A substantial body of research has demonstrated the contribution of specific parenting behaviors and characteristics to the development and maintenance of child behavior problems [1
]. In particular, negative parenting behaviors comprise inconsistent discipline, harsh discipline, poor monitoring and supervision, have been repeatedly linked to child externalizing (e.g., aggression, oppositionality, defiance) problems [3
] and show evidence of continuity across generations [4
]. Negative parenting behaviors provide a negative model of behavior, fail to promote pro-social child behavior, and impede development of adaptive social-cognitive skills [6
]. Such deficits place children at risk of developing externalizing disorders during adolescence [7
] and highlight the importance of identification and intervention to alter this developmental trajectory [8
]. The association between negative parenting behaviors and child externalizing problems is well established [4
]. For instance, poor parental supervision and lack of involvement have been identified as significant risk factors for child conduct problems [10
]. Extreme discipline practices, including parental verbal aggression [12
] and physical abuse [13
] are also associated with child conduct problems. Even if the parent–child relationship is intermittently warm, punitive and physically harsh parenting behaviors are risk factors for the development of externalizing problems [14
]. Studies focusing on bidirectional parent–child exchanges [15
] have found that children who exhibit more externalizing problems tend to have parents who exhibit higher rates of negative parenting behavior over time, and vice versa. Given the fundamental role that parenting plays in shaping child behavior, the need for early parenting interventions that reduce negative parenting behaviors and strengthen the parent–child relationship is highlighted.
Although negative or dysfunctional parenting behaviors have been consistently related to child externalizing problems, there is also research to suggest that negative parenting behaviors are associated with child internalizing problems [17
]. In a longitudinal, population-based survey completed by primary caregivers [19
], negative parenting behavior was found to be one of the consistent and cumulative predictors of early childhood internalizing problems. Caron et al. [17
] found that negative parenting behavior (e.g., threats, guilt induction) were associated with both child externalizing and internalizing problems, particularly for children whose parents also exhibited low warmth. Other researchers found that higher rates of negative parenting behaviors and lower rates of positive parenting behaviors were associated with more depressive symptoms in children [18
]. This suggests the need for parenting interventions aimed at decreasing negative parenting behaviors.
Positive parenting behaviors (e.g., warmth, appropriate discipline, parental involvement) provide the foundations for healthy child development [20
] and are associated with fewer child behavior problems [21
]. Positive parenting behaviors emphasize the importance of promoting prosocial behaviors, such as self-regulatory skills, and minimizing psychologically harmful environments [22
]. For example, children who grow up in environments characterized by warm, supportive and involved parents are less likely to develop antisocial and externalizing behavior problems even when faced with neighborhood deprivation, such as poverty and low socio-economic status [23
]. Increased parental warmth, involvement, and nurturing behaviors are negatively associated with child internalizing problems such as anxiety [24
]. Positive parenting behaviors have been found to buffer children from the detrimental influences of harsh physical discipline [26
]. Promoting positive parenting behaviors are a useful strategy in improving the welfare and psychosocial development of children [27
The influence of parenting stress on parenting behaviors and child behavior outcomes has also been a focus within the field of child development. Research suggests that parenting stress effects parenting behavior and the quality of dyadic parent–child interactions [29
]. Further, the relationship between parenting stress and child behavior problems is bidirectional. That is, child externalizing and internalizing problems lead to increases in parenting stress over time, and high parenting stress leads to increases in externalizing and internalizing problems in children [32
]. Accordingly, parenting stress has been found to be effectively reduced by interventions that teach parents skills and strategies to effectively deal with their child’s behavior and that focus on the parent–child relationship [34
Parenting sense of competence is another parenting construct that has been implicated in the relationship between parenting behaviors and child behavior outcomes [35
]. Parenting sense of competence can be separated into two factors, parenting self-efficacy and parenting satisfaction. Parenting self-efficacy has been defined as the belief that parents hold about their ability to parent successfully [36
], while parenting satisfaction refers to the degree to which parents feel frustrated or fulfilled in their parenting roles [37
]. High maternal self-efficacy and parenting satisfaction have both been associated with positive parenting behaviors [38
], which in turn, may lead to decreased child externalizing and internalizing problems [41
]. Conversely, low parenting self-efficacy and parenting satisfaction have both been linked to negative parenting behaviors [42
], which are in turn correlated with child externalizing and internalizing problems [44
]. Taken together, these findings demonstrate the value of parenting interventions that aim to enhance parenting sense of competence by teaching parents the skills they need to manage specific behavior problems.
