Positive Parenting

Council of Europe definition, 2006

The Council of Europe's Committee of Ministers adopted Recommendation Rec(2006)19 on policy to support positive parenting on 13 December 2006. Its appendix defines positive parenting as parental behavior based on the best interests of the child that is nurturing, empowering and non-violent, and that provides recognition and guidance, including the setting of boundaries, so that the child can develop fully.

The text presents the idea as a basis for public policy on supporting parents. It states that such policies should take a rights-based approach and rest on voluntary choice by the people concerned, except where public authorities must intervene to protect a child. The document is an intergovernmental policy recommendation, not a clinical guideline or a trial report.

Adlerian roots of Positive Discipline

Jane Nelsen's own history page states that Positive Discipline is based on the ideas of Alfred Adler and Rudolf Dreikurs, and that she never studied under either man but learned the approach from others. She describes running parent study groups and working as a school counselor in California, where a federally funded project named Adlerian Counseling Concepts for Encouraging Parents and Teachers (Project ACCEPT) was recognized as exemplary.

The same page reports that Nelsen self-published Positive Discipline in 1981 and that Ballantine began publishing it in 1987. These dates and sales figures come from the developer's account and were not checked against independent histories. The Positive Discipline Association's description of the model repeats the Adler and Dreikurs lineage.

Parent-training program families

A 2012 Cochrane review of group-based programs for early-onset conduct problems searched the program libraries of Triple P, Incredible Years and Parent Management Training in January 2011, which shows that these were established program families by then. A later meta-analysis of Triple P found 116 eligible evaluations conducted over a 33-year period. The sources reviewed do not give founding dates or founders for these programs, so none are stated here.

One phrase, several meanings

Positive parenting is used in at least three ways. It is a policy term, as in the Council of Europe definition. It is part of the name of a specific program, Triple P - Positive Parenting Program. It is also used loosely for non-punitive discipline in general. The sources reviewed treat the first two as distinct from the third, and this page keeps named programs separate from the general label.

Positive discipline appears both as the name of Nelsen's model and as an outcome measured in trials. In an Indonesian cluster trial of Families First, an adaptation of a program called Positive Discipline in Everyday Parenting, positive discipline was one of several parenting outcomes. The abstracts reviewed do not state how that program relates to Nelsen's model, so the two should not be assumed to be the same.

Parent training and related program names

Clinical guidance and Cochrane reviews use the terms parent training or parenting programs, and describe behavioral, cognitive-behavioral or social learning approaches rather than a positive parenting label. NICE guideline CG158 describes group parent training based on a social learning model that uses modelling, rehearsal and feedback.

Parent-Child Interaction Therapy is a separately named therapy with its own trial literature. The sources reviewed do not show that it uses the positive parenting label, so it is treated here as a related program, not as a form of positive parenting.

Relationship to other Machipedia pages

This page is a member of the Machipedia family page Parenting Approaches, which is the place to compare approaches. Gentle Parenting, Attachment Parenting and Conscious Parenting have their own pages, and Play Therapy and Mindfulness are covered separately. The sources reviewed for this page do not define those terms or compare them with positive parenting, so no comparison is made here.

What the approaches describe in general terms

The Positive Discipline Association describes its model as kind and firm, neither punitive nor permissive. It lists principles including a child's need for belonging and significance, teaching social and life skills, mutual respect, a focus on solutions in place of punishment, and encouragement in place of praise. These are the association's own statements of its philosophy.

NICE describes group parent training programs as typically involving 10 to 12 parents, 10 to 16 meetings of 90 to 120 minutes, a social learning model, and a developer's manual that has been positively evaluated in a randomized trial. This page does not set out program techniques or scripts, which program bodies deliver through their own training.

Formats and delivery

Delivery varies by program. Triple P is described in a meta-analysis as a multilevel system of parenting support, with levels that run from universal to more intensive and targeted. NICE refers to group and individual formats, and to individual parent and child programs for severe and complex problems. A Turkish trial of the Positive Discipline Program used eight online sessions, and a Canadian evaluation of Positive Discipline in Everyday Parenting used a group-based format.

Training and accreditation as program bodies state it

The Triple P website states that accreditation is a required, competency-based part of every Triple P training course. Accreditation days are usually held about six to eight weeks after training, in small groups, and practitioners complete a 30-question multiple-choice quiz with an 80 percent pass mark. If minimum competence is not reached, further support or another session is offered.

The Positive Discipline Association states that its model is taught by Certified Positive Discipline Associates and that community members can become facilitators. The page reviewed does not set out certification requirements. These are program bodies' own descriptions; no independent register or statutory standard was found for the general term positive parenting.

