OP33: Making parenting work for children’s mental health

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Occasional Paper:


Publication Date

November 2015


OP33: Making parenting work for children’s mental health
Edited by Cecilia A. Essau and Jennifer L. Allen


Parenting has been identified as a key factor associated with childhood illnesses, spanning beyond mental health problems. The long-term significance of this becomes more apparent as understanding grows regarding the link between experiences during childhood and long-term outcomes. Varying levels of significance attached to different stages in a child’s development, from birth through to adulthood, and recent research investigating the influence of parenting on each of these stages has received consideration from services and governments across the world. The idea for this Occasional Paper was conceived following the Emanuel Miller Memorial Lecture and Annual Conference organized by ACAMH and held in March 2013. The event was entitled “Making Parenting Work for Children’s Mental Health”.

This collection of 7 articles includes contributors from the original programme supplemented by additional papers commissioned to further highlight the importance of parental influence in the prevention and intervention of children with emotional, neurodevelopmental and behavioural disorders. We are very fortunate to have received contributions from authors of parenting interventions for a wide range of child and adolescent emotional and behavioural problems, covering anxiety, temper and conduct disorders, through to behavioural difficulties for children with disruptive behavior problems, ASD and, in a final article, selective mutism.Together they provide a starting point to stimulate readers’ interest in promoting a holistic and evidence-based approach, delivered through supporting better parenting.

Readership: Researchers and postgraduates in educational, school and child psychology; professionals, practitioners and policy makers in the field of Child and Adolescent Mental Health (CAMH) and psychological services for children and young people; families and carers of children and adolescents in need of child mental health services and interventions; policy makers and legislators in child and adolescent education, mental health services and well-being.

To order copies of the complete publication and/or individual chapters please: call +44 (0)20 7403 7458, email occpapers@acamh.org or download an order form


Making parenting work for children’s mental health. Edited by Cecilia A. Essau and Jennifer L. Allen. ACAMH Occasional Papers No. 33. London: Association for Child and Adolescent Mental Health. ISBN: 978-1-899176-24-3 Pp. iv +c. 88. 2015. Price: £8.50


Introduction: Making parenting work for children’s mental health

Cecilia A. Essau and Jennifer L. Allen


Parenting has been identified as a key factor associated with childhood illnesses, spanning beyond mental health problems. The long-term significance of this becomes more apparent as understanding grows regarding the link between experiences during childhood and longterm outcomes. Varying levels of significance attached to different stages in a child’s development, from birth through to adulthood, and recent research investigating the influence of parenting on each of these stages has received consideration from services and governments across the world. This Occasional Paper further highlights the importance of parental influence in the prevention and intervention of children with emotional, neurodevelopmental and behavioural disorders.


Chapter 1 Lessons learned from introducing, researching, and disseminating the Incredible Years programmes in Wales

Judy Hutchings


There is a growing need for evidence about what is needed to deliver effective interventions in service settings. This case study describes the introduction and dissemination of the Incredible Years (IY) programmes across Wales describing what made this successful and some of the challenges. It describes the reasons for selecting the IY parent programme, how it was initially implemented and evaluated and briefly describes the collaborative delivery style and the resources needed to deliver it effectively. Initial implementation, piloting and a subsequent randomised controlled trial (RCT) and its outcomes are described. The success of the RCT led to Welsh Government funding for IY parent group leader training and supervision across Wales. The paper considers the dissemination process within Wales, including the importance of having local support for training and supervision, and explores the challenges and successes with particular emphasis on the challenge of taking evidence-based programmes into every day service settings and achieving good outcomes. The lessons learned led to a similar dissemination process for the IY child and teacher programmes in Wales for which the Welsh Government also funded leader training. These programmes are briefly described along with a summary of outcomes achieved from evaluation studies in Wales. Generally across the UK there has been poor uptake of evidence-based programmes in this field. The paper concludes by exploring the strategies used to address the challenges of supporting effective programme delivery in service settings in Wales, including researching and reporting outcomes, leader surveys and manager workshops on implementation, conferences and other forms of dissemination.

