Positive Parenting Intervention Research Articles

Evaluation of Virtual Enhanced Child Adult Relationship Enhancement in Primary Care Intervention.

Because of COVID-19 pandemic social distancing requirements, the in-person Child Adult Relationship Enhancement in Primary Care (PriCARE) positive parenting intervention was adapted for virtual delivery. Objective was to evaluate the efficacy of the virtual PriCARE program to improve parenting capacity, decrease child behavioral problems, and decrease child maltreatment risk. Caregivers of children 2 to 6 years old recruited from pediatric primary care were randomized to PriCARE (n = 92) or waitlist control (n = 90). Dysfunctional parenting, positive parenting skills, child behaviors, and child maltreatment risk were measured at baseline and 2 to 3 months after intervention using the Parenting Scale (PS), Dyadic Parent-Child Interaction Coding System (DPICS), Eyberg Child Behavior Inventory (ECBI), and Child Abuse Potential Inventory (CAPI). Kruskal-Wallis test compared median change scores from baseline to follow-up by treatment arm. Of 182 enrolled caregivers, 92% (168) were mothers and 67% (122) completed study measures at baseline and follow-up. The median decrease (improvement) in total PS score was greater in the PriCARE group compared with the control group (-0.3 [IQR 0.69] vs -0.1 [IQR 0.56], p = 0.028) as was the median decrease (improvement) in ECBI problem score (-3 [IQR 9] vs -1 [IQR 7], p = 0.045) and ECBI intensity score (-9 [IQR 21] vs 0 [IQR 25], p = 0.006). Improvements in 4 positive parenting skills measured by DPICS were greater in the PriCARE group compared with the control group (all p< 0.003). Median decrease in CAPI abuse score did not differ significantly by study arm (p = 0.055). The PriCARE virtual adaptation demonstrated promise in promoting positive parenting and decreasing child behavior problems.

Positive parenting practices support children at neurological risk during COVID-19: a call for accessible parenting interventions.

Children and youth with neurological and/or neurodevelopmental conditions were at high risk for behavioral and mental health challenges during the COVID-19 pandemic. Positive and responsive parenting practices may be one way to prevent and manage potential difficulties in families. We aimed to identify whether positive parenting practices were associated with reduced behavioral concerns in children at neurological risk during the late stages and aftermath of the COVID-19 pandemic. In addition, we examined whether ongoing parental stress, anxiety, and depression impacted parenting practices during this time period. Families (N = 179) with children 4 to 15 years old (M = 7.11y, SD = 2.02) diagnosed with neurological (84.3%), neurodevelopmental (54.8%) or comorbid neurological and/or neurodevelopmental conditions (21.2%) were contacted to complete online questionnaires regarding demographics, parent stress, child behavior, COVID-19 conditions, and parenting practices. Multivariable linear regression (MLR) analyses examined the association between positive parenting practices and parenting competency measures with child behavioral outcomes, controlling for relevant covariates, including COVID-19 related stress. MLR were also run to determine whether parental mental health impacted parenting practices. More positive parenting practices predicted fewer child problem behaviors and lower intensity of problem behaviors. Similarly, a higher sense of satisfaction with parenting competence also predicted fewer child problem behaviors and lower intensity of problem behaviors. In addition, higher reported parental depression, anxiety, and stress significantly predicted fewer reported positive parenting practices. Findings points to the promising application of positive parenting interventions to support vulnerable families, as well as the need for parental mental health intervention to support parenting practices.

Child Adult Relationship Enhancement in Primary Care (PriCARE) theory of change: A promising intervention to reduce child maltreatment

Child maltreatment (CM) is a pervasive public health problem and there is a critical need for brief, effective, scalable prevention programs. Because problematic parent-child relationships lie at the core of CM, interventions targeting this relationship hold promise as CM prevention strategies. Evidence-based positive parenting interventions, as discussed here, are manualized behavioral interventions that focus on teaching caregivers positive parenting skills and techniques to improve the effectiveness of their parenting and improve their relationship with their child. In this article, we describe one specific parenting intervention, Child Adult Relationship Enhancement in Primary Care (PriCARE)/Criando Niños con CARIÑO, and review the proposed mechanisms through which PriCARE may contribute to CM prevention. PriCARE is a 6-session group parenting intervention for parents of 2-to-6-year-old children. PriCARE was developed and iteratively adapted with input from racially and ethnically diverse families, including low-income families, and was designed specifically for implementation in primary care with inclusion of strategies to align with usual care workflow to increase uptake and retention. PriCARE has the potential to reduce risk of CM directly through improving parenting behaviors and indirectly through the impact of those changes in parenting behaviors on child behaviors. PriCARE has also been shown to reduce parenting-related stress. Finally, by strengthening and bringing warmth to the parent-child relationship, PriCARE may buffer against the negative health consequences associated with CM and childhood adversity.

