Parent-focused Interventions Research Articles

The Power of Positivity: Predictors of Relationship Satisfaction for Parents of Children with Autism Spectrum Disorder.

The current study uses the actor-partner interdependence model to examine the predictors of relationship satisfaction for mothers and fathers of children with autism spectrum disorder. Sixty-seven couples completed measures of optimism, benefit finding, coping strategies, social support, and relationship satisfaction. Results indicated that parent's positive strengths predicted better personal relationship satisfaction. Moreover, parents' benefit finding, use of emotional support, and perceived social support from their partner also predicted their partner's relationship satisfaction. The results of this study highlight the importance of focusing on positive factors that can enhance relationship quality. Implications for the development of parent-focused interventions are discussed.

Reducing child conduct disordered behaviour and improving parent mental health in disadvantaged families: a 12-month follow-up and cost analysis of a parenting intervention.

The effectiveness of the Incredible Years Basic parent programme (IYBP) in reducing child conduct problems and improving parent competencies and mental health was examined in a 12-month follow-up. Pre- to post-intervention service use and related costs were also analysed. A total of 103 families and their children (aged 32-88 months), who previously participated in a randomised controlled trial of the IYBP, took part in a 12-month follow-up assessment. Child and parent behaviour and well-being were measured using psychometric and observational measures. An intention-to-treat analysis was carried out using a one-way repeated measures ANOVA. Pairwise comparisons were subsequently conducted to determine whether treatment outcomes were sustained 1 year post-baseline assessment. Results indicate that post-intervention improvements in child conduct problems, parenting behaviour and parental mental health were maintained. Service use and associated costs continued to decline. The results indicate that parent-focused interventions, implemented in the early years, can result in improvements in child and parent behaviour and well-being 12 months later. A reduced reliance on formal services is also indicated.

General and Specific Approaches to Media Parenting: A Systematic Review of Current Measures, Associations with Screen-Viewing, and Measurement Implications

Parent-focused interventions may help to reduce youth screen-viewing (SV). This review synthesized current information on the links between parenting styles, parenting practices, and youth SV with a focus on measurement. A systematic review of electronic databases was conducted. In all, 29 of 1189 studies met the inclusion criteria. Parenting practices were divided into rule and nonrule-based practices. Seven rules: (1) Limits on total time (n studies=23); (2) limits on time of day (n=7); (3) content restriction (n=11); (4) mealtime rules (n=2); (5) parental supervision (n=3); (6) contingent screentime (n=3); and (7) no-TV policy (n=1) were reported. Two nonrule-based practices were reported: Co-viewing (n=6) and encouragement to view (n=2). Three studies (10.3%) provided information on parenting styles. Only 12 studies (41.4%) provided information on the reliability/validity of the outcome measure, 15 (51.7%) studies provided information on the reliability/validity of the parenting measure, and 6 (20.7%) provided information on the reliability/validity of both outcome and exposure measures. There is mixed evidence that parenting styles and media-related parenting practices are associated with youth SV. The assessment of parental influence of youth media use is hampered by the diversity of measures that have been used. There is a need for new measures that assess a range of media parenting practices that are relevant to multiple forms of SV.

Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay

BackgroundMany children spend too much time screen-viewing (watching TV, surfing the internet and playing video games) and do not meet physical activity (PA) guidelines. Parents are important influences on children’s PA and screen-viewing (SV). There is a shortage of parent-focused interventions to change children’s PA and SV.MethodsTeamplay was a two arm individualized randomized controlled feasibility trial. Participants were parents of 6–8 year old children. Intervention participants were invited to attend an eight week parenting program with each session lasting 2 hours. Children and parents wore an accelerometer for seven days and minutes of moderate-to-vigorous intensity PA (MVPA) were derived. Parents were also asked to report the average number of hours per day that both they and the target child spent watching TV. Measures were assessed at baseline (time 0) at the end of the intervention (week 8) and 2 months after the intervention had ended (week 16).ResultsThere were 75 participants who provided consent and were randomized but 27 participants withdrew post-randomization. Children in the intervention group engaged in 2.6 fewer minutes of weekday MVPA at Time 1 but engaged in 11 more minutes of weekend MVPA. At Time 1 the intervention parents engaged in 9 more minutes of weekday MVPA and 13 more minutes of weekend MVPA. The proportion of children in the intervention group watching ≥ 2 hours per day of TV on weekend days decreased after the intervention (time 0 = 76%, time 1 = 39%, time 2 = 50%), while the control group proportion increased slightly (79%, 86% and 87%). Parental weekday TV watching decreased in both groups. In post-study interviews many mothers reported problems associated with wearing the accelerometers. In terms of a future full-scale trial, a sample of between 80 and 340 families would be needed to detect a mean difference of 10-minutes of weekend MVPA.ConclusionsTeamplay is a promising parenting program in an under-researched area. The intervention was acceptable to parents, and all elements of the study protocol were successfully completed. Simple changes to the trial protocol could result in more complete data collection and study engagement.

