Background:  Parents of adolescents with an intellectual disability experience complex difficulties and report being insufficiently supported by disability services. These adolescents are known to experience significant difficulties during this period such as social and behavioural difficulties. There is a need for an effective tailored parenting programme for parents of adolescents with an intellectual disability. To evaluate the effective of the Parents Plus Special Needs programme, a parenting intervention for adolescents with intellectual disability.

Method: Cluster randomised controlled trial in which 23 services were assigned to PPSN programme or TAU. Cluster eligibility criteria: intellectual disability service supporting families of an adolescent with an intellectual disability. Data were collected across Ireland at three timepoints; pre, post, and 3-month follow-up.. The objective of the study was to evaluate the effectiveness of the PPSN programme. Allocation of cluster to intervention (n=12) and treatment-as-usual (n=11) was blinded and randomised. Participant and intervention providers were not blind to the conditions. Participants consisted of parents of an adolescent with an intellectual disability (n=277). Following cluster randomisation, PPSN consisted of 141 participants and TAU consisted of 136 participants. The primary outcomes were: Parenting Practices, Family Adjustment, Problem Behaviours, Emotional Problems, and Prosocial Behaviours. The secondary outcomes were: Parental Satisfaction, Parental Self-efficacy, and Goal Attainment. All outcomes were measured using the PAFAS, CAPES-DD, KPSS, and PPGF.   Objectives, outcomes, and results pertain to the individual participant level.  All clusters and participants were included in the analysis.

Findings: After PPSN completion, participants reported improvements in parenting practices, problem behaviours, parental satisfaction, parental self-efficacy and goal attainment. The TAU group remained the same on all primary outcome measures. At 3-month follow-up, the PPSN showed improvements in all primary and secondary outcomes except emotional problems and prosocial behaviour.

Interpretation:  The PPSN is effective in improving several outcomes.

ISRCTN Trial Registration: ISRCTN31917713

Read full Paper  in Journal of Applied Research in Intellectual Disabilities published in.  2023

Clinical Study:
This study is a first-level evaluation of a family intervention targeted at adolescents with social, emotional and behavioural difficulties (SEBD) attending Child and Adolescent Mental Health Services (CAMHS) in Ireland. It is a combined implementation of the Working Things Out adolescent programme and the Parents Plus Adolescent Programme (WTOPPAP).

Method: A total of 93 adolescents aged 11–17 years (M = 14.64, SD = 1.31; 39% male) and their parents took part in the study. The study used a quasi-experimental One-Group Pretest-Posttest design to assess change from pre- to post-intervention using the Strengths and Difficulties Questionnaire, the McMaster General Functioning Scale, Goal Attainment, Parent Stress Scale and the Kansas Parenting Satisfaction Scale. Both parent- and adolescent-rated goal attainment and general family functioning improved from pre- to post-intervention. Parents also rated their satisfaction with parenting as having significantly improved. Adolescent-rated emotional difficulties significantly improved for the overall sample and parent-rated child total difficulties for female adolescents significantly improved from pre-test to post-test. Parents of female adolescents also reported a significant drop in parental stress. These findings indicate that the WTOPPAP may be an effective intervention for adolescents with SEBD, particularly females, and their parents. Further implications are discussed. See full paper

Community Study:
Using an RCT design, PPAP was evaluated through a programme roll-out in secondary schools in Kerry and Cork in Ireland, involving 109 parents assigned either to a treatment group (n = 70) or a waiting list control group (n = 39). Assessment took place before and immediately after the eight-week intervention for both groups and at six-month follow-up for the PPAP group. Compared to the waiting list group post-programme, the PPAP group displayed significant reductions in total difficulties and conduct problems as measured by the Strengths and Difficulties Questionnaire, decreased parental stress as measured by the Parenting Stress Index, increased parental satisfaction as measured by the Kansas Parenting Scale, as well as significant improvements in parent-defined problems and goals. The study has been submitted as a PhD thesis in University of Limerick (Nitsch, 2011), and was published by Child and Adolescent Psychiatry and Mental Health (Nitsch, Hannon, Rickard, Houghton & Sharry, 2015).

