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Updated: Aug 17, 2025

Psychophysiological Assessment of the Effectiveness of Emotion Regulation Strategies in Childhood
Published on: February 11, 2017
Does behavioural parent training reduce internalising symptoms (or not) among children with externalising problems?
Christy Bloss1, Sophie Brown1, Vilas Sawrikar2,3
1Department of Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.
Insights
Behaviour parent training (BPT) effectively reduces child externalizing problems. While evidence for reducing internalizing symptoms is unclear, a meta-analysis found BPT shows a small benefit for these issues in children.
Area of Science:
- Child Psychology
- Clinical Psychology
- Developmental Psychology
Background:
- Behaviour parent training (BPT) is established for reducing child externalizing problems.
- The efficacy of BPT for secondary benefits, specifically reducing internalizing symptoms, requires further investigation.
Purpose of the Study:
- To systematically review and meta-analyze the effects of BPT on internalizing symptoms in children aged 2-12 years with externalizing problems.
- To assess the reliability and robustness of BPT's impact on internalizing outcomes.
Main Methods:
- Systematic search of multiple electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, SCOPUS).
- Inclusion of 24 studies examining internalizing outcomes following BPT in children with elevated externalizing problems.
- Meta-analysis of internalizing problem outcomes, including heterogeneity and moderation analyses.
Main Results:
- A significant small treatment effect size (g = -0.41) was found for reducing internalizing symptoms immediately post-BPT.
- Moderate heterogeneity (I² = 44%) was observed across studies.
- Moderation analyses suggested the overall treatment effect was robust to variations in study characteristics, despite methodological limitations.
Conclusions:
- BPT programs targeting externalizing problems demonstrate a potential to improve associated internalizing symptoms.
- Current evidence suggests a small but significant effect, though limitations in study methodology and heterogeneity necessitate cautious interpretation.
- Further research is required to confirm the reliability and clinical significance of these findings.
Abstract:
Behaviour parent training (BPT) is known to effectively reduce child externalising problems. However, evidence for BPT to have secondary benefits for reducing internalising symptoms remains unclear. To address this, electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, and SCOPUS) were systematically searched for studies examining internalising outcomes from BPT among children aged 2-12 years with clinically elevated externalizing problems. Outcomes for internalising problems following BPT were analysed by meta-analysis. Of 9105 studies identified, 24 studies met the eligibility criteria. Results from meta-analysis demonstrated a significant small treatment effect size (g = - 0.41) for reducing internalising symptoms immediately after treatment. Studies showed moderate heterogeneity (I2 = 44%). Moderation analyses indicated that the overall treatment effect was robust against variations in treatment and study design characteristics. However, a review of individual study methods indicate that these results are limited by significant heterogeneity and limitations in clinical assessment. Overall, the results suggest that BPT programmes for reducing externalising problems have the potential to improve internalising outcomes, but that there is limited information to determine the reliability of these effects, highlighting the need for further investigation.
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