2 - (SYM 113) Parental Cognitive Barriers to Treatment Engagement in and Child Outcomes of Behavioral Training for ADHD in Asian American Families

Introduction: Little is known about the proximal barriers of Asian American (AA) families’ engagement in and outcomes of behavioral training (BT) for ADHD. Guided by the Health Belief Model (HBM)², this study examined the predictive effects of parents’ cognitions – parental self-competence and treatment expectations - on parents’ treatment engagement and child outcomes of BT among parents identifying as AA, White, and other Black, Indigenous, and People of Color (OBIPOC).

Methods: We conducted path analyses using data from a randomized controlled trial of BT for ADHD (N = 199 children, ages 7-11)³. We first examined pretreatment parental self-competence and treatment expectations among AA (n = 29), OBIPOC (n = 35), and White (n = 135) parents. For families who received BT (N = 148, AA n = 21, OBIPOC n = 19, White n = 108), we examined the direct effects of parents’ race/ethnicity and pretreatment cognitions on posttreatment child outcomes (ADHD and ODD severity, clinical global improvement) and their indirect effects via treatment engagement. Treatment engagement was measured as session attendance, participation, and adherence to home practice⁴.

Results: At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations than OBIPOC and White parents (Bs = .188, .238; ps < .05). Parents’ pretreatment expectations positively predicted treatment engagement (B = .227, p = .003), which in turn positively predicted child global improvement for all families (B = .206, p = .008). Treatment engagement fully mediated the relationship between treatment expectations and posttreatment child global improvement. At posttreatment, AA parents reported fewer ADHD symptom improvements than White parents and less global improvement than OBIPOC parents (respectively, Bs = -.191, .289; ps < .05).

Discussion: In line with the HBM², our results indicate that parents’ treatment expectations are an important predictor of engagement and success in BT. Downstream effects of treatment expectations were notable for AA parents, who had the lowest expectations. Our results support previous work suggesting that AA parents of children with ADHD feel lower parental competence compared to non-AA parents⁵. Our findings suggest that the efficacy of BT for AA families may be enhanced by bolstering parents’ expectations at the beginning of treatment. Future research can explore how the strength of the relations among treatment expectations, engagement, and outcomes differ by racial/ethnic groups.