Introduction
Child Outcomes
Parenting Ability
Parent Outcomes
The Present Review
Method
Protocol and Registration
Participants
Interventions
Comparisons
Outcomes
Study Designs
Search Strategy
Construct keyword | Construct terms |
---|---|
Child-Behavior AND | ODD OR Conduct OR IED OR behavio* OR ADHD OR disrupt* OR opposit* OR hyperact* OR attention OR aggress* OR tantrum OR dysreg* OR emot* OR defian* OR anti-social OR disord* OR external* OR impuls* OR anger |
Treatment AND | Behavio* OR family OR interven* OR parent* OR program* OR train* OR treat* OR coach* OR educat* OR psych* OR therap* OR manag* OR child* OR infan* OR you* OR juvenile OR minor OR toddler OR early year* OR preschool OR primary OR school-aged* OR dependent OR kinder* OR prep* OR mother* OR father* |
Online | Internet OR net OR web OR on-line OR digital OR distance OR remote OR comput* OR etherapy OR tele-health OR eHealth OR stream* OR electronic* OR virtual |
Study Selection
Data Extraction and Management
Risk of Bias Assessment
Statistical Analyses
Results
Study Characteristics
Study (Author, year, country) | Program | Duration and delivery | Design intervention/comparison | Inclusion criteria | Sample size | Child and parent demographic characteristics | Child outcomes (behavior) | Parenting ability (PSE and relational) | Parent outcomes (regulation and stress) |
---|---|---|---|---|---|---|---|---|---|
Baker et al. (2017) Australia | Triple P Online Brief | 8 weeks Self-administered | RCT (2 groups) Intervention Internet as usual wait list control Pre/post/FU @ 9 months | Child 2–9 years old Scores in borderline clinical range or higher on SDQ | n = 200 Intervention (n = 100) Control (n = 100) | Child: Sex: Male TPOL = 52%, WLC = 58% x̄ age: TPOL = 4.57 years WLC = 4.26 years Parent: Sex: TPOL = 92% female WLC = 92% female x̄ age: TPOL = 35.74 WLC = 35.75 Relationship: TPOL = 83% married WLC = 81% married Education: TPOL = 56% university WLC = 56% university | ECBI – P/I CAPES | CAPES BCPC PCPTOS | PAI PPC DASS-21 PS |
Breitenstein et al. (2016) USA | ezParent adaptation of the Chicago Parent Program | 6 sequential modules + review Self-administered | RCT (2 group) Intervention Attention control condition (information already available in the public domain) Pre, post @12 and 24 weeks | Child 2–5 years old Low-income ethnic minority parents of young children Primary care pediatric clinic patients | n = 79 Intervention (n = 40) Control (n = 39) | Child: Sex: ezP = 57% female Control = 56.4% female Age: ezP = 36.7% 4 years Control = 35.9% 4 years Parent: Sex: ezP = 57% female Control = 56.4% female Age: ezP = 36.7% 4 years Control = 35.9% 4 years Relationship: exP = 60.8% never married Control = 53.8% never married Education: ezP = 62% College/AD Control = 59% College/AD | ECBI P/I | PQ TCQ | PSI-SF |
