Theses Doctoral

Opening the Blackbox of parenting programs: Mediating pathways in parenting programs to prevent externalizing problems and disorders in children and adolescents

Restrepo, Alexandra

(1) Problem: Previous evidence showed that parenting programs effectively reduce externalizing problems and disorders in children living in high-income countries. However, there was less evidence about the effectiveness of parenting programs in low- and middle-income countries (LMICs). In addition, there is a need for more studies that assess how parenting practices and family characteristics mediate the effects of parenting programs. The overall goal of this dissertation was to contribute to closing the gap in the evidence regarding the efficacy of parenting programs in and low- and middle-income countries. Also, this dissertation intended to increase the evidence regarding how parenting practice (i.e., supervision, parent child communication, and punishment) meditate the effects of parenting programs high-income and low- and middle-income countries.

(2) Materials and methods: First, in chapter 2, I conducted a systematic review to synthesize the evidence regarding how parenting practices and family variables mediated the parenting programs effects. In chapter 3, I assessed the effect of Pilas program on child’s oppositional and conduct problems and aggressive behaviors. Also, I examined the mediating mechanism though parent-child communication, supervision, and punishment. Pilas was a multimodal program designed and implemented in Medellin Colombia. The program was evaluated through a cluster randomized control trial, including children aged 6-11 who were followed at baseline, 1-, and 3-year assessments.

In chapter 4, I assessed how parent-child communication and supervision mediated the effect of Fast Track Project (FTP) on antisocial behaviors at grade 7 and 9, exploring the mediating mechanism of FTP in the early- and middle-adolescence. FTP is a multimodal intervention that aim to reduce conduct problem in childhood in four communities of the USA (Durham, NC, Nashville, TN, rural PA, and Seattle, WA.). (3) Results and conclusions: In the chapters 2, the systematic review showed that positive parenting and parental discipline had been the most studied mediators of parenting programs. However, there was limited evidence or methodological problems regarding other mechanisms (i.e., supervision, family functioning, parent-child relationships, harsh parenting, and ineffective discipline). In addition, few articles studied the medium (3-5 years follow-up) and long-term (more than 5 years) mediating mechanisms, and no articles assessed mediation mechanisms in low- and middle-income countries. Among, the most important methodological problems were the lack of control for confounding in the Mediator-Outcome pathway (M-Y pathway) and underreporting of the mediating results.

In chapter 3, I presented the Pilas effects and mediated mechanisms. Children exposed to Pilas had 22% fewer conduct problems, 32% fewer oppositional problems, 36% less indirect aggression, 15% less total aggressive behaviors, and 22% less direct aggression. On the other hand, there were not program effects on child behaviors based on caregivers' reports.

In addition, after three years of follow-up, Pilas reduced the number of psychological and psychical punishments reported by the children, but it did not have an effect on punishment as reported by caregivers. Pilas improved parent-restricted topics and role orienting reported by the caregivers. However, the Pilas effects were not mediated through the target mediators (supervision, parent-child communication, and punishment) so the mediation mechanisms remain unknown.

Chapter 4 presented the medium- and long-term mediating mechanism of Fast-track project. I found that parent-child communication and supervision were not mediators of FTP effects on antisocial behaviors during early- and middle- adolescence. However, FTP improved antisocial behavior in early- and middle-adolescents and improve parenting practices such as parent-child communication and supervision. FTP reduced child antisocial behaviors in grades 7 and 9 and improved child communication and total communication and supervision variables, such as daily discussion of activities and curfew time.

Finally, chapter 5 presented the most important dissertation findings and conclusions. There is evidence about the mediating mechanism of parenting programs. However, the evidence available is not conclusive and had multiple methodological weakness and underreporting. Pilas programs improved children’s conduct problems, oppositional problems and aggressive behavior and reduces punishment against the children. However, the program effect was not mediated through parenting practices. Regarding FTP, the program effects of antisocial behaviors were not mediated through parent-child communication and supervision during early- and middle- adolescence. Further studies should be conducted to enlarge the evidence about the effects of parenting programs on LMIC and research about how parent-child communication meditate the effects of parenting programs in both LMIC and HIC.

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More About This Work

Academic Units
Thesis Advisors
Keyes, Katherine M.
Ph.D., Columbia University
Published Here
January 25, 2023