Poster #47 - Parental Distress Mediates the Relation Between Parental Cognitive Errors and Behavioral Parent training Skill Use

• In Event: Poster Session 11

Abstract

Behavioral parent training (BPT) is a gold-standard treatment for childhood ADHD, producing significant and often sustained improvements across multiple symptom and functional domains. During BPT, parents learn skills to reduce their child’s symptoms and improve functioning that are applied at home; thus, skill use is a crucial mechanism of treatment response. However, approximately 60% of families experience difficulty engaging effectively with treatment. Identifying predictors of skill use is therefore essential to improving treatment outcomes.

Parental cognitive errors (PCEs) are one potential predictor of skill use, reflecting overly negative, stable, and helpless beliefs that parents hold toward their child and parenting practices. Several studies suggest that higher levels of PCEs predict lower rates of BPT skill use, yet little research has examined why this effect occurs. One possible explanatory mechanism is parenting stress. PCEs account for a large proportion of variance in parenting stress (24-44%), and higher parenting stress predicts reduced between-session skill use. Thus, greater PCEs may increase parents’ stress, leading to lower levels of skill use throughout treatment; however, this notion has yet to be tested.

Data were collected as part of a randomized controlled trial of BPT for children with ADHD, and those receiving active treatment were considered (n=148; Child Age M = 9.2, SD = 1.1; 58% boys). PCEs were measured at pre-treatment using the Parent Cognitive Error Questionnaire (PCEQ), which assesses two types of parental cognitive errors: Parent Behavior Errors (i.e., cognitive errors surrounding parents’ own parenting behaviors; “It’s all my fault my child has these problems”) and Child Behavior Errors (i.e., cognitive errors surrounding the child’s behaviors; “My child never does anything he/she is supposed to do”). Parenting Stress was measured at pre-treatment using the Parenting Stress Index-Short Form (PSI-SF), which has three subscales: Parental Distress, Parent-Child Dysfunctional Interaction, and Difficult Child. Measures also included weekly parent-report ratings of Skill Use during BPT.

Bias corrected, bootstrapped mediation analyses examined the effect of Parent/Child Behavior Errors on Skill Use, with the three PSI-SF subscales included as parallel mediators. Parent and Child Behavior Errors were examined as predictors in separate models. Regardless of the type of PCE considered, the indirect effect through Parental Distress was significant (Parent Behavior Errors: .07, 95% CI = .02 to .15; Child Behavior Errors: .11, 95% CI = .06 to .19). Path inspection indicated that greater Parent and Child Behavior Errors were associated with increased Parental Distress, which was collectively associated with lower Skill Use. No mediational relations were found for the Parent-Child Dysfunctional Interaction (Parent Behavior Errors: -.01, 95% CI = -.05 to .02; Child Behavior Errors: -.02, 95% CI = -.10 to .04) or the Difficult Child (Parent Behavior Errors: -.02, 95% CI = -.08 to .03; Child Behavior Errors: -.02, 95% CI = -.08 to .05) subscales.

These findings suggest that BPT skill use may be optimized by incorporating treatment for parents’ stress and distorted thinking. Specifically, reducing PCEs and distress through CBT-based approaches may increase skill use and ultimately improve treatment outcomes.

Authors

• Gabrielle Fabrikant-Abzug, Arizona State University
  Presenting Author

• Lauren M. Friedman, Arizona State University

• Linda Pfiffner, University of California - San Francisco