Parenting under Pressure: a grounded theory of parenting young children with life‐threatening congenital heart disease

To report a grounded theory study to describe the process of parenting young children who have survived hypoplastic left heart syndrome to inform parent-focused interventions. Technological advances in paediatric cardiology worldwide have improved the survival rates for young children with hypoplastic left heart syndrome who undergo staged surgical palliation. These children, however, are at risk for life-threatening complications and parents are charged with the responsibility to monitor their children at home with minimal support and guidance from healthcare professionals once home. A constructivist grounded theory study. The study was conducted in 2006-2008. Participants were 25 parents (15 mothers, 10 fathers) and 28 grandparents (17 grandmothers, 11 grandfathers) of 15 young children (6 months-4·5 years) who had undergone the Sano surgical approach for hypoplastic left heart syndrome. The 53 interviews were digitally recorded, transcribed and analysed using open and focused coding, constant comparative analysis and memoing. A process of Parenting under Pressure emerged that was characterized by four overlapping and re-emerging phases: (1) realizing and adjusting to the inconceivable; (2) growing increasingly attached; (3) watching for and accommodating the unexpected; and (4) encountering new challenges. In-depth understanding of the phases of Parenting under Pressure provides direction for nurses to support parents of children who survive hypoplastic left heart syndrome. Interventions that help carers of children with complex health conditions move through the phases of our Parenting under Pressure process may help them safeguard the survival of their children, and their own survival as parents as they manage multiple demands.

Cost-effectiveness of child-focused and parent-focused interventions in a child anxiety prevention program

In this study, the cost-effectiveness of three indicated anxiety prevention strategies was examined from a societal perspective. Children (aged 8–12) were recruited via primary schools, selecting children scoring as high-anxious on an anxiety screening questionnaire. Participating children and their parents were randomized to a child – a parent-focused, or non-intervention group. All groups completed a diagnostic interview and standardized cost-diaries at pretest, and 1- and 2-year follow-up. Incremental cost-effectiveness ratios per ‘ADIS improved’ child (based on diagnostic information) were calculated and cost-effectiveness acceptability curves and frontiers were plotted. The base-case and most secondary analyses showed it would be cost-effective to offer high-anxious children an intervention, and the parent-focused intervention to be the optimal strategy at lower monetary threshold values than the child-focused intervention and when parents were anxious. The child-focused intervention was dominant when analyses were performed from a healthcare perspective, for boys, and for children of grades 7–8 of primary school.

Parental behaviours, but not parental smoking, influence current smoking and smoking susceptibility among 14 and 15 year‐old children

To explore whether parental behaviours related to smoking socialisation and parenting are associated with smoking susceptibility and current smoking in 14-15 year old students. Data were sourced from the New Zealand 2006 Year 10 In-depth Survey, a school-based survey of 3,189 students. Outcome measures were susceptibility to smoking and current smoking. Potential determinants were second-hand smoke exposure in the home, parental smoking, parental anti-smoking expectations, anti-smoking rules, pocket money, monitoring of pocket money expenditure, general rule setting and monitoring, and concern about education. Analysis used logistic regression to adjust for potential confounding factors. Exposure to second-hand smoke and lack of parental anti-smoking expectations were independently associated with smoking susceptibility and current smoking. Parental smoking was not independently associated with current smoking or susceptibility. Receiving pocket money and an absence of monitoring of expenditure were associated with smoking susceptibility and current smoking. Lack of parental rule setting was associated with smoking susceptibility. Findings were similar whether or not one or more parents were smokers. Not allowing smoking in the home, communicating non-smoking expectations to children, monitoring pocket money, and setting rules to guide behaviour are strategies which are likely to reduce risk of smoking uptake. The study provides evidence to inform the development of parent-focused interventions to reduce the risk of smoking initiation by children.

