An Efﬁcacy Trial: Positive Parenting
Program for Parents of Teenagers
Raziye Salari, Alan Ralph, and Matthew R. Sanders
The University of Queensland, Brisbane, Queensland, Australia
Studies on the efﬁcacy of parent training programs have mostly been conducted
with preadolescents, with only a few studies investigating family treatment models
in adolescents. In this article, a study is described that evaluates Standard Teen
Triple P (Positive Parenting Program), a behavioural family intervention for parents
of 11- to 16-year-old teenagers. Participants were 46 families with a teenager who
was experiencing detectable behavioural and emotional problems. Compared to
parents in the waitlist control condition, parents participating in the intervention
condition reported decreased levels of teen disruptive behaviours and parent ado-
lescent conﬂict, as well as a reduction in the use of ineffective parenting strategies
and conﬂict over child-rearing issues. These positive changes were maintained at
the 3-month follow-up. Results suggest that Standard Teen Triple P is a promising
parenting intervention for tackling adolescent externalising problems.
!Keywords: parenting programs, adolescent problem behaviours
Adolescence is a period of enormous adjustment for both teenagers and families. As
children transition from childhood to adulthood, they go through many physical, emo-
tional and behavioural changes. Not surprisingly, many parents describe adolescence
as the most difﬁcult and anxiety-provoking period of their children’s life (Buchanan
et al., 1990). Parents’ concerns are well justiﬁed, considering the high prevalence of
emotional and behavioural problems during adolescence (Costello, Mustillo, Erkanli,
Keeler, & Angold, 2003). This highlights the importance of prevention and treat-
ment efforts to address emotional and behavioural problems during this developmental
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 (Dekovic, Janssens, &
Van As, 2003). Although studies on parenting programs for parents of teenagers are
far less extensive compared to studies of children (Kazdin, 2005), they show parent
training programs to be effective prevention and intervention strategies to promote
positive development in adolescents. These programs reduce the risk of developing and
maintaining substance abuse, delinquent behaviour and other externalising problems
(Connell, Dishion, Yasui, & Kavanagh, 2007; Mason, Kosterman, Hawkins, Haggerty,
& Spoth, 2003). They also improve parent-adolescent communication and reduce
family conﬂict (Barkley, Edwards, Laneri, Fletcher, & Metevia, 2001; Dishion &
Andrews, 1995). Participating parents feel more conﬁdent and use more effective
parenting strategies (Spoth, Redmond, & Shin, 1998). In several studies, these positive
Address for correspondence: Alan Ralph, Parenting and Family Support Centre, School of Psychology, The
University of Queensland, Brisbane QLD 4072, Australia. Email: firstname.lastname@example.org
Behaviour Change Vol um e 31 Number 12014 pp. 34–52 c
⃝The Author(s), published by Cambridge
University Press on behalf of Australian Academic Press Pty Ltd 2014 doi 10.1017/bec.2013.31
Standard Teen Triple P
changes are maintained over time; in some examples, up to 4 to 10 years (Spoth,
Trudeau, Shin, & Redmond, 2008).
Most parenting programs for parents of teenagers have been designed and evaluated
either as universal and selective prevention strategies (e.g., Preparing for the Drug-Free
Years; Hawkins, Catalano, & Kent, 1991) or as part of a treatment package for severely
disturbed juvenile delinquents (e.g., Multisystemic Therapy; Henggeler, Schoenwald,
Borduin, Rowland, & Cunningham, 2009). There is limited evidence on the efﬁcacy
of parenting programs for adolescents who are currently showing serious difﬁculties,
but have not come in contact with the justice system. Moreover, most programs
are delivered in group formats, which may not be suitable for some families. Some
parents might refuse treatment in a group format because of the anxiety about sharing
problems with others, social anxiety or lack of personal attention. Parents who are not
able or willing to examine their interpersonal behaviours, to disclose themselves, and
to give and receive feedback are not suitable for brief and time-limited group programs
(Yalom & Leszcz, 2005). Other parents may ﬁnd the group format inconvenient for
practical reasons. Due to unpredictable working hours, certain parents may not be
able to commit to a regular schedule of sessions as required for group programs. There
may also be logistical problems in setting up groups, and parents may have to wait for
treatment until there are a sufﬁcient number of parents to begin a group.
The current study is an evaluation of Standard Teen Triple P (STTP). Triple P
is a multi-level behavioural family intervention, based on social learning principles
(e.g., Patterson, 1982), which aims to prevent and treat behavioural, emotional and
developmental problems in children and adolescents by enhancing the knowledge,
skills and conﬁdence of parents (Sanders, 1999). Teen Triple P is speciﬁcally designed
to meet the needs of parents of adolescents. The self-directed and group versions
of this program have already been evaluated and found to be effective in reducing
parent-adolescent conﬂict, dysfunctional parenting (laxness, over-reactivity) and dis-
agreements over parenting issues, as well as adolescent behavioural problems (Ralph &
Sanders, 2003; Stallman & Ralph, 2007). STTP is an individual face-to-face version
of Teen Triple P.
The purpose of this study was to trial the efﬁcacy of STTP. Speciﬁcally, it was
hypothesised that compared to parents in a waitlist control condition, parents who
received STTP would report: (a) decreased disruptive problem behaviours in their
teenagers; (b) decreased levels of parent-teenager conﬂict; (c) decreased use of dys-
functional parenting practices; (d) decreased level of disagreements over child rearing
issues; (e) increased level of relationship satisfaction; and (f) decreased levels of neg-
ative affect (e.g., anxiety, depression).
Participants were recruited through school newsletter advertisements in the Brisbane
area, Australia, from April 2007 to August 2008. The notice targeted parents of
teenagers (‘Are you concerned about your teenager’s behaviour?’), offering them a free
individual parenting program. Interested families were directed to visit a website or
contact the project coordinator for more information. The intervention was delivered
at either the Parenting and Family Support Centre or the Psychology Clinic at The
University of Queensland.
Raziye Salari, Alan Ralph and Matthew R. Sanders
the study. In the ﬁrst stage, a short standardised telephone interview by the author
was used to assess families’ suitability for the program and also to inform parents of the
program details and participation requirements. Families were eligible to participate
if: (a) the target child was aged between 11 and 16 years of age, (b) at least one
parent reported that they were concerned about their child’s behaviour, and (c) the
child was not currently having regular contact with another professional or agency
for emotional or behavioural problems. Families were excluded from the project if
the target child did not live with the interested parent for at least 2 days each
week, or there was evidence of a severe developmental disorder or signiﬁcant health
impairment. If the eligibility criteria were met, the parent(s) were sent the package
of questionnaires or were directed to complete them online, depending on their
preference. Before completing the questionnaires, parents were requested to read
the information sheet and consent to participating in the research, which included
being videotaped during the sessions. In the second stage, parents’ responses to the
questionnaires were examined. For inclusion in the study, the target child was required
to score in the elevated range (i.e., borderline or abnormal range) on the parent version
of the Strengths and Difﬁculties Questionnaire (SDQ; Goodman, 1997, 1999). When
both parents completed the questionnaires, the family was considered eligible if at
least one of the parents indicated that the target child scored in the elevated range on
Figure 1 shows the ﬂow of participants throughout the study. A total of 300 parents
responded to the campaign, contacting the project coordinator by email (87) or phone
(213). Ninety families were excluded from the study because they did not meet the
eligibility criteria (i.e., 13 children were not in the age range, 53 parents were not
concerned about their child’s behaviour, 4 children were in contact with another
mental health professional on a regular basis, 15 parents were unable to attend the
program because of the location or length of the program, 3 children lived with the
interested parents less than 2 days a week, and 2 children had a severe developmental
disorder). A further 65 parents declined to participate. Contact was not possible with
seven parents. Therefore, 138 families received the questionnaires by post (86) or
were provided with online access to the questionnaires (52). Eighty families (60%)
returned the questionnaires. Of these, 18 families (22.5%) were excluded because
neither parent reported serious problem behaviours in the child (the target child did
not score in the borderline or clinical range on the SDQ Total; borderline range =
14 to 16 and clinical range =17 and over). The remaining 62 families were allocated
to one of the two conditions.