Breitenstein et al. (2021) USA | ezParent adaptation of the Chicago Parent Program | 6 sequential modules + review Self-administered | RCT (2 group) Intervention Control Health Promotion Website (comprised of information available in the public domain) Pre, and 3, 6, and 12 months post baseline | Child 2–5 years old Primary care patients | n = 287 Intervention (n = 146) Control (n = 143) | Child: Sex: ezP = 47.2% female Control = 51.7% female Age: ezP = x̄ not provided Control = x̄ not provided Parent: Sex: ezP = 90.3% mothers Control = 92.3% mothers x̄ age: ezP = not provided Control = not provided Relationship: exP = 54.9% never married Control = 51.7% never married Education: ezP not provided Control not provided | ECBI P/I SDQ | PARYC PQ PSOC | PSI-SF |
Carta et al. (2013) USA | Safe Care Planned Activities Training (PAT) | 5 sessions Home visit + telephone support | 3 arm RCT (inc. 2 groups) Intervention CPAT Waitlist control Pre, post, FU @ 6 months | Child 3.5–4.5 years Mother under 18 at first child’s birth across conditions High School Diploma or less across conditions | n = 371 Intervention (n = 113) WLC (n = 116) | Child: Sex: 56% male across conditions Age: x̄ age 4.56 across conditions Parent: Sex: CPAT: 100% female WLC: 100% female x̄ age: CPAT 29.02 WLC 28.66 Relationship: CPAT: 62.8% partnered WLC: 66.4% partnered Education: CPAT: 3.7% university WLC: 4.5% university | BASC-2 | CBRS KIPS | PSI-SF BDI-II PS |
Day and Sanders. (2018a) Australia | Triple P Online (TPOL) | 8 weeks (on-line up to 4 months) Self-directed | 3 arm RCT (inc. 3 groups) Intervention TPOL Waitlist control Pre, post, FU @ 5 months | Child 2–8 years To meet at least one additional socioeconomic or family risk factor associated with child social, emotional, or behavioral problems Score 5 or more on PPC | n = 183 TPOL (n = 57) Waitlist control (n = 60) | Child: Sex: Male TPOL = 42.10% WLC = 55.00 x̄ age: TPOL = 3.44 WLC = 3.43 Parent: Sex: TPOL = 94.70% female WLC = 98.30% female x̄ age: TPOL = 34.81 years WLC = 34.50 years Relationship: TPOL = 89.50% partnered WLC = 91.70% partnered Education: TPOL 65.00% university WLC 65.00% university | ECBI – P/I | RQI PDR PTC | DASS-21 PAI PS PPC |
Dayand Sanders. (2018b) Australia | Triple P Online enhanced (TPOLe) | 8 weeks (on-line up to 4 months Self-directed + clinical telephone support) | 3 arm RCT (inc. 3 groups) Intervention TPOLe Waitlist control Pre, post, FU @ 5 months | Child 2–8 years To meet at least one additional socioeconomic or family risk factor associated with child social, emotional, or behavioral problems Score 5 or more on PPC | n = 183 TPOLe (n = 66) WLC (n = 60) | Child: Sex: Male TPOLe = 42.40%, WLC = 55.00 x̄ age: TPOLe = 3.44, WLC = 3.69 Parent: Sex: TPOLe = 95.30% female WLC = 98.30% female x̄ age: TPOLe = 35.45 years WLC = 34.50 years Relationship: TPOLe = 86.40% partnered WLC = 91.70% partnered Education: TPOLe 57.60% university WLC 65.00% university | ECBI – P/I | RQI PDR CSQ PTC | DASS-21 PAI PS PPC |
Du Paul et al. (2018) USA | Project PEAK | 10, weekly Self-directed + clinical telephone support | 3 arm RCT (inc. 2 groups) Online intervention Waitlist control Pre, mid, post treatment | Child 3 – 5.11 years Met diagnostic criteria for one of 3 presentations of ADHD, risk for ODD | n = 47 Online intervention (n = 15) WLC (n = 16) | Child: Sex: Male Online = 60%, WLC = 81.25% x̄ age: PEAK = 4.52, WLC = 4.27 Parent: Sex: PEAK = 92% female WLC = 92% female x̄ age: PEAK not provided WLC not provided Relationship: PEAK not provided WLC not provided Education: PEAK 53.3% university WLC 62.5 university | CERS | IRP-15 | PSI-SF PS |
