Home Program

Helping the Noncompliant Child (HNC)

Topic Areas
Scientific Rating
Child Welfare Relevance
Disruptive Behavior Treatment (Child & Adolescent)
3  — Promising Research Evidence
Medium
Parent Training Programs that Address Behavior Problems in Children and Adolescents
3  — Promising Research Evidence
Medium

About This Program

Target Population: Parents of children (age 3-8 years old) who are noncompliant and have related disruptive behavior/conduct problems

For children/adolescents ages: 3 – 8

For parents/caregivers of children ages: 3 – 8

Program Overview

HNC is a skills-training program aimed at teaching parents how to obtain compliance in their children ages 3 to 8 years old. The goal is to improve parent-child interactions in order to reduce the escalation of problems into more serious disorders (e.g., conduct disorder, juvenile delinquency). The program is based on the theoretical assumption that noncompliance in children is a keystone behavior for the development of conduct problems; and that faulty parent-child interactions play a significant part in the development and maintenance of these problems.

Parents attend sessions with their children and trainers teach the parents core skills necessary for improving parent-child interactions and increasing their children's compliance.

Program Goals

The goals of Helping the Noncompliant Child (HNC) are:

  • Establish a positive interaction with the child by reducing/eliminating parental coercive behaviors and providing positive attention to the child for appropriate behaviors (and ignoring minor child inappropriate behaviors that are primarily attention-seeking)
  • Provide appropriate limit setting and consequences for both child compliance and noncompliance to parental directives, which should ultimately lead to reduced:
    • Oppositional defiant disorder and conduct disorder diagnoses
    • Engagement in delinquent behavior
    • Risk of substance use problems
    • Child maltreatment

Logic Model

The program representative did not provide information about a Logic Model for Helping the Noncompliant Child (HNC).

Essential Components

The essential components of Helping the Noncompliant Child (HNC) include:

  • Population/Participants
    • Excessive child noncompliance
    • Child age from 3 to 8 years
    • Sessions typically with individual families rather than in groups (although HNC has been adapted for use in groups of 10-15 parents)
    • Individual family sessions with the parent(s) (both mothers and fathers – or other primary care givers, whenever possible) and the child
    • Child in all treatment sessions
  • Program
    • Involves a series of parenting skills to increase positive attention for appropriate child behavior (e.g., attends, rewards), to ignore minor inappropriate behaviors, to provide clear instructions to the child, and to provide appropriate consequences for compliance (e.g., positive attention) and noncompliance (e.g., time out, standing rules)
    • Parenting skills taught using active teaching methods, such as extensive demonstration, role plays, and direct practice with the child in the training setting and at home
    • Progression from one skill to the next is based upon demonstrated proficiency by the parent (i.e., competency-based)
    • HNC consists of two phases:
      • Differential Attention (Phase I):
        • Parents learn to:
          • Increase the frequency and range of social attention to the child (attends, rewards)
          • Ignore minor inappropriate behaviors
          • Reduce the frequency of competing verbal behavior
        • Major goal: Break out of the coercive cycle by establishing a positive, mutually reinforcing relationship between the parent and child.
      • Compliance Training (Phase II):
        • Parents learn to:
          • Use the Clear Instructions Sequence to provide direct, concise instructions to the child
          • Allow the child sufficient time to comply
          • Provide appropriate consequences for compliance (e.g., positive attention) or noncompliance (e.g., time out)
          • Use standing rules to supplement the Clear Instructions Sequence
          • Implement the parenting skills in situations outside the home (e.g., riding in the car, shopping, visiting others)

Program Delivery

Child/Adolescent Services

Helping the Noncompliant Child (HNC) directly provides services to children/adolescents and addresses the following:

  • Excessive noncompliance and other conduct problems

Parent/Caregiver Services

Helping the Noncompliant Child (HNC) directly provides services to parents/caregivers and addresses the following:

  • Parent of a noncompliant child

Recommended Intensity:

60- to 90-minute session once or twice a week

Recommended Duration:

The duration of the program is individualized, based on the parent's attainment of behavioral criteria for each skill. The average number of sessions is 8-10, with a range of 5 to 14 or more, if needed.

