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J Child Psychol Psychiatry. 2021 Oct;62(10):1166-1174. doi: 10.1111/jcpp.13378. Epub 2021 Feb 04.

Practitioner Review: Parenting interventions for child conduct problems: reconceptualising resistance to change.

Journal of child psychology and psychiatry, and allied disciplines

David J Hawes, Mark R Dadds

Affiliations

  1. School of Psychology, The University of Sydney, Sydney, NSW, Australia.

PMID: 33543502 DOI: 10.1111/jcpp.13378

Abstract

Parenting interventions based on social learning theory have received extensive empirical support in the treatment of child conduct problems; yet, they fail to produce lasting gains in as many as a third of cases. Perspectives on these poor outcomes have been informed by numerous lines of research, and practitioner recommendations for improving such outcomes have often emphasized processes related to clinical engagement. In this Practitioner Review, we examine recent theory and evidence pertaining to these processes, including emerging research into the therapeutic relationship across face-to-face and eHealth treatment modalities, and the clinical engagement of both mothers and fathers. The concept of resistance to change is examined in light of these developments, and it is argued that the process of overcoming such resistance can be characterized as one of reflective practice. A novel process model based on this perspective is presented, comprising practical clinical strategies that are designed to be initiated from the earliest contacts with a family and build on one another across treatment.

© 2021 Association for Child and Adolescent Mental Health.

Keywords: Conduct problems; engagement; externalizing problems; parenting interventions; treatment

