Effects of Parent Training on Parenting: Associated Change between Parental Behaviors and Preadolescent Problem Behaviors
Jonas Andersson Supervisor: Håkan Stattin Master Thesis in Prevention Science
Spring 2011 Örebro University
Abstract
The aim of this study was to find out if change in parent behavior is associated with change in preadolescent problem behavior during parent training programs. A total of 561 single parents or couples of mainly Swedish origin were randomized into one out of four parent training programs with different theoretical bases. Parents’ self-reports of their own behavior and of their children’s intensity as well as impact of problem behavior, lack of attention, and hyperactivity showed that effects were equal across interventions for both children and parents. 12 parent constructs were measured. All of them except positive parent behavior constructs correlated with all four outcomes for children on significant levels. Negative parent behavior predicted change in all child outcomes on a highly significant level.
Effects of Parent Training on Parenting: Associated Change between Parental Behaviors and Preadolescent Behavior Problems
Parenting is a challenge for many of us. Our children need time and effort from their parents during many years with periodically changing demands. If it works out well and the children manage to adapt to the different environments they encounter, the time and effort needed lessen. Generally this works out fine if their parents keep attending to their individual needs at the same time as they convey a sense of belonging to the world outside the home. When this does not work at all, children will let their parents know that something is wrong. The ways they choose depend on individual characteristics, but also on the parent-child relation.
Theories of Parenting
The scientific knowledge on parent-child relation originates in the two dominating theories in psychology during the twentieth century, psychoanalysis and learning theory. Following this, merging the behavioral and emotional perspectives, Baumrind (1967) presented a typology of parenting styles. This typology focused on different aspects of parental control; authoritarian, authoritative and permissive parenting. This created a node, that other researchers related to. Though keeping to Baumrind’s foundation, critics lacked verification of how these different styles actually worked in this typology. One way to empirically ground the styles of parenting is to relate them to dimensional constructs, like support and control. The support dimension ranges between positive and negative parent behaviors as acceptance and neglect. The control dimension ranges between
guiding/demanding and restrictive discipline (see Hoeve, Dubas, Eichelsheim, van der Laan, Smeenk, & Gerris, 2009). An integrated model, suggested by Darling, & Steinberg (1993), serves as a foundation for further development. This model puts parental goals for their child’s socialization as a prime mover for the process of development exerting influence on
parental practises, which directly affects outcomes for the child. Parental goals also influences parenting style, which supposedly moderates the effects of parental practises on the children. The style of parenting influences the motivation of the child to adapt according to the parental goal and has a moderating influence on the effects of parental practises on child outcome. This model is limited to family interaction and primary socialization. Also, it places the children as fairly passive recipients of parenting. Neither does it count with larger social systems including peer interaction influences or cultural determinants. A more dynamic perspective would introduce social settings and individual characteristics as possible moderators of effects of parental practises. Furthermore, genetic influences found in twin-studies or reciprocal influences between parent and child are not addressed (see Ogden, 2002; Scarr, 1996; Tilton-Weaver et al., 2010). These factors do necessarily have to be focused in order to put parenting in a more realistic context and ground more effective interventions for children with problem behaviors.
Parent Training Intervention
Parent training is generally conducted in groups. It is defined as ” …procedures by which parents are trained to alter their child’s behavior at home. The parents meet with a therapist or trainer who teaches them to use specific procedures to alter interactions with their child, to promote prosocial behavior, and to decrease deviant behavior ”(Kazdin, 1995, p.82). There are numerous studies of the effects of parent training programs for children with externalizing behaviors, i.e., on the selective level of prevention. Meta-analyses of effects show at least moderate effect-sizes favoring the intervention group (Dretzke et al., 2009; Piquero, Farrington, Webb, Tremblay, & Jennings, 2009). Furthermore, there seems to be no difference between behavioral or non-behavioral programs post-intervention. Follow-up effects tend to be smaller, and for non-behavioral programs there are seldom measures from follow-ups (Lundahl, Risser, & Lovejoy, 2005).
Concerning parental outcomes, I have found three meta-analyses examining parental outcomes. The first is concerned with maternal psychosocial health and shows promising results (Barlow, Coren, & Stewart-Brown, 2009), the second concerns effects on parenting of a Triple P Positive Parenting Program Level 4 intervention (De Graaf, Speetjens, Smit, De Wolf, & Tavecchio, 2008) showing moderate effects on parental styles and competence including follow-up. In the third, Lundahl, et al. (2005) found moderate effects post-intervention on parent behavior and parental perceptions.
