A randomized controlled trial of technology‐enhanced behavioral parent training: sustained parent skill use and child outcomes at follow‐up

Abstract

Background Early‐onset (3–8 years old) disruptive behavior disorders (DBDs) have been linked to a range of psychosocial sequelae in adolescence and beyond, including delinquency, depression, and substance use. Given that low‐income families are overrepresented in statistics on early‐onset DBDs, prevention and early‐intervention targeting this population is a public health imperative. The efficacy of Behavioral Parent Training (BPT) programs such as Helping the Noncompliant Child (HNC) has been called robust; however, given the additional societal and structural barriers faced by low‐income families, family engagement and retention barriers can cause effects to wane with time. This study extends preliminary work by examining the potential for a Technology‐Enhanced HNC (TE‐HNC) program to improve and sustain parent skill proficiency and child outcomes among low‐income families. Methods A randomized controlled trial with two parallel arms was the design for this study. A total of 101 children (3–8‐years‐old) with clinically significant problem behaviors from low‐income households were randomized to HNC (n = 54) or TE‐HNC (n = 47). Participants were assessed at pre‐treatment, post‐treatment, 3‐month, and 6‐month follow‐ups. Primary outcomes were parent‐reported and observed child behavior problems. Secondary outcomes included observed parenting skills use (ClinicalTrials.gov Identifier: NCT02191956). Results Primary analyses used latent curve modeling to examine treatment differences in the trajectory of change during treatment, maintenance of treatment gains, and levels of outcomes at the 6‐month follow‐up. Both programs yielded improvements in parenting skills and child problems at post‐treatment. However, TE‐HNC families evidenced greater maintenance of parent‐reported and observed child behavior and observed positive parenting skills at the 6‐month follow‐up. Conclusions Our findings contribute to an ongoing line of work suggesting that technology‐enhanced treatment models hold promise for increasing markers of engagement in BPT and sustaining long‐term outcomes among low‐income families.

Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence

“…To address difficulties with consistent parent and child treatment adherence, newly developed digital health tools may support the monitoring aspect of BPT by providing structured reward systems with automated reminders and gamification features (Pfiffner et al, 2022). Recent work has found some initial evidence that technology-enhanced BPT improves parent skill use and maintenance over time (Jones et al, 2021;Parent et al, 2021). For child ED, ADHD symptom severity moderated parent treatment adherence.…”

Behavioral Parent Training via Telehealth for Autistic Children: Further Exploration of Feasibility During the COVID-19 Pandemic

“…Therefore, the results may not generalize to families of other backgrounds or in other regions. While research has shown that parents tend to respond favorably to BPT regardless of their SES, disadvantaged families may prematurely discontinue services or struggle to maintain positive changes over time (Leijten et al, 2013 ; Parent et al, 2022 ). Additionally, the telehealth format may be less feasible for families lacking high-speed internet connections and equipment like webcam-enabled computers and smartphones, or those less experienced with such technology (Brunner et al, 2023 ), and in rural or mountainous areas where internet connections are less reliable (Dahiya et al, 2021 ).…”

Estimating the Heterogeneous Causal Effects of Parent–Child Relationships among Chinese Children with Oppositional Defiant Symptoms: A Machine Learning Approach

“…It is also suggested that the PCR plays a pivotal role in the development and exacerbation of oppositional defiant symptoms in Chinese children [ 6 , 10 ]. Moreover, many intervention strategies are focused on the management of PCR [ 6 , 30 ], and have demonstrated the feasibility and effectiveness of improvements in PCR across different cultural contexts [ 31 ]. Behavioral problems in young children, including oppositional defiant symptoms, could be alleviated by improving PCRs with behavioral intervention strategies [ 32 ].…”