Meta-analysis finds parenting interventions work best in helping children with disruptive behaviour problems

A meta-analysis published in the journal Paediatrics has identified the critical role that parents play in interventions aimed at helping children with disruptive behaviour problems and suggests policy makers should take note.

US researchers led by Dr Richard Epstein found that parenting interventions work better either on their own or in combination with other interventions when compared to child-only interventions for children with disruptive problems, the review of previously published studies found.

Results from the meta-analysis also show that all intervention categories were more effective than the treatment as usual/control category.

The authors of Psychosocial Interventions for Child Disruptive Behaviors: A Meta-analysis write:

“Our meta-analytic model suggested that interventions categorized as multi-component interventions and interventions with only a parent component were approximately equivalent in their expected effectiveness (43% probability of being best treatment), whereas interventions with only a child component were estimated to be less effective (14% probability of being best).’’

While existing reviews report positive outcomes for cognitive-behavioral therapy,  behaviour management, and parenting interventions, either alone or in combination with family-based approaches, the authors suggest that evidence for interventions with a child-only component was limited because of the small number of studies and that the estimate for child-only interventions was imprecise. They continue:

“Given recent trends indicating reduced use of behavioural health services and increasing use of psychotropic medications, especially for children with disruptive behaviour disorders, we believe these findings have important policy and practice implications.’’

Triple P founder and director of the University of Queensland’s Parenting and Family Support Centre, Professor Matt Sanders, said the research added to the body of evidence highlighting the importance of parent-focused interventions in treating child disruptive behaviours, including Triple P.

A meta-analysis of more than 100 studies of Triple P has demonstrated positive impacts for child and parent outcomes.

“The current study suggests to parents, practitioners and policy makers that parent interventions may be the most effective means of helping children with disruptive behaviour problems. It points out that these kinds of problems are among the most common child and adolescent psychiatric disorders and are associated with significant impairment,’’ Professor Sanders said.

As the study authors suggest:

“Policymakers may consider incentivising psychosocial interventions that include a parent component to increase the delivery of interventions that have the greatest potential to improve care for these vulnerable children and families.’’

school the conversation

Is your child less likely to be bullied in a private school?

 

Is it really the case that more bullying occurs in public schools? And should this affect a parent’s choice of school for their child?

Do these results reflect what’s happening?

HILDA tracked a sample of 13,000 households in New South Wales between 2001 and 2012. The data on schools comes from 2012 when participants were asked a range of educational questions.

Households with school-aged children were asked whether or not their child was bullied at school. A higher proportion of parents of children in state schools reported their child was bullied compared with private schools. The differences were greatest for high schools, with 22% of parents at state schools reporting their child was bullied, compared to 15% in Catholic and 11% in other private schools.

So is this information likely to be accurate? There is no reason to suggest the sample is not representative of the NSW population. However, given the question about bullying is based on one question only (with no definition of bullying apparent in the report), it would be useful to draw comparisons with other research.

Do bullies discriminate by sector?

There is actually very little research comparing bullying rates at private versus state schools. This is probably because schools are unlikely to agree to take part in research that makes direct comparisons between schools on such a sensitive topic.

There is, however, a similar population sample survey conducted by the US government. In this study, parents whose children attended state schools (29%) also reported higher rates of bullying than parents whose children attended private schools (22%). So does this mean an individual child is less likely to be bullied at a private school?

Parents want the best for their child and are attracted to schools that report good data for students on academic, behavioural and social outcomes. But whether your child will have the same experience as children who have gone before depends on whether the results reported are the result of what happens at the school or whether they are inherent to the sample of children who attend the school.

Misinterpretation of statistics

A team of New Zealand researchers conducted some interesting research on individual and school factors affecting students’ academic success at school and later success in tertiary education.

They found the success of a school can be judged by educational programs but not by the demographics of who attends the school. Given general school-leaving results reflect both demography and education programs, they are not a valid measure of a school’s educational quality.

Students’ academic achievement is influenced not only by the educational program a school offers – but by what the individual student brings to the school in terms of genetic capability, family support and prior learning.

Almost all state schools are required by law to accept all students in their catchment area. Private schools are not bound by this requirement. Private schools attract a selective population of students whose parents can afford the fees and who are conscientious enough to have enrolled their child many years in advance.

