[MUSIC PLAYING] We are the Association for Child and Adolescent Mental Health, or ACAMH for short. And this is ACAMH Learn. The content of parenting programmes has not changed substantially over the past decades. Most established programmes begin with sessions aimed at helping parents strengthen their relationship with their child, followed by guidance on strategies to redirect children's behaviour, for example, by reinforcing prosocial behaviour in children and avoiding the reinforcement of disruptive behaviour in children. However, one main element has changed. All the programmes more frequently include timeout, a technique in which parents avoid reinforcing disruptive child behaviour by taking the child out of the situation for a set period. Although this technique is still used today, it has become less common in the past decades. We found no evidence that in general, programmes with or without timeout differ in their effectiveness. Here we see more noticeable changes. We see that programmes evaluated in recent years often include fewer sessions than those from the earlier years, and these shorter programmes actually seem just as effective, suggesting greater efficiency in more modern programmes. We also see that programmes were more commonly delivered in the earlier years by research staff, meaning that the same individuals who develop, deliver, and evaluate the interventions. While in more recent years programmes are more often delivered by professionals, who work independently from research teams. And lastly, we see that many programmes continue to be offered in-person, but also we see a strong shift towards more online delivery. Comparative studies indicate that online delivery can be just as effective as in-person delivery, provided that the programme is guided by a professional. Other encouraging findings here are that the online delivery can reach more diverse samples, including those who might not be reached by in-person delivery and especially parents facing cumulative stressors. The flexibility and accessibility of online programmes may make it easier for them to participate. So I think that's a very promising development. During the '80s and '90s the effects of programmes gradually declined, and since the early 2000s, the effects have stabilised. So currently they are neither increasing nor decreasing. Some of the earlier declines seem to link to improved research methods, so newer studies tend to have less risk of bias. For example, by reporting randomization processes more transparently and by using stricter data analysis approaches. In addition, programmes are now more often compared to Kerry's usual conditions, rather than wait lists or no intervention groups. Nevertheless, these methodological changes alone do not fully explain the initial decline, so the precise reasons behind the time trend remain unclear. It's difficult to generalise, because families may respond differently to programme elements, but some patterns have emerged in our studies. So first, we see that focusing on a limited number of core elements tends to be more effective than including many different elements. While intuitively it might seem that offering more elements to families would increase benefits, this is usually not the case, and a more focused approach that teaches parents to apply differential reinforcement techniques is often more effective for reducing disruptive child behaviour than broader programmes that combine multiple different strategies. But we also see is that prevention and treatment may require a different emphasis. Intervention elements that work well for the treatment of behavioural disorders are not necessarily the best elements for the prevention of disruptive behaviour problems. What we found, for example, is that in treatment settings, a stronger emphasis on elements to increase the quality of the parent-child relationship was predictive of greater programme effects. While for prevention, programmes focused solely on behaviour management actually yielded greater benefits. So in short, sometimes less is more in parenting programmes, especially in prevention. This is a crucial question, and despite many studies examining individual differences in programme effectiveness, we still struggle to predict which families will benefit most, and in explaining why this is the case. Generally, we see that families with children with more severe disruptive behaviour and their parents struggle more with how to manage these behaviours tend to benefit more likely, because there is greater room for improvement in these children. Encouragingly, we see that families facing socioeconomic disadvantage or belonging to cultural minorities in their country benefit just as much as other families. This suggests that provided that access is equitable, parenting programmes do not widen socioeconomic disparities in disruptive child behaviour. But it also means that most of the variation that we see in programme outcomes remains unexplained. And this highlights a very important challenge. The so-called moderators that we currently study in our treatment trials may not be the true factors that drive differences in benefit. So I think this means we need to work closely with parents, with professionals to identify and measure the factors that truly matter and to better understand differences in programme outcomes between families. Technological developments have transformed not only how parenting programmes are delivered, but also how we evaluate them. Traditionally, we would measure family functioning before and after a programme, and this will tell us whether families function better after the intervention than they did before. But it doesn't tell us anything about what happens during a programme. And now, thanks to mobile technology, we can collect more real-time data. We can, for example, ask parents daily through apps how their interactions with their child went today, or even audio records some of these interactions. And these methods provide a much more precise view of how families changed throughout the programme, and how this process might differ between families. In the near future, such data will allow us to explore important questions, for example, which programme elements trigger early improvements and how initial changes in parent child interaction predict longer term outcomes. And this evidence hopefully will help professionals tailor programmes in a more dynamic way, adjusting their support in-real time to better meet family's needs.