References

  1. Becker, K.D., Lee, B.R., Daleiden, E.L., Lindsey, M., Brandt, N.E., & Chorpita, B.F. (2015). The common elements of engagement in children's mental health services: Which elements for which outcomes? Journal of Clinical Child & Adolescent Psychology, 44, 30-43. - PubMed
  2. Burn, M., Tully, L.A., Jiang, Y., Piotrowska, P.J., Collins, D.A.J., Sargeant, K., … & Dadds, M.R. (2019). Evaluating practitioner training to improve competencies and organizational practices for engaging fathers in parenting interventions. Child Psychiatry & Human Development, 50, 230-244. - PubMed
  3. Cabrera, N.J., Volling, B.L., & Barr, R. (2018). Fathers are parents, too! Widening the lens on parenting for children's development. Child Development Perspectives, 12(3), 152-157. https://doi.org/10.1111/cdep.12275 - PubMed
  4. Chacko, A., Jensen, S.A., Lowry, L.S., Cornwell, M., Chimklis, A., Chan, E., … & Pulgarin, B. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical Child & Family Psychology Review, 19, 204-215. - PubMed
  5. Chamberlain, P., Patterson, G., Reid, J., Kavanagh, K., & Forgatch, M. (1984). Observation of client resistance. Behavior Therapy, 15, 144-155. - PubMed
  6. Coldwell, J., Pike, A., & Dunn, J. (2006). Household chaos-links with parenting and child behaviour. Journal of Child Psychology and Psychiatry, 47(11), 1116-1122. https://doi.org/10.1111/j.1469-7610.2006.01655.x - PubMed
  7. Dadds, M.R., Collins, D.A.J., Doyle, F.L., Tully, L.A., Hawes, D.J., Lenroot, R.K., … Kimonis, E.R. (2018). A benchmarking study of father involvement in Australian child mental health services. PLoS One, 13(8), 1-11. - PubMed
  8. Dadds, M.R., Cauchi, A.J., Wimalaweera, S., Hawes, D.J., & Brennan, J. (2012). Outcomes, moderators, and mediators of empathic-emotion recognition training for complex conduct problems in childhood. Psychiatry Research, 199, 201-207. - PubMed
  9. Dadds, M.R., English, T., Wimalaweera, S., Schollar-Root, O., & Hawes, D.J. (2019). Can reciprocated parent-child eye gaze and emotional engagement enhance treatment for children with conduct problems and callous-unemotional traits: a proof-of-concept trial. Journal of Child Psychology and Psychiatry, 60, 676-685. - PubMed
  10. Dadds, M., & Hawes, D. (2006). Integrated family intervention for child conduct problems: A behaviour-attachment-systems intervention for parents. Bowen Hills, Qld: Australian Academic Press. - PubMed
  11. Dadds, M.R., Sicouri, G., Piotrowska, P.J., Collins, D.A., Hawes, D.J., Moul, C., … & Tully, L.A. (2019). Keeping parents involved: predicting attrition in a self-directed, online program for childhood conduct problems. Journal of Clinical Child & Adolescent Psychology, 48, 881-893. - PubMed
  12. Dadds, M.R., Thai, C., Mendoza Diaz, A., Broderick, J., Moul, C., Tully, L.A., … & Cane, L. (2019). Therapist-assisted online treatment for child conduct problems in rural and urban families: Two randomized controlled trials. Journal of Consulting & Clinical Psychology, 87, 706. - PubMed
  13. Dadds, M.R., & Tully, L.A. (2019). What is it to discipline a child: What should it be? A reanalysis of time-out from the perspective of child mental health, attachment, and trauma. American Psychologist, 74, 794-808. - PubMed
  14. Day, J.J., & Sanders, M.R. (2018). Do parents benefit from help when completing a self-guided parenting program online? A Randomized Controlled Trial Comparing Triple P online with and without telephone support. Behavior Therapy, 49, 1020-1038. - PubMed
  15. Drugli, M.B., Larsson, B., Fossum, S., & Mørch, W.-T. (2010). Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training. Journal of Child Psychology and Psychiatry, 51, 559-566. - PubMed
  16. Fairchild, G., Hawes, D.J., Frick, P.J., Copeland, W.E., Odgers, C.L., Franke, B., … & De Brito, S.A. (2019). Conduct disorder. Nature Reviews Disease Primers, 51, 43. - PubMed
  17. Farrell, N.R., Kemp, J.J., Blakey, S.M., Meyer, J.M., & Deacon, B.J. (2016). Targeting clinician concerns about exposure therapy: A pilot study comparing standard vs. enhanced training. Behaviour Research and Therapy, 85, 53-59. - PubMed
  18. Frank, T.J., Keown, L.J., Dittman, C.K., & Sanders, M.R. (2014). Using father preference data to increase father engagement in evidence-based parenting programs. Journal of Child & Family Studies, 24, 937-947. - PubMed