Comparison of the waitlist and intervention conditions using a series of one-
way between groups analyses of variance (ANOVAs) or chi-square tests revealed
no signiﬁcant differences on sociodemographic variables except for child sex. Only
30.3% of adolescents in the intervention condition were females, compared to 62.1%
of adolescents in the waitlist control condition χ2(1, N=62) =6.29, p=.012. In
the total sample, children ranged in age from 11 to 16 years (M=12.92, SD =1.18),
and there were more boys (54.8%) than girls (45.2%). Based on parents’ reports, the
children were predominantly identiﬁed as Australians or Europeans (93.5%). Parents
who initiated the contact were mainly mothers (91.9%) aged between 27 and 52
Standard Teen Triple P
90 did not meet criteria
72 declined to participate
138 sent the questionnaires
80 completed PRE assessment
58 dropped out
18 not eligible
29 allocated to waitlist control 33 allocated to intervention
26 completed POST assessment
3 dropped out
21 completed POST assessment
19 completed intervention
2 discontinued intervention
5 failed to start
3 dropped out
3 dropped out
17 completed FU assessment
attended 2 sessions only
29 entered and analysed
2 psychotic symptoms
2 withdrew the consent
29 entered and analysed
Flow of participants throughout the study (see Results section for attrition reasons).
years (M=42.08, SD =5.12). Most families were two-parent families (75.8%), with
an average of two children living at home (M=2.45, SD =1.14). The majority of
parents had some type of tertiary education (75.8% of mothers and 79.2% of fathers)
and were employed outside the home (80.6% of mothers and 97.9% of fathers). More
than half of the families (53.1%) had an annual income of more than AUD$75,000.
Raziye Salari, Alan Ralph and Matthew R. Sanders
Teenager problem behaviour.Parents’ perception of prosocial and difﬁcult behaviours
in their teenagers was assessed using the Strengths and Difﬁculties Questionnaire —
extended Version (SDQ; Goodman, 1997, 1999). The SDQ is a behavioural screening
questionnaire for children aged from 3 to 16 years. It consists of 25 statements with
ﬁve subscales (Pro-social, Hyperactivity, Peer problems, Emotional symptoms and
Conduct problems). Each item is rated on a 3-point scale from 0 (not true) to 2
(certainly true). The extended version assesses whether the respondent thinks the
child has a problem, and if so, the perceived impact on the child and burden on the
family. The SDQ has good internal consistency, test–retest reliability and discriminant
validity (Goodman, 2001; Goodman & Scott, 1999).
Conﬂict with teenager.Perceived communication and conﬂict in the parent-
adolescent relationship was assessed using the short version of the Conﬂict Behavior
Questionnaire (CBQ-20; Robin & Foster, 1989). Parents were asked to indicate
whether each statement is true or false. The CBQ has been found to successfully
discriminate between distressed and non-distressed families. The 20-item CBQ has a
correlation of .96 with the 75-item scale which has adequate validity and reliability
(Robin & Foster, 1989).
Parenting style.Parenting Scale — Adolescent version (PSA; Irvine, Biglan,
Smolkowski, & Ary, 1999) is an adaptation of the Parenting Scale (Arnold, O’Leary,
Wolff, & Acker, 1993) and retains 13 items from the original 30. The scale measures
two dysfunctional discipline styles in parents: Laxness (permissive discipline) and
Over-reactivity (authoritarian discipline). For each item, parents are asked to rate
how they would react to a given behaviour problem by choosing between an effective
or ineffective strategy on a 7-point scale. The revised scale has adequate internal
consistency for the Total score (α=.84), Laxness (α=.82), and Over-reactivity
(α=.83) scales as well as good test–retest reliability (r =.86, .82, and .82 respec-
tively; Irvine et al., 1999). The scale has been found to discriminate between parents
of clinic and non-clinic children.
Conﬂict over parenting.The Parent Problem Checklist (PPC), by Dadds and Powell
(1991), is a 16-item questionnaire that measures interparental conﬂict over child
rearing. It rates parents’ ability to cooperate and work together in family management
including the extent to which parents disagree over rules and discipline for child
misbehaviour, the amount of open conﬂict over child-rearing issues, and the extent
to which parents undermine each other’s relationship with their children. The PPC
has moderately high internal consistency (α=.70) and high test–retest reliability
(r=.90; Dadds & Powell, 1991).
Relationship satisfaction.Parents’ relationship satisfaction was measured using the
Relationship Quality Index (RQI; Norton, 1983). The RQI is a six-item index of mar-
ital or relationship quality and satisfaction. It has adequate internal consistency; with
inter-item correlations ranging from .68 to .86 (Norton, 1983), excellent reliability
(α=.97) and discriminant validity (Heyman, Sayers, & Bellack, 1994).
Parental adjustment.Parents’ adjustment was assessed using the Depression Anxiety
Stress Scales-21 (DASS-21; Lovibond & Lovibond, 1995). This is a 21-item question-
naire assessing symptoms of depression, anxiety, and stress in adults. Each item is rated
on a 4-point scale from 0 (did not apply to me)to3(applied to me very much, or most
Standard Teen Triple P
of the time). The DASS-21 has high internal consistency for each of the depression,
anxiety, and stress scales (α=.91, .84 and .90, respectively) and good discriminant
and concurrent validity (Antony, Bieling, Cox, Enns, & Swinson, 1998; Henry &
Client satisfaction.The Client Satisfaction Questionnaire (CSQ; Sanders & Ralph,
2002) addresses the quality of service provided; how well the program met the parents’
needs, increased the parents’ skills, and decreased the child’s problem behaviours;
and whether the parent would recommend the program to others. The scale has
high internal consistency (α=.96), an item-total correlation of .66 and inter-item
correlations of .30 to .87 (Sanders, Markie-Dadds, Tully, & Bor, 2000).
In this study, a quasi-randomised group comparison design was used with two con-
ditions: waitlist control and intervention; and two time periods: pre-intervention
(PRE) and post-intervention (POST). Families in the intervention condition were
also assessed at 3 months post-intervention (FU).
Randomisation and allocation.Using standard methods of randomisation was not
practical in this study. When the study started in April 2007, response to the recruit-
ment was slow. Interns who were trained to deliver the intervention were ﬁnishing
their internship at the end of year and were unable to start working with families later
than August. Therefore, it was decided to assign all eligible families recruited until the
end of August to the intervention condition and allocate eligible families recruited
after this period to the waitlist condition. This would allow enough time to recruit
and train new interns to continue the program.