The Association of Child Mental Health Conditions and Parent Mental Health Status Among U.S. Children, 2007

The purpose of this study is to examine the association of child mental health conditions and parent mental health status. This study used data from the 2007 National Survey of Children's Health on 80,982 children ages 2-17. The presence of a child mental health condition was defined as a parent-reported diagnosis of at least one of seven child mental health conditions. Parent mental health was assessed via a 5-point scale. Logistic regression was used to assess the association of child mental health conditions and parent mental health status, while examining socioeconomic, parent, family, and community factors as potential effect modifiers and confounders of the association. 11.1% of children had a mental health condition (95% CI = 10.5-11.6). The prevalence of child mental health conditions increased as parent mental health status worsened. Race/ethnicity was the only significant effect modifier of the child-parent mental health association. After adjustment for confounders, the stratum-specific adjusted odds ratios (95% CI) of child mental health conditions related to a one-level decline in parent mental health were: 1.44 (1.35-1.55) for non-Hispanic whites, 1.24 (1.06-1.46) for non-Hispanic blacks, 1.04 (0.81-1.32) for Hispanics from non-immigrant families, 1.21 (0.96-1.93) for Hispanics from immigrant families, and 1.43 (1.21-1.70) for non-Hispanic other race children. The effect of parent mental health status on child mental health conditions was significant only among non-Hispanic children. Parent-focused interventions to prevent or improve child mental health conditions may be best targeted to the sub-populations for whom parent and child mental health are most strongly associated.

Blame the Parents? Challenges for Parent‐Focused Programmes for Families of Gang‐Involved Young People

Parent‐focused interventions are a potentially effective tool for preventing and reducing gang involvement, although the challenges of delivering such services are considerable. Drawing from data collected over 26 months for the ethnographic study, Youth Gangs in an English City, including interviews with parents of gang‐involved young people, we identify potential obstacles. These include: psychological barriers to the participation of parents relating to perceived denial, stigma and blame; and possible counter‐productivity of interventions. Strategies to minimise these are discussed.

Parents of Children with Mental Illness: Exploring the Caregiver Experience and Caregiver-Focused Interventions

Serious mental illness in children can significantly impact the parents who care for these children in both positive and negative ways. Caregiver strain and enrichment manifests in all areas of parents' lives, including work, mental and physical health, and social and family relationships. Research has identified numerous predictors of caregiver strain such as severity of child's illness and impairment, race, and social support. These parents need strengths-based, parent-focused interventions to help them care for themselves and their family in a healthy, effective manner. A brief summary describes 4 types of interventions for parents of children with mental illness and the supporting research. Education, support, and skill building are all important components in parent interventions. A parent focus for interventions and research will decrease caregiver strain and create a healthier environment for the entire family.

Efficacy of Child-Focused and Parent-Focused Interventions in a Child Anxiety Prevention Study

This study examined anxiety development in median- (n = 74) and high-anxious children (n = 183) aged 8–13, the effect of parent- and child-focused preventive interventions on child/parental anxiety, and the effect of parental anxiety on child anxiety. High-anxious children were randomized into a parent-focused (n = 69), child-focused (n = 58) or non-intervention (n = 56) group. Families completed a pretest and 1- and 2-year follow-ups. Children selected as high-anxious or at risk were found to remain more susceptible to having anxiety problems and developing anxiety disorders than median-anxious children. Both intervention types showed favorable outcomes compared to no intervention on the number of “ADIS improved” children. These findings underline the need for effective preventive interventions for child anxiety. General improvements over time were found for symptoms of child and parental anxiety, however, and parental anxiety did not predict improvement in child anxiety after controlling for intervention. Therefore, it may not be necessary to focus on parental anxiety in interventions aimed at preventing child anxiety.

Emotion Socialization by Mothers and Fathers: Coherence among Behaviors and Associations with Parent Attitudes and Children's Social Competence.

This study examined interrelations among different types of parental emotion socialization behaviors in 88 mothers and 76 fathers (co-residing with participating mothers) of 8-year-old children. Parents completed questionnaires assessing emotion socialization behaviors, emotion-related attitudes, and their children's social functioning. An observed parent-child emotion discourse task and a child social-problem solving interview were also performed. Parent gender differences and concordance within couples in emotion socialization behaviors were identified for some but not all behaviors. Fathers' reactions to child emotion, family expressiveness, and fathers' emotion coaching during discussion cohered, and a model was supported in which the commonality among these behaviors was predicted by fathers' emotion-coaching attitudes, and was associated with children's social competence. A cohesive structure for the emotion socialization construct was less clear for mothers, although attitudes predicted all three types of emotion socialization behavior (reactions, expressiveness, and coaching). Implications for developmental theory and for parent-focused interventions are discussed.

