Mediators of Change in a Parent Training Program for Early ADHD Difficulties: The Role of Parental Strategies, Parental Self-Efficacy, and Therapeutic Alliance

Abstract

Parental self-efficacy and reductions in negative parenting may mediate change in PT, but more fine-grained time-lagged analyses are needed to establish causality.

What changes when? A reply to Beauchaine and Slep

“…Finally, do we expect change to occur in full already during the intervention, or do parents perhaps need more time to practice and implement the strategies and tips they learn and receive during the sessions? Our findings and those of others might suggest most change occurs already during the intervention and then sustains over time (Rimestad et al, 2017;Weeland et al, 2018).…”

“…From a theoretical point of view, we do not expect single-unidirectional causal relations between parenting practices and child behavior; likewise, the putative mechanisms of change underlying parenting intervention might also be more complex (Burke & Loeber, 2016; Kazdin, 2007; Rimestad, O'Toole, & Hougaard, 2017; Settipani, O'Neil, Podell, Beidas, & Kendall, 2013). Although BPT interventions such as IY directly target parenting behavior (and do not directly target child behavior), it is still possible that changes in child behavior during the intervention precede (further) changes in parenting behavior or that both changes in parenting and child behavior are explained by another (unmeasured) variable.…”

“…For example, a recent Danish study on IY showed that a decline in attention-deficit/hyperactivity disorder symptoms between pre- and midtreatment predicted an increase in parental self-efficacy at posttreatment (and not the other way around). In this case, improved parenting behavior might thus follow, instead of predict, child symptom reductions via an increase in parental self-efficacy (Rimestad et al, 2017). Moreover, the association between changes in child behavior and parenting in the same time interval (during the intervention period) might be explained by another, unmeasured variable.…”

“…It seems unlikely that any single mechanism leads to the outcomes of a comprehensive intervention such as BPT. Recent studies suggest that besides changes in parenting behavior, changes in parents’ cognitions and emotions (e.g., parental attributions, self-efficacy, emotion regulation, and stress), as well as differential treatment fidelity might also be important contributors of change in child behavior (Feldman & Werner, 2002; Lebowitz, 2016; Mikami, Chong, Saporito, & Na, 2015; Mouton & Roskam, 2015; Rimestad et al, 2017; Ros, Hernandez, Graziano, & Bagner, 2016). Some of these change mechanisms might however be difficult to capture through traditional study designs using questionnaires and/or observations at only pre- and posttest.…”

Practitioner Review: Assessment and treatment of preschool children with attention‐deficit/hyperactivity disorder

“…Conversely, harsh or inconsistent parenting has been posited to fuel oppositionality and other disruptive behaviors. Accordingly, a recent study (Rimestad, O'Toole, & Hougaard, 2017) found that heightened parental self-efficacy and diminished negative parenting mediated reductions in ADHD symptoms. Forehand et al (2017) failed to find evidence implicating parent ADHD symptoms as a treatment moderator; otherwise few moderator variables have been identified in research involving BPT in preschool children with ADHD (Daley, Jones, Hutchings, & Thompson, 2009).…”