends the findings to children with developmental delay. These findings highlight the importance of involving fathers in parent training, particularly when working with children with developmental delay.

This study examined how aspects of triadic-level family interaction relate to preschoolers' externalizing behavior problems. The quality of coparenting, family affective processes, and family structure was assessed at 3 years, and mothers, fathers, and teachers reported on children's externalizing behavior problems at 4 years. High levels of supportive coparenting and more adaptive family structures were associated with fewer externalizing behavior problems, whereas high levels of undermining coparenting and negative affect and less adaptive family structures were associated with more externalizing behavior problems. Moreover, the quality of family affectivity and family structure interacted with coparenting and appeared to influence its effects on the family. This study highlights the importance of focusing on triadic, family-level variables for understanding children's behavior problems.

Behavior problems are common in children with functional constipation. This study assessed the prevalence of overall, internalizing, and externalizing behavior problems in children with functional constipation and explored which clinical characteristics of constipation are associated with these behavior problems. Children who had functional constipation, were aged 4 to 18 years, and were referred to the gastrointestinal outpatient clinic at the Emma Children's Hospital were eligible for enrollment. This study made use of baseline data of 133 children who participated in a randomized, controlled trial that evaluated the clinical effectiveness of behavioral therapy compared with conventional treatment. Prevalence of behavior problems was assessed by the Child Behavior Checklist. Univariate and multivariate logistic regression models were used to test the association between clinical characteristics and behavior problems. The prevalence rate of overall, internalizing, and externalizing behavior problems was considerable: respectively 36.8%, 36.1%, and 27.1% compared with 9% in the Dutch norm population. A long duration of treatment was found to have the strongest association with overall and externalizing behavior problems in children with constipation. Children with constipation and nighttime urinary incontinence have an increased risk for having overall behavior problems. Fecal incontinence and the production of large stools seemed to be exclusively related to externalizing behavior problems. Behavior problems are common in children who have constipation and are referred to gastrointestinal outpatient clinics, suggesting that a behavioral screening should be incorporated into the diagnostic workup of children with constipation.

Analysis of behavioral problems in children with sleep-disordered breathing and decreased REM sleep

Risperidone and Parent Training in Pervasive Developmental Disorders

Behavioral parent and teacher training and stimulant medication are recommended interventions for children with attention-deficit/hyperactivity disorder (ADHD). However, not all children with ADHD receive this evidence-based care, and the aim of the current study was to find out why. More specifically, we investigated clinicians’ policy, guideline use, and attitudes towards medication and parent training when treating children with ADHD, as well as several factors that could affect this. A total of 219 Dutch clinicians (mainly psychologists, psychiatrists and educationalists) completed a survey. Clinicians were likely to recommend medication more often than parent training, and clinicians’ policy to recommend medication and parent training was positively associated with their attitudes towards these interventions. Less experienced clinicians and those with a non-medical background reported lower rates of guideline use, whereas clinicians with a medical background reported less positive attitudes towards parent training. Furthermore, a substantial portion of the clinicians based their decision to recommend parent training on their clinical judgement (e.g., prior estimations of efficacy, perceived low abilities/motivation of parents), and many clinicians reported barriers for referral to parent training, such as waiting lists or a lack of skilled staff. To achieve better implementation of evidence-based care for children with ADHD, guidelines should be communicated better towards clinicians. Researchers and policy-makers should further focus on barriers that prevent implementation of parent training, which are suggested by the discrepancy between clinicians’ overall positive attitude towards parent training and the relatively low extent to which clinicians actually advise parent training.

This pilot randomized controlled trial aimed to determine the feasibility, acceptability, and preliminary efficacy of parental problem-solving skills training (PSST) compared with treatment as usual on improving parental mental health symptoms, physical health and well-being, and parenting behaviors. Effects of parent PSST on child outcomes (pain, emotional, and physical functioning) were also examined. Participants included 61 parents of children aged 10 to 17 years with chronic pain randomized to PSST (n = 31) or treatment as usual (n = 30) groups. Parents receiving PSST participated in 4 to 6 individual sessions of training in problem-solving skills. Outcomes were assessed at pretreatment, immediately after treatment, and at a 3-month follow-up. Feasibility was determined by therapy session attendance, therapist ratings, and parent treatment acceptability ratings. Feasibility of PSST delivery in this population was demonstrated by high compliance with therapy attendance, excellent retention, high therapist ratings of treatment engagement, and high parent ratings of treatment acceptability. PSST was associated with posttreatment improvements in parental depression (d = -0.68), general mental health (d = 0.64), and pain catastrophizing (d = -0.48), as well as in child depression (d = -0.49), child general anxiety (d = -0.56), and child pain-specific anxiety (d = -0.82). Several effects were maintained at the 3-month follow-up. Findings demonstrate that PSST is feasible and acceptable to parents of youths with chronic pain. Treatment outcome analyses show promising but mixed patterns of effects of PSST on parent and child mental health outcomes. Further rigorous trials of PSST are needed to extend these pilot results.