Digital Parent Training RCT Meta-Analysis and Systematic Review

Background. Disruptive behavior disorders have increased during the pandemic and are associated with family conflict and child risk of child maltreatment. While parent training interventions are a best-practice intervention to treat a range of disruptive behavior disorders and family dysfunction concerns, there are limited and mixed findings on the efficacy of telehealth or digital parent training interventions. As the field of digital therapeutics continues to expand, it is imperative we seek to understand the program and client factors linked to differential efficacy. Objective. Our objective was to compare digital therapies to their “best-practice” in-person counterparts (i.e. non-inferiority trials), as well as comparing the relative benefits of a given program to waitlists, other ehealth programs, or treatment as usual. Furthermore, we aimed to interrogate which types and components of digital therapeutics are most efficacious and for whom.Methods. We conducted a systematic review and meta-analysis (k = 24, total number of intervention participants = 1654 and control participants = 1001) of the impact of digital parent training interventions on parent skill, parent mental health, and child externalizing outcomes from 2000 to 2021, among children 2-12 years old, across four databases. Exclusionary criteria include programs targeted for parents of children with intellectual disabilities, autism, brain injury, nutrition/health/dental needs or primary medical diagnosis. Results. Across outcomes, digital parent training interventions had a modest effect size (g = .27 to .33), compared to controls. The effects of digital parent training on parent skills and child outcomes were stronger if the intervention was evidence-based, combined interactive platforms with a therapist and was compared to an inactive control. Conclusions. Together, these findings suggest digital parent training interventions are an effective approach linked to modest improvements in reducing child disruptive behavioral symptoms and improving parenting skills. Such scalable and accessible approaches hold high potential to reduce burdens of child and adolescent mental illness, particularly when applied in a stepped care model. We call on future studies to provide standardized sociodemographic reporting to aide in future knowledge synthesis work that can inform tailored interventions to different populations and provide templates for shared measurement. Preregistration and open data files: https://osf.io/e35bt/.