The recruitment was recessed during December 2007 to May 2008 and the program
was not advertised actively during this time because there were not enough qualiﬁed
practitioners to take on new families. Despite this, families who initiated contact
during this time were assessed for their eligibility criteria and if eligible were assigned
to the waitlist control condition. The recruitment started again in June 2008. In this
round, the eligible families were randomly allocated to each condition at point of
entry. A series of one-way between groups analyses of variance (ANOVAs) or chi-
square tests revealed no differences on sociodemographic variables for the families
recruited in the ﬁrst and second round.
Assessment.All families completed the initial assessment (PRE) as part of the re-
quirements of participating in STTP. Parents were given the option to either receive
who agreed to attend the program was asked to complete the assessment. The second
parent (when applicable) was given the opportunity to complete the questionnaires
and attend the intervention, if interested. Identical assessments were carried out at the
subsequent times (i.e., POST, FU). The post-assessment data for the waitlist control
group were collected 3 months after the initial assessment. These families were then
offered the intervention.
Data collection was undertaken with the approval of The University of Queensland
School of Psychology Ethics Review Ofﬁcer.
Raziye Salari, Alan Ralph and Matthew R. Sanders
Session structure.STTP is a 10-session program that provides parents with informa-
tion and practical strategies to promote healthy development and manage problem
behaviours in their teenagers. Both parents (where applicable) are invited to attend
the sessions. Teenagers are encouraged to attend some of the sessions (sessions 2, 5, 7
and 9), though their attendance is not necessary. Sessions are delivered individually
and can last up to 90 minutes. Active skill training methods are utilised to help parents
learn new knowledge and skills. These methods include video demonstration, mod-
elling, behavioural rehearsal, feedback, and homework tasks. Each family receives a
workbook that contains all of the information and strategies presented in the sessions,
as well as homework to be completed between sessions. A self-regulatory framework
is employed throughout the program; parents are encouraged to set their own goals
for change and monitor their progress.
Session content.STTP involves ﬁve modules, comprising three sessions for assess-
ment, two sessions on positive parenting skills, two sessions on managing problem
behaviours, two sessions on dealing with risky behaviour, and a closure session. In the
ﬁrst session, parents are interviewed to obtain information regarding the presenting
problem, the teenager’s developmental history and family history. The teenager is
invited to attend the second session for a short interview. During this session, a task is
set up to observe a parent-teenager interaction. In the third session, the practitioner
shares the assessment results and introduces the possible inﬂuences on teenagers’ be-
haviour. To help parents achieve their goals, a range of strategies is presented and
practised during the next six sessions. Each session of active training (sessions 4, 6,
and 8) is followed by a practice session, where both parents and the teenager are
encouraged to attend in order to provide parents with an opportunity to practise
using the strategies learnt in the previous session. If the teenager refuses to attend,
parents report on how they used the strategies at home. They are then encouraged
to practise using the strategies through role-play. In both scenarios, parents receive
some feedback from the practitioner, reﬁne their goals and revise their parenting plan
accordingly. The ﬁnal session covers additional skills to facilitate generalisation and
maintenance of treatment gains.
Intervention delivery.Twenty-three postgraduate students in psychology (21 females,
two males) conducted the intervention, each working with two families on average.
All practitioners were trained in STTP and received clinical supervision for delivering
the intervention from an experienced clinical psychologist (preliminarily from the ﬁrst
author of the STTP materials). Families were assigned to practitioners on the basis
of scheduling needs (e.g., case ﬂow) in each condition. All practitioners received a
detailed written manual that speciﬁes the content of each session, in-session exercises
to complete, and homework tasks to be assigned.
The efﬁcacy of the intervention was analysed using both the statistical and clinical
signiﬁcance of change. Short-term intervention effects were tested using a series of 2
(condition: STTP, waitlist) ×2 (time: PRE vs. POST) repeated measures ANOVAs
(for individual scale comparison) or MANOVAs (for measures having multiple sub-
scales). Where a signiﬁcant interaction occurred between condition and time, time
effects were examined within each condition using one-way repeated measures (PRE
Standard Teen Triple P
vs. POST) ANOVAs and MANOVAs. Maintenance of short-term intervention ef-
fects was analysed using a series of one-way (time) repeated measures (PRE vs. FU)
ANOVAs or MANOVAs in the intervention condition. The clinical signiﬁcance of
change from PRE to POST was estimated by the reliable change index (Jacobson &
The ﬁnal test was a series of supplementary analyses. An intention to treat analysis
was performed to account for participant attrition. Missing data were imputed using
the last-value-carried-forward method (Kendall, Flannery-Schroeder, & Ford, 1999).
When both parents (in two-parent families) had completed the assessment, the data
for the parent who had initiated the contact was used in data analysis regardless of their
SDQ score. Twelve mothers (eight of them in the intervention) who had initiated
the contact, scored in the normal range of the SDQ Total while their partner (teen’s
father or stepfather) scored in the elevated range. Nevertheless, the mothers’ scores
were used in the data analysis. This is a conservative approach that reduces the chance
of ﬁnding signiﬁcant results, as participants who are in the normal range to begin with
do not have much room to change.
tion vs. waitlist) ANOVAs and MANOVAs was performed to check for differences
between the two conditions in child and family functioning at pre-assessment. Only
two signiﬁcant differences were observed: compared to parents in the intervention
condition, parents in the waitlist condition reported a lower level of burden on their
family due to their teenager’s difﬁculties on the SDQ, F(1,60) =7.45, p<.05; and a
higher level of laxness on PS, F(1,60) =7.25, p<.05. Given the number of analyses
performed, it is possible that these ﬁndings were due to chance. Nevertheless, any
differences at pre-intervention were controlled by using repeated measures ANOVAs
and MANOVAs for analysing the data.
Attrition.Two families who had been assigned to the intervention condition were
excluded from the study due to subsequent evidence of psychotic symptoms in the
target child; they were referred for appropriate clinical services outside of the study
setting. Another two families withdrew the consent for the sessions to be videotaped
and consequently were no longer eligible to participate in the study. These four
families were excluded from all subsequent analyses, including comparison of families
with and without post-assessment data and intention to treat analysis. Therefore, the
sample size for the intervention condition was reduced to 29.
From 29 families in the intervention condition, ﬁve families failed to start the
intervention (17.2%). Reasons for withdrawal were a lack of time (n=4) and seeking
individual help for the teenager’s behaviour where the teenager attended the interven-
tion instead of the parents (n=1). Of 24 families who started the intervention, two
families dropped out after the ﬁrst session without completing the post-assessment and
another family completed the program, but did not return the post-questionnaires.
Therefore, post-assessment data were available for 21 families. Of these, 19 fami-
lies completed the intervention and 2 did not; one family had a teenager with ex-
treme difﬁculties and decided to take her for individual treatment where she was the
Raziye Salari, Alan Ralph and Matthew R. Sanders
direct target of the intervention, and in the other family, the teenager moved out of
home. The ﬁrst family had completed session 5 of the program before dropping out
and thus was considered to have been exposed to active elements of the intervention
and was included in the analyses. The second family had attended only two sessions
(assessment sessions) and as such was excluded from the analyses. The rate of attrition
from pre- to post-assessment was 27.6% (8 out of 29). The intervention attrition rate
(families who did not complete the program) was 31% (9 out of 29) for the total group
and 16.7% (4 out of 24) for families who started the intervention.
compare completers versus non-completers across all sociodemographic characteris-
tics, and child and family functioning. The family that had attended ﬁve sessions of
the intervention and was included in the analysis of the intervention effects, was con-
sidered as a completer here. There were three signiﬁcant differences between families
who completed and families who did not complete the intervention. Both mothers and
fathers in the families who did not complete the intervention were less likely to have
some kind of tertiary education compared to those who completed the intervention;
χ2(1, N=29) =4.49, p=.034 for mother’s education (55.6% of non-completers vs.