Targeting parents for the treatment of pediatric obesity in boys with Duchenne muscular dystrophy: A case series

Obesity is a major public health concern in children. Obesity occurs frequently in boys with Duchenne muscular dystrophy (DMD), complicating treatment and impairing functioning. Parent-focused interventions to facilitate weight loss have been successful in other pediatric samples but have not been studied with this population. The current investigation examined the feasibility and potential efficacy of parent-focused treatment to improve healthy eating and physical activity of parents and eating and weight in their sons with DMD. Three families participated in this case series. Resulting changes in body weight among boys with DMD were an outcome variable. Findings indicate inconsistent changes in boys' weight, decreases in parent weight, increases in healthy foods available in the home, and increases in children's perceived quality of life. Participant ratings of treatment suitability and satisfaction were generally favorable. These preliminary findings support the use of parent-focused psychoeducation for the treatment of obesity in children with DMD.

A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms

Objective To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents’ sexual behavior, knowledge and access to contraception. Material and methods Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent–child dyads in the control and intervention schools were matched according to parents’ propensity score; the average treatment effect (ATE) was estimated for adolescent’s outcome variables. Results At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. Conclusions Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health.

Improving the Mental Health of Children in Child Welfare Through the Implementation of Evidence-Based Parenting Interventions

Any comprehensive approach to children's mental health should consider services systems such as Child Welfare that provide services to children with high rates of emotional and behavioral disorders. This paper will review what is known about efficacious parent-focused interventions that can improve the lives of children in Child Welfare and explore possible reasons why such interventions are rarely used by Child Welfare agencies. Data from a pilot study suggest key features for increasing the implementation of efficacious practices to improve children's mental health.

Parental reactions to children’s negative emotions: Prospective relations to Chinese children’s psychological adjustment.

The prospective relations between five types of parental reactions to children's negative emotions (PRCNE) and children's psychological adjustment (behavioral problems and social competence) were examined in a two-wave longitudinal study of 425 school-age children in China. Parents (mostly mothers) reported their own PRCNE. Parents, teachers, and children or peers reported on children's adjustment. Parental punitive reactions positively predicted externalizing problems (controlling for baseline), whereas emotion- and problem-focused reactions were negatively related to internalizing problems. Parental minimizing and encouragement of emotion expression were unrelated to adjustment. Concurrent relations were found between PRCNE and parents' authoritative and authoritarian parenting dimensions. However, PRCNE did not uniquely predict adjustment controlling for global parenting dimensions. The findings have implications for cultural adaptation of parent-focused interventions for families of Chinese origin.

The CHEER Study to Reduce BMI in Elementary School Students: A School-Based, Parent-Directed Study in Framingham, Massachusetts

Childhood obesity may be lessened by parent-focused interventions. A pilot parent-directed trial with 46 parents of overweight and obese elementary school students was conducted at two ethnically diverse public schools in Framingham, Massachusetts. Parents were randomly assigned to either the Materials Group, which received mailed educational materials, or the Materials plus Personal Encounters Group, which received educational materials through interactions with community health workers (CHWs). Parents completed baseline and post-intervention surveys; children's body mass index (BMI) percentiles were measured at baseline and post-intervention. There were no differences in the reduction of children's BMI between groups. However, the mean BMI percentile for all children dropped from 94.1 to 90.6 (p = .005), while there was no change in BMI among a nonrandomized contemporaneous control group. Findings are limited by the lack of a true control group and small sample size. Results from this school nurse and CHW outreach program to parents are encouraging.