Broadly, parent training interventions are focused, time-limited programs aimed at helping parents develop the parenting skills necessary to manage their child’s behavior and development. Many of these programs are informed by social learning theory and are based on the assumption that improvements in parenting behavior will lead to decreases in child problem behavior. Reviews have demonstrated that group-based parent training programs are among the most effective interventions for reducing child behavior problems [45
]. Benefits of participating in a group with other parents can include gaining support and acceptance from other parents, and normalization of parent’s experiences [48
]. Moreover, group-based parenting programs have been shown to improve parenting behavior and parenting self-efficacy as well as reduce parenting stress at least in the short-term [47
Group-based parent training programs vary widely in regard to program content and delivery components [51
]. However, programs generally use a range of strategies, including discussion, videotaped demonstrations, activities, and modelling of parenting behaviors and are typically delivered in 1–2 h weekly sessions over a period of 4 to 12 weeks [52
]. Some group-based parent training programs include a parent–child interactive component, during which parents practice discipline skills and relationship enhancement skills with their child during treatment [53
]. The inclusion of a parent–child interactive component is supported by studies demonstrating that changes in child behavior is activated by assisting parents to alter their own behavior and teaching parents how to interact more positively with their children via direct in vivo coaching strategies [54
]. Further, there is research evidence to support the use of parent training programs that involve in-session modelling, feedback and practice of new skills with parent’s own child [56
]. There is limited evidence however concerning the additional benefits of incorporating a parent–child interactive component
in group-based parenting programs with respect to parenting behavior, parenting stress and parenting sense of competence.
There are two parent training programs that involve an in vivo parent–child interactive component in treatment. The Exploring Together program is one example of a group-based parent training program that includes a parent–child interactive component [53
]. The Exploring Together program was developed to treat children at risk of developing internalizing and/or externalizing disorders, their parents and teachers. The program aims to develop parents' understanding of factors underlying their child's internalizing and/or externalizing problems, teach parents behavior management principles and techniques and assist parents to identify and regulate their own feelings. The Exploring Together program includes a parent–child interactive component in which parent–child relationship and interaction issues can be addressed as they arise, positive parent–child interaction can be modeled and encouraged, and problem solving and conflict resolution skills can be taught and practiced [53
]. The program treats parents and children as dyads and involves live coaching of parenting behaviors with both parent and child together in a group environment. The Exploring Together program has been found to significantly reduce negative parenting behaviors (e.g., authoritarian discipline, physical punishment) [59
], as well as significantly improve parenting satisfaction [60
]. Parent–Child Interactive Therapy (PCIT) is an individual parent training program for young children with externalizing and internalizing disorders that uses in vivo coaching of parental behaviors whilst the parent and child are together in treatment [54
]. More recently, group-based adaptations of PCIT have been found to result in significantly reduced negative parenting behavior and parenting stress [61
] and has shown promising evidence for reduction of child externalizing and internalizing problems [62
While prior research supports the feasibility of using the live or video-feedback [65
] coaching, it remains unclear whether the addition of a parent–child interactive coaching component improves outcomes within parent training programs relative to programs without an interactive component. Prior studies have identified positive parenting, negative parenting and behavior modification skills as the agents of change in reducing child behavior problems within parent training interventions [66
]. However, unlike other parenting-focused interventions, programs that incorporate a parent–child interactive component use in vivo coaching or video feedback to allow for an individualised approach to changing the dysfunctional parent–child relationship [56
]. Given that the inclusion of a parent–child interactive components requires greater resource allocation (e.g., additional staffing) further investigation into the added value of including such a component in treatment programs is warranted.
Research has shown that poor parenting quality is an important environmental factor that influences a young child’s behavior; it has almost twice the negative effect on child developmental outcomes of other known risks such as an impoverished environment [69
]. Parent training programs aim to increase parental insight into the role of their own behaviors and responses to their child. The underlying assumption of parent training programs is that improving parenting behavior is the key mechanism of change in child behavior problems [70
]. In order to reduce problem behaviors and enhance the development and wellbeing of children, it is therefore essential that parent training programs successfully change parenting behavior. Prior work from the same research project found that the Exploring Together program [72
] significantly reduced child externalizing and internalizing problems, both with and without the parent–child interactive component. Given that parenting behaviors are the assumed mechanism of change in child behavior outcomes, it is necessary to evaluate outcomes in terms of this construct.