90% of completers) and χ2(1, N=24) =4.89, p=.027 for father’s education (57.1%
of non-completers vs. 94.1% of completers). Furthermore, mothers who did not com-
plete the intervention were signiﬁcantly younger than mothers who completed the
intervention; F(1, 29) =4.66, p=.040 (M=38.56 vs. M=43.25). There were no
other signiﬁcant differences between the two groups.
In the waitlist control condition, three of the 29 families did not complete the
post assessment (10.3%). In one family, the teenager had moved out and the other
two families provided no reason for not completing the questionnaires. A chi-square
test demonstrated no signiﬁcant differences in attrition rate between the intervention
and waitlist control conditions. From pre- to post-assessment, the overall attrition
rate (for both the intervention and the waitlist control condition) was 19%. A series
of one-way (attrition) between groups (POST completed vs. POST not completed)
ANOVAs and MANOVAs and chi-square tests demonstrated no signiﬁcant differ-
ences in the sociodemographic characteristics and child and family functioning of
families who completed and did not complete post assessment. The attrition rate from
pre-assessment to follow-up (for the intervention condition only) was 34.6% (families
who withdrew from the study were not invited to subsequent assessments).
Client satisfaction.Satisfaction with the program is reported for all families who
participated in the program and completed the Client Satisfaction Questionnaire,
even if they did not complete the program (n=21). Parents who participated in the
intervention reported high levels of satisfaction with the program and the amount of
help they received; 95.2% being satisﬁed to very satisﬁed. All parents (100%) rated
the quality of the service they received as good to excellent. The majority of parents
reported that the program had met most of their teenager’s needs (61.9%), and their
own needs (81%). Most parents (90.5%) stated the program had helped them to deal
more effectively both with problems that arose in their family and with the teenager’s
behaviours; 90.5% reported improvements in their teenager’s behaviour, and 76.2%
said they were satisﬁed with their teenager’s progress.
Standard Teen Triple P
Protocol adherence.Session Summary Checklists (SSC) list the key content areas that
should be covered in each session (e.g., ‘Outline the purpose of discussing inﬂuences
on teenagers’ behaviour’, ‘Explain tasks to be completed between sessions’). It was
developed to guide practitioners in delivering the intervention and also to check
protocol adherence. Practitioners completed the checklists after conducting each
session. Analyses of the SSC indicated 97.8% self-reported compliance to the program
Short-Term Intervention Effects
The results of the two-way (condition by time) and one-way (time) repeated measures,
(PRE vs. POST) ANOVAs and MANOVAs on adolescent and parent outcomes are
described below. Table 1 shows means, standard deviations, Fvalues, levels of signiﬁ-
cance, effect sizes and their 95% conﬁdence intervals for the univariate condition by
Adolescent outcomes.From pre- to post-assessment for the SDQ Total score, the two-
way ANOVA revealed a signiﬁcant condition by time interaction, F(1, 44) =4.42,
P=.041. In the one-way ANOVA for the SDQ Total, there was a signiﬁcant time
effect for the intervention condition only, F(1, 19) =19.74, p<.001. Therefore,
an overall reduction in teen problem behaviours was observed for the intervention
group, but not for the waitlist control condition. The effect size for teen overall
problem behaviours was medium (d=.62).
From pre- to post-assessment for all the SDQ subscales, the MANOVA revealed
asigniﬁcantconditionbytimeinteraction,F(1, 44) =4.42, p=.043. However,
the univariate condition by time interaction was only signiﬁcant at the Bonferroni-
corrected level of signiﬁcance (p<.01) for the Conduct Problems and Hyperactivity
scales, F(1, 44) =8.27, p=.006, and F(1, 44) =8.07, p=.007, respectively. The
univariate condition by time interaction for all other three subscales of the SDQ
was non-signiﬁcant. In the one-way MANOVAs, there was a signiﬁcant multivariate
time effect for the intervention condition only, F(1, 19) =18.08, p<.001. In the
intervention condition, the univariate time effect was signiﬁcant for both Conduct
Problems, F(1, 19) =14.98, p=.001; and Hyperactivity, F(1, 19) =27.58, p=.001.
This indicates that from pre- to post-assessment, behavioural problems remained stable
in the waitlist condition, but decreased signiﬁcantly in the intervention condition.
These changes were associated with large effect sizes (d>.80). There was no signiﬁcant
change in the social or emotional problems.
For the SDQ impact supplement measures, the MANOVA revealed a signiﬁcant
condition by time interaction, F(1, 44) =6.54, p=.003. The univariate condition by
time interaction was signiﬁcant at the Bonferroni-corrected level of signiﬁcance (p<
.025) for both the SDQ Impact, F(1, 44) =8.83, p=.005; and the SDQ Burden, F(1,
44) =10.13 p=.003. In the one-way MANOVAs there was a signiﬁcant multivariate
time effect for both the intervention and waitlist control condition, F(1, 19) =18.04,
p<.001, and F(1, 25) =4.07, p=.03, respectively. However, the univariate time
effect for the SDQ Impact and the SDQ Burden was signiﬁcant at the Bonferroni-
corrected level of signiﬁcance (p<.025) for the intervention condition only; F(1,
19) =12.25 p=.002; and F(1, 19) =38.00, p<.001, respectively. As shown in
Table 1, while in the intervention condition both the SDQ Impact and the SDQ
Burden decreased from pre- to post-assessment, in the waitlist control condition there
was an increase in the SDQ Impact and a reduction in the SDQ Burden. This result
Raziye Salari, Alan Ralph and Matthew R. Sanders
TABL E 1
Short-Term Intervention Effects: Descriptive Statistics,
values and Effect Sizes for the Univariate Condition by Time Interactions
Waitlist Control (
=20)bPRE to POST time effect
PRE POST PRE POST intervals for d
SDQ Total Difﬁculties 17.50 (4.59) 15.65 (6.21) 16.90 (6.58) 11.85 (8.28) 4.42 .041 .62 .03 1.22
SDQ Emotional Symptoms 3.96 (2.63) 3.08 (2.70) 3.10 (2.59) 2.35 (2.50) .03 .860 −.05 −.63 .53
SDQ Conduct Problems 5.07 (1.47) 4.50 (2.10) 5.15 (2.39) 2.85 (2.35) 8.28 .006 .82 .21 1.42
SDQ Hyperactivity 5.35 (2.33) 5.27 (2.03) 6.05 (2.44) 4.55 (2.78) 8.07 .007 .86 .25 1.47
SDQ Peer Problems 3.12 (2.03) 2.81 (2.25) 2.60 (2.44) 2.10 (2.47) .20 .661 .13 −.45 .72
SDQ Prosocial Behavior 5.00 (2.02) 5.04 (2.62) 5.95 (2.24) 6.80 (1.96) 2.65 .111 −.49 −1.08 .11
SDQ Impact 3.35 (1.98) 3.85 (2.19) 3.40 (1.70) 2.00 (2.47) 8.83 .005 .90 .29 1.51
SDQ Burden .96 (.60) .65 (.63) 1.55 (.61) .55 (.83) 10.13 .003 .95 .34 1.57
CBQ 15.85 (3.27) 13.76 (4.94) 14.20 (4.49) 6.35 (4.89) 15.72 <.001 1.18 .55 1.81