In a meta-analysis of components in successful parent training programs several components of great importance were found; increasing positive parent-child interaction and emotional communication, teaching time-out, parenting consistency, and focus on in vivo practice of new skills during sessions (Wyatt Kaminski, Valle, Filene, & Boyle, 2008). These components are effective for children, 0-7 years old, with externalizing behavior problems. It is safe to conclude that parenting programs make an important difference for children and their parents.
Mediation of Child Outcomes
To learn more about how the changes come about researchers have conducted analyses of intervening variables affecting outcome variables. These variables are called mediator variables (Baron, & Kenny, 1986). Parenting affects child behavior, that much we know. Choosing the longitudinal method and thereby capturing a developmental process not experimentally manipulated, researchers have done findings of which variables that mediate change in child behavior. These studies are most often from USA and Canada and concern the links between salient factors, like parental health factors or parental conflicts and child behavior. According to them, parental behaviors as nurturance, rejection, and monitoring mediate the link between parental health factors and child adjustment in a general sample of children and adolescents (Elgar, Mills, McGrath, Waschbusch, & Brownridge, 2007). Studies
of sub-groups of children whose parents were characterized by low income, single parenthood and ethnicity show that the link between inter- and co-parental conflict and child adjustment is mediated by parent behaviors as warmth in a mother-child relation, monitoring, acceptance, discipline and control (Jones, Shaffer, Forehand, Brody, & Armistead, 2003; Gonzales, Hill, Pitts &, Roosa, 2000). Besides these studies and more specific, the link between parental anxiety and children’s internalizing behavior has been found to be mediated through the way of parental beliefs and parent behavior of harsh discipline, respectively (Laskey, &
Cartwright-Hatton, 2009).
Intervention studies make it possible to experimentally investigate and confirm the results from longitudinal studies. Such studies, which may include analyses of mediating variables, have been conducted of evidence-based parent training programs. These programs are conducted on a selective level of prevention and target parents with children who display conduct problems. Almost uniformly they show that the parent training interventions affects disciplinary parent behavior, which in turn mediates different aspects of problem behaviors, observed in children with conduct problems. The increased use of praise and incentives combined with decreased use of harsh and critical discipline seems to be an especially effective way to affect externalizing behavior (Gardner, Burton, & Klimes, 2006; Kling, Forster, Sundell, & Melin, 2010). Mediation by parental attitudes or beliefs directed at their children and parent behavior or directly on child behavior problems has not gained support in these studies. However, the reverse condition, child behavior affecting depression or stress in parents or parental attitudes has been shown in two studies (Feinfield, & Baker, 2004;
Degarmo, Patterson, & Forgatch, 2004). This first intervention had a concurrent child intervention beside the parent-training component. The result suggests experimental support for reciprocal influences between parent and child and the necessity to focus on these
these findings, one study has shown that compliance with the use of homework in parent training programs mediates outcome for children (Kling et al., 2010). Also, dosage plays a role in changing children’s problem behavior (Beauchaine, Webster-Stratton, & Reid, 2005). Furthermore, findings from longitudinal studies show experimental support for paternal parent behavior as a mediator of the relationship between inter-parental conflict and the externalizing behavior of children (Kjøbli, & Hagen, 2009). There are not many experimental studies investigating how the change process of parenting comes about. A rare and interesting example concerns the above named Triple P parenting program (Hartung, & Hahlweg, 2011). The purpose of that study was to investigate the links between dysfunctional parenting, individual stress, self-efficacy and stress at the work place. They found a mediational path between parenting, individual stress and work-related stress. A final and important finding is the link between negative parent-child interactions and physical abuse of children (Chaffin et al., 2004). In the light of these findings from intervention studies, there is a shortage of scientific knowledge of how the change process of how parent behavior affects child behavior. All parents that engage in evidence-based parent training programs do not change their parental practises (Beauchaine et al., 2005). To reach those who do not change their practises further investigation of the change process is warranted.
This Study
Evaluations of parent training programs are mainly concerned with outcomes for the children. The results are favorable for both children and parents and the effects tend to last at follow-up 6-12 months later. Behaviorally based programs are often more rigorously
evaluated and we know more about their preventive effects. However, the mismatch between parenting and child behavior, early on, is contributing to the development of severe behavior problems in adolescence. These kinds of problems become entangled with psychosocial problems commonly encountered by families of limited resources. The further consequences
for the families and the greater society may be costly. Undoubtedly, parents are the primary agents to prevent their children from embark on delinquent developmental pathways. This study tries to make a contribution to the understanding of how the change process in parenting interventions work. It makes possible a comparison of variables affecting outcomes of parent training programs with different theoretical bases on a national level. It is an effectiveness trial and as such the ecological validity can be expected to be acceptable. This is especially important when you are trying to reach clients under pressure who may not choose help opportunities from an informed position.