Helping families help themselves: The (Un)intended impacts of a digital parenting program

Parenting practices play a crucial role in child development. We evaluate the impact of a free digital stress management and positive parenting intervention designed to improve caregiver’s mental health and positive caregiver–child interactions in El Salvador. Drawing on the prior success of in-person interventions, we study the effects of digital intervention delivery and examine differential treatment effects by caregiver’s sex. Using an individual-level experiment, we find that the intervention increased stress and anxiety and lowered caregiver–child interactions among male caregivers. In contrast, among female caregivers, we did not detect changes in mental health and observed a decrease in the use of physical violence against children. We also find that family structure and the severity of economic deprivation greatly moderated the intervention’s impact, especially among male caregivers. Our findings indicate that one-size-fits-all digital parenting interventions may not serve all caregivers effectively, emphasizing the need for thorough evaluations prior to extensive implementation.

Estimated Therapy Costs and Downstream Cost Consequences of iBASIS–Video Interaction to Promote Positive Parenting Intervention vs Usual Care Among Children Displaying Early Behavioral Signs of Autism in Australia

The growing global prevalence of autism spectrum disorder (ASD) is associated with increasing costs for support services. Ascertaining the effects of a successful preemptive intervention for infants showing early behavioral signs of autism on human services budgets is highly policy relevant. To estimate the net cost impact of the iBASIS-Video Interaction to Promote Positive Parenting (iBASIS-VIPP) intervention on the Australian government. Infants (aged 12 months) showing early behavioral indicators of autism were recruited through community settings into the multicenter Australian iBASIS-VIPP randomized clinical trial (RCT), a 5- to 6-month preemptive parent-mediated intervention, between June 9, 2016, and March 30, 2018, and were followed up for 18 months to age 3 years. This economic evaluation, including cost analysis (intervention and cost consequences) and cost-effectiveness analyses of iBASIS-VIPP compared with usual care (treatment as usual [TAU]), modeled outcomes observed at age 3 through to 12 years (13th birthday) and was conducted from April 1, 2021, to January 30, 2023. Data analysis was conducted from July 1, 2021, to January 29, 2023. iBASIS-VIPP intervention. To project the diagnostic trajectory and associated disability support costs drawing on the Australian National Disability Insurance Scheme (NDIS), the main outcome was the differential treatment cost of iBASIS-VIPP plus TAU vs TAU and disability-related government costs modeled to age 12 years, using a clinical diagnosis of ASD and developmental delay (with autism traits) at 3 years. Costs were calculated in Australian dollars and converted to US dollars. Economic performance was measured through the following: (1) differential net present value (NPV) cost (iBASIS-VIPP less TAU), (2) investment return (dollars saved for each dollar invested, taking a third-party payer perspective), (3) break-even age when treatment cost was offset by downstream cost savings, and (4) cost-effectiveness in terms of the differential treatment cost per differential ASD diagnosis at age 3 years. Alternate values of key parameters were modeled in 1-way and probabilistic sensitivity analysis, the latter identifying the likelihood of an NPV cost savings. Of the 103 infants enrolled in the iBASIS-VIPP RCT, 70 (68.0%) were boys. Follow-up data at age 3 years were available for 89 children who received TAU (44 [49.4%]) or iBASIS-VIPP (45 [50.6%]) and were included in this analysis. The estimated mean differential treatment cost was A $5131 (US $3607) per child for iBASIS-VIPP less TAU. The best estimate of NPV cost savings was A $10 695 (US $7519) per child (discounted at 3% per annum). For each dollar invested in treatment, a savings of A $3.08 (US $3.08) was estimated; the break-even cost occurred at age 5.3 years (approximately 4 years after intervention delivery). The mean differential treatment cost per lower incident case of ASD was A $37 181 (US $26 138). We estimated that there was an 88.9% chance that iBASIS-VIPP would deliver a cost savings for the NDIS, the dominant third-party payer. The results of this study suggest that iBASIS-VIPP represents a likely good-value societal investment for supporting neurodivergent children. The estimated net cost savings were considered conservative, as they covered only third-party payer costs incurred by the NDIS and outcomes were modeled to just age 12 years. These findings further suggest that preemptive interventions may be a feasible, effective, and efficient new clinical pathway for ASD, reducing disability and the costs of support services. Long-term follow-up of children receiving preemptive intervention is needed to confirm the modeled results.

