Prevention of psychosocial problems in adolescenceBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38951.482431.BE (Published 31 August 2006) Cite this as: BMJ 2006;333:460
- Sabina Dosani, consultant child and adolescent psychiatrist ()
Good parenting protects against psychosocial problems in adolescence. In this issue of the BMJ, Walker and colleagues present a controlled trial that adds to the growing body of evidence that interventions to stimulate children and expose them to more positive parenting reduce the risks of antisocial behaviour, truancy, pregnancy, substance misuse, delinquency, and emotional and behavioural disorders in adolescence.1
Parenting plays a key part in children's emotional and behavioural development. Good parenting helps children adjust to change and adversity and establishes healthy patterns of emotional, social, and cognitive functioning. Harsh, unpredictable parenting that relies on manipulation, threats, punishment, and passivity is strongly associated with antisocial behaviour in children. Children with uncontrolled antisocial behaviour are at markedly increased risk of morbidity during adolescence and beyond. They are more likely to play truant, leave school without qualifications, and offend during adolescence or adulthood and are less likely to form meaningful, lasting relationships.2
Most trials of parenting programmes are conducted in research centres, with highly motivated staff and groups of parents who have volunteered to participate. It is heartening to read a “real world” study, which included more than 100 families from deprived areas of Kingston, Jamaica. Walker and colleagues evaluated an intervention that included two years of psychosocial stimulation—a one hour weekly session for mothers and children that taught developmental play (free toys and books were also provided). Weekly stimulatory play resulted in long term improvements in children's cognitive development, enhanced emotional wellbeing, and fewer problems with attention in adolescence.
More than 20 years ago, Patterson showed that parental reactions to antisocial behaviour often perpetuate such behaviour, and that ignoring undesired behaviour stops it.3 Behaviour based parenting programmes may prevent emotional and behavioural disorders in adolescence. Scott and colleagues' multicentre controlled trial of parenting groups for childhood antisocial behaviour delivered in clinical practice found that such parenting groups reduce serious antisocial behaviour in children.4
The group based parenting programme pioneered by Webster-Stratton teaches active listening, child focused play, praise, limit setting (how strict parents should be about enforcing rules), how to offer incentives for good behaviour, and disciplinary methods that help children develop self control.5 The theoretical basis of the programme is explained to parents. The programme aims to produce sociable and self reliant children.
Conduct disorder in adolescence and juvenile delinquency are important problems, not only for young people and their families, but for society. Adolescents with conduct disorder consume many resources offered by the health, social care, and justice systems. Parenting interventions can have many beneficial effects, such as reducing rates of arrest and time spent in institutions. This may result in cost savings for society.6
Walker and colleagues' study is particularly inspiring as their positive parenting intervention was offered before children developed emotional or behavioural difficulties.1 Because of the worldwide shortage of child psychiatrists, most clinical responses are reactive rather than proactive and preventive. Effective parenting is a powerful protective factor that could mitigate the impact of socioeconomic adversity, low levels of parental education, low birth rate, and other environmental risk factors.
Hoghughi has called for “an urgent shift of emphasis from reactive intervention to prevention and health promotion.”2 Most parents know they have an important role in the emotional and cognitive development of their children, but many of them lack the information and self confidence needed to have a positive influence. Health visitors and other primary care workers are ideally placed to educate and enhance parents' skills. Webster-Stratton suggests that parenting programmes would have a higher impact, be less stigmatising, and be more cost effective if offered as a preventive measure.7 Offering parenting programmes to parents of all young children would confer a degree of herd immunity against future development of psychosocial problems in adolescence. We have a collective duty to educate, support, and enable all parents to succeed in this vital role.
Research p 472