  19. Fukkink, R.G. (2008). Video feedback in widescreen: A meta-analysis of family programs. Clinical Psychology Review, 28(6), 904-916. - PubMed
  20. Gardner, F., Leijten, P., Harris, V., Mann, J., Hutchings, J., Beecham, J., … & Landau, S. (2019). Equity effects of parenting interventions for child conduct problems: a pan-European individual participant data (IPD) meta-analysis. The Lancet Psychiatry, 6, 518-527. - PubMed
  21. Green, J. (2006). Annotation: The therapeutic alliance - a significant but neglected variable in child mental health treatment studies. Journal of Child Psychology and Psychiatry, 47, 425-435. https://doi.org/10.1111/j.1469-7610.2005.01516.x - PubMed
  22. Haine-Schlagel, R., & Walsh, N.E. (2015). A review of parent participation engagement in child and family mental health treatment. Clinical Child & Family Psychology Review, 18, 133-150. - PubMed
  23. Hawes, D.J., & Dadds, M.R. (2013). Parent and family assessment strategies. In Diagnostic and behavioral assessment in children and adolescents: A clinical guide (pp. 316-347). New York: The Guilford Press. - PubMed
  24. Hawes, D.J., Price, M.J., & Dadds, M.R. (2014). Callous-unemotional traits and the treatment of conduct problems in childhood and adolescence: A comprehensive review. Clinical Child & Family Psychology Review, 17, 248-267. - PubMed
  25. Kaminski, J.W., & Claussen, A.H. (2017). Evidence base update for psychosocial treatments for disruptive behaviors in children. Journal of Clinical Child & Adolescent Psychology, 46, 477-499. - PubMed
  26. Kimonis, E.R., Fleming, G., Briggs, N., Brouwer-French, L., Frick, P.J., Hawes, D.J., … & Dadds, M.R. (2018). Parent-child interaction therapy adapted for pre-schoolers with callous-unemotional traits: An open trial pilot study. Journal of Clinical Child & Adolescent Psychology, 6, 1-15. - PubMed
  27. King, G., Currie, M., & Petersen, P. (2014). Child and parent engagement in the mental health intervention process: A motivational framework. Child and Adolescent Mental Health, 19, 2-8. - PubMed
  28. Kirkman, J.J.L., Dadds, M.R., & Hawes, D.J. (2018). Development and validation of the knowledge of parenting strategies scale: Measuring effective parenting strategies. Journal of Child & Family Studies, 27, 3200-3217. - PubMed
  29. Kirkman, J.J., Hawes, D.J., & Dadds, M.R. (2016). An open trial for an e-health treatment for child behavior disorders I: social acceptability, engagement, and therapeutic process. Evidence-Based Practice in Child & Adolescent Mental Health, 1, 196-212. - PubMed
  30. Leijten, P., Gardner, F., Melendez-Torres, G.J., Weeland, J., Hutchings, L.S., … & Scott, S. (2019). Co-occurring change in children's conduct problems and maternal depression. Development and Psychopathology, 31, 1851-1862. - PubMed
  31. Leijten, P., Scott, S., Landau, S., Harris, V., Mann, J., Hutchings, J., … & Gardner, F. (2020). Individual participant data meta-analysis: Impact of conduct problem severity, comorbid ADHD and emotional problems, and maternal depression on parenting program effects. Journal of the American Academy of Child & Adolescent Psychiatry, 59, 933-943. - PubMed
  32. Mejia, A., Leijten, P., Lachman, J.M., & Parra-Cardona, J.R. (2017). Different strokes for different folks? Contrasting approaches to cultural adaptation of parenting interventions. Prevention Science, 18(6), 630-639. - PubMed
  33. Mence, M., Hawes, D.J., Wedgwood, L., Morgan, S., Barnett, B., Kohlhoff, J., & Hunt, C. (2014). Emotional flooding and hostile discipline in the families of toddlers with disruptive behavior problems. Journal of Family Psychology, 28, 12-21. - PubMed
  34. Miller, W.R., & Rollnick, S. (2012). Motivational interviewing. Helping people change (3rd edn). New York: Guilford Press. - PubMed
  35. Minuchin, S. (1974). Families & family therapy. Oxford, UK: Harvard U. Press. - PubMed
  36. Niec, L.N., Barnett, M.L., Gering, C.L., Triemstra, K., & Solomon, D.T. (2015). Differences in mothers' and fathers' readiness for change in parent training. Child and Family Behavior Therapy, 37(3), 224-235. https://doi.org/10.1080/07317107.2015.1071980 - PubMed
  37. Nock, M.K., & Ferriter, C. (2005). Parent management of attendance and adherence in child and adolescent therapy: A conceptual and empirical review. Clinical Child and Family Psychology Review, 8, 149-166. - PubMed
