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.’’

To reach parents in a culturally sensitive way we first need to listen to the local community

More than 90 per cent of the world’s children and families live in low- and middle-income countries.

So how do we reach them in a culturally sensitive way?

In our project in Panama, we tested the efficacy of Triple P Discussion Groups with 108 parents from six high-risk, low-resource neighborhoods.

Even though the intervention was delivered in its original form, “intuitive” cultural adaptations took place during delivery.

For example, we started sessions with an ice breaker activity, we worked with local facilitators and used local jargon when giving examples.

I come from a family of social workers in Panama and so my passion has always been to support families living in poverty.  But to help them in a respectful way, I firstly needed to understand what is it like to live and raise a child in a high-risk neighbourhood.

I also wanted others around the world to understand the experiences of families living in poverty.  I was pretty sure that images would speak louder than any words.

The idea then was to film a short documentary in collaboration with two mothers from San Joaquin.

San Joaquin is a high-risk community in Panama City recognized as the epicenter of violence and home to the deadliest gangs in the country.  This 10-minute documentary follows the life of Cecilia and Dora, two mothers who also took part in the Triple P intervention.  It’s interesting to see how both mothers show great resilience in their discourse even though they are facing daily adversity.

Filming this documentary made me understand the importance of using collaborative approaches to increase engagement of community members with new interventions.  This documentary allowed me to give voice to mothers who would otherwise not have any platform to speak up.  They felt as if they were active participants disseminating results from the project and became the main advocates for it.  Participatory research such as this increases ownership, sustainability and ensures interventions fit local needs and culture.

Using this work in Panama as a case example, and in collaboration with other researchers at the Parenting and Family Support Centre at the University of Queensland, I’m currently involved in developing and testing models to approach new communities in a collaborative, participatory way.

We feel it’s important that programs are sustainable once they have been introduced into a new community. In order to do this, we’re exploring models or ways to listen to the community and learn about its local history.

By doing this, we hope to understand how local people who want to bring about change in those communities would like to deliver the program, rather than imposing change from the top down.

We are developing guidelines to conduct cultural engagement in a systematic manner.  These guidelines will provide “conceptual lenses” to practitioners and researchers delivering and implementing Triple P in any context or culture worldwide, such as with families in low- and middle-income countries, refugee parents and Indigenous communities in Australia.

And in turn, we hope to give the voice of change back to the community.

Note: All participants provided written informed consent for the dissemination of this footage for academic purposes.

For more information on the RCT:  Mejia, A., Calam, R., & Sanders, M.R. (2015).  A pilot randomized controlled trial of a brief parenting intervention in low resource settings in Panama. Prevention Science. DOI: 10.1007/s11121-015-0551-1


Inaugural inductees Kelston boys high school

Proud rugby school famous for turning out All Blacks takes Triple P founder back to where it all began

A New Zealand boys high school famous for its connection to the mighty All Blacks has recognised The University of Queensland’s Professor Matt Sanders among its first distinguished alumni.

Professor Sanders is the founder of the Triple P – Positive Parenting Program, a Professor of Clinical Psychology and director of UQ’s Parenting and Family Support Centre. He has published more than 300 research papers.

However, as a very young student at Kelston Boys High School, in West Auckland, Professor Sanders says he was not one of the top academic achievers.

“The key for me was that my very early academic career wasn’t seen by the school as a limitation. I had one teacher in particular who got me aside and basically told me, ‘come on, you can do it’,’’ Professor Sanders said.

“For me it reinforces the idea that people should not make too many judgments too soon about young people and what they are capable of if they have good family and school support.’’

Professor Sanders (pictured left in picture above), who attended Kelston from 1966-70, was recognised at Keltson’s inaugural alumni for his achievements in academia alongside the chief executive of the Pascoe Group, David Norman (1962-1965, second from left), for his services to business; current New Zealand Sevens rugby union captain, DJ Forbes (1997-2000, second from right), for services to sport; and former New Zealand rugby league captain, Duane Mann (1979-1983, right), for services to the community and sport.

Kelston principal Brian Evans said the school was honoured to have someone of the calibre of Prof Sanders as one of its first distinguished alumni.

“Professor Sanders’ work and achievements speak for themselves and he is a very proud Kelstonian and an inspiration for our current students on what can be achieved with such dedication,’’ Mr Evans said.

“It was a wonderful evening for our old boys and a great celebration of what great things our ex-students go on to achieve.’’

Kelston Boys High School in West Auckland is highly regarded for the quality of its rugby program, with former All Blacks coach Graham Henry a former principal of the school, and for its support of Maori and Pacific Island families.

