Adolescence is a period of enormous adjustment for both teenagers and families. As children transition from childhood to adulthood, they go through many physical, emotional and behavioural changes. Not surprisingly, many parents describe adolescence as the most difficult and anxiety-provoking period of their children’s life. Parents’ concerns are well justified, considering the high prevalence of emotional and behavioural problems during adolescence. Although health professionals and researchers share parents’ view of adolescence as a challenging period of life, the scope of research on adolescents is scarce compared to research on children and adults. However, this is now changing. Research on adolescent development and adolescent psychopathology has increased dramatically during the last two decades. Reducing risk factors in adolescents’ development has been receiving more and more attention both from researchers and policy makers. Family risk factors such as inadequate parental monitoring and family conflict are among potentially modifiable risk factors that can be targeted in order to reduce the rate of emotional and behavioural problems in adolescents. Behavioural family intervention is considered to be one of the promising intervention systems in this area because of the extensive empirical support it has received in research with families of preadolescence children. The research presented in this thesis focuses on parenting programs for parents of teenagers. The first study evaluates the efficacy of a behavioural family intervention (Triple P – Positive Parenting Program) targeting parents of teenagers. The second study explores factors which affect parents’ decisions to participate in parenting programs. The first study outlines a randomised control trial (RCT), assessing the efficacy of a parenting intervention in reducing behavioural problems in adolescents. The study provides support for an intensive individual version of Teen Triple P – a behavioural family intervention designed specifically for parents of high risk adolescents. The intervention aims to improve adolescent behaviour by reducing parents’ use of ineffective parenting. Participants were 46 families with a teenager aged 11 to 16. The outcomes of the intervention included a reduction in teen disruptive behaviours (d > .85) and parent-adolescent conflict (d = .1.21), as well as decreased parental use of harsh and coercive parenting strategies (d = 1.15) and a decrease in parents’ conflict over child rearing issues (d = .64). These positive changes were maintained at the three-month follow up. In spite of the growing recognition of parents’ need for information, guidance and support during the crucial and challenging years of adolescence, little is known about the factors which affect parents’ engagement in programs designed to help them in their parenting roles. The second study aimed to provide a conceptual framework for understanding parents’ decisions to accept or decline participation in a parenting program by employing the Health Belief Model (HBM). The model suggested that parents are more likely to participate in a program when they (a) perceive their adolescents to be susceptible to development of problem behaviours, (b) perceive the problem behaviours to have serious consequences, (c) believe the parenting program to be beneficial in reducing the risk of development of problem behaviours in their adolescent, (d) perceive the personal, social and financial cost of attending the program to be low, and (e) are confident in their ability to successfully learn and apply what they learn in these programs. The model explained 31% of the variance in parents’ inclination to participate in parenting programs. The study also showed that parents differ in their preferences of delivery format for parenting programs. These two studies contribute to the literature in a number of ways. Firstly, they demonstrate that parent training is an effective intervention in the treatment of adolescent problem behaviours. Secondly, they highlight the importance of addressing parents’ beliefs and attitudes about the benefits of parenting programs as well as reducing participation barriers to encourage greater parental engagement in prevention and intervention programs. Finally, the research emphasises that in order to increase participation rate, parenting programs should be made available in a range of delivery formats. The implications of the current research and future directions are presented and discussed.

This study used a concurrent multiple-probe across three mother-child dyads with a non-concurrent addition of a fourth mother-child dyad to assess the extent to which behavior specialists’ use of coaching and performance feedback via telehealth effects the degree to which the parent implements the multi-component behavior support plan (BSP) strategies with fidelity in their home to decrease their child’s challenging behavior. Four behavior specialists and four mothers with their children who exhibit mild to moderate behavior participated in this study. The research question examined if a functional relation exists between implementation of coaching and performance feedback from the behavior specialists via the telehealth model on the parents’ level of implementation fidelity of the strategies in the BSP and the improvement in the level of child’s target challenging behavior and adaptive behavior. Results indicate the efficacy of coaching and performance feedback via telehealth in improving parent treatment fidelity. These results support the use of telehealth to deliver training on multi-component interventions. Additionally, participating behavior specialists and parents indicated that they found the procedures used to be both acceptable and effective. Further implications for practice and directions for future research are discussed.