Delivery Settings

This program is typically conducted in a(n):

  • Outpatient Clinic
  • Community-based Agency / Organization / Provider

Homework

Helping the Noncompliant Child (HNC) includes a homework component:

At the end of each session, parents receive a handout and record sheet pertaining to the session content. In the first phase of the program, parents practice skills daily in the context of a 10-15 minute session of the Child's Game, in which the parent and child engage in a play activity chosen by the child. In addition, parents learn to apply differential attention skills to relevant child behaviors. In Phase II, parents are given specific tasks concerned with giving clear instructions to their child, providing positive attention for compliance, and time out for noncompliance. Parents also practice setting up and explaining standing rules to their child, and applying the parenting skills to situations outside the home and to other children in the family.

Languages

Helping the Noncompliant Child (HNC) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

  • A playroom-type of room that is large enough for the trainer, 1-2 parents, and the child: Room should be large enough so that there is room for the child to play with toys separately from where the parents and trainer are sitting
  • Age-appropriate toys required

Manuals and Training

Prerequisite/Minimum Provider Qualifications

Practitioners should have a background in psychology or education, a Master's level degree in some aspect of human services, and should be familiar with social learning principles and their application to child behavior. Ideally, the trainer would have experience working with young (3-8 year-old) children with conduct problems and their parents.

Supervisors should have at least a Master's degree and prior experience implementing and/or supervising social learning-based parent management programs with young children. Ideally, they should have experience providing the HNC program themselves.

Manual Information

There is a manual that describes how to deliver this program.

Program Manual(s)

Manual details:

  • McMahon, R.J., & Forehand, R.L. (2003). Helping the Noncompliant Child: Family based treatment for oppositional behavior (2nd ed.). Guilford Press.

The manual is available in hardcover, paperback, and e-books at https://www.guilford.com/books/Helping-the-Noncompliant-Child/McMahon-Forehand/9781593852412.

Training Information

There is training available for this program.

Training Contact:
Training Type/Location:

Training is typically provided onsite at the contracting agency.

Number of days/hours:

Trainees are required to read and study the trainer's manual prior to the training. This will take approximately 8 hours). Initial training is conducted in two consecutive 8-hour days. This is followed by a series of one-day (8 hours) booster trainings and regular consultation phone calls (60-90 minutes each).

Additional Resources:

There currently are additional qualified resources for training:

  • Nick Long, PhD
    Department of Pediatrics
    University of Arkansas for Medical Sciences
    phone: 501-364-1021
    email: LongNicholas@uams.edu

Implementation Information

Pre-Implementation Materials

There are no pre-implementation materials to measure organizational or provider readiness for Helping the Noncompliant Child (HNC).

Formal Support for Implementation

There is formal support available for implementation of Helping the Noncompliant Child (HNC) as listed below:

A minimum of 4 one-day booster sessions (i.e., 4, 10, 16-18, and 22-24 months after the initial training) are recommended. Consultation for case review and problem solving is also available (e.g., every 3 weeks for the first 4 months or until first booster).

Fidelity Measures

There are fidelity measures for Helping the Noncompliant Child (HNC) as listed below:

There are fidelity measures available for each session of HNC that are comprised of a checklist of the key content and process issues for that session. The checklists can be completed by the therapist or by a supervisor or someone else who observes the session. They are available by request from the program contact listed at the end of this entry.

Implementation Guides or Manuals

There are no implementation guides or manuals for Helping the Noncompliant Child (HNC).

Implementation Cost

There have been studies of the costs of implementing Helping the Noncompliant Child (HNC) which are listed below:

Honeycutt, A. A., Khavjou, O. A., Jones, D. J., Cuellar, J., & Forehand, R. L. (2015). Helping the Noncompliant Child: An assessment of program costs and cost-effectiveness. Journal of Child and Family Studies, 24, 499–504. https://doi.org/10.1007/s10826-013-9862-7

Khavjou, O., Forehand, R., Loiselle, R., Turner, P., Buell, N., & Jones, D.J. (2020). Helping the Noncompliant Child: An updated assessment of program costs and cost-effectiveness. Children and Youth Services Review, 114, Article 105050. https://doi.org/10.1016/j.childyouth.2020.105050