Clinical Study:
To evaluate the Parents Plus Children’s Programme (PPCP) a sequential block design was used to assign 74 parents of children referred to a CAMHS service to the PPCP group (n = 42) or the ‘treatment as usual’ (TAU) comparison group (n = 32). Assessment took place before and again immediately after the eight-week intervention for both groups, and there was also a five-month follow-up for the PPCP group. In comparison to the TAU group, significant reductions in children’s total difficulties and conduct problems, as measured by the Strengths and Difficulties Questionnaire, decreased parental stress and increased parental confidence were observed in the PPCP group. There were also significant improvements in parent-defined problems and goals among participants of the PPCP group. These positive changes were maintained at five-month follow-up, and further significant improvements in children’s peer problems and prosocial behaviour were observed in the PPCP group at five-month follow-up also. The findings also suggested that PPCP is more effective for parents of children with behaviour problems only, than it is for those whose children have behaviour problems and associated developmental difficulties. The full study was published in Clinical Child Psychology and Psychiatry (Coughlin, Sharry, Fitzpatrick, Guerin & Drumm, 2009).

Disability Study:
The Parents Plus Children’s Programme was delivered as an intervention for parents of children with mild intellectual disabilities in a special school setting and evaluated as part of a small Randomised Control Trial. A significant reduction in clinical range scores for treatment group participants (n = 16) was observed. Conversely, clinical range scores for waiting list control group participants (n = 13) increased, or remained elevated. The full study was published in Clinical Child Psychology and Psychiatry (Hand, Ní Raghallaigh, Cuppage, Coyle & Sharry, 2012).

Community Study:
The Parents Plus Children’s Programme  was evaluated using a RCT design as part of a national delivery by frontline staff in primary schools throughout Ireland. Participating parents with children aged 6 to 11 were randomly assigned to a treatment group (n = 44) or a no-treatment control group (n = 31).  The efficacy of training was assessed using self-report questionnaires completed by participants in both treatment and control groups. Significant improvements were recorded on measures of parenting-related stress, child problem behaviour and parent satisfaction with medium to large effect sizes for the treatment group post-intervention, and results were maintained at 6-month follow-up. The findings support the efficacy of the PPCP as a community-led intervention with potential to prevent and interrupt child behaviour problems through supported parenting practice before problems become critical and entrenched. The study was published in the International Journal of Clinical and Health Psychology (Hand, McDonnell, Honari & Sharry, 2013).

ADHD study

The Effect of Parenting Programme on the Symptoms and the Family Functioning of Children with Attention Deficit and Hyperactivity Disorder Who Have Residual Symptoms Despite Medical Treatment

The children in the study were aged 6–11 years, and they had been diagnosed with ADHD and had residual symptoms despite effective dosage and timing of their medication. Forty-six couples, who with their children met the eligibility criteria, were enrolled and randomly allocated to the PPCP or the control group. The intervention involved a 9-week, 2 h a week, parenting group exercise. Those in the PPCP group improved significantly more over time on Conners’ Parent Rating Scale-Revised, Family Assessment Device, and Parent Stress Index than those in the control condition. The trial is the first clinical study involving the parents of children with ADHD that addresses residual symptoms and functional impairments that remain despite the administration of the maximum effective dose of pharmacological treatment.

Full study is published in Behaviour Change (2021)

Child and Adolescent Mental Health Service (CAMHS):
Within a sample that included parents of children with ADHD,  a sequential block design was used to assign 74 parents of children referred to a CAMHS service to the Parents Plus Children’s Programme (PPCP) group (n = 42) or the ‘treatment as usual’ (TAU) comparison group (n = 32). Assessment took place before and again immediately after the eight-week intervention for both groups, and there was also a five-month follow-up for the PPCP group. In comparison to the TAU group, significant reductions in children’s total difficulties and conduct problems, as measured by the Strengths and Difficulties Questionnaire, decreased parental stress and increased parental confidence were observed in the PPCP group. There were also significant improvements in parent-defined problems and goals among participants of the PPCP group. These positive changes were maintained at five-month follow-up, and further significant improvements in children’s peer problems and prosocial behaviour were observed in the PPCP group at five-month follow-up also. The findings also suggested that PPCP is more effective for parents of children with behaviour problems only, than it is for those whose children have behaviour problems and associated developmental difficulties. The full study was published in Clinical Child Psychology and Psychiatry (Coughlin, Sharry, Fitzpatrick, Guerin & Drumm, 2009).

