Mindfulness-enhanced parenting programs for improving outcomes for children and their parents

Key messages

• Mindfulness-enhanced parent training programmes may improve some child and parent outcomes, including child emotional and behavioural adjustment, parenting skills, parental depression or anxiety, parenting stress, and parent mindfulness.

• When mindfulness parent training is combined with a skills-based parent training programme, this may decrease parenting stress.

• The current body of evidence is limited, with more research needed to be confident in our findings.

Children's emotional and behavioural difficulties

Emotional and behavioural difficulties in children are common, and are characterised by a range of externalising and/or internalising behaviours that can be highly stable over time. They are an important cause of functional disability in childhood, and predictive of poor psychosocial, academic, and occupational functioning into adolescence and beyond. The prevalence, stability, and long-term consequences of emotional and behavioural difficulties highlight the importance of intervening in childhood when behavioural patterns are more easily modified.

Why mindfulness-enhanced parent training?

Parenting plays an important role in the development and/or maintenance of emotional and behavioural difficulties in children. Traditional behavioural or skills-based parent training programmes have been shown to have a positive impact on a range of child and parent outcomes, but they do not work for all parents. One reason for this might be that parents' emotional reactions could prevent them from using parenting skills effectively. Including additional components into parenting training that aim to improve parental emotional responses may enhance the outcomes of these programmes. Recent research shows that mindful parenting interventions may promote positive outcomes for parents and children by improving parents' ability to regulate emotions and stress. Combining mindful parenting approaches with traditional parent training programmes may therefore be beneficial for both parents and their children.

What did we want to find out?

We explored whether behavioural or skills-based parent training programmes with a mindfulness component – 'mindfulness-enhanced' parent training programmes – can improve outcomes for children and their caregivers.

What did we do?

We searched a range of sources for literature that evaluated the effectiveness of mindfulness-enhanced parent training programmes, including electronic databases, trial registries, and organisations and experts in the field. We included studies evaluating these interventions using randomised controlled trials (studies where participants are randomly assigned to one of two or more treatment groups) or quasi experimental designs (where participants are assigned to different treatment groups using a method that is not truly random). We included studies that assessed child emotional and behavioural adjustment, and/or a range of parent outcomes, including parenting skills, parenting stress, depression or anxiety, mindfulness or self-compassion.

What did we find out?

We included 11 studies and data from 2118 participants in the review. The studies compared the outcomes of children or parents (or both) who participated in a mindfulness-enhanced parent training programme to the outcomes of children or parents (or both) who did not participate in parent training, or who participated in an alternate behavioural or skills-based parent training programme. When we combined the findings from these studies, we found that mindfulness-enhanced parent training, when compared to no intervention, may improve child emotional and behavioural adjustment, parenting skills, parenting stress, parental depression and anxiety, and mindfulness, but we are very uncertain about these results. Evidence for the added value of mindfulness training when included in a skills-based parent training programme suggests that mindfulness training may further promote reductions in parenting stress, and may also further reduce parental depression or anxiety, but we are uncertain about these results. It is unclear from the current body of evidence whether adding mindfulness training to a skills-based parent training intervention has any further effect on child emotional and behavioural adjustment, parenting skills, or mindfulness. No studies reported adverse effects or measured self-compassion.

What are the limitations of the evidence?

We are not confident in the overall body of evidence. This is primarily because there was a lot of variation across the interventions and the participant groups, as well as how the outcomes were measured. The studies were also usually quite small, and participants were likely to be aware of what intervention they were receiving, which can sometimes influence the results. It is likely that these findings will change as more studies are undertaken in this area of research.

How up-to-date is this evidence?

We searched for and included research up to April 2023.

Authors' conclusions: 

Mindfulness-enhanced parenting training may improve some parent and child outcomes, with no studies reporting adverse effects. Evidence for the added value of mindfulness training to skills-based parenting training programmes is suggestive at present, with moderate reductions in parenting stress. Given the very low to low certainty evidence reviewed here, these estimates will likely change as more high-quality studies are produced.

Read the full abstract...
Background: 

Emotional and behavioural difficulties (EBD) in children are common, characterised by externalising or internalising behaviours that can be highly stable over time. EBD are an important cause of functional disability in childhood, and predictive of poorer psychosocial, academic, and occupational functioning into adolescence and adulthood. The prevalence, stability, and long-term consequences of EBD highlight the importance of intervening in childhood when behavioural patterns are more easily modified.

