Parenting and children's behavioural problems: Micro- and macro-processes at play in the context of intervention

Child mental health problems are a public concern: 5-10% of children are currently living with a diagnosed mental health disorder. Around half of these relate to behaviour problems (e.g., tantrums, aggression). Left untreated, children are at higher risk of school exclusion, social difficulties and later mental health disorder. Behaviour problems are one of the most common reasons parents ask for or are referred for professional support ("intervention"). Intervention can be effective, but a third of children don't improve. Understanding the origins and development of these problems as well as how, when and why intervention works is crucial.

A common belief is that parents "cause" children's behaviour problems because of how they parent or behave themselves. However, while parents influence children, children also affect parents. For example, parents' stress can have a negative impact on parenting and child behaviour. But equally, when children show difficult behaviour, parent stress can increase. Another example is that smacking children can increase the chances of aggression, but children being aggressive can also increase the likelihood of parents using harsh discipline like smacking. Breaking these "negative cycles" between parents and children is one of the best ways to improve behaviour problems and is a common intervention focus.

Although we know that negative cycles are important for child mental health and good targets for support, there are key questions about which we know little. What child, family, school and neighbourhood factors predict negative cycles? Are there positive long-term effects of accessing mental-health services on parenting, child behaviour and negative cycles? These are what we call macro-level questions.

There are also micro-level questions. When we test intervention effects we look for improved parenting and child behaviour. But we tend not to look at the two together, the negative cycle itself. This is crucial if we are to make lasting differences to families because, even if we reduce harsh parenting or improve child behaviour, there is a risk that the negative cycle starts again because of previous history. What happens at home between support sessions? Do negative cycles change during intervention? When? Why?

Both macro- and micro-level questions are important for basic understanding and ultimately knowing how to improve intervention approaches so that more families benefit. To answer them, our project has two parts.

First, in the general population, we will look at negative parent-child cycles and consider what child, family, school and neighbourhood factors help healthier interactions over time. We will also look at the role of intervention in how parenting, child behaviour and negative cycles develop and change across childhood. To do this, we will use information collected over many years from ALSPAC, a large UK research sample of families and link it with mental health service use data.

Second, we will look at changes to negative cycles while intervention is going on, working in partnership with UK child and adolescent mental health services. Here, we will collect new information from families currently receiving support. To collect data that is detailed enough to answer our research questions, we have designed-with parents and intervention providers-an App called CALMS (Contextualising and Augmenting Learning in Mental Health Support). CALMS allows parents to tell us about their own and their child's behaviours twice a day. For the first time, CALMS lets us track information about negative parent-child cycles at home between sessions while intervention is on-going.

We will share our findings with a range of stakeholders including parents, clinicians and academics at an event. We will seek their views on how our study's findings can be used to inform our understanding of and future research on parent-child dynamics in the context of professional support.