Professor Sanders graduated from Kelston to enrol at University of Auckland where he completed three degrees, a Bachelor of Arts, a Master of Arts and a Dip Ed in Psychology before starting his PhD thesis which was the genesis of Triple P.

He then transferred to The University of Queensland where his completed his doctorate.


The author with the subject of awe.

The Grandma Hypothesis: We’ve got more resources to draw from than the rest of the animal kingdom but that doesn’t help family conflict

We often hear the old adage, “it takes a village to raise a child”, yet with increasing independence, geographical movement, and isolation how true 300-320 is this? Interesting data out of the US shows that we are indeed more isolated than ever before, with up Windows 10 Product Keyto 40 percent or more of all households containing a single a href=””>parajumpers jas heren 70-494 occupant in cities such as San Francisco, Denver and Seattle.

What is surprising about this is that as humans we know we are

, meaning that we have evolved as a species to work in groups, where a broad range of individuals helps support the mother and father in raising offspring. And you can see this not only in humans, but clearly in other mammalian species, particularly with our closest relatives the chimpanzees and apes where we share up to 97-99 per cent of our DNA.

Gorillas are actually my all-time favourite animal. I fell absolutely in love with them when I watched David Attenborough’s documentary Life on Earth where he comes face-to-face with the mighty silverback and his family. The episode left a lasting impression on me. And in 2013 I was able to go on a trip of lifetime and realise my dream of going gorilla trekking in Rwanda with my wife.

Visiting the gorillas involved a mighty trek through the Virunga Mountains, one of the last remaining places on earth you can see these incredible animals. When I came face to face with the silverback and his family the thing that immediately struck me is how similar we are. Our toenails, thumbs, and most amazingly our eyes – there is no doubt we share a common ancestor. The very next thing I noticed is how the gorilla family or “troop” is so similar to ours. They need a family in order to both survive and thrive. There was dad – the silverback, a number of females (the mothers), and of course the very cute baby gorillas. But where was grandma?

Why Grandma is important

Indeed, this is a defining aspect of the human species: As adults we live much longer after our ability to reproduce finishes, whereas when other species reach the end of reproduction they very shortly pass on. This means, as humans, we have a very long post-reproductive period – indeed we can live for up to 40-50 years longer. And this isparajumpers jas ugo where grandma becomes very important.

The grandmother hypothesis suggests that grandma involvement in family life helps increase her daughter’s fertility and chance of the grandchildren surviving. Indeed, data shows that if the grandmother is present in the family, in some cases it doubles the chances of more children being born. Why? Well, all of a sudden mum has somebody at home to help provide childcare to her other children, whilst she looks after her newborn.

In Australia, more than one million children receive regular child care from their grandparents. That’s one in every four children. On average grandparents provide 12 hours of care per week to their grandkids aged between 0-12 years.

Grandparent involvement in childcare is a very altruistic and compassionate act. Indeed, grandparents often give up some of their working hours, social events, and hobbies to help look after their grandchildren. Grandparent involvement also helps mothers re-enter the workforce, increase family income, and help stimulate economic growth. However, providing regular child care can come at cost.

When grandparents provide regular child care it is not uncommon for  tension, conflict, and disagreement to occur between grandparents and parents, which can negatively impact child development.

For example, researchers have consistently found that parents dislike unsolicited parenting advice from grandparents, and that it contributes to poorer Lenovo IdeaPad V570 AC Adapter grandparent-parent relationship quality.

Despite grandparents being aware of this, they find it difficult to refrain from providing parenting advice, and can struggle with accepting parenting decisions. This of course can lead to family conflict, which in turn, can adversely impact the psychbaby gorillaological adjustment, and parenting practices, of both grandparents and parents. Family conflict and tension can also negatively impact Dell Latitude E6500 AC Adapter children’s social, emotional and behavioural development.

Of course this is not true for all grandparents and parents, as many get along just great, but when tension and family conflict exist between grandparents and parents it can become very difficult for all parties involved.

So how can we help grandparents and parents in this critical and important role of co-parenting?

Evidence-based parenting programs are one of the best ways to help, with meta-analyses showing that parenting programs positively influence child, parent and family outcomes. However, until recently there was no specific evidence-based parenting program yet modified for grandparents.

The Triple P-Positive Parenting Program, in a world’s first, designed and developed a program specifically for grandparents providing regular child care called Grandparent Triple P. And to point out any potential conflict of interest, I must advise that I am a co-author of the program along with Triple P founder, Professor Matt Sanders.