Multiple factors contribute to the aetiology of EBD in children, and parenting plays an important role. The relationship between parenting and EBD has been described as bidirectional, with parents and children shaping one another’s behaviour. One consequence of bidirectionality is that parents with insufficient parenting skills may become involved in increasingly negative behaviours when dealing with non-compliance in children. This can have a cyclical effect, exacerbating child behavioural difficulties and further increasing parental distress.

Behavioural or skills-based parenting training can be highly effective in addressing EBD in children. However, emotional dysregulation may intercept some parents' ability to implement parenting skills, and there is recognition that skills-based interventions may benefit from adjunct components that better target parental emotional responses. Mindful parenting interventions have demonstrated some efficacy in improving child outcomes via improvements in parental emotion regulation, and there is potential for mindfulness training to enhance the effectiveness of standard parent training programmes.

Objectives: 

To assess the effectiveness of mindfulness-enhanced parent training programmes on the psychosocial functioning of children (aged 0 to 18 years) and their parents.

Search strategy: 

We searched the following databases up to April 2023: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL Plus, PsycINFO, Sociological Abstracts, Social Sciences Citation Index, Conference Proceedings Citation Index – Social Science & Humanities, AMED, ERIC, ProQuest Dissertations & Theses, Cochrane Database of Systematic Reviews, Campbell Collaboration Library of Systematic Reviews, as well as the following trials registers: ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We also contacted organisations/experts in the field.

Selection criteria: 

We included randomised and quasi-randomised trials. Participants were parents or caregivers of children under the age of 18. The intervention was mindfulness-enhanced parent training programmes compared with a no-intervention, waitlist, or attentional control, or a parent training programme with no mindfulness component. The intervention must have combined mindfulness parent training with behavioural or skills-based parent training. We defined parent training programmes in terms of the delivery of a standardised and manualised intervention over a specified and limited period, on a one-to-one or group-basis, with a well-defined mindfulness component. The mindfulness component must have included mindfulness training (breath, visualisation, listening, or other sensory focus) and an explicit focus on present-focused attention and non-judgemental acceptance.

Data collection and analysis: 

We followed standard Cochrane procedures.

Main results: 

Eleven studies met our inclusion criteria, including one ongoing study. The studies compared a mindfulness-enhanced parent training programme with a no-treatment, waitlist, or attentional control (2 studies); a parent training programme with no mindfulness component (5 studies); both a no-treatment, waitlist, or attentional control and a parent training programme with no mindfulness component (4 studies). We assessed all studies as being at an unclear or high risk of bias across multiple domains. We pooled child and parent outcome data from 2118 participants to produce effect estimates. No study explicitly reported on self-compassion, and no adverse effects were reported in any of the studies.

Mindfulness-enhanced parent training programmes compared to a no-treatment, waitlist, or attentional control

Very low certainty evidence suggests there may be a small to moderate postintervention improvement in child emotional and behavioural adjustment (standardised mean difference (SMD) −0.46, 95% confidence interval (CI) −0.96 to 0.03; P = 0.06, I2 = 62%; 3 studies, 270 participants); a small improvement in parenting skills (SMD 0.22, 95% CI 0.06 to 0.39; P = 0.008, I2 = 0%; 3 studies, 587 participants); and a moderate decrease in parental depression or anxiety (SMD −0.50, 95% CI −0.96 to −0.04; P = 0.03; 1 study, 75 participants). There may also be a moderate to large decrease in parenting stress (SMD −0.79, 95% CI −1.80 to 0.23; P = 0.13, I2 = 82%; 2 studies, 112 participants) and a small improvement in parent mindfulness (SMD 0.21, 95% CI −0.14 to 0.56; P = 0.24, I2 = 69%; 3 studies, 515 participants), but we were not able to exclude little to no effect for these outcomes.

Mindfulness-enhanced parent training programmes compared to parent training with no mindfulness component

Very low certainty evidence suggests there may be little to no difference postintervention in child emotional and behavioural adjustment (SMD −0.09, 95% CI −0.58 to 0.40; P = 0.71, I2 = 64%; 5 studies, 203 participants); parenting skills (SMD 0.13, 95% CI −0.16 to 0.42; P = 0.37, I2 = 16%; 3 studies, 319 participants); and parent mindfulness (SMD 0.11, 95% CI −0.19 to 0.41; P = 0.48, I2 = 44%; 4 studies, 412 participants). There may be a slight decrease in parental depression or anxiety (SMD −0.24, 95% CI −0.83 to 0.34; P = 0.41; 1 study, 45 participants; very low certainty evidence), though we cannot exclude little to no effect, and a moderate decrease in parenting stress (SMD −0.51, 95% CI −0.84 to −0.18; P = 0.002, I2 = 2%; 3 studies, 150 participants; low certainty evidence).