Mindfulness-Enhanced Parenting Programs Improve the Psychosocial Outcomes of Children up to 18 Years and Their Parents

Do mindfulness-enhanced parenting programs improve child-or parent-related outcomes in families with children with emotional and behavioral difficulties?

When compared with no treatment, mindfulness-enhanced parent training programs result in a small improvement in parenting skills (standardized mean difference [SMD] = 0.22; 95% CI, 0.06 to 0.39) and a moderate decrease in parental depression or anxiety (SMD = −0.50; 95% CI, −0.96 to −0.04).¹ The addition of a mindfulness component to parent training programs decreases parenting stress compared with programs that do not include mindfulness (SMD = 0.51; 95% CI, −0.84 to −0.18). No studies reported on adverse effects.¹ (Strength of Recommendation: B, low-quality, patient-oriented evidence.) Uniform assessments for emotional and behavioral difficulties were lacking, interventions were heterogeneous, patients typically knew what treatment they received, and these interventions can be challenging to implement; thus, these conclusions may not yet change clinical practice.

Emotional and behavioral difficulties in children are common; are an important cause of functional disability; and are predictive of subsequent poorer psychosocial, academic, and occupational functioning in adolescence and adulthood.¹ These difficulties can be characterized as internalizing behaviors, such as anxiety and depression, and externalizing behaviors, such as aggression and hyperactivity.¹ The relationship between parenting and emotional and behavioral difficulties has been described as bidirectional; behavioral or skills-based parenting training has been shown to be highly effective in addressing these difficulties in children.¹ Mindfulness parenting techniques use strategies to achieve change through acceptance and nonjudgment of present experience, which may be a more effective method of facilitating the extinction of unwanted thoughts, feelings, and impulses. Mindfulness parenting interventions have demonstrated some effectiveness in improving child outcomes (internalizing and externalizing behaviors) via improvements in parental emotional regulation, and mindfulness training might enhance the effectiveness of standard parent training programs.¹ The authors of this Cochrane review sought to assess the effectiveness of mindfulness-enhanced parent training programs on the psychosocial functioning of children up to age 18 years and their parents.

This review involved 11 studies with a total of 2,118 parent-child participants. It included studies whose interventions were mindfulness-enhanced parent training programs defined as a standardized intervention over a specified period that included mindfulness training (eg, breath, visualization, listening, other sensory focus) and an explicit focus on present-focused attention and nonjudgmental acceptance. Five of the 11 studies were conducted in the United States, with the others conducted in Australia, Germany, the United Kingdom, Canada, and Israel. Six studies focused on children with specific behavioral, developmental, or physical diagnoses (eg, attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder, conduct disorder), three targeted a specific parent qualifier (eg, substance misuse, recent military deployment). Mindfulness-enhanced parenting programs were compared with no intervention, wait-list, or attention control, or a parent training program without mindfulness components. Results were analyzed for impact of interventions on child and parental psychosocial functioning (eg, child emotional and behavioral adjustment, parenting skills, parental depression or anxiety, parenting stress, parental mindfulness) using various questionnaires. Session interventions typically were 1 to 2 hours in length, and follow-up lasted 6 to 12 weeks.