Washington State Institute for Public Policy. (2023). Benefit-Cost results: Helping the Noncompliant Child for children with disruptive behavior. https://www.wsipp.wa.gov/BenefitCost/Program/541

Research on How to Implement the Program

Research has been conducted on how to implement Helping the Noncompliant Child (HNC) as listed below:

Jones, D. J., Forehand, R. L., Cuellar, J., Parent, J., & Honeycutt, A. A. (2014). Technology-enhanced program for child disruptive behavior disorders: Development and pilot randomized control trial. Journal of Clinical Child and Adolescent Psychology, 43, 88–101. https://doi.org/10.1080/15374416.2013.822308

Jones, D. J., Loiselle, R., Zachary, C., Georgeson, A. R., Highlander, A., Turner, P., Youngstrom, J. K., Khavjou, O., Anton, M. T., Gonzalez, M., Bresland, N. L., & Forehand, R. (2021). Optimizing engagement in behavioral parent training: Progress toward a technology-enhanced treatment model. Behavior Therapy, 52(2), 508–521. https://doi.org/10.1016/j.beth.2020.07.001

Kaehler, L., Jacobs, M., & Jones, D. J. (2016). Distilling common history and practice elements to inform dissemination: Hanf-Model BPT programs as an example. Clinical Child and Family Psychology Review, 19, 236–258. https://doi.org/10.1007/s10567-016-0210-5

McCall, M. P., Anton, M. T., Highlander, A., Loiselle, R., Forehand, R., Khavjou, O., & Jones, D. J. (2023). Technology-enhanced behavioral parent training: The relationship between technology use and efficiency of service delivery. Behavior Modification, 47(5), 1094–1114. https://doi.org/10.1177/01454455231165937

McMahon, R. J., Forehand, R., & Griest, D. L. (1981). Effects of knowledge of social learning principles on enhancing treatment outcome and generalization in a parent training program. Journal of Consulting and Clinical Psychology, 49, 526–532. https://doi.org/10.1037/0022-006X.49.4.526

Parent, J., Highlander, A. Loiselle, R., Yang, Y., McKee, L. G., Forehand, R., & Jones, D. J. (2023). Technology-enhanced BPT for early-onset behavior disorders: Improved outcomes for children with co-occurring internalizing symptoms. Journal of Clinical Child and Adolescent Psychology. Advance online publication. https://doi.org/10.1080/15374416.2023.2222391

Parent, J., Jones, D. J., DiMarzio, K., Yang, Y., Wright, K., Sullivan, A. D. W., & Forehand, R. (2023). The effects of young children’s callous-unemotional traits on behaviorally observed outcomes in a standard and technology-enhanced behavioral parent training. Research on Child & Adolescent Psychopathology, 51, 165–175. https://doi.org/10.1007/s10802-022-00979-1

Parent, J., Anton, M., Loiselle, R., Highlander, A., Breslend, N., Forehand, R., Hare, M., Youngstrom, J., A., & Jones, D. J. (2022). A randomized controlled trial of technology-enhanced behavioral parent training: Sustained parent skill use and child outcomes at follow-up. Journal of Child Psychology and Psychiatry, 63, 992–1001. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9177891/

Wells, K. C., Griest, D. L., & Forehand, R. (1980). The use of a self-control package to enhance temporal generality of a parent training program. Behaviour Research and Therapy, 18, 347–358. https://doi.org/10.1016/0005-7967(80)90094-7

Relevant Published, Peer-Reviewed Research

Child Welfare Outcome: Child/Family Well-Being

Forehand, R., Wells, K. C., & Griest, D. L. (1980). An examination of the social validity of a parent training program. Behavior Therapy, 11(4), 488–502. https://doi.org/10.1016/S0005-7894(80)80065-7

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 30

Population:

  • Age — Adults: Not specified; Children: Mean=58.4–63.9 months (approx. 4.9–5.3 years)
  • Race/Ethnicity — Not specified
  • Gender — Adults: 100% Female; Children: Not specified
  • Status — Participants were self-referred by parent, referred by professionals in the community, or recruited through the media.