Clinical Study: 
In a large scale multi-site controlled outcome study of children aged 1 to 6 years (N = 81) and their parents, it was found that for families attending the Parents Plus Early Years Programme (PPEY) there was a:

• Decrease in conduct problems and total difficulties and an increase in prosocial behaviour as measured by Strengths and Difficulties Questionnaire.
• Decrease in Parental Stress as measured by Parent Stress Scale.
• Reduction in commands and increase in positive attends in the parent-child interaction as measured by independent before and after video observation.
• Significant reduction of parent-defined problems and gains in parent-defined goals.

Compared to those in the ‘treatment as usual’ group, parents in the PPEY group reported more significant reductions in their children’s behavioural problems post-intervention. There was no significant difference in benefit for children with developmental delay and children with behaviour problems primarily, suggesting that the PPEY programme is equally beneficial to both groups. Furthermore, positive gains were maintained at five month follow-up. The study has been been published by the International Journal of Clinical and Health Psychology (Griffin, Guerin, Sharry & Drumm, 2010) and the pilot study was published by Clinical Child Psychology and Psychiatry (Sharry, Guerin, Griffin & Drumm, 2005).

Community Study: 
A pre and post community study of the PPEY programme delivered in highly disadvantaged junior schools (Kilroy, Sharry, Flood & Guerin, 2011) showed that a significant number of the 40 parents enrolled in the programme reported high levels of behavioural and emotional problems in their children pre-intervention (23% in the clinical range) suggesting the high need for these supports. Most encouraging though was the high impact of the PPEY groups – only 3% of children whose parents completed the course were found to be in the clinical range post PPEY, lending support for parenting groups in the community.

Early Intervention Study:
The PPEY Community Course was delivered as part of a suite of interventions to preschool childcare services in disadvantaged areas over several years. The programme was independently delivered and independently evaluated as part of a clustered randomised control trial (RCT). Significant positive effects were observed within the home learning environment for parents who completed the PPEY.
‘In particular, this finding isolates the Parents Plus Community Course as being a key component in improving the home-learning environment, even two years after the course was attended’ (Hayes, Siraj-Blatchford, Keegan & Goulding, 2012, p. 39).

Universal Delivery Study:
As one of the 10 national projects supported by the the National Early Years Access Initiative, the Parents Plus Community Course was rolled out to over 700 families in 35 different childcare services in North Dublin over a two year period. The resultant study (Gerber, Sharry, Streek & McKenna, 2016) involving the 277 parents who completed the course found that there were significant reductions in child behavior problems and parental stress from pre- to post-intervention. Most significantly, the courses successfully engaged disadvantaged families with significant problems (40% of sample) and these families benefited most overall. The results demonstrate the unique attributes and potential that preschool PPEY programmes can offer as a cost-effective and sustainable resource for early intervention with young children and their families. The study was published in the European Early Childhood Education Research Journal in 2016 (Volume 24 Issue 5).

Qualitative Research:
A short qualitative study by Griffin, Sharry, Guerin and Drumm (2006) describes parents’ reports of the main benefits of the PPEY group at follow-up. Group support was identified as the main benefit.