Keywords Early intervention, prevention, conduct disorder, parenting, evidence-based, fidelity


Chapter 2 When one size doesn’t fit all: temperament-based parenting interventions

Jennifer L. Allen


There is growing recognition of the need for early intervention and prevention work in the field of parenting and child psychopathology. Great strides have been made in the development and broad-scale evaluation of parenting interventions for a variety of childhood mental disorders. However, there are problems with even our current ‘best practice’ parenting interventions including lack of family engagement, failure to achieve clinically significant improvements for a substantial number of families, and difficulty maintaining treatment gains over time. Recently, investigators have drawn on the field of individual differences as a way of answering the question of ‘what works best for whom?’ Researchers are currently exploring how to ‘personalise’ assessment and treatment on the basis of child temperament, an important source of individual differences. This paper will review research and theory demonstrating that the interface between child temperament and parenting has significant implications for the development of child psychopathology and social-emotional skills. This knowledge has informed the selection and assessment of families in early intervention and prevention trials, as well as the nature, content and delivery of parenting interventions. Specifically, temperament-based parenting programmes aim to tailor existing parenting strategies to provide a better ‘fit’ for families on the basis of the child’s temperament profile. Temperament-based parenting interventions are still at an early stage in terms of evaluation, but the evidence to date suggests they are a promising avenue for the treatment of children with a wide range of mental health difficulties.

Keywords Temperament, parenting, early intervention, prevention, child psychopathology


Chapter 3 Making parenting work for anxious children

Sam Cartwright-Hatton


Anxiety disorders in early and middle childhood are common. Untreated, they are often persistent into adolescence and adulthood and are associated with a range of poor outcomes. Despite this, we have few treatment approaches that are designed for this young age group. There is evidence that anxious children experience the same cognitive distortions as predicted by models of anxiety disorders for adults, therefore, cognitive approaches are likely to be useful. However, delivering standard CBT to this age group is difficult. There is also evidence of parenting differences in anxious children, and some indication that these might be involved in the maintenance of the disorder. Anxious children may be particularly susceptible to parenting influences. Therefore, modifying parenting might also be fruitful in treatment of this age group. This paper outlines a parenting intervention that is designed specifically for young anxious children. This ten-session programme is designed for delivery to small groups of parents who have an anxious child. The intervention weaves together two strands, namely training in basic cognitive behavioural techniques that parents may use when their children are anxious, and modified behavioural parent training techniques that are designed to provide the child with a warm, calm, clear and consistent environment in which to develop.

Keywords Anxiety, young children, CBT, parenting, intervention


Chapter 4 Callous–unemotional traits and the re-evaluation of parent training for child conduct problems

David J. Hawes


Risk processes based in the parent–child relationship play a key role in shaping childhood conduct problems, and parent training interventions based on social learning theory have proven to be highly effective. Despite this, a significant proportion of children fail to benefit from such interventions, and the reasons for this have been poorly understood. Attempts to explain poor outcomes have focused largely on ecological factors associated with disruptions to treatment delivery and implementation (e.g., socioeconomic disadvantage, marital problems, parental psychopathology). Considerable work has in turn been devoted to process-based models for engaging multi-stressed families in treatment (e.g., Dadds & Hawes, 2006). However, it has also become increasingly apparent that children with conduct problems are highly heterogeneous, and that among different subgroups of children conduct problems may arise from distinct neurodevelopmental and parenting processes. As such, some children who respond poorly to parent training may do so because the risk mechanisms that are most proximal to their problems differ to those that are typically targeted. Some of the most compelling support for this perspective comes from research into callous–unemotional (CU) traits (e.g., lack of guilt and empathy), also referred to as ‘limited prosocial emotions’. As discussed in this chapter, current evidence indicates that children and adolescents with conduct problems and CU traits present with unique treatment needs, showing a relatively poor response to existing parent training interventions. At the same time, however, such parent training appears to be capable of producing lasting improvement in CU traits, especially when delivered early in childhood. Emerging evidence of the interplay between parenting, CU traits, and conduct problems, suggests numerous ways in which the planning and delivery of parent training interventions may be informed by clinical information about the CU traits of children referred for conduct problems.


