Skip to main content
Log in

Systematic Review and Meta-analysis of Parent Group Interventions for Primary School Children Aged 4–12 Years with Externalizing and/or Internalizing Problems

  • Original Article
  • Published:
Child Psychiatry & Human Development Aims and scope Submit manuscript

Abstract

This systematic review and meta-analysis evaluates the efficacy of parent training group interventions to treat child externalizing and/or internalizing problems. A search identified 21 randomized controlled trials of parent group interventions aimed at ameliorating child externalizing and/or internalizing problems in children aged 4–12 years. Random effects meta-analyses yielded significant pooled treatment effect size (g) estimates for child externalizing (g = −0.38) and internalizing problems (g = −0.18). Child anxiety symptoms or internalizing problems evident in children with externalizing behavior problems did not change significantly following intervention. Study quality was a statistically significant moderator of treatment response for child externalizing problems, however hours of planned parent group treatment and treatment recipient were not. Findings support the use of parent group interventions as an effective treatment for reducing externalizing problems in children aged 4–12 years. Whilst statistically significant, programs had a limited impact on internalizing symptoms, indicating a need for further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O et al (2011) Child and adolescent mental health worldwide: evidence for action. Lancet 378:1515–1525

    Article  PubMed  Google Scholar 

  2. Lawrence D, Johnson S, Hafekost J, Boterhoven de Haan, K, Sawyer M, Ainley J et al (2015) The mental health of children and adolescents. Report on the second Australian child and adolescent survey of mental health and wellbeing. Department of Health, Canberra

    Google Scholar 

  3. Edwards RT, Céilleachair A, Bywater T, Hughes DA, Hutchings J (2007) Parenting program for parents of children at risk of developing conduct disorder: cost effectiveness analysis. BMJ. doi:10.1136/bmj.39126.699421.55

    Google Scholar 

  4. Beauchaine TP, Hinshaw SP (eds) (2013) Child and adolescent psychopathology, 2nd edn. Wiley, New Jersey

    Google Scholar 

  5. Bor W, Dean AJ, Najman J, Hayatbakhsh R (2014) Are child and adolescent mental health problems increasing in the 21st century? A systematic review. Aust N Z J Psychiatry 48:606–616

    Article  PubMed  Google Scholar 

  6. Rutter M, Kim-Cohen J, Maughan B (2006) Continuities and discontinuities in psychopathology between childhood and adult life. J Child Psychol Psychiatry 47:276–295

    Article  PubMed  Google Scholar 

  7. Access Economics (2009) The economic impact of youth mental illness and the cost effectiveness of early intervention. http://www.orygen.org.au

  8. Knapp M, Scott S, Davies J (1999) The cost of antisocial behavior in younger children. Clin Child Psychol Psychiatry 4:457–473

    Article  Google Scholar 

  9. Scott S, Knapp M, Henderson J, Maughen B (2001) Financial cost of social exclusion: follow up study of antisocial children into adulthood. BMJ 323:191–196

    Article  PubMed  PubMed Central  Google Scholar 

  10. Dunlap G, Strain PS, Fox L, Carta JJ, Conroy M, Smith BJ et al (2006) Prevention and intervention with young children’s challenging behavior: Perspectives regarding current knowledge. Behav Disord 32(1):29–45

    Google Scholar 

  11. Halfon N, Hochstein M (2002) Life course health development: an integrated framework for developing health, policy, and research. Millbank Q 80(3):433–479

    Article  Google Scholar 

  12. Zahn-Waxler C, Klimes-Dougan B, Slattery MJ (2000) Internalizing problems of childhood and adolescence: Prospects, pitfalls and progress in understanding the development of anxiety and depression. Dev Psychopathol 12:443–444

    Article  PubMed  Google Scholar 

  13. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders: DSM-5, 5th edn. American Psychiatric Association, Arlington

    Book  Google Scholar 

  14. Merikangas KR, He J-P, Brody D, Fisher PW, Bourdon K, Koretz DS (2010) Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics 125(1):75–81

    Article  PubMed  Google Scholar 

  15. Bayer JK, Sanson AV, Hemphill SA (2009) Early childhood aetiology of internalizing difficulties: a longitudinal community study. Int J Ment Health Promot 11(1):4–14

    Article  Google Scholar 

  16. Carter AS, Briggs-Gowan MJ, Davis NO (2004) Assessment of young children’s social emotional development and psychopathology: recent advances and recommendations for practice. J Child Psychol Psychiatry 45(1):109–134

