Original Article

Yonago Acta medica 2015;58:109–114

A Comparative Evaluation of Parent Training for Parents of Adolescents with
Developmental Disorders
Risa Matsuo,*† Masahiko Inoue‡ and Yoshihiro Maegaki**Division of Child Neurology, Development of Brain and Neurosciences, School of medicine, Tottori University Faculty of Medicine,
Yonago 683-8503, Japan, †Department of Child studies, College of Humanities, Okinawa University, Naha 902-8521, Japan and ‡Department of Clinical Psychology, Graduate School of Medical Sciences, Tottori University, Yonago 683-8503, Japan

ABSTRACTIn Japan, parent training (PT) is a known method of
support for parents of children with developmental disorders (DDs).1–4 In other countries, these PT programs
consisted of individual sessions, out-reach programs, andtelephone programs.5–8 In contrast, the PT program inJapan is implemented by approximate ten-person group
work sessions. Recently this PT program has become
the main family support for attention deficit hyperactivity disorder (ADHD).9–12 Additionally, in Japan, there isno specific program for parents of adolescent-age children with DDs,13 despite the many parent-child conflicts
and secondary disorders that are known to arise fromsaid adolescent children. These adolescent children are
also often in the developmental stage of asserting their
independence from their families. Takahashi14 reported
that it is more difficult for parents to have a relationshipwith a child who has a DD, particularly in adolescence,as compared to a neurotypical child.
Nomura et al.15 pointed out that the depression rate
for mothers of children with pervasive developmental disorders (PDDs) is higher than that of mothers ofneurotypical children. The depression rate for mothersof children with PDDs was 40% compared to 20% formothers of neurotypical children. Furthermore, 10%of mothers of children with PDDs experienced severe
depression compared to 1% of mothers of neurotypicalchildren.
According to these studies, a support program isneeded for parents of children of all ages who havedevelopmental disorders. Specifically, the need forthe development of a PT for parents with adolescentchildren afflicted with DDs has been stressed.16–18 PT

Background In the present study, we evaluated the ef-

fectiveness of a parent training (PT) program in Japanfor parents of adolescents with developmental disorders(DDs). In Japan, there were no separate programs forparents of children with DDs in early adolescence andbeginning to assert their independence from their families despite the many parent-child conflicts and secondary disorders arising from the children.
Methods The parents of forty-four adolescent children
ranging in ages from ten to seventeen were assigned toeither a control group or an experimental group. The
program comprised two hour biweekly sessions for threemonths. The program we examined in this program are:how to praise, stress management for parents, cognitive
restructuring, how to scold, problem-solving communication training and how to make a behavior contract. To
compare the effectiveness of this program in the control
and experimental groups, two-way analysis of variance
was used to analyze data collected using psychologicalassessment scales such as the Strengths and Difficulties Questionnaire (SDQ), the Child Behavior Checklist(CBCL), the Conflict Behavior Questionnaire for Parents(CBQ), and the Beck Depression Inventory (BDI-II).
Results The results showed a significant difference
between pre- and post test scores on CBCL, BDI-II, and
CBQ, but not on SDQ. The findings indicate that children’s behavioral problems and parent–child conflict inthe experimental group were improved at the end of the
program.
Conclusion Accordingly, special programs are needed
for adolescent PT as well as PT programs for children
with DDs.

Corresponding author: Risa Matsuo
r-matsuo@okinawa-u.ac.jp
Received 2015 June 19
Accepted 2015 July 8
Abbreviations: ADHD, attention deficit hyperactivity disorder;
ASD, autism spectrum disorder; BDI, Beck Depression Inventory;
CBCL, Child Behavior Checklist; CBQ, Conflict Behavior Questionnaire for Parents; DD, developmental disorder; LD, learning disorders; PDD, pervasive developmental disorder; PT, parent training;
SDQ, Strengths and Difficulties Questionnaire

Note: For this study ‘adolescent’ is considered minors
aged ten to eighteen, ‘children’ is considered minors
aged nine and under.
Key words

adolescence; developmental disorder; par-ent training
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R. Matsuo et al.