The Healthy Kids & Families study: Outcomes of a 24-month childhood obesity prevention intervention

Socioeconomically disadvantaged children experience a high burden of obesity but few interventions address obesity prevention in this population subgroup. The Healthy Kids & Families study tested the effect of a parent-focused community health worker (CHW)-delivered lifestyle intervention to prevent childhood obesity. Participants were child-parent/guardian (Kindergarten to 6th grade at baseline) dyads (n = 247) recruited through schools located in socioeconomically disadvantaged neighborhoods in Worcester, MA, USA. Using a quasi-experimental design, the study tested the impact of Healthy Kids & Families, a theory-based, low-intensity, parent-focused, CHW-delivered intervention to improve children’s weight, healthy eating and physical activity. The attention-control comparison condition was a positive parenting intervention. The primary outcome was change in child body mass index (BMI) z-score at 24 months. Secondary outcomes included number of positive child and parent changes in selected diet and physical activity behaviors targeted by the intervention and change in parent BMI. Outcomes were assessed following the intent-to-treat principle and using multivariable generalized linear mixed models. Compared to the attention-control comparison condition, the Healthy Kids & Families intervention led to a greater reduction in children’s BMI z-score (β = −0.17, 95 %CI: −1.92 to −0.36; p = 0.057) and a greater number of positive behavior changes among children (β = 0.57, 95 %CI: 0.08–1.06; p = 0.02) at 24 months. There was no significant change in parent outcomes. The Healthy Kids & Families intervention shows promise for obesity prevention among children in socioeconomically disadvantaged communities.

Pandemic Perils and Promise: Implementation of a Virtual Parenting Intervention during COVID-19 among Children with Early Neurological Conditions

ABSTRACT Objective In this study, we examined feasibility, acceptability, and preliminary efficacy of a telepsychological positive parenting intervention (I–InTERACT-North, Internet-basedInteracting Together Everyday: Recovery After Childhood Traumatic Brain Injury) during the COVID-19 pandemic among Canadian families of children at-risk for neurodevelopmental challenges given congenital or neonatal conditions. I–InTERACT-North was developed to improve behavioral and emotional outcomes in children with neurological conditions by utilizing and adapting parenting strategies from several established family-focused programmes. Methods A pragmatic prospective pre-post single-site pilot study design was used to assess feasibility, acceptabilty, and preliminary efficacy of I-InTERACT North during the COVID-19 pandemic. Results Thirty-five families of children ages three to nine years were referred between March 2020 and January 2021. Eighteen families enrolled, and 12 (67% adherence) completed the programme. Parents reported strong therapeutic alliance and programme acceptability with barriers due to competing time demands. Therapists reported high acceptability but perceived parental burnout. Parenting confidence (d = 0.70), and child behavior (d = 1.30) improved following the intervention. Conclusions Results demonstrate the programme’s value to families during the pandemic, while underscoring unique participation barriers. Future research and clinicial implications are discussed.

A positive parenting program to enhance positive affect in children of previously depressed mothers.

Children of mothers with a history of depression are at heightened risk for developing depression and other maladaptive outcomes. Deficits in parenting are one putative mechanism underlying this transmission of risk from mother to child. The present study evaluated whether a brief intervention with mothers with a history of depression produced greater use of positive parenting behaviors and an increase in observed positive affect in their 8- to 10-year-old children. Mothers with a history of depression (n = 65) were randomly assigned to either a positive parenting intervention or an attention control intervention condition. In addition, a comparison group of 66 mothers with no history of depression was evaluated one time. Results revealed significant increases in positive parenting behaviors (e.g., active listening, praise) immediately postintervention in mothers randomized to the positive parenting intervention as compared to those in the attention control condition. Children of mothers in the positive parenting intervention showed increases in positive affect as compared to children of mothers in the attention control intervention. Increases in mothers' active listening and smiling/laughing significantly predicted increases in children's positive affect. The intervention did not increase the rate of children's moment-by-moment positive affect contingent on mothers' positive parenting behaviors. This study showed the short-term effectiveness of a brief parenting intervention for enhancing interactions between mothers with a history of depression and their children by directly targeting mothers' positive parenting and, indirectly, children's expressions of positive affect. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Promoting positive parenting and mental wellbeing in Hong Kong Chinese parents: A pilot cluster randomised controlled trial.

