PTSD as a moderator of a parenting intervention for military families.

Abstract

The stress of multiple deployments and exposure to combat places service members at risk for posttraumatic stress disorder (PTSD), which may detrimentally affect parenting. Evidence-based parenting programs have been successful in promoting adaptive parenting practices among families exposed to stress. However, the effects of preventive interventions on parenting may vary by military parent's PTSD. The current study includes families who participated in a randomized controlled trial of a parenting intervention for military families known as After Deployment, Adaptive Parenting Tools (ADAPT). Families were randomized to either a 14-week, group-based parenting program or a comparison group. Participants included families with 4- to 12-year-old children in which at least 1 parent deployed to Iraq or Afghanistan (N = 336; 945 individuals). Structural equation modeling was used to examine parent self-reported PTSD as a potential moderator of the relationship between intent-to-treat status and effective parenting practices 12 months postbaseline while accounting for baseline effective parenting, length and number of deployments, and family demographics. Father PTSD was a significant moderator, such that the intervention was less effective for fathers who met clinical levels of PTSD. No significant moderation effects were found among mothers. These findings may have important implications for the development of future evidence-based parenting programs. (PsycINFO Database Record

Maternal PTSD and Behavioral Parent Training Treatment for a Girl With Conduct Disorder and Callous–Unemotional Traits

“…For example, Gewirtz, Erbes, Polusny, Forgatch, and Degarmo (2011; Gewirtz, Pinna, Hanson, & Brockberg, 2014) employed a modified curriculum known as After Deployment Adaptive Parenting Tools Program (ADAPT), which included core principles of BPT including limit setting, positive involvement, monitoring children’s activities, and family problem solving, as well as additional modules focused on postdeployment readjustment and emotion regulation. ADAPT was associated with improvements in parenting (Chesmore et al, 2018), and interestingly, improvements in parenting were associated with reduced PTSD symptoms (Gewirtz et al, 2011; Gewirtz et al, 2014). Yet, more recent evidence suggests that parents with particularly high levels of PTSD may insufficiently respond to ADAPT (Chesmore et al, 2018), and the impact of co-occurring child CPs on intervention outcomes is unclear.…”

“…ADAPT was associated with improvements in parenting (Chesmore et al, 2018), and interestingly, improvements in parenting were associated with reduced PTSD symptoms (Gewirtz et al, 2011; Gewirtz et al, 2014). Yet, more recent evidence suggests that parents with particularly high levels of PTSD may insufficiently respond to ADAPT (Chesmore et al, 2018), and the impact of co-occurring child CPs on intervention outcomes is unclear. Families in which a parent is diagnosed with PTSD and a child displaying CP/CU traits may present with substantially more strain compared with previous work addressing parenting among veterans or BPT work for children with CPs with or without CU.…”

“…Gewirtz, Forgatch, & Wieling, 2008), which may negatively affect the course of BPT. Symptoms of trauma in parents, including emotional numbness, lack of empathy toward others, and increased irritability, have been associated with harsh punishment, inconsistent discipline, and poor supervision (Gewirtz, Polusny, DeGarmo, Khaylis, & Erbes, 2010;McFarlane, 2009), and emerging work focused on parents returning from deployment finds similar associations between posttraumatic stress disorder (PTSD) symptoms and parenting difficulties (Chesmore, Piehler, & Gewirtz, 2018). Parental PTSD symptoms may impair parents' ability to consistently implement reward and discipline strategies of BPT, although work to date has produced mixed findings.…”

Secondary Trauma and Parenting Practices in Internet Crimes against Children Task Force Investigators

“…Parental exposure to traumatic experiences and the presence of parental PTSD have been linked to heightened levels of parental distress and decreased parenting satisfaction as well as problematic parenting behaviors, such as emotional distance towards children and a higher risk of child abuse, as well as increased incidence of PTSD and anxiety in children (Berz et al 2008;Cross et al 2018;Gewirtz et al 2010;Ruscio et al 2002). Similarly, National Guard members who were deployed during the Iraq and Afghanistan conflicts who experienced greater PTSD symptoms were more likely to self-report poorer parenting behaviors such as greater likelihood of utilizing harsh disciplinary actions (Chesmore et al 2018). PTSD symptomatology in deployed and returning veterans has also been found to be associated with negative parenting outcomes.…”

“…Low satisfaction in parenting, increased aggression toward children, low warmth and engagement, and emotional distance from children have all been found to be related to the emotional numbing symptom of PTSD; with poorer, disengaged parent-child relationships being associated with the avoidance symptom of PTSD (Davidson and Mellor 2001;Duranceau et al 2015;Lauterbach et al 2007;Samper et al 2004;Sherman et al 2016). Related to gender differences, a study examining the moderating role of PTSD on a parenting intervention for military families yielded results that indicated paternal PTSD significantly moderated the effects of parenting interventions, such that the interventions were less effective for fathers with PTSD (Chesmore et al 2018). Findings from this study suggest that fathers with clinical levels of PTSD displayed smaller improvements in effective parenting skills compared to fathers without PTSD, possibly because fathers with PTSD were avoiding managing child problems because of the emotional arousal associated with parenting practices (Chesmore et al 2018).…”