PS Laxness 3.42 (.95) 3.25 (.88) 2.57 (.83) 2.01 (.76) 2.66 .110 .50 −.10 1.09
PS Overreactivity 4.45 (.79) 4.04 (.073) 3.95 (1.30) 2.68 (.91) 14.23 <.001 1.15 .46 1.71
PPC Problem 7.50 (4.03) 6.67 (4.35) 7.33 (4.42) 4.07 (2.96) 4.42 .044 .73 .03 1.44
PPC Intensity 4.48 (1.59) 3.52 (1.72) 3.86 (1.03) 2.11 (1.12) 2.07 .160 .50 −.19 1.20
RQI 32.56 (9.76) 36.44 (7.69) 34.87 (7.99) 35.8 (9.42) 1.34 .256 .40 −.29 1.09
DASS-21 Depression 7.85 (8.63) 4.30 (5.42) 6.4 (8.07) 3.5 (6.19) .06 .814 −.07 −.65 .51
DASS-21 Anxiety 3.38 (5.18) 2.00 (3.10) 3.10 (3.52) 1.40 (1.60) .07 .794 .08 −.50 .66
DASS-21 Stress 12.15 (7.42) 8.85 (6.40) 12.40 (7.18) 6.60 (5.73) 1.10 .300 .31 −.27 .90
Note: PRE =pre-intervention assessment, POST =post-intervention assessment, SDQ =Strengths and Difﬁculties Questionnaire, CBQ =Conﬂict Behavior
Questionnaire, PS =Paren ting Scale, PPC =Parent Pr oblem C hecklis t, RQI =Relationship Quality In dex, DASS-21 =short version of the Depression Anxiety Stress
=18 for PPC Problem, PPC Intensity, RQI (18 sole parents). b
=15 for PPC Problem, PPC Intensity, RQI (15 sole parents, 1 missing datum and 1 parent
separating from her partner during the intervention course. She did not complete these questionnaires at post-assessment and her data was excluded when
calculating the means and standard deviations for the pre-assessment too).
Standard Teen Triple P
indicates that the general negative impact of the teenager’s difﬁculty decreased for the
families in the intervention condition and increased for the families in the waitlist
control condition. These changes were associated with large effect sizes (d>.89).
From pre- to post-assessment for the CBQ, the two-way ANOVA revealed a
signiﬁcant condition by time interaction, F(1, 44) =15.72, p<.001. In the one-way
ANOVA for the CBQ there was a signiﬁcant time effect for both the intervention
condition, F(1, 19) =50.63, p<.001, and the waitlist condition, F(1, 25) =4.74,
p=.039. This demonstrates an overall reduction of conﬂict in adolescent-parent
relationship for both conditions, but the reduction was signiﬁcantly greater for the
intervention condition compared to the waitlist condition. This change was associated
with a very large effect size (d=1.18).
Parent outcomes.From pre- to post-assessment for two measures of parenting style, the
MANOVAs revealed signiﬁcant condition by time interactions, F(1, 44) =6.97, p=
.002. The univariate condition by time interaction was signiﬁcant at the Bonferroni-
corrected level of signiﬁcance (p<.025) for the PS Overreactivity, F(1, 44) =14.23,
p<.001; but not for the PS Laxness. This indicates that the change in coercive
parenting style from pre- to post-assessment was different for the two conditions.
The one-way ANOVAs revealed signiﬁcant time effects for both the intervention
condition, F(1, 19) =33.36, p<.001, and the waitlist condition, F(1, 26) =14.35,
p<.004. This indicates that parents’ use of coercive parenting practice decreased
in both conditions, but the reduction was signiﬁcantly greater in the intervention
condition compared to the waitlist condition. The effect size for Overreactivity was
very large (d=1.15).
From pre- to post-assessment for the PPC Problems, the two-way ANOVA re-
vealed a signiﬁcant condition by time interaction, F(1, 31) =4.24, p=.044.
In the one-way ANOVA for the PPC Problem, there was a signiﬁcant time effect
for the intervention condition only, F(1, 14) =12.81, p=.003. This demonstrates
that the amount of open conﬂict over childrearing issues signiﬁcantly decreased for
parents in the intervention condition, but did not change for parents in the waitlist
control condition. This change was associated with a medium effect size (d=.73). For
the other two-parent outcomes (RQI and the DASS subscales), the two-way ANOVA
revealed no signiﬁcant condition by time interaction.
Supplementary analysis.Because gender distribution was different between the two
conditions, the data were also analysed using gender as a covariate. The results for
the two-way (condition by time) repeated measures (PRE vs. POST) ANOVA and
MANOVAs were very similar to the original two-way ANOVA and MANOVAs,
indicating that ﬁndings were not impacted by the difference in gender distribution
between the two conditions. In addition, an intention to treat analysis that included all
original 58 families regardless of whether they withdrew early from the study revealed
similar results with two exceptions. The two-way MANOVA for the SDQ subscales
and the two-way ANOVA for the PPC Problem were no longer signiﬁcant. A trend
similar to the results of the main analyses was observable for these measures.
Clinical signiﬁcance.The clinical signiﬁcance of change was estimated for the eight
measures, with signiﬁcant short-term intervention effects. For adolescent outcomes,
signiﬁcant differences were observed between the distribution of positive and negative
changes in the two conditions for the SDQ Conduct Problems, χ2(1, 46) =10.73, p<
.001, the SDQ Burden, χ2(1, 46) =4.46, p=.035, and the CBQ, χ2(1, 46) =19.31,
Raziye Salari, Alan Ralph and Matthew R. Sanders
p<.001. In the intervention condition, 35% and 25% of families showed reliable
positive change for the SDQ Conduct Problems and the SDQ Burden, respectively. In
the waitlist control condition, no reliable change was observed for the SDQ Conduct
Problems and only 3.8% positive reliable change was observed for the SDQ Burden.
Therefore, from pre- to post-assessment, families participating in the intervention were
more likely to show reliable decreases in teen conduct problems and in the burden
of teen’s difﬁculties on the family. For the CBQ, 80% of families in the intervention
condition showed reliable positive changes, compared to only 15.4% of families in the
waitlist condition, indicating that families participating in the intervention were more
likely to report reliable improvements in the parent-adolescent relationship from pre-
to post-assessment. The distribution of positive and negative reliable change did not
differ between the conditions for SDQ Total, SDQ Hyperactivity or SDQ Impact.
For parent outcomes, signiﬁcant differences were observed between the distribution
of positive and negative changes in the two conditions for the PS Overreactivity,
χ2(1, 46) =7.64, p=.006. In the intervention condition, 35% of parents showed
reliable positive change in this measure compared to only 3.8% in the waitlist control
condition. This indicates that parents participating in the intervention were more
likely to show reliable decreases in their use of coercive parenting practices from pre-
to post-assessment. For the PPC Problem, the distribution of positive and negative
reliable change did not differ between the conditions.
The one-way (time) repeated measures (PRE vs. FU) ANOVAs and MANOVAs
on adolescent and parent outcomes conﬁrmed maintenance of all treatment gains.