Most private schools also have enrolment applications that exceed their quota, so they can screen for academic ability and behaviour. These schools do not end up with a representative sample of students (and neither do the minority of state schools that have merit entry).

It is therefore a fallacy that we can deduce the relative benefit schools can provide for our child by simply comparing outcome data across schools.

More at-risk minorities in state schools

There is no research to my knowledge that examines the differences in effectiveness of private or state schools in preventing or addressing bullying. However, we do know that private schools start with different populations of students from state schools.

Not surprisingly, the HILDA report shows that family income and the proportion of parents holding university degrees are highest in non-Catholic private schools and lowest in state schools; state schools also have a higher proportion of single parents.

There are more at-risk minorities in state schools.

The greater diversity of students at state and private schools results in state schools educating more students at risk of being bullied. Several demographic factors on which state and private schools differ have been found to be relevant to the risk of a child being bullied.

Children with a disability are much more likely to be victims of bullying and violence at school than other students, as are children enrolled in special education classes.

Parents’ educational level has also been found to discriminate bullied from non-bullied children. Children whose father is absent (likely to be more often the case in single-parent families) are also at greater risk of victimisation.

This suggests that the differences in victimisation between private and state schools may not be due to a higher level of victimisation across all state school students; rather they may reflect a higher proportion of a minority of children who are frequently victimised.

The 2015 Productivity Commission report also provides evidence that a much higher proportion of at-risk students attend state rather than private schools.

In 2013, 84% of Indigenous students and 76% of students with a disability attended state schools. Nationally in 2013, the proportion of students with disability was significantly higher in state schools (6.2%) than in private schools (3.6%).

Around 10% of children in Australia are bullied on a daily basis. For these frequently bullied children, victimisation tends to be chronic over time. It can continue even when children change schools, which includes crossing from primary to middle or secondary school contexts.

In a study at the Parenting and Family Support Centre, where making a fresh start at a new school was part of an intervention for some of the children, there were at least as many successful transitions for children moving from private to state schools as for children moving from state to private schools. What was more important was the ability of the child to fit in and make friends at the new school.

So is a child less likely to be bullied at a private school?

Although more parents from state schools report their child is bullied than do parents from private schools, this could result from the higher proportion of at-risk students who attend state schools. Therefore we cannot conclude that an individual child will be less likely to be bullied if they attend a private school.

There is bullying at all schools. A number of factors impact a child’s risk of being targeted for bullying. These include school management, the child’s social and emotional skills, support from friends and the parenting they receive.

Children’s friendships at school are an important protective factor against bullying. So whether your child already has good friends or is likely to be able to make good friends at a school is an important factor in choosing a school for your child.

Supportive family relationships help protect children against the emotional consequences of bullying at school, so families should take lifestyle factors such as the financial burden of school fees and long travel times into account when choosing a school.The Conversation

Karyn Healy is Program Coordinator (Psychologist), Resilience Triple P program Parenting and Family Support Centre at The University of Queensland.

This article was originally published on The Conversation.

Read the original article.

ireland

Data bank could ensure early intervention research for years to come

AN eight-year study into the effectiveness of early intervention programs in an historically disadvantaged community in Ireland could have research implications that last a lot longer than the original study.

Dr Orla Doyle

Dr Orla Doyle

Funded by Atlantic Philanthropies and the Irish Government, the experimental evaluation of the Preparing for Life early childhood intervention in a community in Dublin, Ireland, is now reaching the end of its data collection period.

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Ireland and the population-level effect: How schools were the key to reaching those most in need

Brief interventions played a major role in the success of a population-level delivery of the Triple P system in the Irish Midlands, the director of the partnership involved in the rollout, Conor Owens, told this year’s Helping Families Change Conference (HFCC) in Amsterdam.

The Longford Westmeath Parenting Partnership made Triple P available free to all parents of children under the age of eight to reduce prevalence rates of clinically elevated social, emotional and behavioural problems in children, estimated to be one in five children in Ireland.

Their goal was also to help parents become more confident and feel more supported, as well as to reduce parents’ levels of anxiety and depression relating to their children’s behaviour.

