University of Oxford, UK; University of Amsterdam, The Netherlands.
University of Oxford, UK.
J Am Acad Child Adolesc Psychiatry. 2019 Feb;58(2):180-190. doi: 10.1016/j.jaac.2018.07.900. Epub 2018 Nov 26.
Parenting programs are the recommended strategy for the prevention and treatment of disruptive child behavior. Similar to most psychosocial interventions, it is unknown which components of parenting programs (ie, parenting techniques taught) actually contribute to program effects. Identifying what parents need to be taught to reduce disruptive child behavior can optimize intervention strategies, and refine theories on how parenting shapes disruptive child behavior.
In two meta-analyses, we updated the evidence-base for effectiveness of parenting programs delivered at various levels of prevention and treatment of disruptive behavior. We searched six databases (eg, PsycINFO, MEDLINE) for randomized trials and coded the parenting techniques taught in each program. We identified the techniques associated with program effects in general, and for prevention versus treatment, and immediate versus longer-term effects, specifically.
Parenting program effects on disruptive behavior gradually increased per level of prevention (universal d = -0.21, selective d = -0.27, indicated d = -0.55) and treatment (d = -0.69) (Meta-Analysis 1: 154 trials, 398 effect sizes). Three of 26 parenting techniques were associated with stronger program effects: positive reinforcement, praise in particular, and natural/logical consequences. Several additional techniques (eg, relationship building and parental self-management) were associated with stronger effects in treatment but weaker effects in prevention. No techniques were associated with stronger longer-term effects (Meta-Analysis 2: 42 trials, 157 effect sizes).
Positive reinforcement and nonviolent discipline techniques (eg, applying natural/logical consequences) seem to be key parenting program techniques to reduce disruptive child behavior. Additional techniques (eg, parental self-management skills) might improve program effects in treatment, but not in prevention.
育儿课程是预防和治疗儿童行为障碍的推荐策略。与大多数心理社会干预措施一样,育儿课程中的哪些组成部分(即教授的育儿技巧)实际上有助于产生课程效果尚不清楚。确定父母需要教授哪些内容以减少儿童行为障碍,可以优化干预策略,并完善关于育儿如何影响儿童行为障碍的理论。
在两项荟萃分析中,我们更新了各种预防和治疗破坏性行为水平的育儿课程有效性的证据基础。我们在六个数据库(例如,PsycINFO、MEDLINE)中搜索了随机试验,并对每个课程中教授的育儿技巧进行了编码。我们确定了与课程效果相关的技巧,包括总体效果、预防与治疗效果、即时效果与长期效果。
育儿课程对破坏性行为的影响逐渐增加,每提高一个预防水平(普遍性 d = -0.21,选择性 d = -0.27,针对性 d = -0.55)和治疗水平(d = -0.69)(分析 1:154 项试验,398 个效果量)。26 种育儿技巧中有 3 种与更强的课程效果相关:正强化、特别是表扬和自然/逻辑后果。其他几种技巧(例如,建立关系和父母自我管理)与治疗中的更强效果相关,但在预防中效果较弱。没有技巧与更强的长期效果相关(分析 2:42 项试验,157 个效果量)。
正强化和非暴力纪律技巧(例如,应用自然/逻辑后果)似乎是减少儿童行为障碍的关键育儿课程技巧。其他技巧(例如,父母自我管理技能)可能会提高治疗中的课程效果,但不能提高预防效果。