Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis

Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child's underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0-18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = - 0.17) and INT (SMD = - 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.

An Updated Account on Parents' Use of and Attitudes Towards Time-Out

Time-out (TO) is a well-established technique for effectively managing childhood conduct problems, yet there is increasing controversy around its use. Using a mixed-methods approach, we investigated the impact of recent criticisms against TO on parents' use of and attitudes towards it. A community sample of parents (N = 297, M_age = 37.14) completed an online survey (Study 1) to investigate use of and acceptability of TO. Results showed that 57.91% of parents reported using TO, slightly lower than past estimates. Perceived effectiveness and trust in clinicians predicted TO acceptability. To thoroughly examine negative attitudes towards TO, parents who did not use TO (N = 17, M_age = 38.29) participated in individual interviews (Study 2). Amongst other findings, Study 2 found that parents view TO as punitive and contrary to their value of connection. We discuss implications for parenting interventions, dissemination of parenting information, and future research.

Practitioners' Use and Acceptability of Time-Out

Time-out is an empirically supported component of parenting interventions for child conduct problems; however, it is receiving increasing criticism among parents and some practitioners. This study aimed to investigate practitioners' use and acceptability of time-out for child conduct problems; examine whether perceived effectiveness and knowledge of evidence-based parameters of time-out implementation influence use and acceptability of time-out; and explore practitioners' perceptions about alternatives to time-out. One hundred and ten Australian and New Zealand practitioners who have worked with children and families completed an online survey investigating their use and acceptability of time-out for children with conduct problems. Results showed that 55.5% of the sample have used timeout, with 38.0% considered current TO users. Acceptability of the strategy varied, with some practitioners critical of time-out. Increased knowledge of evidence-based parameters of time-out implementation was associated with increased frequency of time-out use and acceptability, while perceived effectiveness was associated with increased acceptability only. Practitioners perceived a number of other parenting strategies as effective alternatives to time-out. These findings have important implications for improving practitioners' implementation of time-out with parents of children with conduct problems.