Keywords callous–unemotional traits; psychopathy; treatment; conduct problems; conduct disorder; oppositional defiant disorder; limited prosocial emotions


Chapter 5 Tuning in to Kids: an emotion-focused parenting intervention for children with disruptive behaviour problems

Sophie S. Havighurst, Christiane E. Kehoe, Ann E. Harley and Katherine R. Wilson


The way parents model emotional expression, the way they react to children’s emotional expressions, and the way in which they teach children about emotions all play an important role in promoting emotional competence and behaviour in children. The Tuning in to Kids (TIK) program targets parents’ awareness and responses to emotions in themselves and their children, with the goal of improving parent–child relationships, enhancing children’s emotional competence and positively impacting children’s behavioural functioning. This paper explores how this emotion-focused parenting approach can be applied to understanding and intervening with children with disruptive behaviour problems. Particular aspects of TIK are discussed including paying attention to lower intensity emotions, parent emotion awareness and regulation, exploring influences of family of origin, and use of time in rather than time out. A case study is used to illustrate how the TIK program might be applied in parent work. The evidence for TIK is reviewed (both with clinical and community samples) as well as evidence for other program variants. Finally, program dissemination is outlined. This overview outlines how an emotion-focused approach to parent work is an alternative to the dominant behavioural parenting approaches for working with children with disruptive behaviour problems.

Keywords Tuning in to Kids, disruptive behaviour problems, emotional expression, emotion regulation, emotion coaching


Chapter 6 Psychosocial interventions for social communication, repetitive, and emotional-behavioral difficulties in children and young people with autism spectrum disorders: an update on effectiveness and the role of caregivers

Francisca J. A. van Steensel and Iliana Magiati


A number of time-limited psychosocial interventions targeting social skills, internalizing and externalizing difficulties have been developed for children and young people with ASD. Increasingly more evidence is emerging that such interventions are effective in reducing difficulties and improving skills. However, large variability between studies and large individual heterogeneity in outcomes have been reported. Furthermore, there are concerns about the limited generalization of learnt skills. For example, what might be learnt in a training program in a clinical setting may not generalize to the school or home setting or even from one person to the next. In addition, experiences and difficulties in childhood are likely to be different from those in adolescence or adulthood and learnt skills to cope with such difficulties may not be transferable across different developmental periods. Furthermore, very little is known about potential mechanisms of change following these interventions. One possible effective “ingredient” to improve outcomes might be the active role and involvement of caregivers. In this update review paper, we summarize the current empirical evidence for the effectiveness of time-limited psychosocial interventions for children and young people with ASD, examine how parents are involved in these interventions and the scientific evidence for the inclusion of caregivers in these interventions.

Keywords Autism spectrum disorder, intervention, social skills, comorbidity, CBT, mindfulness, parents/caregivers


Chapter 7 Viewing selective mutism as a phobia of talking: the importance of accurate conceptualisation for effective clinical and parental management

Maggie Johnson and Alison Wintgens


Selective mutism (SM) is a childhood disorder that can profoundly disrupt the lives of individuals and families and present great challenges for teachers. It is characterised by a consistent failure to speak in certain social situations where speaking is expected, despite speaking in other situations. Recognised and treated early, SM can be completely overcome. Inappropriately treated or left untreated, it can lead to school refusal and lifelong psychological problems. There is no doubt that SM is more widely recognised and written about than ever before; yet in spite of this the psychological aspects are not always properly understood. Without proper understanding backed up by accurate classification there is no guarantee of appropriate evidence-based intervention, including optimum management by parents and school staff. After a brief introduction to the nature, prevalence and management of SM, this paper takes a close look at the essential characteristics of the disorder, with feedback from those who have or have had SM, and the experience of practitioners in the field who have worked with many children and young people with SM and their families. It considers the misconceptions that persist from its earlier history; the DSM-IV criteria that are helpful and have been retained in DSM-5; and the argument to conceptualise SM as a specific phobia of talking. The paper concludes by discussing the implications for effective practice, particularly from a parent’s viewpoint.

Keywords Selective mutism; elective mutism; mutism; specific phobia; anxiety disorder; social anxiety disorder; selective mutism intervention; exposure therapy; speech and language

Individual chapters are available to order by calling +44 (0)20 7403 7458 {PDFs at £2.50 each (£2.08 + VAT) or by emailing occpapers@acamh.org


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