Updated 15 February 2019

Kids do better at therapy when parents are present

Children with behavioural disorders interact better with a therapist when their parents are in the room, a new study has found.

ADHD which include behaviours such as temper tantrums, interpersonal aggression and defiance, impact an estimated 3.5 percent of kids and teens, researchers note in the journal Pediatrics.

In their analysis of previous studies of interventions, they found that while any therapy was better than none, the children didn't respond as well to on their own as they did to approaches focused on their parents.

"Common sense and research evidence suggest that parent involvement is important to a wide range of psychosocial interventions for children, not just those aimed at alleviating disruptive child behaviour," said lead author Richard Epstein, a research fellow at the Chapin Hall Centre for Children at the University of Chicago, who did the analysis while at Vanderbilt University in Nashville. 

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Parents had the biggest impact on the outcomes of therapy for preschoolers and for kids in elementary school, rather than for teenagers, the study found.

Many studies included in the analysis lacked outcomes data from independent observations of children by researchers who didn't know what type of treatment the kids received, the authors acknowledge. And few of the studies directly examined child-only approaches.

Even so, the authors conclude that parent involvement, either alone or in combination with other components of therapy, is more likely to help children improve their behaviour than leaving parents out of the mix.

"Disruptive child behaviour doesn't occur in a vacuum, and parent-child interactions are the primary context within which child development unfolds," Jonathan Comer, a researcher at the Centre for Children and Families at Florida International University in Miami, said by email.

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"When it comes to treating ADHD, you just don't get much traction without working on how the adults in children's lives respond to children's disruptive behaviours," Comer added by email.

The findings should offer some reassurance to parents who want to try therapy for their children before turning to medication to address behavioural disorders, noted Daniel Bagner, also of the Centre for Children and Families.

"While medication can sometimes be helpful when problems are complex and include extremely challenging behaviours (e.g. severe aggression), it should only be used in conjunction with psychosocial treatment," Bagner, who wasn't involved in the study, said by email.

Read: Kids with ADHD may gain more from family-centred care

Parents can make therapy more successful for their children because when kids are treated on their own, the lessons may be hard for them to apply in the settings where they have behavior problems, like home, school or the playground, said Ricardo Eiraldi, a researcher in paediatric psychology at the University of Pennsylvania Perelman School of Medicine in Philadelphia.

When parents are involved, therapy can help them learn behaviour management strategies to help their children improve, Eiraldi, who wasn't involved in the study, added by email. Successful approaches might include praise for good behaviour, ignoring minor misbehaviour, giving effective commands, and letting the child earn rewards for behaving according to expectations, he said.

The paper also offers more evidence that parents can help kids most by getting involved in therapy sooner, Matt Burkey, a researcher at Johns Hopkins University who wasn't involved in the study, said by email.

"The findings of this analysis support the idea that earlier interventions, especially in the preschool period, are more effective," Burkey said. "Once children are older, parents have somewhat less influence over children's behaviour.

Read more:

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Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

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