A Randomized Controlled Trial Evaluating an Online Parenting Programme for Parents of Preschool-Aged Children with Hyperactive/Inattentive Behaviour Difficulties

Abstract

Parent-child relationships of pre-school aged children with hyperactive/inattentive behaviour problems are often difficult, leading to parenting stress and negative parent-child interactions. By intervening early it may be possible to reduce some of the poor long-term outcomes associated with these early behaviour difficulties, such as exacerbation of ADHD symptoms and relationship problems with family, teachers, and peers. No online self-help parenting programme has been tested in this population. Online delivery may decrease the burden on clinicians, while meeting the need for parenting services. This study investigated the efficacy of the self-administered, online version of Triple P Positive Parenting Program, which consists of eight modules, with two added telephone consultations with a qualified Triple P facilitator. Semi-structured interviews were conducted with a subsample of 11 parents to gain a more in-depth understanding pf parents experience with using the online parenting programme. In the first part of the study a randomized control design, with an intervention condition (n = 27) and a delayed intervention condition (n = 26), was used to test the efficacy of Triple P online in a total sample of 53 parents of three to four year old children with hyperactive/inattentive behaviour difficulties. Participant selection was based on elevated levels of child hyperactivity/inattentiveness according to parent report on the Werry-Weiss-Peters Activity Rating Scale (age range 6 to 18; WWP; Routh, 1978) as well as interviewer ratings of inattention and hyperactivity on the Parental Account of Children’s Symptoms Interview (PACS; Taylor, Sandberg, Thorley, & Giles, 1991). Questionnaire data on child behaviour, parenting, parent mental health, and parenting efficacy were collected at three different time points (pre-intervention, post-intervention, and six-month follow-up). With regard to child behaviours, mother- and father-ratings on inattention/hyperactivity, defiance/aggression, and social functioning were collected, as well as mother-ratings of restlessness/impulsivity and teacher-ratings of child hyperactivity, peer problems, and prosocial behaviour. At post-intervention, results indicate that in comparison to the delayed intervention group, the intervention group showed significant improvements in child inattention/hyperactivity, restlessness/impulsivity, social functioning, and prosocial behaviour, as well as significant improvements in parental overreactivity, verbosity, positive parenting, stress, depression, parenting satisfaction, and parenting self-efficacy. At the six-month follow-up the intervention group showed greater improvements in overreactivity, verbosity, anxiety, stress, depression, satisfaction, and self-efficacy. The second part of the study comprised semi-structured post-intervention interviews with a subsample of 11 families to evaluate parents’ experience and satisfaction with using the online parenting programme. Thematic analysis of the interview data revealed a number of barriers and facilitators to using and completing the programme. Time constraints were the most frequently mentioned barrier, followed by lack of partner involvement and the linearity of the programme. Programme content, particularly parenting information and parenting skills, was the most often cited facilitator, followed by programme format such as videos demonstrating parenting strategies and the engaging activities provided. The analysis also showed that parents were regularly using strategies taught by the programme, such as being consistent with discipline, remaining calm, and having logical consequences for misbehaviour. In addition, all parents had noticed improvements in at least two hyperactive/inattentive child behaviours. These included being better able to follow instructions, more on task behaviour, like independent play, and reductions in restless behaviour, for instance, staying seated at mealtimes. Key implications of the study findings include evidence for the usefulness of online self-help as a first-step-approach in treating preschool hyperactivity, including the increase in parental self-efficacy and the decrease in parental laxness, both associated with child hyperactivity.