    Article  PubMed  Google Scholar 

  17. Felner RD (1999) An ecological perspective on pathways of risk, vulnerability, and adaptation: Implications for preventive interventions. In: Russ SW, Ollendick TH (eds) Handbook of psychotherapies with children and families. Academic/Plenum Press Publishers, New York

    Google Scholar 

  18. NICE (National Institute for Health and Care Excellence) (2013). Antisocial behavior and conduct disorders in children and young people: recognition, intervention and management. NICE, Manchester

    Google Scholar 

  19. Lundahl B, Risser HJ, Lovejoy CM (2006) A meta-analysis of parent training: moderators and follow-up effects. Clin Psychol Rev 26(1):86–104

    Article  PubMed  Google Scholar 

  20. Kaminski JW, Valle LA, Filene JH, Boyle CL (2008) A meta-analytic review of components associated with parent training program effectiveness. J Abnorm Child Psychol 36(4):567–589

    Article  PubMed  Google Scholar 

  21. Dretzke J, Davenport C, Frew E, Barlow J, Stewart-Brown S, Bayliss S et al (2009) The clinical effectiveness of different parenting programs for children with conduct problems: a systematic review of randomized controlled trials. Child Adolesc Psychiatry Ment Health. doi:10.1186/1753-2000-3-7

    PubMed  PubMed Central  Google Scholar 

  22. Bayer J, Hiscock H, Scalzo K, Mathers M, McDonald M, Morris A et al (2009) Systematic review of preventive interventions for children’s mental health: what would work in Australian contexts? Aust N Z J Psychiatry 43:695–710

    Article  PubMed  Google Scholar 

  23. Brestan EV, Eyberg SM (1998) Effective psychosocial treatments of conduct-disordered children and adolescents: 29 years, 82 studies, and 5,272 kids. J Clin Child Psychol 27(2):180–189

    Article  PubMed  Google Scholar 

  24. Sanders MR, Kirby JN, Tellegen CL, Day JJ (2014) The triple P-positive parenting program: a systematic review and meta-analysis of a multi-level system of parenting support. Clin Psychol Rev 34:337–357

    Article  PubMed  Google Scholar 

  25. Kjobli J, Hukkelberg S, Ogden T (2013) A randomized trial of group parent training: reducing child conduct problems in real-world settings. Behav Res Ther 51(3):113–121

    Article  PubMed  Google Scholar 

  26. Comer JS, Chow C, Chan PT, Cooper-Vince C, Wilson LAS (2013) Psychosocial treatment efficacy for disruptive behavior problems in very young children: a meta-analytic examination. J Am Acad Child Adolesc Psychiatry 52(1):26–36

    Article  PubMed  Google Scholar 

  27. Sanders MR (2012) Development, evaluation, and multinational dissemination of the Triple P-Positive Parenting Program. Annu Rev Clin Psychol 8:345–379

    Article  PubMed  Google Scholar 

  28. Patterson G, Reid J, Dishion T (1992) Antisocial boys. Castalia, Oregon

    Google Scholar 

  29. Furlong M, McGilloway S, Bywater T, Hutchings J, Smith SM, Donnelly M (2012) Behavioral and cognitive-behavioral group-based parenting programs for early-onset conduct problems in children aged 3 to 12 years. Cochrane Database Syst Rev. doi:10.1002/14651858.CD008225.pub2

    PubMed  Google Scholar 

  30. Webster-Stratton C, Hammond M (1997) Treating children with early-onset conduct problems: a comparison of child and parent training interventions. J Consult Clin Psychol 65(1):93–109

    Article  PubMed  Google Scholar 

  31. Cartwright-Hatton S, McNally D, Field AP, Rust S, Laskey B, Dixon C et al (2011) A new parenting-based group intervention for young anxious children: results of a randomized controlled trial. JAACAP 50:242–251

    Google Scholar 

  32. Lyneham HJ, Rapee RM (2006) Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behav Res Ther 44:1287–1300

    Article  PubMed  Google Scholar 

  33. Thienemann M, Moore P, Tompkins K (2006) A parent-only group intervention for children with anxiety disorders: pilot study. JAACAP 45:37–46

    Google Scholar 

  34. Lebowitz ER, Omer H (2013) Treating childhood and adolescent anxiety: a guide for caregivers. Wiley, New Jersey

    Book  Google Scholar 

  35. Berkien M, Louwerse A, Verhulst F, van der Ende J (2012) Children’s perceptions of dissimilarity in parenting styles are associated with internalizing and externalizing behaviour. Eur Child Adoles Psy 21:79–85

