Background: The use of Self-help interventions for parents of children with
behaviour problems is becoming more prevalent. This review critically evaluated
the evidence supporting the efficacy of such programmes for children with
behaviour problems.
Methods: Using a systematic literature search, two modes of delivery were
evaluated, namely bibliotherapy and multi-media. Programmes that included
minimal therapist support were also included.
Results: Overall, there is good evidence supporting the efficacy of self-help
programmes in improving child behaviour, over the short and longer-term. Self-help programmes led to outcomes similar to those achieved with more intensive
therapist input. Including minimal levels of therapist suppo11 in addition to self-help materials enhances child and parent outcomes. Parents view self-help
favourably but significantly less so than programmes including some form of
therapist input.
Conclusions: The future directions for self-help parent programmes include the
need for longer-term follow -ups, the identification of moderators of outcome, and economic evaluations of self-help programmes.
This review examines the efficacy of self-help parent training (PT) programmes
for children with behaviour disorders. Typically, PT is delivered within a group or
individual basis with both modes of delivery including therapist-led discussions of parenting skills. A number of evidence-based programmes follow this format,
most notably the Incredible Years (Webster-Stratton, 1998), Triple-P (Sanders et
al, 2002), and New Forest Parent Training Programme (Thompson et al. 2009).
There is substantial evidence that these programmes produce immediate
improvements in parenting practices and child behaviour post treatment (Reid et
al, 2004) and in the longer-term (Sanders et al, 2007; Webster-Stratton, 1990). A
nunber of trials also report improvements in maternal wellbeing (Sonuga-Barke
et al., 2001 ), stress and depression (Hutchings et al., 2007), and reductions in
parental conflict (Morawska & Sanders, 2006). Consequently, group-based PT is
recommended by the National Institute for Health and Clinical Excellence (NICE)
in the management of children with conduct disorder (NICE, 2006), pre-school
children with ADHD, and school-age children with moderate symptoms of
ADHD (NICE, 2008).
Despite the evidence suppo11ing group-based PT for childhood behaviour
disorders, there are a number of factors that limit its utility. These programmes
are resource and cost intensive, and require extensive therapist time through
training and supervision (Foster, Johnson-Shelton & Taylor 2007). Additionally
logistical barriers, such as lack of childcare, transport costs, and work schedules,
may prevent families accessing sessions. Time demands and scheduling conflicts
are often primary barriers to programme participation (Spoth et al, 1996), and
contribute to treatment dropout (Kazdin et al, 1997). Such barriers are
compounded in rural locations, where clinics are less accessible (Connell et al,
1997). Optimizing parental engagement in treatment may be accomplished
through utilizing more flexible modes of delivery (Miller & Prinz, 1990), where
evidence-based aspects of a programme are retained while eliminating potential
barriers to engagement. Self-help PT represents one potentially efficacious
method of providing intervention for families.
This review examines the evidence supporting the efficacy of self-help
parent programmes, for children with behaviour disorders. Self-help programmes
that include brief therapist contact will also be examined to clarify the role of
therapist assistance. Two previous overviews have been published in this area.
Elgar and McGrath's (2003) article focused on self-help treatments for children
and adolescents with a variety of mental health (depression, and self-harm) and
physical complaints (headache, and nocturnal enuresis) and did not include many of the articles in this review. A Cochrane review (Montgomery et al, 2006) also examined self-help parent programmes for children with behaviour problems.
However, it included studies up to 2005 and limited its comparison of self-help
intervention to no treatment groups making it difficult to draw conclusions about the relative efficacy of self-help treatment compared with group-based, therapist-delivered treatments.