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‘We need to turn wishful thinking to help the lives of children into a public funding priority to support the skills of parents’

In a world where the well-being of children is a priority, preparing for parenting would become something people aspire to, not something associated with stigma, Professor Matt Sanders, founder of the Triple P – Positive Parenting Program, told delegates at this year’s Helping Families Change Conference in The Netherlands.

In such a world, evidence-based parenting programs would become a policy priority for governments and be funded accordingly because parents had demanded that it be so.

“The single most important thing we as a community we can do to promote the well-being of children and reduce child maltreatment is to increase the skills, confidence and competence of parents at a whole-of-population level,’’ Professor Sanders said in his keynote address to the 17th annual HFCC at the historic Beurs Van Berlage building in the heart of Amsterdam.

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Bryan Samuels: Why removing a child from harm’s way should not simply mean ‘case closed’


IMG_5433 (10)The University of Chicago’s Bryan Samuels during his presentation to this year’s Helping Families Change Conference at Beurs Van Berlage  in Amsterdam.

Mounting evidence of the cumulative effects of complex trauma, toxic stress and adverse childhood experiences has helped shift the way that child support services are delivered across a number of US states, this year’s Helping Families Change Conference (HFCC) was told.

In his keynote address to the 17th annual HFCC in Amsterdam, the former director of the Illinois Department of Children and Family Services, Bryan Samuels, said that for the past 15 years, US state administrators had focused on the safety and permanency of children in the welfare system at the expense of outcomes based on child welfare.

“There is no doubt that children in harm’s way should be removed from a dangerous situation,’’ Mr Samuels said. “However, simply moving a child out of immediate danger does not in itself reverse or eliminate the way that he or she has learned to be fearful. The child’s memory retains those learned links and such thoughts and memories are sufficient to elicit ongoing fear and make a child anxious.’’

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The quest for glycemic control in children with type 1 diabetes. Can a parenting intervention such as Triple P help?

Parenting interventions such as Triple P have been shown to reduce mental health problems in children. But can a parenting intervention moderate the impact of type 1 diabetes in children as well as improve their mental health and wellbeing?

Two separate studies into the effects of Triple P – one conducted by a team across Melbourne, the other by an international team from Manchester and the University of Queensland’s Parenting and Family Support Centre – suggest these research questions are definitely worth pursuing.

The Melbourne randomised controlled trial (RCT), published in Pediatric Diabetes last year, tested whether Triple P could reduce or prevent mental health problems and improve glycemic control in children with type 1 diabetes.

Meticulous glycemic control is regarded as crucial in preventing serious complications for people diagnosed with type 1 diabetes.

If not managed properly, type 1 diabetes can lead to serious short-term consequences, such as extremely low and high blood glucose levels, both of which can be fatal. Long-term complications include blindness and damage to kidneys, nerves and heart.

Unfortunately, day to day management of type 1 diabetes is complicated and onerous, especially for teens who would prefer someone “just invent a cure already’’ and parents struggling with behaviour problems in their kids.

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When spanking is at the heart of controversy, so are the myths. Ron Prinz weighs into the debate in a South Carolina newspaper

Spanking and corporal punishment can set off a firestorm of debate under any circumstances.

Add a high-profile NFL case, and we have a recipe for a vigorous public dialogue about parenting, child abuse and best practices.

Public debate is healthy. Unfortunately, this one tends to be marked by myths and distracting generalities.

Myth No. 1: All spanking is child abuse and therefore should be banned. Fact: Most spanking episodes in fact do not rise to child abuse.

Myth No. 2: Parents who spank are bad parents, and spanked children will suffer poor outcomes. Fact: Parents who spank represent a very broad spectrum, ranging from effective to abusive. Generally speaking, children fare well if their families provide a warm, structured and safe environment with appropriate encouragement as well as discipline and limit-setting — whether parents spank or not.

Myth No. 3: Parents who do not spank are effective parents. Fact: Not necessarily. There are many other elements that go into what makes parents more or less effective.

We have all seen an out-of-control child running amok in the grocery store. And we have heard bystanders comment, “What that child needs is a good lickin.”

However, we also have observed parent-child struggles where the young child acts up in the market, is yelled at, continues to act up, gets slapped or spanked and a few minutes later acts up again.

In such common scenarios, the fundamental question is not whether to spank. Instead, it is how parents get into such predicaments and how they can extricate themselves or, better yet, prevent such events.

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