Few studies have examined the effects of varying the level of intensity of a parenting intervention in the treatment of conduct problems in children. In particular, it is unclear whether group parenting interventions that incorporate adjunctive cognitive interventions designed to reduce parental stress add to the efficacy and durability of effects of standard parenting skills training. Adjunctive interventions designed to reduce depression, stress, anger management problems or cognition biases, delivered in group settings, have the potential to augment parenting skills training. There is some empirical support for adjunctive interventions, but there are also conflicting findings. This study reviews the data from existing randomized controlled trials evaluating the effectiveness of group based cognitively enhanced behavioral parenting programs for reducing children's disruptive behavior and parent distress. The findings show the potential that such interventions have in reducing children's disruptive behavior and draw some lines for future integration of the cognitive components in behavioral parent training.
Keywords: cognitively enhanced, behavioral parent training, disruptive behavior
There is evidence from a range of follow-up studies to suggest that a number of factors relating to the mother's psychosocial and mental health can have a significant effect on the mother-infant relationship, resulting in both emotional and behavioral problems in childhood. Longitudinal studies have also shown an effect of maternal mental health problems on the long-term emotional and psychological health of the child (Caplan, Cogill, Alexandra, Robson et al, 1989). There is, therefore, considerable potential for interventions aimed at promoting the psychosocial wellbeing of the mother, to reduce the disruption to the child's emotional, behavioral and social adjustment (Rutter, 1996; Ghodsian, Zajicek, & Wolkin, 1984). The use of parenting programs began in the 1960s and the use of groups to train parents began in the 1970s. The expansion of groupbased parenting programs has taken place in a number of countries over the past decade, with the growing involvement of voluntary organizations in their provision. Parenting programs are now being offered in a variety of settings and a recent systematic review of randomized controlled trials (Bunting, 2004) showed that they are effective in improving behavior problems in young children. It is now thought to be important that parenting programs have a role to play in the improvement of maternal mental health.
It is problematic to keep adding components to a treatment that might enhance or indeed actually does enhance therapeutic change. From a methodological standpoint, demonstrating that any new component will make a difference can be quite difficult because of limitations in assessment (e.g., ceiling effects) and research design (e.g., sample sizes needed to show small increments in effects). The methodological and design constraints limit how much one can add to an evidence-based treatment and expect to show an effect, even if there is one. From a more clinical and service delivery standpoint, the strategy of adding components to treatment has further limitations (David, Miclea, & Opre, 2004). Patient attrition, already high in child, adolescent, and adult therapy (40%-60%) is a partial function of the demands made of the client (Kazdin, Holland, & Crowley, 1997) and the duration of treatment (Phillips, 1985). Adding a component to treatment that increases either one of these is quite likely to cause greater attrition so that fewer patients will complete treatment. Also, of course, there is the monetary cost. Improving treatment by adding components may add to the number of sessions and raise reimbursement issues and questions about incremental costs in relation to incremental benefits.
A few strategies have been proposed to enhance treatment effects. …