    Article  Google Scholar 

  36. Cunningham NR, Ollendick TH (2010) Comorbidity of anxiety and conduct problems in children: Implications for clinical research and practice. Clin Child Fam Psychol Rev 13:333

    Article  PubMed  Google Scholar 

  37. Webster-Stratton C, Herman K (2008) The impact of parent behavior-management training on child depressive symptoms. J Couns Psychol 55(4):473–484

    Article  PubMed  Google Scholar 

  38. Niec LN, Barnett ML, Prewett MS, Shanley Chatham JR (2016) Group parent-child interaction therapy: a randomized control trial for the treatment of conduct problems in young children. J Consult Clin Psych 84(8):682–698

    Article  Google Scholar 

  39. Reynolds S, Wilson C, Austin J, Hooper L (2012) Effects of psychotherapy for anxiety in children and adolescents: a meta-analytic review. Clin Psychol Rev 32:251–262

    Article  PubMed  Google Scholar 

  40. Moher D, Liberati A, Tetzlaff J, Altman DG, the PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269

    Article  PubMed  Google Scholar 

  41. Higgins JPT, Green S (eds) (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration

  42. Perestelo-Pérez L (2013) Standards on how to develop and report systematic reviews in psychology and health. Int J Clin Health Psychol 13:49–57

    Article  Google Scholar 

  43. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2010) A basic introduction to fixed-effect and random-effects models for meta-analysis. Res Synth Methods 1:97–111

    Article  PubMed  Google Scholar 

  44. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale

    Google Scholar 

  45. Huedo-Medina T, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? CHIP Documents 19. http://digitalcommons.uconn.edu/chip_docs

  46. StataCorp (2011) Stata statistical software: release 12. Stata Corporation LP, College Station

    Google Scholar 

  47. Duncombe ME, Havighurst SS, Kehoe CE, Holland KA, Frankling EJ, Stargatt R (2014) Comparing an emotion- and a behavior-focused parenting program as part of a multisystemic intervention for child conduct problems. J Clin Child Adolesc Psychol. doi:10.1080/15374416.2014.963855

    PubMed  Google Scholar 

  48. Havighurst SS, Duncombe M, Frankling E, Holland K, Kehoe C, Stargatt R (2015) An emotion-focused early intervention for children with emerging conduct problems. J Abnorm Child Psychol 43:749–760

    Article  PubMed  Google Scholar 

  49. Chacko A, Wymbs BT, Wymbs FA, Pelham WE, Swanger-Gagne MS, Girio E et al (2009) Enhancing traditional behavioral parent training for single mothers of children with ADHD. J Clin Child Adolesc Psychol 38(2):206–218

    Article  PubMed  Google Scholar 

  50. Rajwan E, Chacko A, Wymbs BT, Wymbs FA (2014) Evaluating clinically significant change in mother and child functioning: comparison of traditional and enhanced behavioral parent training. J Abnorm Child Psychol 42:1407–1412

    Article  PubMed  Google Scholar 

  51. Axberg U, Broberg AG (2012) Evaluation of ‘‘the incredible years’’ in Sweden: the transferability of an American parent-training program to Sweden. Scand J Psychol 53:224–232

    Article  PubMed  Google Scholar 

  52. Braet C, Meerschaert T, Merlevede E, Bosmans G, Van Leeuwen K, De Mey W (2009) Prevention of antisocial behavior: evaluation of an early intervention program. Eur J Dev Psychol 6(2):223–240

    Article  Google Scholar 

  53. David OA, David D, Dobrean A (2014) Efficacy of the rational positive parenting program for child: can an emotion-regulation enhanced cognitive-behavioral parent program be more effective than a standard one? Int J Evid Based Healthc 14(2):159–178

    Google Scholar 

  54. de Groot J, Cobham V, Leong J, McDermott B (2007) Individual versus group family-focused cognitive behavior therapy for childhood anxiety: pilot randomized controlled trial. Aust N Z J Psychiatry 41:990–997

    Article  PubMed  Google Scholar 

  55. Fung ALC, Tsang SHKM (2006) Parent–child parallel-group intervention for childhood aggression in Hong Kong. Emot Behav Diffic 11(1):31–48

    Article  Google Scholar 

  56. Hand A, McDonnell E, Honari B, Sharry J (2013) A community led approach to delivery of the parents plus children’s program for the parents of children aged 6–11. Int J Clin Health Psychol 13:81–90