Time Since Last Cervical Cancer Screening, Behavioral Risk Factor Surveillance System (Brfss), United States, 2000 And 2006

The use of parent-focused internet-based programs for the prevention and treatment of childhood obesity has shown promise but there is an acknowledged gap in parent-focused interventions which target the early childhood stage.The aim of this study is to determine the efficacy of Time2bHealthy - an online healthy lifestyle program for parents of preschool-aged children. The program will be evaluated using a two-arm, parallel, randomised controlled design. The 11-week program is underpinned by Social Cognitive Theory and consists of interactive modules on healthy eating, physical activity, screen-time and sleep. The intervention also involves elements of social media, where participants share discuss ideas and experiences and they can interact and obtain information with experts. Time2bHealthy is being compared to a comparison condition. Outcomes include change in BMI (primary outcome), dietary intake, physical activity, sleep, child feeding, parental role-modelling and parent self-efficacy. Process evaluation data, such as adherence and engagement with the online forums, will also be collected.Time2bHealthy is the first randomised controlled trial to our knowledge to assess the efficacy of an online parent-focussed healthy lifestyle program for preschool-aged children in changing body mass index. Early childhood is a crucial time for establishing healthy lifestyle behaviours and parents play an important role. This study therefore fills an important gap in the literature. If found to be efficacious, Time2bHealthy has potential for broad-reach access and translation into primary health care services.The study is registered with the Australian and New Zealand Clinical Trials Registry (12616000119493).

Spectacle Acceptance among Secondary School Students in Rural China: The Xichang Pediatric Refractive Error Study (X-PRES)—Report 5

To assess determinants of spectacle acceptance and use among rural Chinese children. Children with uncorrected acuity < or = 6/12 in either eye and whose presenting vision could be improved > or = 2 lines with refraction were identified from a school-based sample of 1892 students. Information on obtaining glasses and the benefits of spectacles was provided to children, families, and teachers. Purchase of new spectacles and reasons for nonpurchase were assessed by direct inspection and interview 3 months later. Among 674 (35.6%) children requiring spectacles (mean age, 14.7 +/- 0.8 years), 597 (88.6%) were followed up. Among 339 children with no glasses at baseline, 30.7% purchased spectacles, whereas 43.2% of 258 children with inaccurate glasses replaced them. Most (70%) subjects paid US$13 to $26. Among children with bilateral vision < or = 6/18, 45.6% bought glasses. In multivariate models, presenting vision < 6/12 (P < 0.009), refractive error < -2.0 D (P < 0.001), and amount willing to pay for glasses (P = 0.01) were predictors of purchase. Reasons for nonpurchase included satisfaction with current vision (78% of those with glasses at baseline, 49% of those without), concerns over price or parental refusal (18%), and fear glasses would weaken the eyes (13%). Only 26% of children stated that they usually wore their new glasses. Many families in rural China will pay for glasses, though spectacle acceptance was < 50%, even among children with poor vision. Acceptance could be improved by price reduction, education showing that glasses will not harm the eyes, and parent-focused interventions.

Ethnic differences in overweight and obesity in early adolescence in the MRC DASH study: the role of adolescent and parental lifestyle

Ethnicity is a consistent correlate of excess weight in youth. We examine the influence of lifestyles on ethnic differences in excess weight in early adolescence in the UK. Data were collected from 6599 pupils, aged 11-13 years in 51 schools, on dietary practices and physical activity, parental smoking and overweight, and on overweight and obesity (using International Obesity Task Force criteria). Skipping breakfast [girls odds ratio (OR) 1.74, 95% confidence interval (CI) 1.30-2.34; boys OR 2.06; CI 1.57-2.70], maternal smoking (girls OR 2.04, CI 1.49-2.79; boys OR 1.63, CI 1.21-2.21) and maternal overweight (girls OR 2.01, CI 1.29-3.13; boys OR 2.47, CI 1.63-3.73) were associated with obesity. Skipping breakfast, more common among girls, was associated with other poor dietary practices. Compared with White UK peers, Black Caribbeans (girls OR 1.62, CI 1.24-2.12; boys OR 1.49, CI 1.15-1.95) and Black Africans (girls OR 1.96, CI 1.52-2.53; boys OR 2.50, CI 1.92-3.27) were more likely to skip breakfast and engage in other poor dietary practices, and Indians were least likely. White Other boys reported more maternal smoking (OR 1.37, CI 1.03-1.82). All these reports were more common among those born in the UK than those born elsewhere. Black Caribbean girls were more likely to be overweight (OR 1.38, CI 1.02-1.87) and obese (OR 1.65, CI 1.05-2.58), Black African girls to be overweight (OR 1.35, CI 1.02-1.79) and White Other boys to be overweight (OR 1.37, CI 1.00-1.88) and obese (OR 1.86, CI 1.15-3.00). Adverse dietary habits and being born in the UK contributed to these patterns. These findings signal a potential exacerbating effect on ethnic differences in obesity if adverse dietary habits persist. Combined adolescent and parent-focused interventions should be considered.