The Parents Plus Parenting When Separated (PP PWS) programme was evaluated as part of a randomised control trial (RCT) involving 25 individual agencies throughout Ireland and the UK. In total 161 separated parents took part. 82 participants were assigned to the treatment group and were compared with 79 participants in the waiting list control group. They were assessed on measures of client goals, parenting satisfaction, child and parental adjustment and interparental conflict at baseline (Time 1) and six weeks later (Time 2) after the treatment group completed the PP PWS programme. From Time 1 to Time 2 significant goal attainment, increases in parenting satisfaction, and decreases in child behaviour problems, parental adjustment problems and interparental conflict occurred in the PP PWS group, but did not in the control group. These results supported the effectiveness of PP PWS, and demonstrates significant benefits to parents attending. The study has been submitted as a PhD thesis in UCD (Keating, 2013) and was published by Clinical Child Psychology and Psychiatry (Keating, Sharry, Murphy, Rooney & Carr, 2016).

Clinical Study – Working Things Out:
Sixty-seven adolescents attending child and adolescent mental health services were randomly allocated to the Working Things Out CBT based group programme or to ‘treatment as usual’. Standardised measures were completed pre- and post-intervention, and at three-month follow-up. Adolescents who completed the Working Things Out programme had a significant reduction in their emotional and behavioural difficulties, and used significantly more ‘good’ coping strategies three months following completion of the programme. Those who received treatment as usual also improved, but their coping strategies failed to improve significantly. The study has been submitted as a PhD thesis in UCD (Brosnan, 2015).

Clinical Study – Adolescents Programme and Working Things Out:
In an evaluation of the combined delivery of the Parents Plus Adolescent and Working Things Out programmes (PPAPWTO) targeted at adolescents with social, emotional and behavioural difficulties (SEBD), the outcomes of 93 adolescents aged 11–17 years (M = 14.64, SD = 1.31; 39% male) attending Child and Adolescent Mental Health Services (CAMHS) in Ireland, and their parents were analysed. The study used a quasi-experimental One-Group Pre-test-Post-test design to assess change from pre- to post-intervention using the Strengths and Difficulties Questionnaire, the McMaster General Functioning Scale, Goal Attainment, Parent Stress Scale and the Kansas Parenting Satisfaction Scale. Both parent- and adolescent-rated goal attainment and general family functioning improved from pre- to post-intervention. Parents also rated their satisfaction with parenting as having significantly improved. Adolescent-rated emotional difficulties significantly improved for the overall sample and parent-rated child total difficulties for female adolescents significantly improved from pre-test to post-test. Parents of female adolescents also reported a significant drop in parental stress. These findings indicate that the PPAPWTO may be an effective intervention for adolescents with SEBD, particularly females, and their parents. The study was published in the Journal of Child and Adolescent Mental Health (Wynne, Doyle, Kenny, Brosnan & Sharry, 2016).

Community Study – Adolescents Programme and Working Things Out:
In an evaluation of the combined delivery of the Parents Plus Adolescent and Working Things Out Programmes targeted at adolescents with emotional and behavioural difficulties in Irish post-primary schools, the outcomes of 47 participating parents and their adolescent children (mean age being 13.81 years) were analysed. The study used a repeated-measures design to assess change at pre- and post-intervention and five-month follow-up using the Strengths and Difficulties Questionnaire (parent and adolescent rated), McMaster General Functioning Scale (parent- and adolescent-rated), Parent Stress Scale, and Kansas Parenting Satisfaction Scale as assessment measures. Parent and adolescent rated behavioural difficulties significantly improved from pre- to post-test, as did parents’ stress and their satisfaction with parenting. These gains were largely maintained at five-month follow-up, although parent stress increased from post-test to follow-up. These findings indicate that the combined PPAPWTO programme may be an effective intervention for adolescents with emotional and behavioural difficulties, and their parents. It was also demonstrated that a cost-effective, manualised family intervention could be effectively rolled out in a post-primary school setting, with delivery and evaluation being conducted by school staff. This study has been published by Clinical Child Psychology and Psychiatry (Rickard, Brosnan, O’Laoide, Wynne, Keane, McCormack & Sharry, 2015).

In a small scale comparative study, Behan et al. (2001) found that parents who completed the original Parents Plus Programme (for parents of children aged 4-11 years) reported fewer child behaviour problems and improved parent-child interaction post-intervention, when compared to a waiting list control group.