    Article  Google Scholar 

  57. Havighurst SS, Wilson KR, Harley AE, Kehoe C, Efron D, Prior MR (2013) Tuning into kids: reducing young children’s behavior problems using an emotion coaching parenting program. Child Psychiatry Hum Dev 44:247–264

    Article  PubMed  Google Scholar 

  58. Herman KC, Borden LA, Webster-Stratton C, Reinke WM (2011) The impact of the incredible years parent, child, and teacher training programs on children’s co-occurring internalizing symptoms. Sch Psychol Q 26(3):189–201

    Article  PubMed  PubMed Central  Google Scholar 

  59. Holmes MC, Donovan CL, Farrell LJ, March S (2014) The efficacy of a group-based, disorder-specific treatment program for childhood GAD—a randomized controlled trial. Behav Res Ther 61:122–135

    Article  PubMed  Google Scholar 

  60. Larsson B, Fossum S, Clifford G, Drugli MB, Handegard BH, Morch WT (2009) Treatment of oppositional defiant and conduct problems in young Norwegian children: results of a randomized controlled trial. Eur Child Adolesc Psychiatry 18(1):42–52

    Article  PubMed  Google Scholar 

  61. Lau AS, Fung JJ, Ho LY, Liu LL, Gudiño OG (2011) Parent training with high-risk immigrant Chinese families: a pilot group randomized trial yielding practice-based evidence. Behav Ther 42:413–426

    Article  PubMed  Google Scholar 

  62. Little M, Berry V, Morpeth L, Blower S, Axford N, Taylor R et al (2012) Evidence-based programs delivered in public systems. Int J Conf Violence 6(2):260–272

    Google Scholar 

  63. Sayal K, Taylor JA, Valentine A, Guo B, Sampson CJ, Sellman E et al (2016) Effectiveness and cost-effectiveness of a brief school-based group program for parents of children at risk of ADHD: a cluster randomized controlled trial. Child Care Health Dev 42(4):521–533

    Article  PubMed  Google Scholar 

  64. Scott S, O’Connor TG, Futh A, Matias C, Price J, Doolan M (2010) Impact of a parenting program in a high-risk, multi-ethnic community: the PALS trial. J Child Psychol Psychiatry 51(12):1331–1341

    Article  PubMed  Google Scholar 

  65. Scott S, Sylva K, Doolan M, Price J, Jacobs B, Crook C et al (2010) Randomized controlled trial of parent groups for child antisocial behavior targeting multiple risk factors: the SPOKES project. J Child Psychol Psychiatry 51(1):48–57

    Article  PubMed  Google Scholar 

  66. van den Hoofdakker BJ, van der Veen-Mulders L, Sytema S, Emmelkamp PMG, Minderra RB, Nauta MH (2007) Effectiveness of behavioral parent training for children with ADHD in routine clinical practice: A randomized controlled study. J Am Acad Child Adolesc Psychiatry 46(10):1263–1271

    Article  PubMed  Google Scholar 

  67. Waters AM, Ford LA, Wharton TA, Cobham VE (2009) Cognitive-behavioral therapy for young children with anxiety disorders: comparison of a child + parent condition versus a parent only condition. Behav Res Ther 47:654–662

    Article  PubMed  Google Scholar 

  68. Webster-Stratton CH, Reid MJ, Beauchaine T (2011) Combining parent and child training for young children with ADHD. J Clin Child Adolesc Psychol 40(2):191–203

    Article  PubMed  PubMed Central  Google Scholar 

  69. Wiggins TL, Sofronoff K, Sanders MR (2009) Pathways triple P-positive parenting program: effects on parent-child relationships and child behavior problems. Fam Process 48(4):517–530

    Article  PubMed  Google Scholar 

  70. Achenbach TM (1991) Manual for the child behavior checklist 4–18 and 1991 profile. University of Vermont, Department of Psychiatry, Burlington

    Google Scholar 

  71. Eyberg S, Pincus D (1999) Eyberg child behavior inventory and Sutter-Eyberg student behavior inventory-revised: professional manual. Psychological Assessment Resources, Odessa

    Google Scholar 

  72. Goodman R (1999) The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry 40(5):791–799

    Article  PubMed  Google Scholar 

  73. Pelham WE, Fabiano GA, Massetti GM (2005) Evidence-based assessment of attention-deficit/hyperactivity disorder in children and adolescents. J Clin Child Adolesc Psychol 34:449–476

    Article  PubMed  Google Scholar 

  74. Conners CK, Sitarenios G, Parker JDA, Epstein JN (1998) The revised Conners’ parent rating scale (CPRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 26:257–268

