Parenting a child with a disability can be challenging and identifying effective support and interventions for these caregivers is therefore a priority. But our understanding of what kind of interventions are most effective, and what supports or limits engagement, acceptability and effectiveness of these programmes, is only partial.
Therefore, in this evidence review, we employed an umbrella review, meta-analysis and meta-synthesis to investigate the current evidence base on parenting interventions for parent carers of children and young people with a wide range of disabilities, including those with special educational needs.
The review followed established evidence synthesis methods to identify published and unpublished evidence that describes outcomes for disabled children and young people and their caregivers from robust impact evaluations of interventions using experimental and quasi-experimental designs. The review also identified qualitative research answering questions on the implementation and experiences of interventions.
The PRISMA checklist was used to guide the conduct and reporting of the review, and the PRO EDI framework was used to guide the integration of equality, diversity, and inclusion principles in the review. A review protocol was developed a priori and published on Foundations website, as well as the Open Science Framework.
Of the studies included in this review, 213 randomised controlled trials looked at the impact of programmes, and 115 qualitative studies looked at the experiences of parent carers in relation to a parenting programme. 106 systematic reviews were also included in the umbrella review to provide a consolidated understanding of the effectiveness of parenting interventions for parent carers and disabled children and young people.
Overall, the umbrella review found that parenting interventions in general showed evidence of effectiveness on a range of child outcomes, including improvements in behaviours that challenge, communication skills, and psychosocial functioning across various child populations (e.g., autistic children and young people, and those with attention deficit hyperactivity disorder (ADHD), cerebral palsy, brain injury, and intellectual disability). Most systematic reviews also reported positive effects on parental outcomes, such as reduced stress levels, enhanced parental competencies, and improved parent-child interactions.
Findings from the meta-analysis of 213 randomised controlled trials showed that parenting interventions, on average, had positive effects on child-related outcomes, while evidence from 108 studies demonstrated similarly positive effects on parent-related outcomes. These effects remained consistent after removing low quality studies or studies with high risk of bias.
The GRADE framework was used to assess the certainty of the evidence from meta-analysis, and this concluded that there was high-certainty of evidence that, on average, parenting interventions are effective for improving both child- and parent-related outcomes across all ages and disabilities studied.
A meta-regression was used to explore potential demographic factors and intervention components that may have contributed to differences in effectiveness of interventions. For child-related outcomes, younger children (<6 years) benefited most from interventions, with effectiveness diminishing in older age groups, particularly those aged 13–25 years. In contrast, parent-related outcomes showed no clear age-related patterns.
A key finding from the meta-synthesis suggests that it is crucial to deliver interventions in a way that is perceived as practical and accessible. However, the findings also suggest that there is no one way of making an intervention accessible: this must be considered in relation to the caregivers’ own context and needs. The meta-synthesis also indicates that there is no one-size-fits-all solution for intervention delivery: the same formats that are seen positively by some parents (e.g., attending a group intervention that fosters a sense of shared experience) might be seen negatively by others (e.g., feeling demoralised).
Overall, the review provides clear evidence that parenting interventions should be considered as a first line of support for parent carers of children with a wide range of disabilities. The evidence shows that parenting interventions are effective for these groups of parent carers and children and young people, and a range of delivery approaches can be helpful
More specifically, parenting interventions targeted at younger children (<6 years) appear to be the most effective, with the effectiveness of parenting interventions on child-related outcomes decreasing as the child’s age increases, especially for children and young people aged 13-24. However, the difference in effectiveness of parenting interventions across child age groups was not found with regard to parent-related outcomes, such as parenting stress. This suggests that parent carers of children of all ages can be helped by parenting interventions, but the impact of those interventions on a range of child-related outcomes may decrease, emphasising the importance of early intervention.
While both face-to-face and remote interventions were found to be equally effective on average, future interventions should consider the specific context and needs of the families they aim to support. There is no ‘one size fits all’, and services should be able to provide a ‘personalised’ approach, which takes into account the specific needs and preferences of children and their caregivers.
Ultimately, practitioners should focus on customising intervention approaches to the specific demographic, developmental, and disability-related factors that influence outcomes.
Parenting interventions should be tailored to address the specific needs of children and their families, accounting for age, type of disability, and cultural context – for example, flexible delivery formats, including telehealth and home-based programmes, can improve accessibility for diverse populations.
You can view the project linked to this publication here:
Rated 1: Set up and delivery is low cost, equivalent to an estimated unit cost of less than £100.
Rated 2: Set up and delivery is medium-low cost, equivalent to an estimated unit cost of £100–£499.
Rated 3: Set up and delivery is medium cost, equivalent to an estimated unit cost of £500–£999.
Rated 4: Set up and delivery is medium-high cost, equivalent to an estimated unit cost of £1,000–£2,000.
Rating 5: Set up and delivery is high cost. Equivalent to an estimated unit cost of more than £2,000.
Set up and delivery cost is not applicable, not available, or has not been calculated.
Click here for more information.
Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient montes, nascetur ridiculus mus.
Supporting children’s mental health and wellbeing: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing child maltreatment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Enhancing school achievement & employment: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing crime, violence and antisocial behaviour: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing substance abuse: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing risky sexual behaviour & teen pregnancy: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Preventing obesity and promoting healthy physical development: Lorem ipsum dolor sit amet, consectetuer adipiscing elit. Aenean commodo ligula eget dolor. Aenean massa. Cum sociis natoque penatibus et magnis dis parturient.
Rated 2: Has preliminary evidence of improving a child outcome from a quantitative impact study, but there is not yet evidence of causal impact.
Rated 2+: Meets the level 2 rating and the best available evidence is based on a study which is more rigorous than a level 2 standard but does not meet the level 3 standard.
Rated 3: Has evidence of a short-term positive impact from at least one rigorous study.
Rated 3+: Meets the level 3 rating and has evidence from other studies with a comparison group at level 2 or higher.
Rated 4: Has evidence of a long-term positive impact through at least two rigorous studies.
Rated 4+: Meets the level 4 rating and has at least a third study contributing to the Level 4 rating, with at least one of the studies conducted independently of the intervention provider.
Rating has a *: The evidence base includes mixed findings i.e., studies suggesting positive impact alongside studies, which on balance, indicate no effect or negative impact.
Click here for more information.