4 - (SYM 126) Relations Between Caregiver Engagement in Parent Behavior Management Training, Caregiver Strain and Child Treatment Outcomes

Objective: Parenting a child with ADHD places high demand on caregivers, leading to stress and strain which in turn can exacerbate behavior problems. Although parent Behavioral Management Training (BMT) can decrease behavior problems, stress may impact a caregiver’s ability to engage in these interventions and use program skills. More research is needed to understand which aspects of caregiver engagement are meaningful and may serve as mechanisms by which caregiver stress mitigates intervention benefits.

The current study examines ways of measuring engagement across two similar BMT programs and how engagement may serve as a mechanism between baseline caregiver characteristics and child ADHD outcomes.

Method: Caregivers of children ages 6-10 with ADHD were randomized to one of two BMT programs: Standard BMT based on Barkley’s Defiant Children curriculum, and specialized BMT with an added focus on health behaviors. Caregivers completed pre- and post-test standardized clinical measures as well as the Treatment Adherence Inventory, which measures parent use and perceived helpfulness of each program skill as well as perceptions of treatment engagement and motivation. Mediation models were run in SPSS with baseline scores on the Caregiver Strain Questionnaire predicting outcomes on the Conners-3 Parent Rating Scale, mediated by program engagement and skill use.

Results: Participants were primary caregivers of 57 children (M age = 8.03, SD = 1.34; 70.1% male). The most frequently used skills in standard BMT were following a consistent bedtime routine (M = 4.42 of 5, SD = 0.72) and following the child’s lead during special time play (M = 4.48 of 5, SD = .57), while for health behavior-focused BMT they were giving attention to positive behaviors (M = 4.47, SD = 6.29) and effective instructions (M = 4.45, SD = 0.57). Overall frequency of skill use and skill helpfulness were not statistically different across treatment groups (t (60) = 0.29, p = .92), though perceived parent engagement was higher for health-focused BMT. There was evidence for partial mediation by program engagement variables in the relation between baseline caregiver strain and child clinical outcomes.

Conclusions: Results highlight meaningful caregiver engagement metrics in BMT, which may help explain how baseline parent functioning affects treatment outcomes. Interventions aimed at reducing caregiver stress and improving their ability to practice program skills may boost child and family treatment outcomes.