Academic journal article Journal of Evidence-Based Psychotherapies

Efficacy of the Rational Positive Parenting Program for Child Externalizing Behavior: Can an Emotion-Regulation Enhanced Cognitive-Behavioral Parent Program Be More Effective Than a Standard One?

Academic journal article Journal of Evidence-Based Psychotherapies

Efficacy of the Rational Positive Parenting Program for Child Externalizing Behavior: Can an Emotion-Regulation Enhanced Cognitive-Behavioral Parent Program Be More Effective Than a Standard One?

Article excerpt

Child externalizing disorders refer to conditions such as attention deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), or conduct disorder (CD; DSM-5, APA, 2013), which are all characterized by non- compliant, impulsive or aggressive behaviors. These disorders are considered (Raine et al., 2005) highly prevalent and chronic conditions across lifespan development. Parenting (e.g., coercive practices, over reactivity; see Gershoff, 2002) has been identified (Lipscomb et al., 2012), together with other risk factors (e.g., genetic make-up, low SES), as an important etiopathogenetic factor for externalizing disorders in childhood. Cognitive-behavioral parent programs have been developed to address parent patterns associated with childhood externalizing behavior problems (Sanders, Markie-Dadds, Tully, & Bor, 2000). Nowadays, cognitive-behavioral parenting interventions are the treatment of choice for addressing externalizing disorders in childhood (see NICE, 2008; 2013), since their effectiveness has been well documented (Kazdin, 2005; Sanders et al., 2000; Thomas & Zimmer-Gembeck, 2007).

The Standard Group based Cognitive-Behavioral Parent Programs

Cognitive-behavioral group based parenting interventions (considered standard in this paper) include mainly the use of techniques based on behavioral learning theory (operant and respondent learning), social learning theory (e.g. modeling, behavioral rehearsal) and, some of them, cognitive theories of learning (e.g., challenging misattributions about parenting) (Webster-Stratton, 1990). Many meta-analyses (see Bradley & Mandell, 2005; Kaminski, Valle, Filene, & Boyle, 2008; Lundahl, Risser, & Lovejoy, 2006; Maughan, Christianse, Jenson, Olympia, & Clark, 2005) evaluating effects of peer-reviewed studies of parent training programs for child externalizing disorders have shown effects that are small to moderate after the treatment (overall D = 0.22-0.52, see Lundahl et al., 2006), and small effect size at follow-up (overall D = 0.21). Although parenting training methods can successfully improve young children's externalizing behavior problems (i.e., 4-12 years old children; Kaminski et al., 2008), some families are not deriving any benefit from participating in these programs, with up to 50% of children included in studies failing to respond to treatment (Kazdin, 1993; Webster-Stratton, 1990).

It is recognized that dysfunctional parenting, together with other complex and interacting factors such as stress, poor parental emotion-regulation abilities, and psychopathology, can contribute either directly or indirectly to early onset conduct problems. Thus, there are increasing efforts to address parental self- regulation aspects in parental programs for reducing child externalizing disorders, and it was proposed (Gavita, David, & Joyce, 2011; Gavita, DiGiuseppe, & David, 2013) that such programs might be enhanced by a special focus on mechanisms found to be important to parental emotion-regulation. However, the existing enhanced cognitive-behavioral parenting programs vary in the extent to which they include these components, and the extent to which they target at risk families, or children with clinical problems (Hutchings & Lane, 2005).

The Enhanced Cognitive-Behavioral Parent Programs

Based on the documented the role of maternal distress/psychopathology (Dix & Meunier, 2009), it was proposed that the standard cognitive-behavioral parent programs for child behavior problems should be enhanced to include the development of efficient emotion-regulation strategies in parents for maximizing their long-term effects (see Griest et al., 1982; Lovejoy, Graczyk, O'Hare, & Neuman, 2000; McMahon et al., 1981; Webster-Stratton, 1990). When using the term emotion-regulation strategies here, we refer to (Gross, 2002) the cognitive processes documented to be involved in generating (i.e., altering or modulating) negative/positive affect. …

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