The current study aimed to compare the effectiveness of two versions of the Exploring Together program for improving parenting behavior, parenting stress and parenting sense of competence, associated with (Exploring Together; ET) and without (Exploring Together-Adapted; ET-Adapted) the parent–child interactive component. The study also aimed to compare parenting satisfaction with the two versions of the program at post intervention. It was hypothesized that (1) there would be a reduction in negative parenting behaviors and improvement in positive parenting behaviors across treatment (ET, ET-Adapted) over time (baseline, post intervention, 6- and 12-month follow-up) and (2) there would be a reduction in parenting stress and improvement in parenting sense of competence across treatment (ET, ET-Adapted) over time (baseline, post intervention, 6- and 12-month follow-up). It was also hypothesised that (1) the reduction in negative parenting behaviors and improvement in positive parenting behaviors would be greater for parents in the ET program compared to the ET-Adapted program over time (baseline, post intervention, 6- and 12-month follow-up) and (2) the reduction in parenting stress and improvements in parenting sense of competence would be greater for parents in the ET program compared to the ET-Adapted program over time (baseline, post intervention, 6- and 12-month follow-up).
This study examined the effectiveness of two versions of the Exploring Together program on parenting behavior, parenting stress and sense of competence, with (ET) and without (ET-Adapted) the parent–child interactive component. Study results provided evidence of reduction in negative parenting behavior across both treatment groups (ET, ET-Adapted) at post intervention, maintained at the 6- and 12-month follow-ups. The significant reduction in negative parenting behavior found in this study is consistent with a review of group-based parent training programs [47
]. There was no evidence to suggest that the inclusion of the parent–child interactive groups in the ET program resulted in superior change in negative parenting behavior compared to the ET-Adapted program. However, this study’s demonstration of a 12-month maintenance of treatment effect on negative parenting behavior is an important outcome.
Results indicated no significant improvement in positive parenting behavior across both treatment groups (ET, ET-Adapted). This finding is consistent with other studies of group-based parenting programs that demonstrated significant reduction in negative parenting behavior but no significant improvement in parent self-report of positive parenting behavior [98
]. However, this finding is in contrast with a review [47
] and some studies of group-based parenting programs [100
]. This contradictory finding could be due to parents’ high self-report of positive parenting behavior prior to treatment. Study findings indicated that children who were invited to participate in treatment were less socio-economically disadvantaged compared to children who did not receive treatment. As compared to higher socio-economic family environments, parenting within low socio-economic family environments has been observed to demonstrate lower levels of positive parenting behaviors [103
]. Therefore, it is possible that the lack of significant improvement for positive parenting behavior may have occurred because parents excluded from the study would perhaps report lower levels of positive parenting. Rather than relying solely on parent self-report of parenting behaviors, future studies could also use independent observational measures to explore change in behaviors as an outcome of parent training.
Total parenting stress on the PSI-SF did not decrease significantly across both treatment groups (ET, ET-Adapted). This result conflicts with findings from a review of group-based parent training programs [49
]. However, in this study the baseline mean PSI-SF total scores for participants in both treatment groups (ET, ET-Adapted) were below the cut-off for the range considered to be clinically significant [94
]. Children who were invited to participate in treatment were less socio-economically disadvantaged than children who met SDQ eligibility criteria but were not invited to receive treatment. As previous research has shown that families with a higher socio-economic status experience fewer stressors compared to those with a lower socio-economic status [104
], results may have been influenced by the demographic composition of the sample. Previous research has also shown social/partner support to be a potential mitigator of parenting stress [33
]. As such, participants in this sample may have experienced higher levels of social/partner support in their parenting role compared to other parents, which may partially explain lower levels of parenting stress reported by parents at baseline.
Significant improvement was found for parenting self-efficacy across both treatment groups (ET, ET-Adapted), maintained up to six-months after program completion. This benefit of both versions of the Exploring Together program is in keeping with a previous review that found evidence of a significant benefit of group-based intervention programs on parental self-efficacy [50
]. Given that parental self-efficacy has been demonstrated to directly affect the quality of parenting behavior [43
], findings support the benefit of strengthening self-efficacy in parenting programs that provide active skills training for parents and teach parents how to improve their relationships with their children. There was a significant difference between groups on parental self-efficacy at post intervention. However, caution is warranted in interpreting this finding due to a lack of significant difference between groups at the 6- and 12-month follow-ups and sample attrition at 12-month follow up.