SUBJECTS AND METHODS

programs for parents of children with DDs teach themethod of training these children basic hygiene, manners and social interactions with the parents. Whereas,
PT for adolescence teaches fence-mending (mend relations) by parent-child communication, the process ofmaking promises(groundrules) between parent-child,and parental stress management. No general consensus
has been reached as to the effectiveness of PT programs
for adolescents. Cedar et al.19 did not find any correlation between PT and adolescents’ age but, in their metaanalysis study, Serketich et al.20 found that the overall
effectiveness of PT decreases as the child gets older.
Ruma et al.21 indicated that group PT would be less effective with older children because as they increase in
age the following occurs: i) the children develop a stronger sense of emerging identity; ii) the children strive formore autonomy; iii) the children’s peers often become astronger source of influence; iv) the children spend lessand less time at home. Smith et al.22 said family support
is needed specializing in the development of programsfor children in adolescence. Chronis et al.23 pointed
out it is important for teachers and parents to cooperatein encouraging the children themselves to make timeschedules and do their homework.
Based on these studies, we believe the support needed for parents of adolescents with DDs is different fromthe needs of parents of younger children with DDs. As
such, we need to create a new specialized program forparents of adolescents with DDs.
The present study evaluates the effectiveness of a
PT for parents of adolescents with DDs.

Subjects

All minors were clinically diagnosed with autism spectrum disorders (ASDs), ADHD or learning disorders(LDs) according to the DSM-IV-TR guidelines. The
minor’s ages ranged from 10.8 to 17.2 years. The subjects consisted of forty-four mothers, and two fathers.
Informed consent was obtained from all parents.
DesignSubjects were assigned to one of two groups determinedby the following conditions: i) Experimental group:
practitioner-assisted group PT was implemented across
six sessions, comprising five groups that completed thetraining between 2008 and 2011. In this group twentyfour parents of adolescents with DDs participated for3 months and ii) Control group: twenty parents participated and were required to take the psychological preand post tests without completing the 3-month training
program. The control group consisted of twenty parents.
Seven of the twenty parents in the control group, laterjoined the experimental group.
No differences were found between the experimental and control groups in terms of descriptive characteristics (Table 1).
The facilitator of the experimental group was thefirst author who was attending a doctoral course with acertified clinical psychotherapist.
Psychological assessment scales

To assess the impact of the adolescent’s problem behaviors, the parents completed the burden and impact
scales from the Strengths and Difficulties Questionnaire(SDQ),24 and the Child Behavior Checklist (CBCL).25
The scales have been proven to discriminate between
clinical populations of children with diagnoses. SDQ isa brief behavioral screening questionnaire for three tosixteen year olds. SDQ is composed of twenty-five questions with the responses recorded on the 3 likert scale.

Note: For this study ‘adolescent’ is considered minors
aged ten to eighteen, ‘children’ is considered minors
aged nine and under.

Table 1. Demographic characteristics of the sample (n = 44)
Variable

Experimental group (n = 24)MsChild’s age
13.01
1.61
M (s)
Gender Child75(% male)Parent’s age
42.2
4.02
M (s)
Gender Parent
4.2(% male)M, average value; n.s., no significant difference.

Control Group (n = 20)
M

s

t (v)

P

14.1

2.48

–2.45 (44)

n.s.

71.4

n.s.

42.44

7.28

5.0

–0.09 (44)

n.s.
n.s.

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PT of adolescents with DDs

CBCL is a method of identifying problem behavior inchildren aged four to sixteen years old. To assess the impact of communication and conflict in parent-adolescentinteractions, the Conflict Behavior Questionnaire for
Parents (CBQ)26 was used. CBQ is a twenty question 2
choices self-report. To assess the impact of the depression of parents, the Beck Depression Inventory (BDI-II)27
was used. BDI-II is one of the most widely used instruments for measuring the severity of depression.

that participation was voluntary, that they could withdraw at any time without facing negative consequences,that their anonymity would be protected and that thedata obtained would not be used for purposes other thanresearch. Participants gave written informed consent.
RESULTS
Psychological testing

Effects on the experimental group compared to the control group were tested with a two-way factorial analysis
of variance, using the posttest outcome as the baseline
score. Results are shown in Table 3.
The result showed that there was a significant difference among pre- and post tests scores on CBCL, BDIII, and CBQ but not on SDQ. There was a main effect oftime, pre- and post test, on attention problems {F (1, 42)= 7.88, P < 0.01}, thought (cognitive) problems {F (1, 42)= 4.19, P < 0.05}, social problems {F (1, 42) = 3.88, P <0.10}, and aggressive behavior {F (1, 42) = 4.09, P < 0.10}
in CBCL. In CBQ total scores, there was a main effectof group {F (1, 42) = 5.10, P < 0.05}. There was also aninteraction effect of conduct problems in SDQ {F (1, 42)= 3.07, P < 0.10} and CBQ total scores {F (1, 42) = 7.10,
P < 0.05}.

