JMIR Publications

ABSTRACT

Background:

Digital parent training programs are effective in reducing early childhood behavioral problems, yet little is known about how changes in parenting behaviors translate into sustained changes in child symptoms in real-world, large-scale implementations. Network analysis provides a systems-level framework for examining how parenting styles and child behavioral symptoms dynamically interact and reorganize following digital interventions.

Objective:

This study applied network analysis to examine how parenting styles and children’s behavioral symptoms are interrelated before and after a digital assisted parenting program implemented at a national scale, and how these associations evolve over short- and long-term follow-up (6 and 24 months).

Methods:

36,591 families of four-year-old children were screened of whom 2900 met the screening criteria, and received an 11-week digital parenting intervention embedded in Finland’s public healthcare system. Parent-reported measures of behavioral symptoms and parenting styles were collected at baseline, 6 months, and 24 months follow-up. Network analysis was performed using Mixed Graphical Models, and bootstrapping was used to assess changes in edge weights from baseline. Strength centrality indices were also computed.

Results:

At baseline, child aggressive behavior was the most central symptom (strength centrality = 1.35), strongly linked to callousness (edge = 0.45) and emotional reactivity (0.34). Parenting variables were peripheral. The associations between changes in parental overreactivity and child aggression were significant (6 months = 0.18; 24 months = 0.14; Ps < .05). Overreactivity also showed a modest increase in centrality in the change networks (centrality indices =0.75, 0.73), while aggressive behavior remained the most central node in the networks of change (centrality indices = 1.53, 1.34). Several associations among child symptoms, particularly internalizing-related edges, weakened over time.

Conclusions:

Findings highlight the value of network analysis for identifying pathways through which digital parenting programs foster change, particularly the strengthened linkage between reductions in overreactive parenting and decreases in child aggression. Results support the utility of network analysis for identifying durable intervention mechanisms and targeting central nodes in behavioral systems.