Telehealth provides an alternative delivery form of parent training that allows practitioners to disseminate information and feedback at a distance. Telehealth can be as effective as in-person training (Wacker et al., 2013a; Wacker et al., 2013b; Vismara et al., 2009). Despite most telehealth studies indicating high satisfaction, research on patient satisfaction using telehealth has depended mostly on survey instruments, which limits definitive conclusions and may not translate into actual use or selection (Whitten & Love, 2005). The primary purpose of this study was to evaluate a procedure for identifying parent preference of in-person or telehealth training modalities. Secondary purposes were to evaluate and compare correspondence between preference as measured in a choice format and a social validity measure, determine if the procedures can be used to detect differences in acquisition from each modality, and to evaluate effects of parent training on child appropriate and inappropriate behavior. The results support previous research that telehealth can be as effective as in-person training. Participants overall chose telehealth 40.93% of the time. Parent choice on any particular occasion was jointly influenced by other variables. Reported preference results at the end of the study differed from the choice data, which suggests satisfaction may differ from preference or actual use. Future studies could use this method to evaluate preference on a larger scale, or for different kinds of interventions and training modalities.

Many individuals with developmental disabilities do not develop vocal repertoires. Thus, teaching the use of an augmentative and alternative communication (AAC) device is imperative. A speech-generating device (SGD) is an example of an AAC that is universally understood. Individuals with developmental disabilities have been taught to communicate using such device. Teaching caregivers to conduct communication training with their children may be one to way to foster communication in an individual’s natural environment. Thus, the purpose of this study was to extend previous research by using behavioral skills training (BST) to teach caregivers to implement SGD-based mand training using an adapted training sequence. Additionally, we evaluated whether training caregivers to implement mand training with their children resulted in an increase of independent mands in their children. This study found that BST was effective in teaching caregivers to implement SGD-based mand training with their children. Additionally, independent mands increased from pre-training to post-training observations for two children.

Young children who display disruptive behaviors are at risk for negative outcomes in later development such as school dropout, early pregnancy, and unemployment (Bradshaw, Schaeffer, Petras, & Ialongo, 2010). For this reason, it is imperative parents of children with disruptive behaviors seek early intervention to reduce problem behaviors and prevent negative effects (Breitenstein, Hill, & Gross, 2009). Parent behavioral training interventions are effective for reducing problem behaviors in young children. Attrition from parent training interventions, however, is a common problem that reduces positive outcomes for children with challenging behaviors (Kazdin, Holland, & Crowley, 1997; Prinz & Miller, 1994). Barriers to treatment, such as negative perceptions toward treatment, can influence parents’ attendance (Kazdin et al., 1997) and behavioral outcomes for children (Brestan, Jacobs, Rayfield, & Eyberg, 1999). This study (N = 139) examined relationships of parents’ attendance and perceptions of a behavioral parent training intervention, the empirically supported Helping Our Toddlers Developing Our Children’s Skills, or HOT DOCS (Armstrong, Lilly, & Curtiss, 2006). Regression analyses were conducted to test relationships between parent perceptions of treatment effectiveness, attendance, and child behavior ratings, and whether attendance mediated the relationship between parent perceptions of treatment and ratings of child behavior. No significant relationships were found between these variables, and no mediating relationship of attendance between parent perceptions and child behavior ratings was found. Results for this study may indicate factors other than parent perceptions are important to predict attendance or change in behavior ratings. Ethical considerations and limitations of this study are also discussed.