Grandparent Triple P

Grandparent Triple P is a nine-week group program and has three aims: 1) provide a refresher course on parenting strategies, 2) p
rovide communication strategies to enhance the parent-grandparent relationship, and 3) provide coping skills for grandparents to manage the stress of providing regular child care.

The program has been evaluated in two randomised controlled trials, one in Australia with 54 grandparents, and one in Hong Kong with 56 grandparents.

Based on both evaluations the program was found to help improve grandparent confidence, reduce stress, and most importantly, improve childhood behavioural outcomes. Importantly, the Australian trial also found it helped improve parent-grandparent relationship satisfaction.

Researchers are now looking at making a shorter version of the program.

So as humans we are lucky to have grandparents. Unfortunately the beautiful gorilla troop didn’t have a grandma around to help with the upbringing of their offspring. We have been giving evolutionary advantage, which we often do not recognise and acknowledge.

Twitter: @JamesNKirby




matt and shannon

Queensland Government rollout of Triple P launched with free parenting seminars

A large media contingent was present for the official launch of the Queensland Government and Triple P International’s Queensland-wide roll-out of the Triple P – Positive Parenting Program at Broncos Leagues Club last Wednesday.

Triple P founder and director of the University of Queensland’s Parenting and Family Support Centre, Professor Matt Sanders, pictured above with Queensland Government Communities Minister, Shannon Fentiman, officially launched the rollout with a seminar on the Power of Positive Parenting at Broncos Leagues Club for more than 100 parents and carers.

Later that night, it was standing room only for around 150 carers at the same venue. These seminars were followed by three more in the Logan district.

“We know parenting is hard work, and we are committed to making sure all Queensland mums, dads, grandparents and caregivers know they are not alone in raising the next generation of Queenslanders,” Ms Fentiman said.

Ms Fentiman said the Government was not in the business of telling Queensland families what to do.

“It’s about letting them know that it’s okay to ask for help,” she said.

Professor Sanders praised the Government for intervening early to help Queensland families before major problems develop down the track.

“Lots of programs focus on the pointy end, the difficult families who have already experiended major, major problems,” Professor Sanders said at the launch. “This is about the prevention of those problems.”

Earlier, in an interview with ABC Radio 612 that morning, Professor Sanders explained how Level 2 Triple P Seminars give parents a taste of other, more intensive forms of help available, should they need it.

“Doing a seminar is a bit of a taster: you come in, you’re given a chance to really pause and reflect on the parenting issues you’re confronting, and how you’re dealing with them,Matt Ch 7” Professor Sanders said.

“You decide whether or not what you’re doing is working. If it’s working, keep doing what you’re doing. It’s not about preaching to people that they must do differently.”

Professor Sanders said it was rewarding to see the work of so many researchers and students from the PFSC acknowledged by the Queensland Government’s support of the two-year trial. It was also gratifying to see the Government get behind this Queensland success story and become the first government to offer the full suite of Triple P programs, including Triple P Online, to families of children up to the age of 16.

Channel Seven Brisbane News also featured Professor Sanders in the studio, pictured at right, in its coverage of the event. That coverage is available here.

Minister Fentiman’s press release announcing the launch is available here.

Parents can find out how to participate in a Triple P session here.


New direction in Triple P research looks at harnessing the power of the family


An unusual collaboration is looking at whether a solution that has already helped millions around the world can be adapted and integrated to tackle some of the world’s toughest problems.

University of Queensland researchers across the behavioural sciences, engineering, business and marine environmental management are working together with researchers from the newly formed Triple P Innovation Precinct to tackle issues such as food security, sustainability and energy poverty.

“Working through the family, we are seeking to overcome the obstacles currently preventing the successful deployment of reliable, affordable and sustainable solutions for the developing world,’’ Triple P founder, Professor Matt Sanders, said.

As part of this new direction in research, the Triple P team is collaborating with the Global Change Institute (GCI) and the UQ Energy Initiative to apply behaviour change mechanisms to some pressing regional problems.

The first collaboration, an environmental management initiative, applies behavioural principles from Triple P to the Capturing Coral Reef and Related Ecosystem Services (CCRES) project, managed by the GCI, and funded by the World Bank.

CCRES Chief Scientist Professor Peter Mumby said coral reefs, mangroves and seagrass beds in Indonesia and the Philippines were under threat from human pollution, unsustainable development, overfishing and climate change.

But often, simply educating people about the benefits of cooperation and the science behind sustainability failed to change the way these communities interact with their environment.

The second collaboration brings together behavioural parenting researchers with engineers form the UQ Energy Initiative to examine how clean cook stoves can be successfully deployed within India to prevent diseases caused by household air pollution.