Location/Institution: Georgia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the effectiveness of a parent training program [now called Helping the Noncompliant Child (HNC)]. Participants were either in a clinic group that received treatment or a non-clinic comparison group. Measures utilized include the Parent’s Attitude Test and the Beck Depression Inventory (BDI). Results indicate that at posttest, mothers in the treated group reported significant improvement in their children’s behavior, although they still perceived them as less well-adjusted than did mothers in the comparison group. Improvements were maintained at the two-month follow-up. Limitations include lack of randomization of participants, lack of long-term follow-up, and attrition of parents from the posttest period.

Length of controlled postintervention follow-up: 2 months.

Griest, D. L., Forehand, R., Rogers, T., Breiner, J., Furey, W., & Williams, C. A. (1982). Effects of parent enhancement therapy on the treatment outcome and generalization of a parent training program. Behavior Research Therapy, 20(5), 429–436. https://doi.org/10.1016/0005-7967(82)90064-X

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 32

Population:

  • Age — Adults: Not specified; Children: Mean=59 months (approx. 4.9 years)
  • Race/Ethnicity — Not specified
  • Gender — Adults: 100% Female; Children: Not specified
  • Status — Participants were referred to the University of Georgia Psychological clinic for behavior problems, or by newspaper announcements.

Location/Institution: University of Georgia

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the effectiveness of parent enhancement training in facilitating treatment and maintenance of the Hanf Parent Training Program [now called Helping the Noncompliant Child (HNC)]. Participants were assigned to either parent training alone (PTA) or parent training plus parent enhancement training (PTE). Measures utilized include the Parent Attitude Test, the Beck Depression Inventory, the Locke Wallace Marital Inventory Test, and the Community Interaction Checklist. Results indicate that enhanced parent training was more effective than parent training alone and also superior to the no-treatment comparison group. Limitations include the small sample size, low inter-rater reliability on treatment outcome variables, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Forehand, R., & Long, N. (1988). Outpatient treatment of the acting out child: Procedures, long term follow-up data, and clinical problems. Advances in Behavior Research and Therapy, 10(3), 129–177. https://doi.org/10.1016/0146-6402(88)90012-4

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 42

Population:

  • Age — Adults: Not specified; Children: 11–14 years at follow-up
  • Race/Ethnicity — Not specified
  • Gender — Adults: 100% Female; Children: Not specified
  • Status — Participants were parent-child pairs who had previously participated in a training program.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to report on the effectiveness of the Hanf Parent Training Program [now called Helping the Noncompliant Child (HNC)] aimed at alleviating problems with compliance and aggression. Participants were assigned to either the Hanf Parent Training Program or to a publicly recruited comparison group. Measures utilized include the Revised Problem Behavior Checklist (RPBC), the Issues Checklist (IC), the Conflict Behavior Questionnaire (CBQ), the Children’s Depression Inventory (CDI), the Perceived Competence Scale for Children (PCSC), the Rating Scale of Child’s Actual Competence (RSCAC), the Parent Competency Inventory (PCI), the Beck Depression Inventory (BDI), the Dyadic Adjustment Scale (DAS), and the O’Leary Porter Scale (OPS). Results indicate that the adolescents in the Hanf Parent Training Program were functioning similarly to those in the comparison group. Higher scores were found for conflict behavior, according to parent ratings and for anxiety, according to teacher ratings. Children in the Hanf Parent Training Program were also found to have more academic performance difficulties. Limitations include the high attrition rate, lack of information in the methods sections, and lack of a matched comparison group.

Length of controlled postintervention follow-up: Approximately 4.5 years.

Wells, K.C., & Egan, J. (1988). Social learning and systems family therapy for childhood oppositional disorder: Comparative treatment outcome. Comprehensive Psychiatry, 29(2), 138–146.& https://doi.org/10.1016/0010-440X(88)90006-5

Type of Study: Randomized controlled trial
Number of Participants: 19

Population:

  • Age — 3–8 years
  • Race/Ethnicity — Not specified
  • Gender — Not specified
  • Status — Participants were families with children referred to an outpatient clinic and diagnosed for oppositional disorder.