The aim of this study is, firstly, to find out what aspects of preadolescent children’s problem behavior changes during parent training. Secondly, if such changes are found, are there general changes in parenting which are independent of the type of intervention offered? Thirdly, how do the changes in parenting associate with changes in children’s problem behavior?
Method Participants
The sample consisted of parents of 756 children 3-13 years old. The majority were boys (62%). Parents’ age ranged between 20 and 60 years old. The median value for mothers was 37 years old. The corresponding age for fathers were 40 years old. A great majority of the children (94%) were born in Sweden, while 3% were born outside Europe. Also, a great majority of the parents (88% of the mothers and 82% of the fathers) were born in Sweden, while a small minority was born outside Europe. (7% and 8%, respectively). Most of the families (53%) were living in their own house. The highest educational level of the parent attending most sessions of the intervention was the mandatory nine years only for 8%, while 46% had an educational level of university. The monthly income for a majority of the households was more than 30000 Swedish kronor for a majority (64%). Following this, a
majority (69%) did not worry about their economic situation. Also, the great majority of the children (83%) did not have any diagnosis or were on any kind of medication.
Procedure and Referral
The National Comparison Study (NCS) concerns parent training programs and goes on in four cities in Sweden. Of the cities, two were big and two were mid-size cities. NCS
compares parent training programs at the selective level of prevention, targeting children with identified problem behavior. Parents with children 4-12 years old who had sought help at either Social Welfare Authorities (Socialtjänsten) or Child- and Youth Psychiatry (Barn- och Ungdompsykiatri) were invited to participate in one of five conditions. One of them consisted of reading a book on parenting. A total of 756 parents accepted and were randomized to one condition. All intervention conditions were not offered at all sites. Ethics
Interventions
Four interventions were offered to parents. Three of them were behavioral programs. Three of them have been evaluated in a Swedish context before making up a part of NCS. CoMet (Communications Method) is an adaption of PMTO (Parent Management Training-Oregon model). It is a behavioral program and has been evaluated in a Swedish context for children 3-11 years old (Kling et al., 2010). Another intervention was the Incredible Years Basic parent-training program (IY). It is also a behavioral program and has been evaluated for children 3-8 years in a Swedish context in an open study (Axberg, Hansson, & Broberg, 2007). Connect is a Canadian parent program. It is based on attachment theory and never evaluated in a Swedish context. It has been evaluated in Canada by the program developer for 12-16 year old adolescents (Obsuth, & Moretti, 2009). Finally, the Canadian COPE
(Community Parent Education Program) was offered. COPE is a behavioral program and probably the most common of the four programs used in Sweden for the time being (see Thorell, 2009).
Measures
The parent attending most sessions of the intervention was asked to contribute with demographic information, parent measures and child measures. In the great majority of the cases this was the mother.
Parent measures. In this study 12 different constructs were created initially covering six aspects of parental actions/reactions. The aspects were punishment, praise, affect, sense of competence, conflict management and stress. Punishment and affect were single-constructs. In the case of parental stress and conflict management two constructs were created. The stress construct concerned objective stress, the other focused on subjective stress. The conflict management construct consisted of attempt to understand and outburst. Two final aspects were made up of three constructs each. The sense of competence construct was made up of frustration, adaptive behavior and unmotivation. Finally, the praise construct contained three constructs, where two of them were variations of the praise construct and the third covered the use of incentives. The results of a preliminary analysis of these are decribed in a following section. Some of these constructs were reorganized and constituted the base for the final analyses. These final constructs were divided into to two higher-order behavioral constructs: positive and negative parent behavior. I will describe them in the next two paragraphs.
Positive parent behavior. This construct consisted of the sub-constructs praise and incentives (Parent Practises Interview; Webster-Stratton, Reid, & Hammond, 2001). 12 items were included. Parents were for example asked to rate ”How often do you usually do any of the following when your child behaves or do something well?”. ”Praise the child or give compliments” and ”Give points or stars on a poster or alike” was examples of items. Also, the parents were asked to rate ”How often during the last two days do you have praised your child, when she/he has done something well?” Seven alternatives were given for each question.