  38. Nock, M.K., Ferriter, C., & Holmberg, E. (2007). Parent beliefs about treatment credibility and effectiveness: Assessment and relation to subsequent treatment participation. Journal of Child and Family Studies, 16, 27-38. - PubMed
  39. Panter-Brick, C., Burgess, A., Eggerman, M., McAllister, F., Pruett, K., & Leckman, J.F. (2014). Practitioner review: Engaging fathers-recommendations for a game change in parenting interventions based on a systematic review of the global evidence. Journal of Child Psychology and Psychiatry, 55, 1187-1212. - PubMed
  40. Patterson, G.R., & Chamberlain, P. (1994). A functional analysis of resistance during parent training therapy. Clinical Psychology: Science and Practice, 1, 53-70. - PubMed
  41. Piotrowska, P.J., Tully, L.A., Collins, D.A.J., Sawrikar, V., Hawes, D.J., Kimonis, E.R., … & Dadds, M.R. (2019). ParentWorks: Evaluation of an online, father-inclusive, universal parenting intervention to reduce child conduct problems. Child Psychiatry & Human Development, 51, 503-513. - PubMed
  42. Piotrowska, P.J., Tully, L.A., Lenroot, R., Kimonis, E., Hawes, D., Moul, C., … & Dadds, M.R. (2017). Mothers, fathers, and parental systems: A conceptual model of parental engagement in programmes for child mental health - connect, attend, participate, enact (CAPE). Clinical Child & Family Psychology Review, 20, 146-161. - PubMed
  43. Prinz, R.J., & Miller, G.E. (1994). Family-based treatment for childhood antisocial behavior: Experimental influences on dropout and engagement. Journal of Consulting and Clinical Psychology, 62, 645-650. - PubMed
  44. Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19, 276-288. - PubMed
  45. Sawrikar, V., & Dadds, M. (2018). What role for parental attributions in parenting interventions for child conduct problems? Advances from research into practice. Clinical Child & Family Psychology Review, 21, 41-56. - PubMed
  46. Sawrikar, V., Hawes, D.J., Moul, C., & Dadds, M.R. (2019). How do mothers’ parental attributions affect child outcomes from a positive parenting intervention? A mediation study. Child Psychiatry & Human Development, 51, 597-608. - PubMed
  47. Scott, S., & Dadds, M.R. (2009). When parent training doesn't work: Theory-driven clinical strategies. Journal of Child Psychology and Psychiatry, 50, 1441-1450. - PubMed
  48. Seabra-Santos, M.J., Gaspar, M.F., Azevedo, A.F., Homem, T.C., Guerra, J., Martins, V., … & Moura-Ramos, M. (2016). Incredible years parent training: What changes, for whom, how, for how long? Journal of Applied Developmental Psychology, 44, 93-104. - PubMed
  49. Shaw, D.S., Galán, C.A., Lemery-Chalfant, K., Dishion, T.J., Elam, K.K., Wilson, M.N., & Gardner, F. (2019). Trajectories and predictors of children's early-starting conduct problems: Child, family, genetic, and intervention effects. Development and Psychopathology, 31, 1911-1921. - PubMed
  50. Smith, J.D., Dishion, T.J., Moore, K.J., Shaw, D.S., & Wilson, M.N. (2013). Effects of video feedback on early coercive parent-child interactions: The intervening role of caregivers' relational schemas. Journal of Clinical Child and Adolescent Psychology, 42(3), 405-417. - PubMed
  51. Stoolmiller, M., Duncan, T., Bank, L., & Patterson, G.R. (1993). Some problems and solutions in the study of change: Significant patterns in client resistance. Journal of Consulting and Clinical Psychology, 61, 920. - PubMed
  52. Tomm, K. (1987). Interventive interviewing: Part II. Reflexive questioning as a means to enable self-healing. Family Process, 26, 167-183. - PubMed
  53. Tully, L.A., Collins, D.A.J., Piotrowska, P.J., Mairet, K.S., Hawes, D.J., Moul, C., … & Dadds, M.R. (2018). Examining practitioner competencies, organizational support and barriers to engaging fathers in parenting interventions. Child Psychiatry & Human Development, 1, 109-122. - PubMed
  54. Tully, Hawes & Dadds, in press. - PubMed
  55. Tully, L.A., Piotrowska, P.J., Collins, D.A.J., Mairet, K.S., Black, N., Kimonis, E.R., … Dadds, M.R. (2017). Optimising child outcomes from parenting interventions: Fathers' experiences, preferences and barriers to participation. BMC Public Health, 17(1), 550. - PubMed
  56. Weisenmuller, C., & Hilton, D. (2020). Barriers to access, implementation, and utilization of parenting interventions: Considerations for research and clinical applications. American Psychologist. https://doi.org/10.1037/amp0000613. - PubMed

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