Location/Institution: Not Specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the comparative effectiveness of a social learning-based parent training (SLPT) program, Hanf Parent Training Program [now called Helping the Noncompliant Child (HNC)] with Systems Family Therapy (SFT). Participants were randomized to either SLPT or SFT. Measures utilized include the Beck Depression Inventory (BDI) and the Locke Wallace Marriage Inventory. Results indicate that participants in the SLPT group showed higher improvement on the symptoms of oppositional disorder and parenting behaviors. Limitations include the small sample size, lack of untreated control group, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Long, P., Forehand, R., Wierson, M., & Morgan, A. (1994). Does parent training with young noncompliant children have long-term effects? Behavior Research Therapy, 32(1), 101–107. https://doi.org/10.1016/0005-7967(94)90088-4

Type of Study: Pretest–posttest study with a nonequivalent control group (Quasi-experimental)
Number of Participants: 26

Population:

  • Age — Adults: Not specified; Children: 2–7 years at time of treatment
  • Race/Ethnicity — Not specified
  • Gender — Adults: 100% Female; Children: 17 Male and 9 Female
  • Status — Participants were in a training program for parents with noncompliant children.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the long-term effects of Hanf Parent Training Program [now called Helping the Noncompliant Child (HNC)]. Participants who had completed Hanf Parent Training Program as children were compared to a sample of youth from the community. Measures utilized include the Conflict Behavior Questionnaire, the National Youth Survey, the Michigan Alcohol Screening Test (MAST), the Rosenberg Self Esteem Scale, and the Brief Symptom Inventory. Results indicate that the treated group did not differ from the community sample on relationship with parents, delinquency, substance use, or emotional adjustment (self-esteem) scores. Limitations include the lack of an untreated control group and reliance on self-reported measures.

Length of controlled postintervention follow-up: Approximately 14 years.

Jones, D. J., Forehand, R., Cuellar, J., Parent, J., Honeycutt, A., Khavjou, O., Gonzalez, M., Anton, M., & Newey, G. A. (2014). Technology-enhanced program for child disruptive behavior disorders: Development and pilot randomized control trial. Journal of Clinical Child and Adolescent Psychology, 43(1), 88–101. https://doi.org/10.1080/15374416.2013.822308

Type of Study: Randomized controlled trial
Number of Participants: 37

Population:

  • Age — Adults: Mean=36.73–38.25 years; Children: 3–8 years
  • Race/Ethnicity — Children: Not specified, Adults: Not specified
  • Gender — Adults: 87% Female; Children: 53% Male
  • Status — Participants were parents of children with disruptive behaviors.

Location/Institution: North Carolina

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to develop and pilot test a technology-enhanced version of Helping the Noncompliant Child (HNC) with the goal of increasing engagement of low-income families and, in turn, child behavior outcomes, with potential cost-savings associated with greater treatment efficiency. Participants were randomized to and completed standard HNC or Technology-Enhanced HNC (TE-HNC). All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), the Attends Survey, and the Consumer Satisfaction Scale. Results indicate that TE-HNC yielded larger effect sizes than HNC for all engagement outcomes. Both groups yielded clinically significant improvements in disruptive behavior; however, findings suggest that the greater program engagement associated with TE-HNC boosted child treatment outcome. Limitations include the small sample size, concerns of privacy and security, and lack of follow-up.

Length of controlled postintervention follow-up: None.

Abikoff, H. B., Thompson, M., Laver‐Bradbury, C., Long, N., Forehand, R. L., Brotman, L. M., Klein, R. G., Reiss, P., Huo, L., & Sonuga‐Barke, E. (2015). Parent training for preschool ADHD: A randomized controlled trial of specialized and generic programs. Journal of Child Psychology and Psychiatry, 56(6), 618–631. https://doi.org/10.1111/jcpp.12346

Type of Study: Randomized controlled trial
Number of Participants: 164

Population:

  • Age — Parents: Mean=36.73–38.25 years; Children: 3–4 years
  • Race/Ethnicity — Parents: Not specified; Children: 70% Caucasian, 26% Hispanic, 16% African American, 9% Asian, and 6% Other
  • Gender — Parents: 87% Female; Children: 74% Male
  • Status — Participants were parents of children with disruptive behaviors.