Negative parent behavior. The construct consisted of the sub-constructs punishment, harshness (Parent Practises Interview; Webster-Stratton, Reid, & Hammond, 2001), outburst (Tilton-Weaver, et al., 2010) and affective dyscontrol (Affect Regulation Checklist; Moretti, 2003). 12 items were included. Concerning punishment and harshness the parents were asked to rate ”How often do you usually do any of the following when your child behaves badly?” Examples of items included were: ”Raise the voice (yell or curse)” and ”Give the child a beating”. The other sub-constructs included items, where the parents were asked to rate items like: ”I get really angry and throw a tantrum” and ”It takes a long time for me to get over things when I feel upset”. There were seven alternatives for rating.
Child measures. To measure outcomes for children four different measures was used. Firstly, the Eyberg Child Behavior Inventory (ECBI; Robinson, Eyberg, & Ross, 1980), which covers the intensity of externalizing behaviors. Secondly, a problem scale from ECBI was used. The problem scale measures how big a problem a specific behaviors constitute for the parents. Thirdly, the lack of attention scale from Swanson, Nolan, and Pelham Rating Scale (SNAP-IV; Swanson, 1992) containing nine items and finally the hyperactivity scale from SNAP-IV was used containing another nine items.
Analyses
Attrition. The 755 cases of data were reduced with 190 (25,2%) at posttest on all child measures and the seven parent measures which made up the two higher-order constructs positive and negative parent behavior. This group did not differ significantly from the whole group at pretest (R²=.037, p >.05).
Statistics. I used a general linear model to describe and analyze variance measures concerning overall changes in the child outcomes. Partial eta squared was chosen to express the magnitudes of the changes due to different sample sizes. Also, the use of partial eta squared makes it possible to show how much change could be attributed to one specific
variable and no other (Field, p.415-416). The specific example of such a variable in this study was program effect. The range of a small magnitude of change amounts to a partial eta-two of .01 to .09. The moderate level ranges to .25. Above .25 is considered a large magnitude of change (H. Stattin, personal communication, April 27, 2011). This analysis made possible a differentiation of the general effects on parent behavior from the specific program effects. It calculates the standardized residuals of the changes in parenting constructs, which in the next stage were correlated with the change in child outcomes. Finally, these correlations were analysed and each of the child outcomes were regressed onto the two parent behavior variables to test the significance of the four models. This method is not a mediational analysis. This would have been possible if child outcome variables at pre-test had been independent of child outcome variables at post-test (Baron, & Kenny, 1986). In this case pre- and post-test measures were measurements of the same variables. Instead the findings were expected to show if changes in parent behavior possibly predicted changes in child behavior using measurements at two different points in time.
Results
The changes on child outcomes from pre- to post-test for all conditions were significant. Means and standard deviations are shown in Table 1.
Table 1
Means and Standard Deviations
___________________________________________________________________________ ____CoMet ___Connect____ __IY Basic __ ____COPE_____ M(SD) ________ M(SD) _______ M(SD)________ M(SD)_________ Variable________Pre_____ Post____Pre____Post____ Pre_____Post____ Pre_____Post___
Intensity 3,6(0,9) 2,6(0,8) 3,4(1,0) 2,8(0,9) 3,8(0,9) 2,9(0,6) 3,6(0,9) 2,8(0,7) Problem scale 0,4(0,2) 0,2(0,2) 0,4(0,2) 0,3(0,2) 0,4(0,2) 0,3(0,2) 0,4(0,2) 0,3(0,2) Lack of attention 1,0(0,7) 0,7(0,6) 1,1(0,7) 1,0(0,7) 1,2(0,8) 0,8(0,7) 1,2(0,7) 0,9(0,7) Hyperactivity 1,0(0,8) 0,8(0,7) 0,9(0,7) 0,8(0,7) 1,3(0,8) 0,9(0,6) 1,2(0,7) 0,9(0,7)
___________________________________________________________________________
The effect size for intensity of behavior problems was large, partial ² = .57. The problem scale of ECBI also showed a large effect, partial ² = .33. Effects on lack of
attention and hyperactivity was bordering the limit between moderate to large range, , partial ² = .25 and partial ² = .24, respectively. All changes reached significance. This means that there were general effects of the interventions on child problem behavior with small
differential effects controlling for the specific program effects. See Table 2. Table 2
Magnitude of Changes on Child Outcomes by Time and by Time x Program
___________________________________________________________________________ Variable (T; T x P) F-ratio ____Time F-ratio Time x Program
Intensity (1, 405; 3, 405) 550.58 .57*** 10.21 .07*** Problem scale (1, 354; 3, 354) 176.10 .33*** 7.34 .06*** Lack of attention (1, 406; 3, 406) 138.54 .25*** 4.07 .03** Hyperactivity (1, 405; 3, 405) 129,18 .24*** 4.70 .03** ___________________________________________________________________________ Note. * p <.05, ** p <.01, *** p <.001.