Table 2 shows means and standard deviations for the adolescent and parent measures
at PRE, POST and FU for the intervention condition. It also presents Fvalues, levels
of signiﬁcance and effect sizes for the univariate time effects from pre- to follow up
The current study evaluated the effects of STTP, a behavioural family intervention for
parents of adolescents, on several adolescent and parent outcomes. The intervention
aimed to reduce adolescent problem behaviours by reducing parents’ use of ineffec-
tive parenting strategies. As predicted, compared to parents in the waitlist control
condition, parents in the STTP group reported decreased teen disruptive problem
behaviours, reduction in the negative impacts associated with teen difﬁculties, and
greater improvement in the parent-child relationships. The intervention was also
associated with a greater reduction in using coercive parenting strategies, as well as
decreased disagreement over child-rearing issues in dual-parent families. No change
was observed in parent marital relationship or personal adjustment.
The results of the current study are consistent with the results of other studies
evaluating Triple P in general. These studies found Triple P to be consistently asso-
ciated with a reduction in child behavioural problems and parental use of ineffective
parenting practices, but not necessarily related to improvements in parent marital re-
lationship or parental adjustment (e.g., Bor, Sanders, & Markie-Dadds, 2002; Hoath
& Sanders, 2002; Ireland, Sanders, & Markie-Dadds, 2003; Martin & Sanders, 2003;
Matsumoto, Sofronoff, & Sanders, 2007). The results are also consistent with the out-
comes of previous studies on other variants of Teen Triple P in ﬁnding the program
Standard Teen Triple P
TABL E 2
Follow-Up Effects: Descriptive Statistics and Effect Sizes for the Univariate Time Effects
(Intervention Condition Only,
PRE to FU time
PRE POST FU effect
Measure M SD M SD M SD F P d
SDQ Total Difﬁculties 16.51 6.03 10.71 7.20 9.94 5.74 31.06 >.001 .92
SDQ Emotional Symptoms 3.30 2.71 2.18 2.24 1.82 1.81 9.16 .008 .52
SDQ Conduct Problems 4.94 2.22 2.29 1.65 2.47 1.59 17.62 .001 1.28
SDQ Hyperactivity 5.76 2.44 4.18 2.81 4.12 2.55 26.46 >.001 .35
SDQ Peer Problems 2.53 2.15 2.06 2.28 1.53 1.81 6.18 .024 .41
SDQ Prosocial Behavior 5.94 2.33 7.00 1.87 6.41 2.12 .64 .436 −.21
SDQ Impact 3.35 1.80 1.59 2.00 1.41 1.84 18.66 .001 1.07
SDQ Burden 1.53 .62 .53 .80 .47 .80 34.11 >.001 1.48
CBQ 13.41 4.40 5.71 3.90 6.71 4.41 63.86 >.001 1.19
PS Laxness 2.52 .84 1.92 .75 2.18 .73 3.16 .095 .43
PS Overreactivity 3.83 1.11 2.59 .85 2.82 .84 18.12 .001 1.03
PPC Problem 7.43 4.57 4.07 3.08 5.43 3.55 6.62 .023 .33
PPC Intensity 3.98 .95 2.08 1.15 2.18 1.25 14.38 .002 1.62
RQI 34.43 8.10 35.21 9.49 34.07 10.62 .03 .874 .03
DASS-21 Depression 6.35 8.43 2.00 2.83 2.59 3.86 2.65 .123 .57
DASS-21 Anxiety 3.41 3.66 1.06 1.43 1.53 2.07 5.36 .034 .63
DASS-21 Stress 12.59 7.48 5.65 4.49 8.24 6.63 3.72 .072 .62
Note: Effect sizes were provided for PRE versus FOLLOW-UP. PRE =pre-intervention assessment, POST
=post-intervention assessment, FOLLOW-UP =3-month follow-up assessment, SDQ =Strengths and
Difﬁculties Questionnaire, CBQ =Conﬂict Behavior Questionnaire, PS =Parenting Scal e, PPC =Par ent
Problem Checklist, RQI =Relationship Quality I ndex, DASS-2 1 =short version of the Depression
Anxiety Stress Scales. a
=14 for PPC Problem, PPC Intensity, RQI (2 sole parents, 1 missing datum).
to be effective in reducing teen problems, parent-child conﬂict and dysfunctional
parenting (Ralph & Sanders, 2003; Stallman & Ralph, 2007).
Improvements in parenting practices are in line with other studies on parenting
programs for parents of teenagers, which show these programs are effective in increas-
ing parents’ use of positive strategies (e.g., Hawkins et al., 1991). However, previous
studies have mostly focused on changes in parental monitoring (Dishion, Nelson, &
Kavanagh, 2003). This study is one of the ﬁrst attempts to measure the effects of
parenting programs on more general parenting practices. Positive changes in adoles-
cent behaviour and parent-adolescent relationships have also been observed in other
studies. Parenting programs have been shown to be effective in improving parent-
adolescent relationships and reducing the risk of substance abuse and delinquent
behaviour in teenagers (Barkley et al., 2001; Dishion & Andrews, 1995; Kosterman,
Hawkins, Spoth, Haggerty, & Zhu, 1997). In addition, the current study shows that
parenting programs not only improve parenting skills and adolescent behaviour, but
also increase parents’ agreement over child-rearing issues.
Raziye Salari, Alan Ralph and Matthew R. Sanders
In this study, the overall rate of attrition in the intervention condition was 34.4%
(including families who failed to start the intervention, families who attended at
least one session but did not complete the program, and the family who completed
the intervention but did not return the post-assessment questionnaires). These rates
are similar to attrition rates cited in other parent training and child and adolescent
treatment studies (Boggs et al., 2004; Cottrell et al., 1988; Gross & Grady, 2002;
Hoare, Norton, Chisholm, & Parry-Jones, 1996). In a meta-analysis, the average rate
of terminating the treatment prematurely was estimated to be between 40 to 60% for
studies on child psychotherapy (Wierzbicki & Pekarik, 1993).
Comparisons of families who completed the program and those who failed to start
or who dropped out early revealed that dropout mothers were less educated and younger
compared to completer mothers. These are among the most common differences found
between child treatment dropouts and completers (Kazdin, 1990; Kazdin, Mazurick,
experience higher levels of stress, which can interfere with their attendance in child
treatment (Kazdin et al., 1993). Similarly, lower educational attainment is related to
lower socioeconomic status and higher levels of life stress and may hinder parents’
ability to cope with treatment demands (Kazdin, 1990).
This study has several limitations that warrant comment. To begin with, intervention
outcomes were assessed through self-report measures only. This presents a potential
limitation because parents participating in the intervention are more likely to be
aware of socially desirable responses that may speciﬁcally affect their ratings of their
own parenting behaviours despite no change in the real behaviour (Spoth, Redmond,
Haggerty, & Ward, 1995). Observational measures of parent adolescent interaction
would have been useful, but were not carried out due to ﬁnancial and time constraints.
Second, the small sample size did not allow examination of moderators and medi-
ators of intervention effects. Factors contributing to the intervention outcomes, such
as characteristics of families who respond well and did not respond so well, could
not be examined due to the small sample size. In addition, improvements in other
measures such as permissive parenting may have reached signiﬁcance if the sample
size had been larger. Nevertheless, the study yielded signiﬁcant results in several ado-
lescent and parent outcome measures, implying the robustness of the intervention
in reducing family risk factors for adolescent problem behaviours. This was achieved
even in spite of the conservative approach adopted in choosing which parents’ data
would be included in the analysis in cases where more than one parent per family had
completed the questionnaires.