Ehrensaft et al. (2016) USA | Triple P Online (TPOL) | 8, weekly Self-directed | RCT (2 groups) Online intervention Waitlist control Pre, post, FU | Child 2–6 years PSI Total Stress Scale scores exceeding the scale mean of 69 were eligible | n = 52 Online intervention (n = 26) WLC (n = 26) | Child: Sex: TPOL and WLC not provided Age: TPOL and WLC = 2–6 Parent: Sex: TPOL and WLC all female x̄ age: TPOL = 23.76 WLC = 24.97 Relationship: TPOL and WLC not provided Education: POL and WLC all currently attending university | PSI-SF PS | ||
Enebrink et al. (2012) Sweden | Internet Based Parent training (PMT) | 10, weekly Self-directed + non-clinical telephone support | RCT (2 groups) Intervention Waitlist control | Child 3–12 years 1 SD above the mean of the ECBI Scores above ECBI cut off (> 114) | n = 104 Intervention (n = 58) Control (n = 46) | Child: Sex: Male Online = 60% WLC = 81.25% x̄ age: PEAK = 4.52, WLC = 4.27 Parent: Sex: PEAK = 92% female WLC = 92% female x̄ age: PEAK not provided WLC not provided Relationship: PEAK not provided WLC not provided Education: PEAK 86% university WLC 93.5% university | ECBI – P/I SDQ | PPI | |
Fossum et al. (2018) Canada/ Finland | Strongest Families Smart Website (SFSW) | 11, weekly Self-directed + clinical telephone support | RCT (2 groups) Intervention non-treatment control Pre, 6 and 12 months post | Child 4 years Scored 5 + on the SDQ CD subscale | n = 464 Intervention (n = 232) | Child: Sex: not provided Age: 4 year children Parent: Sex: SFSW = 90% female WLC = 93% female x̄ age: Male SFSW = 33.2 Female = 30.5 Male WLC = 31.4 Female = 29.8 Relationship: SFSW not reported WLC = not reported Education: SFSW 57.4 university WLC 58% university | CBCL 1.5–5 | Barkley’s Adult AD/HD Quick Screen | DASS 21 PS |
Franke et al. (2020) New Zealand | Triple P online | 16, weekly Self-help | RCT (2 groups) Intervention Delayed Intervention Pre, post, FU 6 months | Child 3–4 years Met cut off criteria on WWP (≥ 14) and PACS (≥ 16) | n = 53 Intervention (n = 27) Delayed intervention (n = 26) | Child: Sex: Male = 71.7% across conditions Age: 3 and 4 year old children Parent: Sex: not provided x̄ age: mothers = 35.4 across conditions fathers = 38.8 across conditions Relationship: not provided Education: 55.7% of mothers university degree | Connors EC-BEH CBS SDQ | ASRS PSDQ-A PSOC CSQ | DASS-21 PS |
Porzig-Drummond et al. (2015) Australia | 123 Magic | 3 h 46 min of videos + tip sheets. Self-directed video-based | RCT (2 groups) Intervention Delayed Intervention Pre, post, FU 6 months | Child aged 2–10 Falls within the clinical range on the PSI-SF | n = 84 Intervention (n = 43) WLC (n = 41) | Child: Sex: Male 123 Magic = 62.1% WLC = 39.4% x̄ age: 123 Magic = 5.21 WLC = 5.33 Parent: Sex: 123 Magic = 86.2% female WLC = 90.9% female x̄ age: 123 Magic = 37.8 WLC = 38.61 Relationship: 123 Magic not reported WLC not reported Education: 123 Magic 96.6% university WLC 90.1% university | ECBI – P/I | PSI-SF DASS-21 | |
