Associate Professor Patty Leijeten Hi, I’m  Patty Leijeten, and I work as an Associate   Professor at the University of Amsterdam.  I study how parents and children shape each   other’s behaviour in daily interactions,  and how we can use our understanding of   these interactions to help parents support  their child’s mental health. In this video,   I’ll share with you how we can support parents to  reduce disruptive behaviour in children [pause]. Every child is unique, and disruptive  behaviour in different children can be   caused and maintained by different  factors. What we know, however,   is that when children show disruptive behaviour,  such as oppositional, defiant or aggression,   it can be difficult for parents to respond to  this behaviour in a way that does not unwillingly   increases this behaviour. When children  behaviour gets really intense, for example,   it can be hard for parents to stay calm and  patient. And when children get really forceful   in demanding what they want, it can be hard for  parents not to give in. And, yet, each of these   responses increases the likelihood that disruptive  behaviour will occur again in the future [pause]. Programmes with the best evidence tend to have  three key elements. First, when children often   show severe levels of disruptive behaviour,  it can be hard for parents to also engage in   positive interactions with their child. And, yet,  such positive interactions, through joint play,   for example, of parents showing appreciation  of the child’s effort to be prosocial,   can help strengthen the parent-child relationship  quality. And programmes with the best evidence,   therefore, help parents engage  in these positive interactions,   even in the face of many difficult  interactions with their children. Second, these programmes help parents find  out what the antecedents are of disruptive   behaviour. So, what are the situations that are  likely to elicit disruptive behaviour and how can   parents prevent these situations? For example,  by setting clearer rules, or by preventing some   situations from occurring. And, third, these  programmes help parents take a look at what   consequences they currently provide to disruptive  behaviour and whether these are consequences that   are effective, or whether they may unwillingly  reinforce disruptive behaviour in children. Effective strategies to deal with  disruptive behaviour can be strategies   that ignore the behaviour, if it is  mild behaviour that can be ignored,   and strategies that prevent  reinforcement of the behaviour,   for example, through removing privileges  or other non-violent strategies [pause]. All these programmes vary a bit from each other,  but, actually, most programmes classified as   evidence-based in reducing disruptive behaviour  are more similar than different from each other.   Most programmes are based on the same underlying  theoretical principles of social and operational   learning theory, and encourage the same  parenting techniques. They can differ,   however, in the emphasis they place on  different parenting techniques and how they   are being delivered. Some programmes are delivered  one-to-one, sometimes even with life coaching of   parent-child interactions, some are delivered in  groups, and some are delivered online [pause]. It seems like they do, at least in a way. In  cases where disruptive behaviour is more severe,   it is particularly important that pa –  programmes start with strengthening the   quality of parent-child relationship quality. We  see that programmes that help parents engage more   in positive interactions with children, before  they move onto teaching parents techniques about   breaking coercive parent-child interactions are  particularly effective in treatment settings. And the reason why they seem to work so well  might be because if parents and children have   been living with such difficult interactions for  years, this may have led to some erosion in the   relationship quality. Restrengthening some of that  relationship quality then provides a more sound   base for the use of parenting techniques, designed  to break these coercive interactions [pause].  The type of parenting techniques taught in these  programmes is usually the same, regardless of   how they are being delivered, but each format  can have its own benefits. Individual formats   allow for more flexibility, to adapt the content  to the specific needs to individual parents.   And when the goal of the parenting support  is really to learn new techniques and for   parents to apply them in their specific parenting  situations, then individual formats can be great. Group formats, on the other hand, have the power  of social support from other parents, which can   normalise parents’ difficulties, the struggles  they experience, in raising their children. And   one of our research studies also then suggests  that group programmes might be particularly   powerful for improving parents’ mental health,  in addition to children’s mental health [pause]. So, mediators are about the mechanisms  through which interventions work,   and in the case of parenting programmes,  these are often changes in the parents’   behaviour. It seems to mainly be  reductions in parental harshness   towards children that mediates parenting  programme effects on disruptive behaviour,   and this is harshness can be expressed in terms  of shouting or scolding, or corporal punishment. In families where we see that such  harshness reduces, these families   have the most likelihood to also benefit in  terms of increased positivity in children’s   behaviour and less disruptive behaviour.  Another main element seems to be parents’   ability to follow through on the discipline  they intend to engage in. This creates a more   predictable situation for children and prevents  disruptive behaviour from being reinforced. It seems to be the case though, that some of  these mediators also differ between families.   My team and I are currently trying to find out  how this works exactly. This relates to the   question of moderators, of course, which is about  individual differences between families in how   much they benefit. And we know that individual  family characteristics, like the child’s age,   or gender, they rarely moderate programme  effects. We also see that parenting programmes   seem to work equally well across families with  different levels of socioeconomic disadvantage,   provided, of course, that these families  have access to the programme. We do see,   in terms of individual differences, that  it is mainly families with children with   more severe disruptive behaviour that benefit  more. And I think this is a hopeful message   for professionals and parents dealing with more  severe disruptive behaviour in children [pause]. This is one of the biggest challenges of  parenting programmes. On the one hand,   it is essential that programmes match parents’  everyday reality, and this may not be the case   if we transport them from one context to another.  At the same time, it will not be possible for us   to develop and thoroughly test every possible  cultural specific version of programmes, given   the incredibly rich cultural diversity within  – we see within countries, as well as between. Fortunately, established parenting programmes  for disruptive behaviour tend to transport fairly   well across countries and cultures. And the key  here seems to be to keep the theory of change,   and align these interventions intact, but to seek  ways to adapt the specific opportunalisations,   the form that these theories  take, to the local context. For example, positive reinforcement of  prosocial child behaviour, so parents showing   their appreciation for this behaviour, in a way  that increases the likelihood that children will   increasingly show this behaviour, can take the  form of verbal praise, for example, but parents   can also show their appreciation to their child’s  behaviour in different ways. And professionals and   parents can together discuss what way of positive  reinforcement fits their culture best [pause]. Relationships are not built in a day.  This also means that parents may not   immediately see the effects of their efforts  reflected in their child’s behaviour. What   we see that often helps in this process is  that parents actually often like to engage   in relationship enhancement techniques,  such as child led interactions and play.   And parents tell us that it helps  them see also beyond their child’s   disruptive behaviour and to really engage in  a different way than they would do usually. So, it can be liberating for both parents  and children to engage, for example,   in activities where the main goal is to have  fun together, or to follow the child’s lead,   rather than for parents to teach a child  new skills, or to redirect this behaviour.   And if parents manage to consistently  engage in this behaviour, we see that   definitely the quality of the parent-child  relationship can improve over time [pause]. This evidence is very encouraging. Online  parenting programmes do not seem to be   inferior to in-person parenting programmes,  as long as parents are being well supported   by professionals. And such support can be  provided, for example, through weekly calls   with parents watching online material in  between calls, or through a video call. And online programmes have many advantages  that in-person programmes may not have. Some   professionals we know are concerned that they  may be less accessible for families living,   for example, with more socioeconomic  disadvantage, but the evidence actually   suggests the opposite. They might be  more accessible for families because it   is easier to schedule, parents do not need to  travel, do not need to arrange for childcare,   and most parents nowadays have access  to smartphones. So, online parenting   programmes definitely deserve a prominent  place in our parenting programme landscape.