Intended for healthcare professionals

Views & Reviews From the Frontline

Universal parenting classes won’t help conduct disorders

BMJ 2012; 345 doi: https://doi.org/10.1136/bmj.e7977 (Published 23 November 2012) Cite this as: BMJ 2012;345:e7977
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}yahoo.co.uk

Confidently, my brother threw the huge new bowie knife at the door. The handle hit the wood, and it bounced wildly backwards, narrowing missing my ear. We laughed.

“The best present ever,” my brother said.

Few children get knives as presents these days. We were a generation whose parents were distant. We were largely ignored, rarely affirmed, yet paradoxically free, independent, and self contained. Those were harsher days.

Today’s children seem not only materially indulged but also emotionally indulged and immature. I feel uncomfortable when parents suggest their children are their “best friends” or sport fixed smiles as they say how wonderful their children are. We have our own “little emperor” phenomenon. What has become of parents and childhood?

Parenting is now big business. Coiffured PhDs sit on daytime television’s sofas, flogging pseudoscientific parenting books and programmes. But parenting is confounded by so many things, such as circumstance, the kids’ and parents’ personalities, and the age and number of children, to name but a few. So I spurn cookbook parenting, believing that parenting is not about simplistic lessons but only constant practice. The one certainty of parenting is its contradictions.

But parenting classes for all is now official government policy and is supported by the National Institute for Health and Clinical Excellence.1 The rationale is obvious: give parents basic parenting advice and we prevent (and save money on) conduct disorders. This is simply a good idea based on simple reasoning. But a recent systematic review questions this certainty for a widely implemented initiative called Triple P.2 The research, relying on unregistered trials, is open to selective reporting, is limited in long term outcomes, and is confounded by the quicksand that is self reported outcomes. The review casts doubt on effectiveness in the all important hard to reach groups.2 Results from other large trials are emerging that challenge the effectiveness of universal parenting programmes.3 4

Could parenting courses do harm? These courses and books are undermining, and put the notion of good parenting in constant flux. Parenting classes suggest that there are right and wrong parenting styles, rather than normal old just-getting-by-and-doing-our-best parenting. Also, what of the opportunity cost? Would these large resources be better spent on targeting the most needy, or tackling the chronic underinvestment in health visitors? What parents really need are continuity and personalised advice.

But the corporate parenting business is really eroding those traditional local sources of parenting advice, from health visitors, nursery staff, and doctors, to the much maligned grandparents. Lastly, the focus on parenting classes serves as a distraction from the root causes of conduct disorders: poverty, family break up, and unemployment.5 Aren’t universal parenting programmes just tokenistic middle class social evangelism?

Notes

Cite this as: BMJ 2012;345:e7977

Footnotes

References

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