The aim of behavioral parent training is to improve the child's behavior through improved parenting. Noting that "it is unknown which of its components are most effective," a Dutch team of researchers conducted a systematic search of the peer-reviewed medical literature to identify randomized controlled trials (RCTs) suitable for meta-analysis.
Twenty-nine RCTs with a combined total of 2,345 participants met the criteria.
The team explored five types of outcome variables:
· Positive parenting: behaviors such as reinforcement, monitoring, stimulating, and guiding the child.
· Negative parenting: behaviors such as corporal punishment, harsh discipline, inconsistent parenting, and poor monitoring.
· Parenting sense of competence: the extent to which parents perceive themselves as competent or effective in raising their child.
· Quality of the parent-child relationship: signs of affection, support, sensitivity, and responsiveness.
and behavioral parent training aims:
· Parental mental health: measures included parenting stress and several indices of parental psychopathologies, such as depression and anxiety.
A meta-analysis of 19 RCTs with 1,070 participants found a medium effect size improvement in positive parenting. Evidence of publication bias was borderline, but a trim-and-fill adjustment still reported a medium effect size reduction in ADHD symptoms. Similarly, limiting the meta-analysis to the 12 RCTs that were probably blinded made no difference in the outcome.
A second meta-analysis, of 15 RCTs with 878 participants, found a small-to-medium effect size reduction in negative parenting, after adjusting for publication bias. Limiting the meta-analysis to the six RCTs that were probably blinded modestly increased the effect size.
After adjusting for publication bias, a meta-analysis of 13RCTs with a combined total of 783 participants reported a small-to-medium effect size improvement in the quality of parent-child relationships. Limiting the meta-analysis to the six RCTs that were probably blinded made no difference in the outcome.
After adjusting for publication bias, a meta-analysis of 17 RCTs with a combined total of 1,083 participants reported a medium effect size improvement in parent sense of competency.
Finally, with no sign of publication bias, 23 RCTs with a combined total of 1,191 participants found a small-to-medium effect size improvement in parental mental health.
The team concluded, "Parent training had robust small- medium-sized positive effects on all parental outcomes relative to control conditions, both for unblinded and probably blinded measures. ... A reassuring finding was that effect sizes on positive parenting, negative parenting, and the parent-child relationship did not differ between probably blinded and unblinded measures, indicating that effects are not merely attributable to parents' investment affecting their assessment of outcome measures."
Tycho J. Dekkers, Rianne Hornstra, Saskia van der Oord,Marjolein Luman, Pieter J. Hoekstra, Annabeth P. Groenman, Barbara J. van denHoofdakker, "Meta-analysis: Which Components of Parent Training Work forChildren With Attention-Deficit/Hyperactivity Disorder?" Journal of theAmerican Academy of Child & Adolescent Psychiatry (2021), publishedonline, https://doi.org/10.1016/j.jaac.2021.06.015.
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