Effective and brief positive parenting interventions could be adopted widely, but evidence is limited. We aimed to evaluate the effectiveness of a positive parenting programme in Hong Kong Chinese parents. We conducted a pilot cluster randomised controlled trial in 2017 in 144 Hong Kong Chinese parents (84.7% women, mean age 42.5 [SD 5.87] years) of school-age children (mean age 10.9 [2.8] years) in 4 family service centres (clusters). The intervention included two 2-hour interactive talks (4 hours in total). The contents covered skills of giving praise, showing appreciation and playing enjoyable family games. The control group was offered the intervention after all the data were collected. Praise, appreciation and enjoyment related behaviours were measured as primary outcomes at baseline, 1 month and 3 months. The secondary outcomes were subjective happiness, wellbeing, personal health and happiness, family health, family happiness and harmony, and family relationship. After the completion of all assessments, five focus group discussions with the parents and four individual in-depth interviews with community service providers were conducted to explore their experiences. Compared with the control group (n = 69), the intervention group (n = 75) showed greater positive changes in appreciation and enjoyment at 3 months with small effect sizes (d = 0.42 and 0.32, respectively), and greater improvements in the secondary outcomes at 3 months with small effect sizes (d: 0.29-0.48). In the focus groups, the parents reported more praise to their children, better temper control, more focus on their children's strengths and better family relationships. According to the service providers, most of the parents enjoyed the activities. The brief intervention in community settings with the engagement of community service providers has shown preliminary effectiveness in promoting positive parenting and mental wellbeing of Hong Kong Chinese parents. The authors confirm that all ongoing and related trials for this intervention are registered. The study reported in this manuscript is registered as clinical trial at clinicaltrials.gov: NCT03282071. https://clinicaltrials.gov/ct2/show/NCT03282071.

Moderate low birth weight and socioemotional competence among children: The role of parenting factors in early childhood

BackgroundAlthough the importance of birth weight for socioemotional trajectories among children has become a topic of growing interest for researchers, the majority of prior studies were limited to the more extreme subgroups of low birth weight children. PurposeThe purpose of this study was to examine the longitudinal associations among moderate low birth weight status, parenting factors, and socioemotional competence among at-risk children. This paper also examined the role of parenting factors as a moderator in the associations between birth weight and indicators of socioemotional competence at age 9. MethodsParticipants include a subsample (N = 1809) of families participating in the Fragile Families and Child Wellbeing Study, a national longitudinal birth cohort study. Birth weight and prenatal data were taken from medical records. Parenting factors were assessed during in-home assessments at ages 3 and 5. Teachers reported on externalizing behaviors and social skills at age 9. Structural equation modeling was used to examine the associations among study variables. ResultsOverall, results indicate that moderate low birth weight was significantly associated with lower levels of teacher-reported socioemotional competence at age 9 even after accounting for a large battery of control variables. Results also showed that maternal warmth, but not parenting stress, moderated the longitudinal association between birth weight and indicators of socioemotional competence. ConclusionFindings highlight the importance of birth weight and positive parenting processes in socioemotional outcomes among children. The implications of these findings are discussed for targeting positive parenting interventions and developmental outcomes for at-risk children.

Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation

ObjectiveTo assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India.DesignThis mixed methods study used the Medical Research...

Brief, digital, self-directed, and culturally adapted: Developing a parenting intervention for primary care

Preventive positive parenting interventions support healthy outcomes for children and have the potential to buffer the effects of poverty via changes in parent attitudes and behaviors. Delivering digital parenting interventions that have been adapted for the end-user population within pediatric primary care settings has the potential to support fit, acceptability, and reach of such interventions. This study used an experimental mixed-methods design to develop and test a digital, single-session, self-directed preventive parenting intervention in pediatric primary care during well-child visits. The intervention was developed through integration of common elements of evidence-based parenting practices and surface structure adaptations following end-user (i.e., caregiver) prototyping (Phase 1). The adapted intervention, Parenting A to Z, was tested in a beta-testing randomized controlled trial (N = 60) during well-child visits for children ages 2 to 8 years of age in primary care clinics serving primarily low-income Latinx families (Phase 2). Phase 1 results included adaptations to the procedures, content, and aesthetics using end-user feedback. Phase 2 results indicated the feasibility and acceptability of the adapted intervention and its digital delivery format. The effect size of the intervention on parental stress was commensurate with other, higher dose evidence-based preventive interventions. The results demonstrate how a brief, digital, self-directed parenting intervention aligned with the goals of the end-user population increased the reach and access to underserved children and families.