Location/Institution: New York University (NYU) Langone Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the short- and long-term efficacy and generalization effects of New Forest Parenting Package (NFPP) compared to Helping the Noncompliant Child (HNC) in young children with attention-deficit/hyperactivity disorder (ADHD). Participants were randomized into, NFPP, HNC, or a wait-list control group. Measures utilized include the Wechsler Preschool Primary Scale of Intelligence, 3rd edition (WPPSI-III), the Revised Conners Teacher and Parent Rating Scales (CTRS-R and CPRS-R), the Diagnostic Interview Schedule for Children-Parent Report Version 4 modified Young Child Version (DISC-IV-YC), the Clinical Evaluation of Language Fundamentals (CELF-2), the New York Teacher and Parent Rating Scales (NYTRS), the Parenting Practice Interview (PPI), the Global Impressions of Parent' Child Interactions–Revised (GIPCI–R), Parenting Stress Index-Short Form Revised (PSI-R), and the Consumer Satisfaction Questionnaire (CSQ). Results indicate that in both treatment groups, children's ADHD and oppositional defiant disorder (ODD) behaviors, as well as aspects of parenting, were rated improved by parents at the end of treatment compared to controls. Most of these gains in the children's behavior and in some parenting practices were sustained at follow-up. However, these parent-reported improvements were not corroborated by teacher ratings or objective observations. NFPP was not significantly better, and on a few outcomes was significantly less effective, than HNC. Limitations include lack of control group during follow-up, concerns about generalizability due to the education level of parents, and the brief period of treatment for NFPP.

Length of controlled postintervention follow-up: 6.8 months (intervention only).

Parent, J., Anton, M. T., Loiselle, R., Highlander, A., Breslend, N., Forehand, R., Hare, M., Youngstrom, J. K., & Jones, D. J. (2022). A randomized controlled trial of technology-enhanced behavioral parent training: sustained parent skill use and child outcomes at follow-up. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 63(9), 992–1001. https://doi.org/10.1111/jcpp.13554

Type of Study: Randomized controlled trial
Number of Participants: 101

Population:

  • Age — Parents: Mean=31.66 years; Children: Mean=4.19 years
  • Race/Ethnicity — Parents: 68% White, 22% Black/African American, 8% Multiracial, 7% Hispanic/Latinx, and 1% Native American/Alaskan; Children: 63% White, 21% Black/African American, 14% Multiracial, 7% Hispanic/Latinx, and 1% Native American/Alaskan
  • Gender — Parents: 97% Female; Children: 55% Male
  • Status — Participants were families of low-income with children exhibiting problem behaviors.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the potential for a technologically-enhanced Helping the Noncompliant Child (HNC) (TE-HNC) program to improve and sustain parent skill proficiency and child outcomes in low-income families. Participants were randomized to standard Helping the Noncompliant Child (HNC) alone or TE-HNC. All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. Measures utilized include the Eyberg Child Behavior Inventory (ECBI) and Behavioral Observation Coding System in parent child observations. Results indicate that both programs yielded improvements in parenting skills and child problems at post-treatment. However, TE-HNC families evidenced greater maintenance of parent reported and observed child behavior and observed positive parenting skills at the 6-month follow-up. Limitations include length of follow-up and concern over sustainability due to low-income status of families that let their phone service plans lapse.

Length of controlled postintervention follow-up: 3 and 6 months

Parent, J., Highlander, A., Loiselle, R., Yang, Y., McKee, L. G., Forehand, R., & Jones, D. J. (2023). Technology-enhanced BPT for early-onset behavior disorders: Improved outcomes for children with co-occurring internalizing symptoms. Journal of Clinical Child and Adolescent Psychology 53, 1–14. https://doi.org/10.1080/15374416.2023.2222391

Type of Study: Randomized controlled trial
Number of Participants: 101

Population:

