Short- and Long-Term Changes in the Network of Parenting Styles and Child Symptoms After a Digital Parent-Training Program: Network Analysis of a Nationwide Implementation Study

Abstract Background Digital parent-training programs are effective in reducing early childhood behavioral problems, yet little is known about how changes in parenting behaviors relate to 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 A total of 36,591 families of 4-year-old children were screened, of whom 4665 (12.7%) met the screening criteria and 2900 were enrolled and received an 11-week digital parenting intervention embedded in Finland’s public health care system. Parent-reported measures of behavioral symptoms and parenting styles were collected at baseline and 6- and 24-month follow-ups. Network analysis was performed using mixed graphical models, and bootstrapping was used to assess changes in edge weights from baseline. Strength centrality indexes were also computed. Results At baseline, child aggressive behavior was the most central symptom (strength centrality 1.35), strongly linked to callousness (edge weight 0.45) and emotional reactivity (edge weight 0.34). Parenting variables were peripheral. The associations between changes in parental overreactivity and child aggression were significant (edge weights: 0.18 at 6 months and 0.14 at 24 months; all P values <.05). Overreactivity also showed a modest increase in centrality in the change networks (centrality index: 0.75 and 0.73, respectively), while aggressive behavior remained the most central node in the networks of change (centrality index: 1.53 and 1.34, respectively). Several associations among child symptoms, particularly internalizing-related edges, weakened over time. Conclusions These findings highlight the value of network analysis for characterizing how the associations between parenting styles and child behavioral symptoms reorganize following a digital parenting program delivered at scale, particularly the strengthened association between changes in overreactive parenting and changes in child aggression. The results support the utility of network analysis for describing durable shifts in behavioral systems and for informing the selection of central intervention targets in future controlled research.