The correlation between the parenting constructs underlying the six aspects of parenting and child outcomes uniformly yielded significant results for affect, conflict management, competence and stress, but not for parent behavior constructs like punishment and praise. This was not expected with regard to findings in many studies where parent behaviors have been shown to be systematically correlated to child behavior. Also, constructs like affect, competence, and stress are difficult to separate from behavioral constructs like punishment and praise. Furthermore, it seems theoretically unsound to formulate a hypothesis to be tested that supposes that what parents do affect their children’s behavior less than do cognitive and emotional states of mind. To elaborate on this two higher-order behavioral
constructs were analyzed: positive and negative parent behavior. This analysis resulted in significant correlations between negative behavior and all child outcomes. This was not the case for positive behavior, which only was associated to intensity and lack of attention. Table 3
Correlations between Behavioral Parenting Constructs and Child Outcomes
___________________________________________________________________________ Variables Reliability Intensity Problem scale Lack of attention Hyperactivity (Cronbach’s α pre, post)________________________________________________________ Positive behavior -.14** -.08 .09* -.07
Praise 1 -.09* -.08 -.08 -.11** (.71, .76)
Praise 2 -.16*** -.09 -.07 -.02 (.84, .84)
Incentives (Values not known on submission date) (.72, .72) Negative behavior .44*** .44*** .24*** .29*** Punishment .25*** .24*** .10* .18*** (.54, .65) Harshness .32*** .32*** .22*** .20*** (.62, .68) Emotional outburst .26*** .29*** .09* .16*** (.79, .76) Affective dyscontrol .27*** .24*** .20*** .22*** (.52, .53) ___________________________________________________________________________ Note. * p <.05, ** p <.01, *** p <.001.
As the final step regression analyses were performed. Each of the four outcome variables were regressed on to the predictors (i.e., positive and negative parent behavior). The analyses show that the predictive value of negative parent behavior on all outcomes is highly significant. Positive parent behavior does not predict child problem behavior of any sort.
Table 4
Predictors of Change in Child Outcomes
___________________________________________________________________________ ___Intensity___ _Problem scale Lack of attention _Hyperactivity_ Variable B SE B β B SE B β B SE B β B SE B β___ Constant .08 .04 .06 .04 .07 .04 .10 .04 Negative behavior .62 .06 .42*** .66 .06 .44*** .34 .06 .23*** .42 .06 .29*** Positive behavior -.07 .06 -.05 .02 .06 .02 -.06 .06 -.04 -.00 .06 -.00 R square .19 .20 .06 .09 ___________________________________________________________________________ Note. *** p <.001.
According to the R square values the change in child behavior explained by negative parent behavior was not large. This suggests that other explanatory variables of change were present. Again, this was most obvious for the variables covering attention problems and hyperactivity.
Discussion
The interplay between parents and children determinate the process of child and adolescent development. This process can go awry early on in the life of the child and then contribute to consequences that cause suffering that may never stop. This study shines a light on the part of the parents when they take on their responsibility as parents and learn new ways in parenting. The results show that all four parent training programs in this study, regardless of theoretical base, are effective for both parents and children. All four programs also showed that parent behavior significantly affected child outcomes with significant effects of negative parent behavior. This suggest that an important change in children’s problem behavior occurs when parents stop treating their children bad or hurt them. To not punish or criticize your child is a simple way of helping them. To manage to control your strong negative feelings as a parent is equally effective. This is valid especially for children with problem behaviors. Additionally, parental use of praise and rewards are not a sure recipy for success. The results
also suggest that the level of parental stress decreases and aspects of parents’ sense of competence increase during the process of change following parent training.
The results put the importance of active positive parent behavior in the somber light of mixed results. Concerning negative parent behavior there seems to be no dispute. The
importance of positive parenting has been highlighted in other studies (CoMet; Kling et al., 2010; IY; Gardner, Hutchings, Bywater, & Whitaker, 2010). On other hand there is at least one study showing that positive parenting does not affect children’s problem behavior (IY; Fossum, Mørch, Handegård, Drugli, & Larsson, 2009). Gardner et al. measured positive parenting in a different way than the others, including this study. They used observational methods to measure a positive parenting construct made up by positive affect, physical positive behavior, praise, and problem solving. This broader definition of positive parenting may be a possible explanation for the positive results. In all three studies the ECBI were, as in this study, used to measure problem behavior. The present study differs in that it covers four interventions, including CoMet and IY. All four interventions put emphasis on strenghtening positive parent-child relations albeit in different ways. In none of them the positive parenting construct manages to reach a significant effect.
