Acceptability and Effectiveness of Behavioural and Non-Behavioural Parenting Interventions for Child and Adolescent Mental Health

Abstract

Mental health problems have widespread impacts on children and adolescents ("youth"), their families, and society. Parenting represents one of the most modifiable and proximal targets for supporting youth mental health. Accordingly, decades of research have examined various theoretical approaches to parenting interventions, which can be broadly categorised as behavioural and non-behavioural parenting interventions. Behavioural parenting interventions rely on social learning principles, whereby, child behaviour is strengthened or weakened through parental reinforcers of attention. These interventions are currently considered the treatment of choice for child externalising problems (e.g., aggression, noncompliance) and also show secondary effects for youth internalising problems (e.g., anxiety, depressive symptoms). Despite the strong empirical support for this model, a core procedure of behavioural parenting interventions, namely "time-out," has received increasing criticism in the community. This has occurred alongside speculation of an apparent paradigm shift towards non-behavioural parenting interventions, specifically attachment- and emotion-focused parenting interventions, which strengthen the parent-child relationship and improve child wellbeing outcomes by helping parents sensitively respond to children's underlying emotional needs behind their behaviour. These interventions have substantial empirical support for improving child secure attachment, caregiver sensitivity, and emotional competence; however, there has been less research attention on the effects of these interventions on youth mental health problems. In particular, the comparative advantages of behavioural and non-behavioural parenting interventions for addressing youth mental health outcomes remains understudied. This thesis included three studies that collectively aimed to examine the effectiveness and acceptability of behavioural and non-behavioural parenting interventions. First, a systematic review and meta-analysis (k=43) on the effectiveness of attachment- and emotion focused parenting interventions found significant small reductions in youth externalising outcomes and small-to-moderate reductions in internalising outcomes. However, the relative effectiveness of these interventions to behavioural parenting interventions remains largely unknown. Second, a survey with 110 practitioners working with children and families found that only 38% of the relevant sample reported using time-out, with some endorsing criticisms of the procedure. Notably, greater knowledge of appropriate time-out implementation was associated with increased time-out use and acceptability. Finally, interviews with 24 psychologists on their broader acceptability and implementation of behavioural and non-behavioural parenting interventions were analysed using reflexive thematic analysis. Results indicated a perceived polarisation between behavioural and non-behavioural parenting interventions in practice; though, not all psychologists were in favour of this. Further, provider-level factors including training, affective experiences, and values played a role in their implementation of parenting interventions. In sum, the findings of this thesis shed light on future research and practice directions in implementing evidence-based parenting interventions for youth mental health problems. Findings suggest that behavioural and non-behavioural parenting interventions are effective and generally acceptable treatment options for youth mental health problems, though, more research is needed to understand the relative effectiveness of these approaches. Furthermore, the misconceptions about behavioural parenting interventions, particularly time-out, warrant attention. Notwithstanding this, it remains essential to consider alternative parenting intervention approaches in research and practice, as inevitably, families' preferences, values, and needs will align with different theoretical approaches. Show more