    Article  PubMed  Google Scholar 

  75. Taylor E, Schachar R, Thorley G, Weiselberg M (1986) Conduct disorder and hyperactivity—1 separating of hyperactivity and anti-social conduct in British child psychiatric patients. Br J Psychiatry 149:760–767

    Article  PubMed  Google Scholar 

  76. Silverman WK, Albano AM (1996) Anxiety disorders interview schedule for DSM-IV child version: parent interview schedule. Psychological Corporation Harcourt, Brace, San Antonio

    Google Scholar 

  77. Weeland J, Chhangur RR, van der Giessen D, Matthys W, de Castro BO, Overbeek G (2017) Intervention effectiveness of the incredible years: new insights into sociodemographic and intervention-based moderators. Behav Ther 48:1–18

    Article  PubMed  Google Scholar 

  78. Smith AM, Flannery-Schroeder EC, Gorman KS, Cook N (2014) Parent cognitive-behavioral intervention for the treatment of childhood anxiety disorders: a pilot study. Behav Res Ther 61:156–161

    Article  PubMed  Google Scholar 

  79. Nauta MH, Scholing A, Emmelkamp PMG, Minderaa RB (2003) Cognitive-behavioral therapy for children with anxiety disorders in a clinical setting: no additional effect of a cognitive parent training. J Am Acad Child Adolesc Psychiatry 42(11):1270–1278

    Article  PubMed  Google Scholar 

  80. Cunningham CE, Bremner R, Boyle M (1995) Large group community-based parenting programs for families of preschoolers at risk for disruptive behavior disorders: utilization, cost effectiveness, and outcome. J Child Psychol Psychiatry 36(7):1141–1159

    Article  PubMed  Google Scholar 

  81. Pevsner R (1982) Group parent training versus individual family therapy: an outcome study. J Behav Ther Exp Psychiatry 13:119–122

    Article  PubMed  Google Scholar 

  82. Webster-Stratton C (1984) Randomized trial of two parent-training programs for families with conduct-disordered children. J Consult Clin Psychol 52:666–678

    Article  PubMed  Google Scholar 

  83. Cox P, Vinogradov S, Yalom I (2008) Group therapy. In: Hales RE, Yadofsky S, Gabbard G (eds) The American psychiatric publishing textbook of psychiatry, 5th edn. American Psychiatric Publishing, Arlington

    Google Scholar 

  84. Michelson D, Davenport C, Dretzke J, Barlow J, Day C (2013) Do evidence-based interventions work when tested in the ‘‘real world?’’ A systematic review and meta-analysis of parent management training for the treatment of child disruptive behavior. Clin Child Fam Psychol Rev 16:18–34

    Article  PubMed  Google Scholar 

  85. Wymbs FA, Cunningham CE, Chen Y, Rimas HM, Deal K, Waschbusch DA, Pelham PE Jr (2016) Examining parents’ preferences for group and individual parent training for children with ADHD symptoms. J Clin Child Adolesc Psychol 45(5):614–631

    Article  PubMed  Google Scholar 

  86. Grégoire G, Derderian F, LeLorier J (1995) Selecting the language of the publications included in a meta-analysis: is there a Tower of Babel bias? J Clin Epidemiol 48:159–163

    Article  PubMed  Google Scholar 

  87. Moher D, Jadad AR, Tugwell P (1996) Assessing the quality of randomized controlled trials: current issues and future directions. Int J Technol Assess Health Care 12:195–208

    Article  PubMed  Google Scholar 

  88. Borenstein M, Hedges LV, Higgins JPT, Rothstein HR (2009) Introduction to meta-analysis. Wiley, West Sussex

    Book  Google Scholar 

  89. Baxter AJ, Scott KM, Vos T, Whiteford HA (2013) Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychol Med 43:897–910

    Article  PubMed  Google Scholar 

  90. Essau CA, Conradt J, Petermann F (2000) Frequency, comorbidity, and psychosocial impairment of anxiety disorders in adolescents. J Anxiety Disord 14:263–279

    Article  PubMed  Google Scholar 

Download references

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kylie M. Gray.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buchanan-Pascall, S., Gray, K.M., Gordon, M. et al. Systematic Review and Meta-analysis of Parent Group Interventions for Primary School Children Aged 4–12 Years with Externalizing and/or Internalizing Problems. Child Psychiatry Hum Dev 49, 244–267 (2018). https://doi.org/10.1007/s10578-017-0745-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10578-017-0745-9

Keywords

Navigation