In an evaluation of the effectiveness of the programme for preschool children with developmental disabilities and behavioural problems, Quinn, Carr, Carroll and O’Sullivan (2006) found that the children of parents in the treatment group (n = 22) showed better adjustment on the total difficulties scale of the Strengths and Difficulties Questionnaire than those of participants in the waiting list control group (n = 17). Furthermore, these gains were maintained at 10-month follow-up. This study was published in the Irish Journal of Psychology. Another related study published in the Journal of Applied Research in Intellectual Disabilities (Quinn, Carr, Carroll & O’Sullivan, 2007), showed that the Parents Plus Programme could also be effective for children with behavioural difficulties, with and without developmental disabilities.

Behan, J., Fitzpatrick, C., Sharry, J., Carr, A. & Waldron, B. (2001). Evaluation of the Parents Plus Programme. Irish Journal of Psychology, 22(3-4), 238-256.
Carr, A. (2015). The evidence base for the Parents Plus & Working Things Out programmes. Parents Plus Innovations in Working with Families Conference, Dublin, Ireland, 3^rd December 2015.
Carr, A., Hartnett, D., Brosnan, E. & Sharry, J. (2016). Parents Plus systemic, solution-focused parent training programs: Description, review of the evidence base, and meta-analysis. Family Process.
Coughlin, M., Sharry, J., Fitzpatrick, C., Guerin, S. & Drumm, M.  (2009). A controlled clinical evaluation of the Parents Plus Children’s Programme: A video-based programme for parents of children with behavioural and developmental problems. Clinical Child Psychology and Psychiatry, 14(4) 541–558.
Coughlin, M., Doyle, C., Sharry, J., Guerin, S., Beattie, D, (2017) The Parents Plus Children’s Programme—a qualitative study exploring parents’ experiences of participation and cognitive factors mediating outcome.  Child Care in Practice   https://doi.org/10.1080/13575279.2017.1342601
Fitzpatrick, C., Beattie, D., O’Donohoe, P. & Guerin, S. (2007). Parent management training for adolescent mental health disorders – A controlled trial. 54th Annual Meeting of the American Academy of Child & Adolescent Psychiatry, Boston, MA, USA. 23-28th Oct 2007.
Gerber, S, Streek, A., & Mc Kenna, G. (2013). A Rising Tide? The potential and possibilities arising from community-based parent support. Early Childhood Ireland: Global Gathering for Early Childhood 2013, 17^th October 2013, Dublin, Ireland.
Gerber, S., Sharry, J., Streek, A., & McKenna, G. (2016). Parent training: Effectiveness of the Parents Plus Early Years Programme in community preschool settings. European Early Childhood Education Research Journal, 24(5).
Griffin, C., Guerin, S., Drumm, M. & Sharry, J. (2005). Evidence-based practice in parent training: the search for sound evidence of effectiveness. The Irish Psychologist, 31(7) 196-200.
Griffin, C. (2006). A clinic-based evaluation of the Parents Plus Early Years Programme. Department of Psychology. University College Dublin: 242.
Griffin, C., Sharry, J , Guerin, S. & Drumm, M. (2006). I am not alone: The importance of the group in parent training. Eisteach: Journal of Irish Association of Counselling and Therapy, 6(2).
Griffin, C., Guerin, S., Sharry, J. & Drumm, M. (2010). A multicentre controlled study of an early intervention parenting programme for young children with behavioural and developmental difficulties. International Journal of Clinical and Health Psychology 10(2) 279-294.
Hand, A., Ní Raghallaigh, C., Cuppage, J., Coyle, S., Sharry, J. (2012). A controlled clinical evaluation of the Parents Plus Children’s Programme for parents of children aged 6–12 with mild intellectual disability in a school setting. Clinical Child Psychology and Psychiatry, 18(4) 536–555.
Hand, A. McDonnell, E., Honari, B. & Sharry, J.  (2013). A community-led approach to delivery of the Parents Plus Children’s Programme for the parents of children aged 6-11. International Journal of Clinical and Health Psychology, 13, 81-90.
Hayes, N., Siraj-Blatchford, I., Keegan, S. and Goulding, E. (2013). Evaluation of the Early Years Programme of the Childhood Development Initiative. Dublin: Childhood Development Initiative (CDI).
Keating, A., Sharry, J., Murphy, M., Rooney, B. & Carr, A. (2016). An evaluation of the Parents Plus – Parenting When Separated programme. Clinical Child Psychology and Psychiatry, 21(2) 240–254.
Kilroy, S., Sharry, J., Flood, C. & Guerin, S. (2008). Parent training in the community – a pilot study. Paper presented at Association of Child Psychology and Psychiatry Research Conference, September 2008.
Kilroy, S., Sharry, J., Flood, C. & Guerin, S. (2011). Parent training in the community: Linking process to outcome. Clinical Child Psychology and Psychiatry 16(3) 459–473.
Lonergan, A., Gerber, S., Streek, A. & Sharry, J. (2015). Parenting groups, how long is enough? The efficacy of a community-run Parents Plus Early Years Program as a preschool parenting intervention of modifiable duration. Global Journal of Community Psychology Practice, 6(1) 1-13.
Nitsch, E. (2011). Positive Parenting: A Randomized Controlled Trial Evaluation of the Parents Plus Adolescent Programme in Schools. Dept. of Psychology, University of Limerick.
Nitsch, E., Hannon, G., Rickard, E., Houghton, S. & Sharry, J. (2015). Positive parenting: A randomised controlled trial evaluation of the Parents Plus Adolescent Programme in schools. Child and Adolescent Psychiatry and Mental Health, 9:43.
Sharry, J., Guerin, S., Griffin, C. & Drumm, M. (2005). An Evaluation of the Parents Plus Early Years Programme: A video-based early intervention for parents of preschool children with behavioural and developmental difficulties. Clinical Child Psychology and Psychiatry 10(3) 319-336.
Quinn, M., Carr, A., Carroll, L. & O’Sullivan, D. (2006). An evaluation of the Parents Plus Programme for pre-school children with conduct problems: A comparison of those with and without developmental disabilities. The Irish Journal of Psychology, 27(3-4) 168-182.
Quinn, M., Carr, A., Carroll, L. & O’Sullivan, D. (2007). Parents Plus Programme I: Evaluation of its effectiveness for pre-school children with developmental disabilities and behavioural problems. Journal of Applied Research in Intellectual Disabilities, 20(4) 345–359.
Rickard, E. D., Brosnan, E., O’Laoide, A., Wynne, C., Keane, M., McCormack, M. & Sharry, J. (2015). A first-level evaluation of a school-based family programme for adolescent social, emotional and behavioural difficulties. Clinical Child Psychology and Psychiatry.