This thesis investigated the views, opinions and experiences of children, young people and parents of mental health services and Triple P parent training using qualitative methods. It is divided into four separate papers, the first three written as standalone journal papers. Paper 1 is a systematic review and synthesis of qualitative studies exploring children’s views and opinions of mental health services. The review used specific databases, a search of qualitative journals and a general Internet search to identify relevant studies. The paper utilized inclusion/exclusion criteria and a quality appraisal assessment. Fifteen studies meeting inclusion and quality criteria were identified exploring the experiences of 378 children and young people aged between 5 and 16 years, from a range of countries. The review then involved synthesising the findings of these studies to generate several overarching themes. Themes that emerged were; the stigma of mental health difficulties; alliance making and breaking properties; the physical location of services; consent and confidentiality; preferences for creative therapies and a recognition of therapeutic stages. Paper 2 is an original research study that explored the experiences of parents of Triple P parent training. Eight parents were interviewed using a semi-structured protocol. Data were analysed using Interpretative Phenomenological Analysis. Emergent themes were; a search for a cause; the stigma of parenting difficulties; the destruction and recreation of family life and a shift in perspective. Paper 3 explores the views and opinions of children whose parents have recently undertaken Triple P parent training. This qualitative study used ‘In My Shoes’, a computer assisted interview tool, to explore the experiences of eleven children from England aged between five and sixteen years. Children’s data were analysed using Thematic Analysis. Children’s themes were; a search for a cause; changes in life brought about by Triple P and wider difficult life circumstances. Parents and children’s narratives broadly agreed though children talked about being smacked before Triple P and parents did not comment about chastisement. The final section of the thesis was a critical appraisal of the literature review, research study and research process as a whole, including methodological reflections, implications for future research and clinical practice, and the researcher’s personal reflections in undertaking the research.

The current study was designed to replicate and extend previous research on the effectiveness of behavioral parent training. Specifically, the effectiveness of the Behavior Management and Parenting Services (BMAPS) curriculum in teaching parents to exhibit a set of parenting skills and respond accurately to a multiple choice examination about positive parenting techniques was evaluated. In addition, the curriculum was revised so that the relative effectiveness and acceptability of two role play formats could be assessed. The outcomes of the study showed an improvement in the participants' ability to identify correct answers on a multiple choice examination and apply the parenting skills taught in class within a role play format; results pertaining to the efficacy of each role play format were less conclusive.

Research with parents on managing child problem behavior typically measures either child or parent behavior. This study was designed to evaluate the effectiveness of training parents to implement a function-based behavior intervention plan (BIP) in a non-trained natural environment utilizing a Multiple Probe Design across Participants. Participants included four parent-child dyads. Measurement variables included parents' use of effective and ineffective strategies and child problem behavior. Intervention involved training parents to understand and implement the BIP using effective strategies, modeling the effective procedures, and providing feedback following parent implementation of procedures. Results showed that the intervention was very effective in promoting skill generalization of parents and decreasing child problem behavior. The findings have implications for research and clinical practice.

Behavioral skills training (BST) is effective for teaching safety skills but often requires a behavior analyst to conduct the training, which can make it costly and inaccessible for most parents or teachers. Parent-conducted BST may allow for children to receive training without the need for a trained behavior analyst. However, providing parents with training can often be difficult. Manualized training from a website could allow parents access to needed material at a low or no cost. This study evaluated a web-based manualized intervention implemented by parents for teaching firearm safety skills using BST. First, BST experts and parents validated the web-based manual. Next, we used a multiple-probe across participants design to assess the effectiveness of parent-conducted BST. Results indicate that three children acquired the safety skills after parent-conducted BST alone, and the other three children required experimenter-conducted IST. The advantages of parent-conducted BST, limitations, and areas for future research are discussed.

The present study evaluated telehealth training with parents on techniques for working with their children with autism spectrum disorder in Southeastern Europe. The purpose of this study was to research the effects of telehealth training on the parents and the increase of mands on the children. The participants of this study included three mothers and three children, which totaled six participants. Parents were trained on how to increase functional communication in their child. Telehealth training was based on an effective training package called Behavior Skills Training (BST). BST consist of instructions, modeling, rehearsal, and feedback. The resources needed for the training were minimal. They included access to internet, a device installed with a camera, and the children’s preferred items which were placed within view but outside the reach of the child. Sessions were recorded where parents interacted with their child during the generalization sessions as well as during the role plays with the trainer. The videos were observed in order to collect frequency data, determine if parents completed each step of the training, and if the child manded during each session. All three parent participants reported an increase in manding from their child, better communication skills between them and their child, and an increase in self-efficacy. These results suggest that countries in South-Eastern Europe should seek to implement telehealth training, mand training, and parent training as a program that not only these families may benefit from, but also the entire community. Future research should be conducted with a larger sample size and with more trainers using telehealth as an effective tool to increase better communication and decrease problem behaviors.