Another limitation was the lack of a control group at the follow-up assessment. Al-
though families in the intervention condition showed signiﬁcant improvement over
families in the waitlist control condition and had maintained most of the treatment
gains at follow-up, the positive changes from baseline to follow-up cannot conﬁdently
be attributed to the intervention in the absence of a long-term control group. Factors
unrelated to the intervention, such as maturation, regression to the mean, or contem-
poraneous events may have accounted for changes observed from pre- to follow-up
assessment. For ethical reasons, research participants who were experiencing high
levels of difﬁculties at baseline (as was the case in this study), could not be deprived
from receiving intervention for a long period. The alternative approach would have
Standard Teen Triple P
been to compare the intervention with treatment as usual, which allows for long-term
follow-ups. However, treatment as usual could not be used as a comparison condition
in the current study, because the study was carried out in a university clinic where
Triple P was the predominant treatment of choice.
It is also worth mentioning that recruitment of families into this study was dif-
ﬁcult. The recruitment rate could not be estimated, because the number of eligible
families reached through program advertisement was unknown. Nevertheless, the re-
sponse rate to the recruitment was slower than expected and thus some families were
assigned to the intervention or waitlist control condition based on the availability
of practitioners (see method section for more details). Even though families in the
intervention condition did not differ from families in the waitlist control condition in
most socioeconomic variables and child and family functioning measures, caution is
warranted in generalisation of the ﬁndings. There is some evidence that suggests preva-
lence of emotional and behavioural problems in children and adolescents (Carskadon
parent-child involvement (Crouter & McHale, 1993) might vary according to the
time of year. Therefore, families who responded to the advertisement between April
and August might be different from families who initiated contact later during the
Implications for Research, Policy, and Practice
Despite the limitations, this research demonstrated that STTP is an effective inter-
vention in reducing parents’ use of coercive and punitive parenting practices and
adolescent disruptive behaviours, as well as improving the parent-adolescent relation-
ships and parents’ communication about parenting issues. The intervention is directed
at parents and includes minimal therapeutic contact with adolescents. Adolescents
are encouraged to participate, but their participation is not necessary. This allows all
parents of teenagers to receive the program, even those whose teenager is not willing
to attend the sessions.
Nevertheless, the program should be compared to treatment as usual in an effec-
tiveness trial. This design allows for examination of the long-term intervention effects.
Families in the intervention condition can be compared to families in the treatment-
as-usual condition for up to several years, without compromising the ethical issue of
depriving families of receiving appropriate intervention. Moreover, a program that is
demonstrated to be more effective than the services currently available justiﬁes the
efforts and costs associated with incorporating a new program into the existing system.
In conclusion, STTP is a promising parenting intervention for tackling adolescent
externalising problems. Future trials will beneﬁt from the inclusion of observational
measures of change, a larger sample size and establishing the long-term efﬁcacy of the
Raziye Salari now works at the Department of Women’s and Children’s Health,
Uppsala University, Samariterhemmets Hospital, Box 609, 751 25 Uppsala, Sweden.
The ﬁrst author would like to thank Alina Morawska for thoughtful discussions and
Cassandra Tellegen for her helpful comments on an earlier draft of the manuscript.
Raziye Salari, Alan Ralph and Matthew R. Sanders
This paper is drawn from a doctoral dissertation by the ﬁrst author which was supervised
by the second and third authors.
Antony, M.M., Bieling, P.J., Cox, B.J., Enns, M.W., & Swinson, R.P. (1998). Psychometric properties
of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups
and a community sample. Psychological Assessment,10(2), 176–181.
Arnold, D.S., O’Leary, S.G., Wolff, L.S., & Acker, M.M. (1993). The Parenting Scale: A measure
of dysfunctional parenting in discipline situations. Psychological Assessment,5(2), 137–144.
Barkley, R.A., Edwards, G., Laneri, M., Fletcher, K., & Metevia, L. (2001). The efﬁcacy of problem-
solving communication training alone, behavior management training alone, and their combi-
nation for parent-adolescent conﬂict in teenagers with ADHD and ODD. Journal of Consulting
and Clinical Psychology,69(6), 926–941.
Boggs, S.R., Eyberg, S.M., Edwards, D.L., Rayﬁeld, A., Jacobs, J., Bagner, D., & Hood, K. (2004).
Outcomes of Parent-Child Interaction Therapy: A comparison of treatment completers and study
dropouts one to three years later. Child & Family Behavior Therapy,26(4), 1–22.
Bor, W., Sanders, M.R., & Markie-Dadds, C. (2002). The effects of the Triple P-Positive Parenting
Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive
difﬁculties. Journal of Abnormal Child Psychology,30(6), 571–587.
Buchanan, C.M., Eccles, J.S., Flanagan, C., Midgley, C., Feldlaufer, H., & Harold, R.D. (1990).
Parents’ and teachers’ beliefs about adolescents: Effects of sex and experience. Journal of Youth
and Adolescence,19(4), 363–394.
Carskadon, M.C., & Acebo, C. (1993). Parental reports of seasonal mood and behavior changes in
children. Journal of the American Academy of Child & Adolescent Psychiatry,32(2), 264–269.
Connell, A.M., Dishion, T.J., Yasui, M., & Kavanagh, K. (2007). An adaptive approach to family
intervention: Linking engagement in family-centered intervention to reductions in adolescent
problem behavior. Journal of Consulting and Clinical Psychology,75(4), 568–579.
Costello, E.J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development
of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry,60(8), 837–
Cottrell, D., Hill, P., Walk, D., Dearnaley, J., & Ierotheou, A. (1988). Factors inﬂuencing non-
attendance at child psychiatry out-patient appointments. British Journal of Psychiatry,152,201–
Crouter, A.C., & McHale, S.M. (1993). Temporal rhythms in family life: Seasonal variation in the
relation between parental work and family processes. Developmental Psychology,29(2), 198–205.
Dadds, M.R., & Powell, M.B. (1991). The relationship of interparental conﬂict and global marital
adjustment to aggression, anxiety, and immaturity in aggressive and nonclinic children. Journal
of Abnormal Child Psychology,19(5), 553–567.
Dekovic, M., Janssens, J.M.A.M., & Van As, N.M.C. (2003). Family predictors of antisocial behavior
in adolescence. Family Process,42(2), 223–235.
Dishion, T.J., & Andrews, D.W. (1995). Preventing escalation in problem behaviors with high-risk
young adolescents: Immediate and 1-year outcomes. Journal of Consulting and Clinical Psychology,
Dishion, T.J., Nelson, S.E., & Kavanagh, K. (2003). The family check-up with high-risk young
adolescents: Preventing early-onset substance use by parent monitoring. Behavior Therapy,34(4),
Goodman, R. (1997). The Strengths and Difﬁculties Questionnaire: A research note. Journal of Child
Psychology and Psychiatry,38(5), 581–586.