Program content

This program was comprised of lectures, group works,
and homework. Parents in the experimental group received training in positive interactions with their children, including how to praise, how to scold, reframing,
cognitive restructuring, problem-solving skills and how
to make a behavior contract (Table 2).
Statistical analysis

A two-way ANOVA analysis was used to examine
whether there is a significant difference for each psychological assessment measure in order to show the averagevalue of the data both pre and post PT for parents ofadolescents with DDs program. All statistical analysis
was carried out using SPSS version 22.0 (IBM, Armonk,NY).

Post-training session questions for the experimental group

Ethical Considerations

The subjects in the experimental group completed 3
questions after the end of the training session, as follows: i) Was it easy to understand the program? ii) What

This study was approved (No.1889) by the ethics committee of Tottori University. The subjects were assured

Table 2. Program content
Session
No

1

2
3

4
5
6

LectureOrientation
Fill in the questionnaire
Stress management
Features of adolescence Development
pointsBreaking the ice
Positive contact with children
Cognitive restructuring
Reframing
How to scold
Anger management for parents
Problem-solving skills
How to make a behavioral contract
How to set reward
Review this program
Fill in the questionnaire

Group Works

Homeworks

Self-introduction

Fill in “Communication assessment
sheet”

Make a list of how praise children

Work to praise a lot of children

Sharing homework

Commands that teens are likely to obey

Sharing homework
Think about being “the worst” versus“the best” supervisor

Work to quality time
Fill in “Problem-solving sheet”

Sharing homework

Work to create behavioral contract

Review

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R. Matsuo et al.
Table 3. Effect of parent training for parents of adolescents with developmental disorder
Experimental Group(n = 24)PretestPosttest
BDI-Ⅱ
SDQ

Group
F (v)

Interaction
F (v)

M
s

14.38
(9.59)

13.25(10.16)

16.94(11.56)

12.56(10.62)7.90 (1,42)** 2.76 (1,42)

0.09 (1,42)

Conduct Problems

M
s
M
s
M
s
M
s
M
s
M
s

4.08
(1.95)
5.67(2.41)
4.21(2.69)
4.46(1.79)
3.63(2.16)
18.46(4.27)

3.63(1.69)
5.75(2.19)
3.54(2.25)
4.46(2.11)
4.04(2.10)
17.50(5.02)

2.88(2.00)
5.75(2.24)
3.94(2.62)
4.75(2.21)
4.56(3.33)
17.38(5.51)

2.94(1.81)
5.19(2.83)
4.00(2.53)
4.75(1.81)
4.63(2.94)
17.00(4.97)

0.59 (1,42)

0.02 (1,42)

3.07 (1,42)†

0.61 (1,42)

1.10 (1,42)

0.11 (1,42)0.70 (1,42)

1.02 (1,42)

0.02 (1,42)

0.00 (1,42)

0.00 (1,42)

0.25 (1,42)0.82 (1,42)

0.45 (1,42)

0.93 (1,42)0.75 (1,42)

0.14 (1,42)

0.33 (1,42)

M
s
M
s
M
s
M
s
M
s
M
s
M
s
M
s
M
s
M
s
M
s

67.54
(8.95)
59.46(10.08)67.54(8.96)
68.08(8.92)
66.21(11.52)
68.67(7.14)
63.67(8.24)
65.21(8.76)
67.96(8.58)
65.71(9.51)
70.58(8.17)

64.04(8.31)
57.96(7.91)
64.67(9.77)
65.79(8.79)
63.25(10.67)64.54(8.31)
61.75(8.43)
63.38(8.42)
64.58(8.86)
62.83(9.95)
67.25(8.59)

66.56(10.05)57.69(8.35)
66.44(10.26)69.31(10.79)64.94(11.89)69.13(7.54)
59.56(8.77)
62.63(9.70)
66.19(8.72)
62.25(9.92)
68.75(8.81)

66.13(10.63)59.06(7.74)
66.06(10.13)66.31(7.60)
62.13(13.38)65.88(8.18)
60.31(8.72)
60.31(7.82)
66.19(9.88)
61.13(7.81)
68.06(7.57)

2.23 (1,42)

1.39 (1,42)0.04 (1,42)

0.00 (1,42)

1.45 (1,42)

0.02 (1,42)

2.97 (1,42)†

1.76 (1,42)

0.00 (1,42)

3.88 (1,42)†0.07 (1,42)

0.11 (1,42)

4.19 (1,42)*0.00 (1,42)

0.12 (1,42)

7.88 (1,42)** 0.11 (1,42)

0.17 (1,42)

0.18 (1,42)

0.96 (1,42)

1.35 (1,42)

4.09 (1,42)†0.06 (1,42)

