Troy Hanson, MD
Date of Defense:
August 5, 2013
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.
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.).
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.
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.
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.