Stated aims

The Council of Europe frames positive parenting as a way of supporting children's rights and the parental role. The Positive Discipline Association states that its aim is to help children become responsible, respectful and resourceful members of their communities. The World Health Organization guideline on parenting interventions lists aims of reducing child maltreatment and harsh parenting, strengthening the parent-child relationship, and preventing poor parental mental health and child emotional and behavioral problems.

Uses attributed to named programs

Triple P's authors describe it as supporting a blend of universal and targeted parenting interventions to promote child, parent and family wellbeing. Cochrane reviews examine group-based programs for conduct problems in children aged 3 to 12, for emotional and behavioral adjustment in young children, and for parents' own psychosocial health. NICE recommends parent training for parents of children aged 3 to 11 who have, or are at high risk of, oppositional defiant disorder or conduct disorder.

Cochrane reviews of group-based programs

A 2012 Cochrane review of behavioral and cognitive-behavioral group programs included 13 trials with 1,078 participants, whose children were aged 3 to 12 with conduct problems. It reported lower conduct problems (standardized mean difference about -0.53 by parent report, -0.44 by independent assessment) and better parental mental health in the short term, and called for long-term research.

Barlow and colleagues' 2016 review of group programs for children up to about age four included 24 trials and called the evidence tentative: the reduction in overall problems was low quality and was not maintained once two quasi-randomized trials were removed. Their 2014 review of 48 studies found short-term gains in parental depression, anxiety and stress, but only stress and confidence remained significant at six months and none at one year.

Triple P: meta-analyses and a published dispute

Sanders and colleagues' 2014 meta-analysis analyzed 101 studies of 16,099 families and reported significant short-term effects on child outcomes (d = 0.473) and parenting practices (d = 0.578), and significant effects at long-term follow-up. The authors are based at the University of Queensland. A meta-analysis of Stepping Stones Triple P for children with disability found moderate effects on child problems in 12 studies but no significant effect on observed parenting.

Wilson and colleagues' 2012 review found 33 eligible studies, mostly with waiting-list comparisons, and reported a maternal-report effect size of 0.61 but a smaller, non-significant paternal-report effect. It found substantial selective reporting, no registered trials, and 32 of 33 studies authored by Triple P-affiliated personnel, and concluded there was no convincing evidence of population-wide or long-term benefit.

Sanders and co-authors published a commentary arguing that the Wilson review had conceptual and methodological inadequacies. Both positions are published; this page does not adjudicate.

Positive Discipline studies

Controlled evaluations of Positive Discipline are few and results differ. A Turkish randomized trial with 72 parents of children aged 3 to 6 reported gains in cooperation, communication and problem-solving after an online program. A Canadian quasi-experimental evaluation of Positive Discipline in Everyday Parenting with 183 parents reported lower self-reported physical punishment.

In a cluster randomized trial of Families First in 20 Indonesian villages, the intervention did not lower the proportion of caregivers using punishment, and intervention caregivers had lower odds of reporting positive discipline.

Guidelines, related programs and gaps

A 2017 meta-analysis of Parent-Child Interaction Therapy included 23 studies with 1,144 participants and reported reduced child externalizing behavior (standardized mean difference -0.87) compared with control.

Searches covered PubMed for Triple P reviews, Cochrane parenting reviews, Positive Discipline evaluations and Parent-Child Interaction Therapy meta-analyses. No review of positive parenting as a single intervention was found.

Reporting of harms

The Cochrane review of parental psychosocial outcomes examined trials for adverse effects and reported that none of the included trials reported on aggression or adverse effects. Absence of reporting is not evidence of absence of harm. The Indonesian trial found a result in the opposite direction of the program aim on one outcome, which shows that effects can differ by setting.

Children with additional needs and complex difficulties

NICE directs clinicians assessing a suspected conduct disorder to look for complicating factors, including coexisting mental health problems, neurodevelopmental conditions such as ADHD and autism, and learning disability. It recommends individual parent and child programs for severe and complex problems in children aged 3 to 11, and asks clinicians to address parents' concerns that they may feel blamed or stigmatized.

NICE also recommends assessing parents' wellbeing, including mental health and substance misuse. The Stepping Stones Triple P meta-analysis covered 659 families of children with disability and found no significant treatment effect on observed parenting behaviors. A Turkish trial noted culture-specific aspects of the Positive Discipline Program that need improvement.

Discipline guidance and care boundaries

The American Academy of Pediatrics 2018 policy statement says aversive disciplinary strategies, including all forms of corporal punishment and yelling at or shaming children, are minimally effective in the short term and not effective in the long term, and links corporal punishment to higher risk of negative outcomes. It supports adults avoiding physical punishment and verbal abuse, and guides pediatricians in advising parents on positive discipline.

This page is information only and is not medical, psychological or parenting advice. Persistent concerns about a child's behavior, safety, mental health or development, and parental distress, are matters for a qualified clinician, and reading about an approach should not delay or replace care. Program bodies, not this page, set out how their methods are taught.