1.08 (1,42)

2.63 (1,42)

2.63 (1,42)

0.00 (1,42)

2.91 (1,42)†

0.56 (1,42)0.85 (1,42)

3.23 (1,42)†

1.40 (1,42)0.04 (1,42)

M
s

11.17
(4.20)

8.13(4.78)

6.19(4.67)

6.31(3.38)

4.33 (1,42)*

5.10 (1,42)*

7.10 (1,42)*

Emotional Symptoms
Peer Relationship Problems
Prosocial Behavior
Total Problems
Anxious/Depressed
Withdrawn
Somatic
Social Problems
Thought Problems
Attention Problems
Delinquent Behavior
Aggressive Behavior
Internalization
Externalization
Total Problem
CBQ

Time
F (v)

BDI-Ⅱ Total

Hyperactivity/Inattention

CBCL

Control Group(n = 20)PretestPosttest

CBQ Total*P < 0.05.
**P < 0.01.
†P < 0.10.
BDI, Beck Depression Inventory; CBCL, Child Behavior Checklist; CBQ, Conflict Behavior Questionnaire for Parents; M, average value;
SDQ, Strengths and Difficulties Questionnaire.

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PT of adolescents with DDs

decreased, as did parent-child conflict scores comparedwith subjects in the control group. In addition to the psychological test results, we found that the program significantly improved self-reported positive communicationin parent-child interactions. In the beginning stages ofthe program, we delivered sessions on reframing, cognitive restructuring, how to praise and how to scold. In
the final stages of the program, the interaction achieved
through making a behavior contract greatly improved
satisfaction and the feeling of accomplishment.
We found no significant effects in terms of satisfaction of subjects with the contents of the PT program.
However, parents-child relationship improvement might
be expected from carefully reviewing how to praise children and parents’ anger management.
Improvement of anxiety/depression of CBCL in
the experimental group children, and school refusal, or
problem behavior can be influenced by improvement inparents-child relationship, or flexibility in how parents
perceive the behavior of their children. Future researchers could examine the association between the contents
and effects of the PT program.
At present, PT programs for parents of adolescentswith DDs have not been overly effective because theprograms were directed at PT of younger children’s anddid not include PT on how to praise, environmental coordination, and functional assessment.
However, PT for parents of adolescents with DDs
is needed for therapists to assess the mental conditionof the subject. We believe it is necessary to add to theprogram sessions on stress management, cognitive reconstructing, problem-solving skills, and how to make abehavior contract.
Therapists are required in order to provide psychological knowledge and counseling skills to parentsof adolescents with DDs, even more so than parents ofyounger children’s PT programs.

Table 4. Satisfaction with the program (unit: %)i) Was it easy to understand the program?
MostlyMiddleSlightly
Agree
Disagreeagree
undecided disagree
85

15

0

0

0

ii) What did you learn in the lecture that was helpful when you
communicated with your children?
MostlyMiddleSlightly
Agree
Disagreeagree
undecided disagree
92

8

0

0

0

iii) Through the program, did you have a cognitive change withthe children?
MostlyMiddleSlightly
Agree
Disagreeagree
undecided disagree
62

38

0

0

0

did you learn in the program that was helpful when you
communicated with your children? iii) After completingthe program, did you have a cognitive change with yourchildren? The experimental group subjects reported highlevels of satisfaction for each question (Table 4).
General impression provided by the experimental
group

According to the survey results, the general impressionof the experimental group was that praise greatly improved the attitudes of the children, focusing on positive
behavior created positive results, interaction within thegroup caused a feeling of mutual support and shared experiences, and PT experiences triggered an evaluation of
past parenting failures.
DISCUSSION
In the present study, we examined the effectivenessof a PT program for parents of adolescents with DDs.
Previous reports do not include reports specializing inparents with adolescent children. Until now, programs
intended for younger children were used with parents ofadolescents with DDs. This proved to be an ineffective
method causing major difficulties with parents of adolescent children with DDs. Therefore, it is important thata special program specifically created for adolescents beutilized.
Subjects who completed the program showed improvement in the parent’s attitude toward their children,
and a reduction in parent-child conflict and behavioral
problems of the children directly related to reframing,
cognitive restructuring, problem-solving skills, and how
to make a behavior contract. The anxious/depression
levels of children in the experimental group significantly

Directions for future research

Future research must be directed at developing appropriate and more effective experimental programs for adolescent children with DDs and also for their parents.
Yearly inspections of follow up data are necessary, inorder to analyze whether improvement gains were maintained.
The authors declare no conflict of interest.

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R. Matsuo et al.

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