Symposium 126 - Rethinking Parent Behavior Management Training for Disruptive Behavior and ADHD: Increasing Engagement, Adherence and Adaptation for Diverse Caregiving Populations

Saturday, November 18, 2023

8:30 AM – 10:00 AM PST

Location: Ashnola (301), Level 3

CE: 1.5

Keywords: Externalizing, Treatment/ Program Design, Parent Training
Level of Familiarity: Moderate
Recommended Readings: Armando A. Pina, Antonio J. Polo & Stanley J. Huey (2019) Evidence-Based
Psychosocial Interventions for Ethnic Minority Youth: The 10-Year Update, Journal of Clinical Child
& Adolescent Psychology, 48:2, 179-202, DOI: 10.1080/15374416.2019.1567350, Nix, R. L., Bierman, K. L., & McMahon, R. J. (2009). How attendance and quality of participation affect treatment response to parent management training. Journal of consulting and clinical psychology, 77(3), 429., Chacko, A., Jensen, S. A., Lowry, L. S., Cornwell, M., Chimklis, A., Chan, E., ... & Pulgarin, B. (2016). Engagement in behavioral parent training: Review of the literature and implications for practice. Clinical child and family psychology review, 19, 204-215., Parra Cardona, J. R., Domenech‐Rodriguez, M., Forgatch, M., Sullivan, C., Bybee, D., Holtrop, K., ... & Bernal, G. (2012). Culturally Adapting an Evidence‐Based Parenting Intervention for L atino Immigrants: The Need to Integrate Fidelity and Cultural Relevance. Family process, 51(1), 56-72.,

Discussant(s)

Andrea Chronis-Tuscano, Ph.D. (she/her/hers)

Professor
University of Maryland- College Park
College Park, Maryland

Co-Author(s)

EG

Erin Gonzalez, PhD

Principal Investigator
Seattle Children's Hospital
Seattle, Washington, United States of America

Presenter(s)

MS

Megan Schultz, B.A.

Doctoral Student
University of Washington
Seattle, Washington
MK

Michelle Kuhn, Ph.D. (she/her/hers)

Acting Assistant Professor
University of Washington School of Medicine
Seattle, Washington
Cindy Trevino, Ph.D.

Assistant Professor
University of Washington School of Medicine
Seattle, Washington
MC

Mary Charleson, M.S. (she/her/hers)

Seattle Children’s Hospital
SEATTLE, Washington

Approximately 10% of U.S. youth have a diagnosis of ADHD, and an additional 5-10% have disruptive or externalizing behaviors that impair their functioning and cause strain for caregivers (Polanczyk et al., 2014; Demmer et al., 2017). Parent Behavior Management Training (BMT) is the frontline evidence-based behavioral treatment for ADHD and externalizing problems, but the treatment can be burdensome and rates of drop-out average as high as 50% (Chacko et al., 2016). Families from racial and ethnic groups that are historically underrepresented in behavioral treatment research are less likely to engage in and complete BMT. Poor contextual and cultural congruence of the programs, as well as logistical access barriers and stigma, contribute to these discrepancies (Pina, Polo & Huey, 2019). Traditional BMT also does not account for the impact of early childhood trauma or adversity, complicating engagement for caregivers who are foster or non-biological parents.

In this symposium, four researchers will present their investigations to understand family engagement and adherence patterns as well as barriers to participating in BMT, plus implications for adapting this treatment for historically underserved groups. The first talk will examine patterns and predictors of attendance and drop-out in a large transdiagnostic BMT program for children ages 5-12. The second talk examines meaningful measurement of caregiver engagement in BMT and how these measures relate to caregiver attributes and ultimately to child outcomes in a BMT program adapted to increase positive health behaviors for children with ADHD. The third and forth talks discusses the process of adapting existing BMT models to specific populations: Latinx caregivers of children with ADHD receiving BMT in Spanish, and foster and kinship caregivers engaged in trauma-informed BMT to support foster children with a history of early adversity and prenatal substance exposure.

Together, the symposium presentations will highlight predictors and indicators of engagement in BMT and highlight subgroups of caregivers who face heightened barriers to engagement and retention in the treatment. We will then examine the process of improving and adapting BMT for specific subgroups that are historically underserved by ADHD treatments and underrepresented in research on BMT, ADHD and externalizing disorders. Dr. Chronis-Tuscano, a leading expert in adapting BMT to increase caregiver engagement, will discuss implications of the findings for improving the acceptability and efficacy of this widely-used intervention.

Learning Objectives:

At the end of the session, the learner will be able to:

Explain the evidence and rationale for treating childhood disruptive behavior disorders with Parent Behavior Management Training (PBMT).
Identify barriers that lead to lower PBMT engagement for historically marginalized racial and ethnic groups and nontraditional caregivers.
Discuss methods for adapting PBMT to unique caregiver populations and incorporating stakeholder input into program modifications.
Describe multiple ways of measuring adherence, engagement and acceptability in behavioral interventions.
Describe benefits and challenges of implementing behavioral treatments for caregivers via telemedicine "telegroup" formats.
List PBMT skills that serve as mechanisms to improve family and child outcomes following PBMT.