Turan, B., Esin, IS. & Dursun, OB. (2021). The Effect of Parenting Programme on the Symptoms and the Family Functioning of Children with Attention Deficit and Hyperactivity Disorder Who Have Residual Symptoms Despite Medical Treatment. Behaviour Change. 1 doi:10.1017/bec.2021.13

Wynne, C., Doyle, C., Kenny, R., Brosnan, E. & Sharry, J. (2016). A first-level evaluation of a family intervention for adolescent social, emotional and behavioural difficulties in Child and Adolescent Mental Health Services. Journal of Child and Adolescent Mental Health, 28(1) 33-46. 

In 2019-2020 a pre and post evaluation of 42 parents completing the programme, there were significant improvements on the Kansas Parental Satisfaction Scale (KPS) scores, the Lifestyle Behaviour Checklist (LBC) and the programme Healthy Habits Questionnaire.  In addition, on the Healthy Habits Questionnaire parents showed improvement across many domains including Healthy Routines and Mealtimes, Active play, Sleep and Family Connection.

The study has been written up as clinical doctorate thesis by Dr Fionna McDarby in the Dept of Psychology in UCD.

The Healthy Families is currently being evaluated as part of a large RCT study in primary care and Family Resource centres. The study is supervised by Prof Alan Carr University College Dublin