Master's Project Title:

The Effectiveness of Mindfulness Parent Training Interventions on Improving Parent – Child Relationships, Social and Emotional Competence, and Mental Health in Early Childhood: A Systematic Review

MCH Student:

Troy Hanson, MD

Date of Defense:

August 5, 2013

Abstract:

Background
Over the past 20 years, there has been a dramatic increase in the incidence and prevalence  of child and adolescent mental health problems in the  United States as well as throughout  the world. In fact, currently in the U.S., mental health problems account for a majority of  overall child and adolescent morbidity and mortality. Mental health problems have  complex, multifactorial etiologies, but ultimately manifest as a result of underlying  abnormalities or alterations in brain architecture and wiring. Often these wiring  abnormalities emerge during sensitive and critical periods of rapid brain growth in  infancy and early childhood. Parenting and parent – child relationship quality significantly  influence early brain development. Preliminary research on the use of mindfulness parent  training as an intervention/prevention tool has demonstrated improvements in parenting  and parent – child relationship quality a s well as subsequent child and adolescent brain  development, social and emotional competence, and mental health outcomes.

Objective
Through systematic review, the objectives of this review were to determine if  mindfulness parent training (MPT) interventions targeting parents of young children  (prenatal to age 8) effectively: 1) reduce the incidence, prevalence, and severity of child  mental health problems; and/or 2) improve intermediate outcomes associated with  improved child social and emotional brain development and mental health outcomes  (e.g., parent and child social and emotional competence, attachment security, etc.).

Methods
Searches of Cochrane Central Library, PubMed, MEDLINE, PsycINFO, SCOPUS, and  Digital Dissertations electronic databases for prospective controlled and uncontrolled  clinical trials investigating MPT interventions over the past 20 years (1993  – present),  and applying additional pre – defined inclusion and exclusion criteria, were performed in  February 2013. Outcomes were categorized as child-centered, parent – centered, and  parent – child relationship centered.

Results
Nine studies were ultimately included in the review (6 randomized controlled trials and 3  uncontrolled trials). The small total number of included studies as well as t he  heterogeneity of study types, outcomes measured, measurement tools utilized, and data  analysis and synthesis methods performed precluded quantitative meta – analysis. Final  conclusions on treatment effects were based on relative comparisons of the outcome s data  at the level of overall statistical significance.

A total of 90 outcomes were measured and analyzed in the studies, with 89 showing  improvements and benefit from MPT interventions. However, removing data from  uncontrolled trials as well as that which was not statistically different from control group,  statistically significant improvements remained in: child emotional and behavioral  problems; several child social and emotional competence outcomes (e.g., pro – social  behaviors, emotion recognition, emotion regulation, executive functioning, etc.); child  psychosocial impairment; child cognitive development; attachment relationship quality;  parent emotion socialization beliefs and practices; parent emotion awareness and  regulation; overall general parent ing competence; parenting stress; and parent mental  health/substance abuse problems.

Most demonstrated benefits were small – to – modest according to several different  statistical measures of significance (e.g., effect sizes,  z – scores,  t – tests,  F – tests, etc. ).  Because the maximum follow – up period was seven months, longer – term duration of  effects could not be determined.

Study quality, level of certainty in net benefit, and strength of evidence were low and  risks of bias high in all included individual studies as well as the overall review.

Conclusions
Currently available evidence on MPT interventions is insufficient to adequately ascertain  their effects on the incidence, prevalence, or severity of child mental health problems and  other intermediate outcomes on the developmental pathway of life course mental health  and well – being. Longer, large – scale, high – quality population – and  primary prevention – based trials are necessary to identify any potentially significant public health and human  capital benefits. However, because of theoretical and preliminary empirical trends of  benefit without identified significant harm, it would seem reasonable to consider  integrating or adding mindfulness theory and practices into current evidence – based parent  training programs (e.g., behavior – based parent training programs) in order to further  improve parent and child social and emotional development  and mental health outcomes  during highly sensitive and critical periods of early neurodevelopment.