Goodman, R. (1999). The extended version of the Strengths and Difﬁculties Questionnaire as a guide
to child psychiatric caseness and consequent burden. Journal of Child Psychology and Psychiatry,
Standard Teen Triple P
Goodman, R. (2001). Psychometric properties of the Strengths and Difﬁculties Questionnaire. Journal
of the American Academy of Child & Adolescent Psychiatry,40(11), 1337–1345.
Goodman, R., & Scott, S. (1999). Comparing the Strengths and Difﬁculties Questionnaire and the
Child Behavior Checklist: Is small beautiful? Journal of Abnormal Child Psychology,27(1), 17–24.
Gross, D., & Grady, J. (2002). Group-based parent training for preventing mental health disorders
in children. Issues in Mental Health Nursing,23(4), 367–384.
Hawkins, J.D., Catalano, R.F., & Kent, L.A. (1991). Combining broadcast media and parent ed-
ucation to prevent teenage drug abuse. In L. Donohew, H.E. Sypher & W.J. Bukoski (Eds.),
Persuasive communication and drug abuse prevention. (pp. 283–294). Hillsdale, NJ: Lawrence Erl-
Henggeler, S.W., Schoenwald, S.K., Borduin, C.M., Rowland, M.D., & Cunningham, P.B. (2009).
Multisystemic therapy for antisocial behavior in children and adolescents (2nd ed.). New York: Guilford
Henry, J.D., & Crawford, J.R. (2005). The short-form version of the Depression Anxiety Stress Scales
DASS-21): Construct validity and normative data in a large non-clinical sample. British Journal
of Clinical Psychology,44(2), 227–239.
Heyman, R.E., Sayers, S.L., & Bellack, A.S. (1994). Global marital satisfaction versus marital
adjustment: An empirical comparison of three measures. Journal of Family Psychology,8(4),
Hoare, P., Norton, B., Chisholm, D., & Parry-Jones, W. (1996). An audit of 7000 successive child
and adolescent psychiatry referrals in Scotland. Clinical Child Psychology and Psychiatry,1(2),
Hoath, F.E., & Sanders, M.R. (2002). A feasibility study of Enhanced Group Triple P - Positive
Parenting Program for parents of children with attention-deﬁcit/hyperactivity disorder. Behaviour
Ireland, J.L., Sanders, M.R., & Markie-Dadds, C. (2003). The impact of parent training on marital
functioning: A comparison of two group versions of the Triple P-Positive Parenting Program for
parents of children with early-onset conduct problems. Behavioural and Cognitive Psychotherapy,
Irvine, A.B., Biglan, A., Smolkowski, K., & Ary, D.V. (1999). The value of the Parenting Scale for
measuring the discipline practices of parents of middle school children. Behaviour Research and
Jacobson, N.S., & Truax, P. (1991). Clinical signiﬁcance : A statistical approach to deﬁning mean-
ingful change in psychotherapy research. Journal of Consulting and Clinical Psychology,59(1),
Kazdin, A.E. (1990). Premature termination from treatment among children referred for antisocial
behavior. Journal of Child Psychology and Psychiatry,31(3), 415–425.
Kazdin, A.E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial
behavior in children and adolescents. New York: Oxford University Press.
Kazdin, A.E., Mazurick, J.L., & Bass, D. (1993). Risk for attrition in treatment of antisocial children
and families. Journal of Clinical Child Psychology,22(1), 2–16.
Kendall, P.C., Flannery-Schroeder, E.C., & Ford, J.D. (1999). Therapy outcome research methods.
In P.C. Kendall, J.N. Butcher, & G.N. Holmbeck (Eds.), Handbook of research methods in clinical
psychology (2nd ed., pp. 330–363). New York: John Wiley & Sons.
Kosterman, R., Hawkins, J.D., Spoth, R.L., Haggerty, K.P., & Zhu, K. (1997). Effects of a preventive
parent-training intervention on observed family interactions: Proximal outcomes from Preparing
for the Drug Free Years. Journal of Community Psychology,25(4), 337–352.
Lovibond, S.H., & Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales (2nd ed.).
Sydney, Australia: Psychology Foundation Monograph.
Martin, A.J., & Sanders, M.R. (2003). Balancing work and family: A controlled evaluation of the
Triple P-Positive Parenting Program as a work-site intervention. Child and Adolescent Mental
Raziye Salari, Alan Ralph and Matthew R. Sanders
Mason, W.A., Kosterman, R., Hawkins, J.D., Haggerty, K.P., & Spoth, R.L. (2003). Reducing
adolescents’ growth in substance use and delinquency: Randomized trial effects of a parent-
training prevention intervention. Prevention Science,4(3), 203–212.
Matsumoto, Y., Sofronoff, K., & Sanders, M.R. (2007). The efﬁcacy and acceptability of the Triple
P-Positive Parenting Program with Japanese parents. Behaviour Change,24(4), 205–218.
Norton, R. (1983). Measuring marital quality: A critical look at the dependent variable. Journal of
Marriage & the Family,45(1), 141–151.
Patterson, G.R. (1982). Coercive family process.Eugene,OR:CastaliaPublishingCo.
Ralph, A., & Sanders, M.R. (2003). Preliminary evaluation of the Group Teen Triple P program for
parents of teenagers making the transition to high school. Australian e-Journal for the Advancement
of Mental Health,2(3), 1–10.
Robin, A.L., & Foster, S.L. (1989). Negotiating parent-adolescent conﬂict: A behavioral-family systems
approach. New York: Guilford Press.
Sanders, M.R. (1999). Triple P-Positive Parenting Program: Towards an empirically validated multi-
level parenting and family support strategy for the prevention of behavior and emotional problems
in children. Clinical Child and Family Psychology Review,2(2), 71–90.
Sanders, M.R., Markie-Dadds, C., Tully, L.A., & Bor, W. (2000). The Triple P-Positive Parenting
Program: A comparison of enhanced, standard, and self-directed behavioral family intervention
for parents of children with early onset conduct problems. Journal of Consulting and Clinical
Sanders, M.R., & Ralph, A. (2002). Facilitator’s manual for Group Teen Triple P. Brisbane, Australia:
Triple P International Publishing.
Sourander, A., Koskelainen, M., & Helenius, H. (1999). Mood, latitude, and seasonality among
adolescents. Journal of the American Academy of Child & Adolescent Psychiatry,38(10), 1271–
Spoth, R.L., Redmond, C., Haggerty, K., & Ward, T. (1995). A controlled parenting skills outcome
study examining individual difference and attendance effects. Journal of Marriage & the Family,
Spoth, R.L., Redmond, C., & Shin, C. (1998). Direct and indirect latent-variable parenting outcomes
of two universal family-focused preventive interventions: Extending a public health-oriented
research base. Journal of Consulting and Clinical Psychology,66(2), 385–399.
Spoth, R.L., Trudeau, L., Shin, C., & Redmond, C. (2008). Long-term effects of universal preventive
interventions on prescription drug misuse. Addiction,103(7), 1160–1168.
Stallman, H.M., & Ralph, A. (2007). Reducing risk factors for adolescent behavioural and emotional
problems: A pilot randomised controlled trial of a self-administered parenting intervention.
Australian e-Journal for the Advancement of Mental Health,6(2), 1–13.
Wierzbicki, M., & Pekarik, G. (1993). A meta-analysis of psychotherapy dropout. Professional Psy-
chology: Research and Practice,24(2), 190–195.
Yalom, I.D., & Leszcz, M. (2005). The theory and practice of group psychotherapy (5th ed.). New York: