Abstract
Background: Childhood externalising behaviour disorders - such as Conduct Disorder, Oppositional Defiant Disorder, and Attention Deficit-Hyperactivity Disorder – present elevated risk for adverse social, health and educational outcomes and are associated with lower levels of empathy and pro-social behaviour. Empathy develops through exposure to specific parenting behaviours, such as warmth. There is evidence that parental empathy and reflective function are associated with increased pro-social behaviours in children. However, the relationship between these parental “empathic capacities” of warmth, reflective function and empathy and childhood externalising behaviour during middle childhood (6-12 years) is not clear.Methods: The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registration of the protocol on the Prospective Register of Systematic Reviews (PROSPERO) online database (registration reference CRD42022314279). Electronic databases were queried (Medline, PsychINFO and Scopus) using selected search terms, and studies were selected after their evaluation against inclusion and exclusion criteria, followed by data extraction and quality assessment by two independent raters. A narrative synthesis of the findings of selected studies was produced.
Results: The review identified thirteen studies for inclusion, with a total of 8748 parent, and 9399 child participants. These comprised nine cross-sectional studies, three case-control studies, and one longitudinal study. Of these, childhood externalising behaviour was reported in relation to parental measures of warmth (nine studies), empathy (two studies), and reflective capacity (two studies). Externalising behaviour was negatively associated with warmth in five out of the nine studies (effect size: small [n=2]; medium [n=2]; large [n=1]; reflective function in both the studies (effect sizes moderate to large); and empathy in both the studies (small effect size [n=2]). Four studies did not report any significant
associations between parent and child variables. Several studies reported effects moderated by gender with stronger associations between index variables reported in males parent child dyads.
Conclusion: This review provides evidence that in middle childhood lower parental empathic capacities are associated with increased levels of externalising behaviour. Future research examining the efficacy of parenting interventions that specifically target increasing warmth, reflective function and empathy may elucidate this relationship further, and probing causality may be an important next step. For instance, such studies may help to identify whether additional attachment theory-based content in current evidence-based parenting interventions improves empathic capacities and/or child behavioural outcomes. The gender effects reported in this review support an important role of fathers in the
prevention and treatment of externalising behaviours. The findings of this review may inform service development around parenting interventions generally, and in those targeting at risk populations.
| Date of Award | 1 Oct 2023 |
|---|---|
| Original language | English |
| Awarding Institution |
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| Supervisor | Crispin Day (Supervisor) & Emma Godfrey (Supervisor) |
Keywords
- parental empathy
- reflective function
- warmth
- externalising behaviour
- conduct problems
- systematic review