Sanders et al. (2012) Australia | Triple P online | 8, weekly Self help | RCT (2 groups) Intervention Internet as usual control (information already available in the public domain) Pre, post, FU 6 months | Child 2–9 years Elevated levels of child behavior problems on ECBI | n = 116 Intervention (n = 60) Control (n = 56) | Child: Sex: Male TPOL = 70% WLC = 64 x̄ age: TPOL = 4.92 WLC = 4.41 Parent: Sex: TPOL = 90% female WLC = 93% female x̄ age: TPOL = 37.62 WLC = 37.11 Relationship: TPOL = 88 partnered WLC = 91% partnered Education: TPOLe 57% university WLC 59% university | ECBI – P/I SDQ – C/E | PTC FOS | DASS-21 PAI – P/I PS PPC – P/E |
Sourander et al. (2016) Finland | Strongest Families Smart Website (SFSW) | 11 weeks Self-directed parent training + weekly telephone coaching | RCT (2 groups) Intervention WLC (Website (information already available in the public domain) Pre, 6 and 12 months FU | Child aged 4 years Score of > 5 on conduct problems subscale of SDQ | n = 464 Intervention n = 232 Control n = 232 | Child: Sex: Male SFSW = 61.20% WLC = 62.5 age: 4 years old across groups Parents: Sex: SFSW = 90% female WLC = 93% female x̄ age: Male SFSW = 33.2, Female = 30.5 Male WLC = 31.4, Female = 29.8 Relationship: SFSW not reported WLC = not reported Education: SFSW 57.4 university WLC 58% university | SDQ – C CBCL – E ICU | SOC-13 | DASS-21 PS PPC |
Population and Sample Demographics
Study Design
Intervention Characteristics
Module Progression and Completion
Psychometric Assessment
Parental Support
Quality Assessment
Study (author, date) | Random sequence allocation (selection bias) | Allocation concealed (selection bias) | Blinding of study personnel (performance bias) | Blinding of outcome assessment (detection bias) | Incomplete outcome data addressed (attrition bias) | Free of selective reporting (selective reporting) | Free of other bias | Overall rating |
---|---|---|---|---|---|---|---|---|
Baker et al. (2017) | Low risk | Low risk | High riskc | High riskd | Low risk | Low risk | High riskik | High risk |
Breitenstein et al. (2016) | Low risk | Low risk | High riskc | High riskd | Low risk | Low risk | High riskd | High risk |
Breitenstein et al. (2021) | Low risk | Low risk | High riskc | High riskd | Low risk | Low risk | High riskd | High risk |
Carta et al. (2013) | Uncleara | Unclearb | High riskb | Low risk | Low risk | Low risk | High riskl | High risk |
Day and Sanders (2018) | Low risk | Low risk | High riskc | High riskd | High riskf | Unclearh | High riskik | High risk |
Day and Sanders (2018) (TPOLe) | Low risk | Low risk | High riskc | High riskd | High riskf | Unclearh | High riskik | High risk |
Du Paul et al. (2018) | Uncleara | Unclearb | High riskc | High riskd | Unclearg | Unclearh | High riskkm | High risk |
Ehrensaft et al. (2016) | High riska | High riskb | High riskc | High riskd | Low risk | Low risk | High riskl | High risk |
Enebrink et al. (2012) | Low risk | Low risk | High riskc | High riskc | High riskg | Unclearh | High riskkl | High risk |
Fossum et al. (2018) | Low risk | Unclearb | High riskc | High riskc | Low risk | Low risk | High riskdi | High risk |