The International Energy Agency estimates that 2.7 billion people lack access to clean cooking and heating technologies, a number which includes an estimated 1.3 billion people without access to electricity.

UQ Energy Initiative Director Professor Chris Greig said the Initiative had recognised a transdisciplinary approach was needed for the past two years.

He says a behaviour change program that targets a family’s motivation for using cleaner stoves could change the community’s norms for cooking technologies.

Both collaborations are being led by John Pickering, Head of Innovation and Engagement, from the Parenting and Family Support Centre.

After a recent trip to Selayar, a remote island in Indonesia, as part of the CCRES project, Mr Pickering said initial research was encouraging.

“The single strongest message that came through when we spoke with these communities is that people want the best for their children and don’t want to see them go through the same hardships they had,’’ Mr Pickering said. “They want their children to have a better education, better health, better quality of life and they’re motivated to work with us to shape the solution.’’

This story first appeared in UQ’s new magazine for investors of change, Changemakers.


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.

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Treat men as active participants, rather than supporters, and they’ll happily participate in a parenting program

New research into a modified version of Group Triple P in New Zealand could be a game changer when it comes to encouraging fathers to participate in a parenting program.

A randomised controlled trial of a version of Group Triple P for fathers in New Zealand has shown that when men are treated as active participants in the parenting process, rather than being assumed to be there to play a supporting role, men are just as likely as their partner to actively participate in group sessions. They’re also just as likely to benefit and so are their children.

Study authors Tenille Frank, Louise Keown and Matt Sanders said that following the trial, both parents were more likely to report significantly fewer child behaviour problems and increased use of positive parenting practices.  There was also less conflict between parents about child rearing, mothers felt more confident and also reported that their partners’ parenting practices improved.

Given social changes around gender and parenting issues – particularly in middle to upper income countries – it would seem obvious that fathers these days would be more interested in playing an active role in parenting. However, little research had previously been done to see how best to engage fathers or investigate the kinds of issues that fathers would find relevant.

“Parenting programs often involve women training other women to be better parents. Ninety per cent of those who conduct courses are female, and mothers make up 70 per cent of attendees,” Professor Sanders said.

Louise Keown

Louise Keown

Tenille Frank

Tenille Frank

This trial of Group Triple P incorporated a number of new strategies to engage fathers and this began well before actual participation in the program.

Program advertisements were worded to include positive messages about father involvement. Dads as well as mums were also involved in screening interviews about their child’s behaviour and to explain what their participation in the programme would entail.

New content was incorporated to maximize fathers’ engagement and teamwork between parents. Additional topics included explaining the benefits of both father and mother involvement for children’s development and strategies to manage father-identified parenting challenges.

Findings from previous research was used to identify the kinds of issues or problems that dads would be interested in. These included how to balance work and family, how to gain co-operation with their partner in parenting, the range of ways to show physical affection with their kids and how dads can contribute to enhancing their child’s self-esteem.

Other father-identified areas of interest included improving their children’s social skills.

During the group sessions each parent had their own work book. Fathers were asked about their specific concerns, as opposed to just asking the mothers about their children. Fathers and mothers were encouraged to set their own homework tasks between sessions and to each report back their progress on implementing parenting strategies.

When telephone consultations were conducted, the researchers included both fathers and mothers together using a speaker phone or multiple handsets and each parent was encouraged to contribute.

As well as the implications for the way in which practitioners engage with dads, Professor Sanders said the Auckland findings could create a much more compelling case for flexible delivery times by Triple P practitioners as well as making allowances for childcare so that both parents can attend sessions together.

“In the past, the view seems to have been that fathers are reluctant to engage in parenting programs but this study shows that when fathers’ concerns are actively raised during participation to encourage their involvement, gender differences disappear,’’ Professor Sanders said. “Fathers and mothers recorded similar levels of completion of the program, which was high, and similar levels of satisfaction.”

Since the study did not compare a mothers-only intervention with a group involving both mothers and fathers, it’s too early to say from a research perspective that children are more likely to benefit, or more likely to move out of the clinical range of behaviour problems, when fathers as well as mothers attend a parenting program.

However, there is a lot more that can be gained by researchers, providers and agencies from this study, particularly when it comes to the relatively high retention rates. The study authors suggest this might have been due to the fact that because both parents attended together, each was accountable to the other and therefore completion was more likely.

They also suggest that efforts taken to increase teamwork between mothers and fathers, such as joint telephone sessions and tailoring the content for fathers and mothers, may also have contributed to the high levels of program satisfaction.