The PSOC parenting satisfaction scale examines parent’s affective dimensions of anxiety, frustration and motivation in relation to parenting their child. This study found no significant improvement in parenting satisfaction across both treatment groups (ET, ET-Adapted). This finding is in keeping with another group parent training program for children with attention deficit/hyperactivity disorder (ADHD) [105
]. However, this finding is in contrast with other evaluations of parent training programs that reported significant improvements in parenting satisfaction post treatment [106
]. It is likely that parenting satisfaction did not show improvement as scores at baseline approximated a community sample [37
]. There was significantly greater improvement in parenting satisfaction at the 12-month follow-up for parents in the ET-Adapted program compared to the ET program. Further investigation into the longer-term impact of the Exploring Together program for parenting satisfaction as parents to continue to navigate the challenges of parenting may be warranted [108
In summary, this study found significant improvement in negative parenting behavior and parenting self-efficacy across both treatment groups (ET, ET-Adapted). However, contrary to study hypotheses, the ET program (inclusive of parent–child interactive groups) did not result in greater change in negative parenting behavior and parenting self-efficacy compared to participants who completed the ET-Adapted program (without the parent–child interactive groups). Several possible explanations for these findings are provided. First, studies included in prior reviews [56
] that incorporated a parent–child interactive component [109
] had a higher treatment dosage (i.e., greater number of hours spent in the parent–child interactive component of treatment) compared to the current study. Second, compared to prior studies of group-based parent training programs inclusive of a parent–child interactive component [62
], the ET program implemented in this study did not require participants to master parent–child relationship skills (i.e., child-centred skills, decreased leading and directive parent behavior, effective commands) during the parent–child interactive component. Third, the results of the current study relied exclusively on parent self-report measures. This may have limited the capacity for the ET program to demonstrate added benefit over and above the ET-Adapted program.
It is possible that group delivery of the parent–child interactive component of the program may have impacted on learning. With up to eight parent–child dyads in the group, parents and children may have experienced increased social pressure and/or anxiety as they learned and practiced new relationship skills in front of other parent–child dyads [112
]. Further, some studies involving delivery of a parent–child interactive component in a group environment have included fewer parent–child dyads [111
]. Therefore, it is possible that because of the larger number of parent–child dyads included in the parent–child interactive component in this study, there was not enough time for each parent to receive direct coaching and feedback. Also, as this program was delivered in schools, children may have participated in the parent–child interactive component with their peers, which may have increased their self-consciousness and impacted on learning [114
]. Future studies may therefore consider delivering the parent–child interactive component of the program on an individual basis.
This study demonstrated that the two versions of Exploring Together were equally effective. One way to interpret this result is to conclude that the in vivo parent–child interactive groups are not a necessary additional component of the program. Further, factors related to treatment dosage and mastery of parent–child relationship skills may have limited the capacity for the ET program to demonstrate added benefit in terms of parenting outcome variables relative to the ET-Adapted program. It is also possible that there were benefits of either version of the program that were not captured by the outcome measures used. For instance, the parent–child interactive component of the program may have benefits such as increased warmth and security between parents and children due to increased use of positive attention strategies. Although the two versions of Exploring Together were found to be equally effective in this study, notwithstanding study limitations, future studies may benefit from including additional independent observational measures of the parent–child relationship and interaction rather than reliance on parent self-report [116
The current study had a number of strengths and closely adhered to guidelines recommended for cluster-randomized trials [73
]. A key strength of the study was the random assignment of schools, a particularly salient feature given that previous studies of the Exploring Together program did not involve random assignment [53
]. In regard to implementation effectiveness, a high level of treatment satisfaction was reported by parents for all aspects of both versions of the Exploring Together program, an important indicator of parent acceptability of the program. A high rate of average attendance by parents at the weekly treatment sessions across both treatments (ET, ET-Adapted) suggests good parent engagement with the program.
Current study findings must be considered in the context of some limitations. Attrition at the longer-term follow-ups was moderate to high, thus reducing sample size and statistical power. Conclusions drawn from the study should therefore be interpreted with caution. Study results relied exclusively on parent self-report, which does not exclude the possibility of changes occurring due to parent’s perception of the situation. Further, parents were not blinded to school treatment allocation, which could introduce bias due to expectancy effects. Rather than relying solely on parent self-report of parenting behaviors, future trials of the Exploring Together program would benefit from including independent observational measures to explore change in behaviors as an outcome of parent training [100
A potential methodological limitation of the study concerns treatment fidelity. Some treatment group leaders did not complete the 2-day training workshop but instead were trained via a ‘train the trainer’ co-facilitation method. This may have impacted on fidelity of delivery of the program. A number of factors impact the capacity to generalize the findings of this study. Families who had a recent or current significant change in family circumstances or significant parental mental health problems were excluded. It is acknowledged that these parents may well have benefited from the intervention. Findings suggest that children who were invited to participate in treatment were less socio-economically disadvantaged compared to children who did not receive treatment. Therefore, findings may not generalize to socio-economically disadvantaged families.
The research presented in this study has important implications for future research involving group-based parent training programs in primary school settings [117
]. Given disparities in the use of community-based mental health services for children and families [118
], future trials could encourage participation from parents across the socioeconomic spectrum by offering flexible scheduling options, childcare, and transportation assistance, and delivery of the program outside school hours [119
]. This would likely involve complex and coordinated efforts between mental health services, school leadership staff, and other existing resources at the school to achieve such impact.