In a broader and deeper context, where genetic influences on child behavior are brought to the attention, the possibility of actively change children’s problem behavior is considered unrealistic (Scarr, 1996). She argues that central personality traits as emotional stability, intellectual openness, extraversion, agreeableness and conscientiousness in children with problem behavior are hereditary to a non-neglible extent. Therefore, interventions aiming at changing problem behavior in children are not worth the cost unless the child has been exposed to abuse or neglect. Furthermore, she argues that if children get a choice they will sooner or later find their ways of socializing according to their individual preferences. A possible interpretation of why it seems sufficient to refrain from negative parent behavior to
decrease children’s problem behavior is that when parents are given alternatives to
punishment - at the same time as they receive attention to the issue of being a parent - they stop and think. During this, they manage to catch up with themselves as individual human beings and start to reflect on what they are actually doing. This may be seen as a defining moment in their parental careers where they become sensitive to learn and find new ways of relating to their children. Additionally, parent-child interaction components is one of the components that make a difference between parent training programs resulting in large effects and those yielding small effects (Wyatt Kaminski et al., 2008). Another important component is the use of time-out, which communicates the “stop-and-think”-phase to the child as
proposed earlier.
Finally, adopting the interpretation above emphasizes a reciprocal perspective on parenting rather than the more unidirectional, parental style perspective presented earlier. To quit using negative parent behavior creates a possibility for parents to be more attentive to their child and not instinctively respond to behaviors earlier percieved as solely provocative. The reciprocal perspective has gained scientific support concerning adolescents (Tilton-Weaver et al., 2010), but also in the case of preadolescent children with severe problem behavior (Burke, Pardini, & Loeber, 2008). Suffice to say that findings supportive of positive parent behavior as mediators of change in child problem behavior do not become invalidated. Especially not when the parent-child relation is severly strained due to neglectful parenting. Strengths and Limitations
The unique feature of the present study lies in the general focus on effects on parenting. Behavioral and non-behavioral parent training programs were treated as equals although the behavioral programs outnumbered the non-behavioral program in the analyses. Furthermore, it is a nationally and predominantly urban derived sample where the
enables comparisons with samples with other characteristics enabling cultural adaptions. There are limitations of this study. The pre-post design without follow-up makes it difficult to link the positive changes in parent behavior to a pervasive change in parenting and to the impact of attention and focus given when participating in an intervention sorely needed. Sole reliance of parent reports, especially for parent behavior, may be hazardous from a reliability perspective (Sessa, Avenevoli, Steinberg, & Morris, 2001). A solution to this would have been to use observers with coding manual as have been the case in other studies. On the other hand, such arrangements could impact attrition and introduce selection biases.
Further Directions for Research
Future research ought to focus on follow-up effects to establish if the effects of parent training on parenting are independent of the theoretical base of the parent program. Also, the role of components like praise and incentives need to be further investigated. It seems like parents make their own interpretation of what to do of their experiences of parent training that not necessarily fit the theoretical models at hand. There are other kinds of positive parenting that make a difference as mentioned earlier (Gardner et al., 2010). This may shed more light of the reciprocality of parent-child relation suggested in recent research. The moderate magnitudes of change that parent behavior accounts for suggest that there are more influences on child outcomes to be explained. Another suggestion would be to try to get a deeper insight into the child perspective of the change process. Elder preadolescent children are able to convey their experiences of what happens in relation to their parents. Studies of ethnic
minority parents or other cultural traditions in parent training also are needed, especially when the sample in this study was apparently well adjusted. What minority parents with other cultural traditions or heritages make of their participation in parent training programs would possibly enhance the understanding of how parents in general perceive and react to such an intervention.
Parent-child relations are complex, but vital to human development. Prevention science uncovers stepwise the layers of this complexity intregrating scientific research and reason. The sometimes-salient gap between research and practise seems to reach a closure. This study is an example of that. Interplay respecting the physical and psychological boundaries between parent and child is not a simple exchange of do´s and do-not´s. At least not for parents with a secure base to start from. More needs yet to be known to be able to offer alternatives for parents less well adjusted.
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