Preemptive positive parenting intervention in infants reduces ASD at age 3

Typically, intervention for autism spectrum disorder (ASD) doesn't begin until the condition is diagnosed, and diagnosis doesn't occur before age 3. The first trial of an intervention administered to infants before diagnosis has found a statistically significant reduction in ASD behaviors by age 3 years. Treating ASD during the prodromal period is efficacious, the randomized clinical trial found.

Behavioral and Socioemotional Outcomes of the Legacy for Children™ Randomized Control Trial to Promote Healthy Development of Children Living in Poverty, 4 to 6 Years Postintervention.

The objective of this article was to assess the impact on behavioral and socioemotional development, 4 to 6 years postintervention (depending on the curriculum), of Legacy for Children™, a public health approach to improve child developmental outcomes among families living in poverty. Mothers who were recruited prenatally or at the time of childbirth participated in a set of Legacy parallel design randomized control trials between 2001 and 2009 in Miami, Florida, or Los Angeles, California. Of the initial 574 mother-child dyads, 364 completed at least 1 behavioral or socioemotional outcome measure at the third-grade follow-up. Intention-to-treat analyses compared Legacy and comparison groups on behavioral and socioemotional outcomes. Children of Legacy mothers in Los Angeles were at lower risk for externalizing behaviors and poor adaptive skills than children whose mothers did not participate in the intervention. No significant outcome differences by group assignment were found in Miami. Group-based positive parenting interventions such as Legacy may have a sustained impact on children's behavioral and socioemotional development several years after intervention completion.

Violent Behavioural Outcomes: An Empirical Examination of Perceived Parenting Rejection Practices in Lahore, Pakistan

Across the cultures, parenting or child-rearing practices are considered as the concrete behaviors towards the developmental process of rearing or socialization of the children. The study splits the conception of parenting practices among two domains as parental acceptance and parental rejection, depending on the behavioural outcomes under investigation. The cross sectional research was conducted on young males attending colleges in Lahore, Pakistan to understand that how parental rejection dimensions of parenting manifest the violent behavioral outcome among male college students. The research within the Pakistani indigenous culture on parenting practices and its inter-relationship between youth violent behavioural outcomes provide stems from the theoretical anchorage in the socio-psychological works. The sample of 816 male students from public colleges of Lahore was included to collect the responses through self-administered questionnaire as a tool of the study. The results indicated that measures of perceived parental rejection accounts variations in the violent behavioural outcomes of the young male students for 26.2% (R2 = 0.262). The study suggests that positive parenting interventions may cause to reduce the risk factors (i.e. violent behavioral practices) among youth.

The application of positive parenting interventions to academic school readiness: A scoping review.

Positive parenting interventions were traditionally developed for use in infant and preschool mental health. However, there is increasing application to a broader range of developmental outcomes. A scoping review was conducted to map the landscape of the diverse applications of positive parenting interventions to academic school readiness. Positive parenting interventions that took place in the early childhood period (prenatal to 6 years) and included an assessment of academic readiness were eligible (i.e., problem-solving/reasoning, language, executive functions and preacademics). The search strategy included four electronic databases from inception to July 2020 and backward/forward searching of the majority of eligible studies. Data charting was completed by double, independent reviewers and included theoretical frameworks, academic readiness outcomes, parenting behaviour targets, populations serviced and methodological approaches used. The synthesis included quantitative descriptives and tabular/visual representations. Ninety-nine studies met eligibility criteria. There has been a steady increase in published studies since 2005, with each academic readiness skill represented in varying proportions. Attachment theory was the most commonly referenced framework for applying interventions to academic readiness, with a more recent shift towards biobehavioural frameworks. The majority of studies included parental responsiveness as a parent behaviour target, whereas behavioural management was more commonly used with older children and/or those with social-emotional/behavioural difficulties. Most studies used a selective prevention approach, with low socioeconomic families being the most frequently studied group. Research gaps were identified in the measurement of follow-up and parenting behaviour. We discuss changing conceptualizations of academic readiness, applications to public health and practice, and future directions in research.

Fidelity of Motivational Interviewing in School-Based Intervention and Research.

