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Early parenting interventions to prevent internalising problems in children and adolescents: a global systematic
Ilaria Costantini1,2,3, José A López-López4,5, Deborah Caldwell4,6
1Population Health Sciences, University of Bristol Medical School, Bristol, UK i.costantini@ucl.ac.uk.
Insights
Relationship-focused and mixed parenting interventions effectively reduced child internalising problems. Waitlists, however, increased these issues, highlighting concerns with referral waiting times. Further research is needed due to study limitations.
Area of Science:
- Child Psychology
- Developmental Psychology
- Clinical Psychology
Background:
- Child internalizing problems are a significant concern in early childhood.
- Parenting interventions aim to support families and mitigate these issues.
- Understanding the comparative effectiveness of different intervention types and comparator groups is crucial.
Approach:
- A systematic review and network meta-analysis of randomized controlled trials (RCTs) were conducted.
- 59 RCTs involving 18,349 participants were included.
- The study analyzed parenting interventions for children under 4 years old, comparing various types and waitlist versus treatment as usual (TAU).
Key Points:
- Relationship-focused and mixed-focus parenting interventions demonstrated effectiveness in reducing child internalizing problems compared to TAU.
- Waitlist conditions were associated with an increase in internalizing problems relative to TAU.
- Effect sizes attenuated over time, and most included studies had a high risk of bias or some concerns.
Conclusions:
- Preliminary evidence suggests relationship-focused and mixed parenting interventions are beneficial for reducing child internalizing problems.
- The findings underscore the negative impact of waitlist periods, emphasizing the need for timely support.
- Caution is advised when interpreting results due to the high risk of bias in the majority of studies.
Question:
We compared the effectiveness of different types of parenting interventions based on an a priori taxonomy, and the impact of waitlists versus treatment as usual (TAU), in reducing child internalising problems.
Study Selection And Analysis:
We conducted a systematic review and network meta-analysis of published and unpublished randomised controlled trials (RCTs) until 1 October 2022 that investigated parenting interventions with children younger than 4 years.
Exclusion Criteria:
studies with children born preterm, with intellectual disabilities, or families receiving support for current abuse, neglect, and substance misuse. We assessed the certainty of evidence using the Confidence in Network Meta-Analysis framework. We used random-effects network meta-analysis to estimate standardised mean differences (SMDs) with 95% credible intervals (CrIs).
Findings:
Of 20 520 citations identified, 59 RCTs (18 349 participants) were eligible for the network meta-analysis. Parenting interventions focusing on the dyadic relationship (SMD: -0.26, 95% CrI: -0.43 to -0.08) and those with mixed focus (-0.09, -0.17 to -0.02) were more effective in reducing internalising problems than TAU at the first time point available. All interventions were more effective than waitlist, which increased the risk of internalising problems compared with TAU (0.36, 0.19 to 0.52). All effects attenuated at later follow-ups. Most studies were rated as with 'high risk' or 'some concerns' using the Risk of Bias Assessment Tool V.2. There was no strong evidence of effect modification by theoretically informed components or modifiers.
Conclusions:
We found preliminary evidence that relationship-focused and mixed parenting interventions were effective in reducing child internalising problems, and the waitlist comparator increased internalising problems with implications for waiting times between referral and support. Considering the high risk of bias of most studies included, the findings from this meta-analysis should be interpreted with caution. PROSPERO registration number CRD42020172251.
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