After the COVID-19 pandemic, mental health problems in children ages 6–17 years in Hong Kong increased from 16.4% in pre-COVID 2017 to 24.4% in post-COVID 2022 (Wing-man, 2017; Wong et al., 2023). Children from low-income families in Hong Kong tend to experience higher rates of externalizing behaviors, such as attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), as well as internalizing issues like anxiety and depression (Lam & Chung, 2017; Zhang, 2014). A survey by Li et al. (2021) of 21,526 Hong Kong children during the pandemic revealed that 32% of children exhibited mental health problems, but the figure was higher (41%) among children from low-income families.
The Impact of Harsh Parenting on Child Mental Health
Tang’s (2006) study involving 1,662 Chinese parents found that 57.5% of parents used corporal punishment as a response to children’s behavior problems. The study highlighted that low-income parents were more likely to resort to harsh discipline. Unfortunately, such disciplinary practices can worsen children’s behavior problems and contribute to mental health challenges (Ho, 2015; Ren & Zhang, 2018; Siu, 2008). Conversely, nurturing and supportive relationships between mothers and children have been shown to promote better mental health outcomes for children.
Child-Parent Relationship Therapy (CPRT) as an Effective Parenting Strategy
One effective approach to improving children’s behavior and mental health is Child-Parent Relationship Therapy (CPRT). CPRT trains parents to implement child-centered play therapy techniques with their children (Landreth & Bratton, 2019; Parker et al., 2021). Meta-analyses have consistently demonstrated the effectiveness of CPRT (Bratton et al., 2005; Lin & Bratton, 2015; Parker et al., 2021). Studies involving Chinese parents have also shown promising results (Chau & Baggerly, 2024; Chau & Landreth, 1997; Yuen et al., 2002).
Online CPRT for Low-Income Families in Hong Kong: A Promising Study
A study conducted in 2025 by Iris Chau and Jennifer Baggerly, published in the International Journal of Play Therapy, explored the feasibility of online CPRT in improving the behavior of Chinese children from low-income families in Hong Kong. The study involved 107 parents of 6- to 8-year-old children who completed a Chinese translation of the Child Behavior Checklist (CBCL) by Achenbach and Rescorla (2001) both before and after attending CPRT sessions. These sessions were held online over seven weekly synchronous meetings led by a trained Hong Kong play therapist. The process included supervision and fidelity checks.
The results revealed significant improvements in children’s behavior. The Wilcoxon signed-rank test showed statistically and practically significant decreases in children’s CBCL scores for total problems, internalizing and externalizing behaviors, anxiety and depression, and aggression. Of the 107 children in the study, 25 had pretest CBCL scores in the borderline or clinical range, and these children demonstrated notable improvements after participating in CPRT.
Study Findings Align with Previous Research
The findings of Chau and Baggerly’s study are consistent with previous CPRT research. Notably, studies by Yuen et al. (2002) and Leung (2015) have shown that CPRT can effectively improve child behavior among Chinese families in Canada and Hong Kong. Chau and Baggerly’s research further extends this by demonstrating that online CPRT can enhance low-income parents’ acceptance of their children, respect for their children’s feelings, and support for their children’s autonomy. This is the first study to demonstrate that children’s behavior can improve after their parents participate in CPRT online.
Recommendations and Next Steps
Given the positive outcomes of this study, Chau and Baggerly recommend that mental health professionals in Hong Kong receive CPRT training to extend the benefits of this therapy to more low-income families. They also suggest that future studies focus on conducting randomized controlled trials (RCTs) to confirm the efficacy of online CPRT. Additionally, they recommend incorporating teacher observations or direct behavioral assessments of children using the CBCL Teacher Report Form and Direct Observation Form, reviewing therapists’ videos for quality, and ensuring an independent CPRT-trained Chinese play therapist reviews the translated manual for accuracy.
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