Educational researchers and school-based practitioners are increasingly infusing motivational interviewing (MI) into new and existing intervention protocols to provide support to students, parents, teachers, and school administrators. To date, however, the majority of the research in this area has focused on feasibility of implementation rather than fidelity of implementation. In this manuscript, we will present MI fidelity data from 245 audio-recorded conversations with 113 unique caregivers and 20 coaches, who implemented a school-based, positive parenting intervention. The aggregate fidelity scores across coaches, parents, and sessions provide evidence the training and support procedures were effective in assisting school-based personnel to implement MI with reasonable levels of fidelity in practice settings. Further, results suggest that MI fidelity varied between sessions and coaches and that within-coach variation (e.g., session-level variation in the quality of MI delivered) greatly exceeded between-coach variation. Implications for practice and future research are discussed.

The Effectiveness of a Home-Based Delivery of Triple P in High-Risk Families in Rural Areas

Triple P is a positive parenting intervention designed to improve parenting practices and enhance childhood outcomes. Triple P has shown positive effects in various prior studies; however, to date, no studies have examined the potential benefits of home-based Triple P when conducted with rural families with parents at high risk for child abuse. The aim of this study was to use archival data to examine the effects of Triple P on dysfunctional discipline and parental anger as well as child emotional/behavioral difficulties. In addition, the study sought to investigate the potential moderating effect of race/ethnicity in these outcomes. Archival data were analyzed in this study. Data were originally collected using a pre- and post-treatment design. A racially and ethnically diverse sample of 171 caregivers was assessed using various self-report instruments before and immediately after receiving the manualized intervention. A repeated-measures design, with ethnicity examined as a moderating variable, was used to assess the differences in dysfunctional discipline, parental anger, and child emotional/behavioral difficulties prior to and immediately following Triple P services. Overall, participants evidenced significant decreases in scores following treatment. Additionally, some effects were moderated by race/ethnicity. This study demonstrates the potential benefits of a home-based format of Triple P for decreasing dysfunctional parenting behaviors and problematic child behaviors in high-risk, rural families.

A systematic review and meta-analysis of the effectiveness of interventions to improve psychological wellbeing in the parents of children with cerebral palsy

BackgroundCaregivers of children with cerebral palsy (CP) face unique demands and challenges, with potential negative impact on psychological wellbeing and consequences for both caregiver and child. Timely support could improve parental wellbeing. AimTo evaluate the effectiveness of interventions aimed at improving the psychological wellbeing of caregivers of children with CP. Methods and proceduresSystematic review and meta-analysis of randomised controlled trials of interventions to improve the psychological well-being of caregivers of children with cerebral palsy. Databases (including MEDLINE, EMBASE, PsycINFO, Cochrane) were searched for relevant English language publications between January 1990 and December 2017. Risk of bias was assessed including randomization, allocation concealment, incomplete outcome data and selective outcome reporting. Outcome and resultsWe included 13 studies (1293 participants, 1/3 with CP). Six studies investigated a positive parenting intervention; the other seven studies covered a range of other interventions. Meta-analysis of 7 studies (662 participants) showed that interventions significantly improved parental wellbeing (standardised mean difference -0.61, 95% CI -0.92 to -0.30, z = 3.84, p = 0.0001). Conclusions and implicationsLimitations include small sample sizes and heterogeneity in study design; however, our results indicate that interventions can improve the wellbeing of parents of children with CP and should be made available.

Early cumulative risk predicts externalizing behavior at age 10: The mediating role of adverse parenting.

Multiple environmental risk factors in early childhood predict a broad range of adverse developmental outcomes. However, most prior longitudinal research has not illuminated explanatory mechanisms. Our main goals were to examine predictive associations between cumulative ecological risk factors in early childhood and children's later externalizing problems and to determine whether these associations were explained by variations in parenting quality. Participants were 241 children (118 girls) at risk for school-age conduct problems and their parents and teachers. Children were approximately 3 years old at Time 1 (T1) and 10 years old at Time 2 (T2). Reports of contextual risk at T1 were used to develop a cumulative risk index consisting of 6 singular risk variables from 3 ecological levels: social resources (low income; social isolation), family resources (marital aggression; poor total family functioning), and maternal resources (single parent status; poor maternal mental health). At T1, parenting variables were measured (corporal punishment, warm responsiveness, maternal efficacy, and negative perceptions of child behavior). At T2, mothers, fathers, and teachers reported child externalizing problems. Johnson's relative weight analysis revealed that the cumulative risk index was a more powerful predictor of age 10 years externalizing behavior than any of the singular contextual risk variables. Adverse parenting mediated the effects of cumulative risk on later child externalizing problems. Our findings have significant implications for understanding long-term effects of multiple contextual risk factors present in early childhood and for the implementation of positive parenting interventions early on. (PsycINFO Database Record