  • Age — Children: 3–8 years
  • Race/Ethnicity — Caregivers: 68% White, 21% Black or African American, 8% Multiple Races, 7% Hispanic/Latinx, and 1% American Indian/Alaska Native; Children: 64% White, 21% Black or African American, 14% Hispanic/Latinx, 14% Multiple Races, and 1% American Indian/Alaska N
  • Gender — Caregivers: 98% Female; Children: 55% Male
  • Status — Participants were families of children ages 3–8 years old with early-onset behavior disorders and with incomes below 250% of the federal poverty level.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the potential for technology to improve behavioral parent training (BPT) effects on observed parenting and child behavior outcomes for families of children recruited for clinically significant problem behavior who also presented with relatively higher internalizing symptoms. Participants were randomized to an evidence-based BPT program, Helping the Noncompliant Child (HNC), or technology-enhanced HNC (TE-HNC). All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), Behavioral Observation Coding System in parent child observations, and the Child behavior Checklist (CBCL), a supplementary CBCL subscale that measured irritability. Results indicate that families in both groups evidenced improvement in internalizing symptoms at posttreatment; however, TE-HNC yielded the greatest improvement in positive parenting and child compliance at posttreatment and follow-up for children with the highest internalizing symptoms at baseline. Limitations include that the results are secondary analyses and the technology enhancements tested in the parent study were not developed to explicitly target internalizing symptoms; the overrepresentation of mothers in the sample; and the lack of a no treatment control group. In addition, although approximately half of children had elevated levels of internalizing symptoms, children were not recruited for this study based on their baseline levels of internalizing symptomatology; therefore, results may look different if all children met diagnostic criteria for both internalizing and externalizing disorders, for example.

Length of controlled postintervention follow-up: 3 and 6 months.

Parent, J., Jones, D. J., DiMarzio, K., Yang, Y., Wright, K. L., Sullivan, A. D., & Forehand, R. (2023). The effects of young children’s callous-unemotional traits on behaviorally observed outcomes in standard and technology-enhanced behavioral parent training. Research on Child and Adolescent Psychopathology, 51(2), 165–175. https://doi.org/10.1007/s10802-022-00979-1

Type of Study: Randomized controlled trial
Number of Participants: 101

Population:

  • Age — Children: Mean=4.19 years; Parents: Mean=31.66 years
  • Race/Ethnicity — Parents: 69% White, 22% Black/African American, 8% Hispanic/Latinx, 8% Multiracial, and 1% Native American/Alaskan; Children: 63% White, 21% Black/African American, 14% Multiracial, 7% Hispanic/Latinx, and 1% Native American/Alaskan
  • Gender — Children: 55% Male
  • Status — Participants were families of low-income with children exhibiting problem behaviors.

Location/Institution: Not specified

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to examine the relation of baseline child callous-unemotional (CU) traits to changes in observed parent and child behavior in families with low-income. Participants were randomized to either standard Helping the Noncompliant Child (HNC) or a technology-enhanced versions of Helping the Noncompliant Child (TE-HNC) treatment groups. All families received the standard HNC program; however, TE-HNC also included the following smartphone enhancements: (a) skills video series, (b) brief daily surveys, (c) text message reminders, (d) video recording home practice, and (e) midweek video calls. Measures utilized include the Eyberg Child Behavior Inventory (ECBI), Behavioral Observation Coding System in parent child observations, Inventory of Callous Unemotional Traits, Behavioral Observation Coding System, and the Differential Attention or Child’s Game. Results indicate that TE-HNC moderated the relation between CU traits and observed parenting behaviors and child compliance. Specifically, higher levels of child CU traits at baseline predicted lower levels of positive parenting at post-intervention and follow-up, and lower levels of child compliance at follow-up, but only in the standard HNC program group. Limitations include brief clinic observations, concerns around measuring fidelity outside of sessions with the app, lack of feasibility if the parent has no smartphone, and the lack of data collection for maternal CU traits.

Length of controlled postintervention follow-up: 3 months.

Additional References

Forehand, R., & Long, N. (2010). Parenting the strong-willed child (3rd ed.). New York: McGraw-Hill.

Long, N., & Forehand, R. (2010). Parenting the strong-willed child: Leader's guide for the six-week parenting class. (Contact Nicholas Long, LongNicholas@uams.edu)

McMahon, R. J., & Forehand, R. (2003). Helping the noncompliant child: Family-based treatment for oppositional behavior (2nd ed.). New York: Guilford Press.

Contact Information

Deborah J. Jones, PhD
Agency/Affiliation: University of North Carolina at Chapel Hill
Department: Department of Psychology and Neuroscience
Email:
Phone: (919) 843-2351

Date Research Evidence Last Reviewed by CEBC: November 2023

Date Program Content Last Reviewed by Program Staff: October 2023

Date Program Originally Loaded onto CEBC: May 2009