Franke et al. (2020) | Low risk | Unclearb | High riskc | High riskd | Low risk | Low risk | High riskikm | High risk |
Porzig-Drummond et al. (2015) | Low risk | Low risk | Unclearc | Unclearc | Low risk | Low risk | High riskdh | High risk |
Sanders et al. (2012) | Low risk | Unclearb | High riskc | High riskd | Low risk | Unclearh | High riskijk | High risk |
Sourander et al. (2016) | Low risk | Low risk | High riskc | High riskc | Low risk | Low risk | High riski | High risk |

Effect on Child Outcomes
Effect on Parenting Ability
Effect on Parent Outcomes
Parent regulation—Anger
Parent Regulation—Stress
n-studies | Hedges-g | SE | 95% CI | z value | Q | I2 | |
---|---|---|---|---|---|---|---|
Child behavior within | 10 | 0.83*** | 0.17 | 0.50–1.16 | 4.99 | Q(9) = 85.07*** | 89.42 |
Child behavior between | 10 | 0.42*** | 0.12 | 0.20–0.65 | 3.67 | Q(9) = 37.68*** | 76.11 |
Parenting self-efficacy within | 8 | 0.86*** | 0.20 | 0.47–1.25 | 4.28 | Q(7) = 48.28*** | 87.57 |
Parenting self-efficacy between | 7 | 0.37*** | 0.14 | 9.10–0.63 | 2.71 | Q(6) = 23.34*** | 74.29 |
Parent–child relational development within | 4 | 0.68 | 0.08 | − 0.09 to 0.30 | 0.83 | Q(3) = 0.86 ns | 0.00 |
Parent–child relational development between | 4 | 0.07 | 0.08 | − 0.10 to 0.23 | 0.81 | Q(3) = 0.74 ns | 0.00 |
Parent emotion regulation—anger within | 7 | 0.40*** | 0.06 | 0.24–0.48 | 5.85 | Q(5) = 3.40 ns | 0.00 |
Parent emotion regulation—anger between | 6 | 0.50*** | 0.15 | 0.20–0.79 | 6.49 | Q(7) = 24.23*** | 79.37 |
Parent emotion regulation—stress within | 9 | 0.41*** | 0.09 | 0.23–0.60 | 4.37 | Q(8) = 20.63*** | 61.23 |
Parent emotion regulation—stress between | 10 | 0.28*** | 0.05 | 0.19–0.38 | 5.68 | Q(9) = 5.93 ns | 0.00 |
Moderation Analyses
Study | Potential continuous moderators | Potential categorical moderators | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Number of Sessions | Number experimental group | Age experimental group | % Male experimental group | FU months | Parent Sex (f) | Parent Edu (Uni) | F2F Initial Session | Therapeutic telephone support | Therapeutic written support | Text prompts | |
Baker et al. (2017) | 8 | 200 | 4.54 | 52 | 36 | 92 | 56 | 0 | 0 | 0 | 0 |
Breitenstein et al. (2016) | 6 | 40 | 4 | 43 | 24 | 57 | 62 | 1 | 0 | 1 | 1 |
Breitenstein et al. (2021) | 6 | 287 | 53 | 52 | 90 | 1 | 0 | 1 | 1 | ||
Carta et al. (2013) | 5 | 113 | 4.56 | 56 | 26 | 100 | 3.7 | 1 | 1 | 0 | 1 |
Day and Sanders (2018) | 8 | 57 | 3.44 | 42.1 | 22 | 94.7 | 65 | 0 | 1 | 0 | 1 |
Day and Sanders (2018) (TPOLe) | 8 | 66 | 3.44 | 42.4 | 22 | 95.3 | 57 | 0 | 1 | 0 | 1 |
DuPaul et al. (2018) | 10 | 15 | 4.52 | 60 | 92 | 29 | 1 | 1 | 0 | 0 | |
Ehrensaft et al. (2016) | 8 | 26 | 4 | 1 | 1 | 1 | 1 | ||||
Enebrink et al. (2012) | 7 | 58 | 4.52 | 60 | 26 | 92 | 86 | 0 | 1 | 1 | 0 |
Fossum et al. (2018) | 12 | 232 | 4 | 52 | 90 | 57.4 | 0 | 1 | 1 | 0 | |
Franke et al. (2020) | 8 | 27 | 3.5 | 72 | 26 | 100 | 55.7 | 0 | 1 | 0 | 0 |
Porzig-Drummond et al. (2015) | 3 h 46 min | 43 | 5.21 | 62 | 26 | 86.2 | 96.6 | 0 | 0 | 1 | 1 |
Sanders et al. (2012) | 8 | 60 | 4.92 | 70 | 26 | 90 | 57 | 0 | 0 | 1 | 1 |
Sourander et al. (2016) | 11 | 232 | 4 | 61 | 52 | 90 | 57.4 | 0 | 1 | 0 | 0 |