The Relationship between Symptom Change and Utilization of a Web-Based Self-Help Intervention for Parents of Children with Externalizing Disorders (Preprint)

Abstract

BACKGROUND Web-based self-help parent management trainings have widely been implemented in the evidence based treatment of children with behavioral problems. However, little is known about the direct association of caregiver usage and child externalizing symptom changes. OBJECTIVE This study aims to examine the association between the utilization of web-based self-help (WASH) for caregivers and their children’s externalizing symptoms. METHODS Longitudinal data of 276 families from two intervention conditions of a randomized controlled trial (either unguided or supported by a therapist via telephone) were analyzed. Child symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) were assessed before (T1), during (T2), and after the 6-month WASH intervention (T3). Additionally, two indicators of caregivers’ utilization of the WASH intervention were considered: number of logins and completed tasks/videos (%). Associations of caregivers’ utilization during early (T1-T2) and late treatment (T2-T3) with child externalizing symptoms were analyzed using path analyses (structural equation modeling). RESULTS Frequency and intensity of use were higher at T1-T2 than at T2-T3. The intensity of use at early treatment (T1-T2) was significantly associated with ADHD symptoms at T2 (but not at T3), and the frequency of use during early treatment (T1-T2) was significantly associated with ODD symptom severity at T3 (but not at T2). Moreover, child ADHD severity at T2 predicted number of caregiver logins in the following period (T2-T3). CONCLUSIONS The findings underline the importance of the frequency and intensity of use in order to achieve symptom improvements during WASH. The lack of significant associations between utilization in the later treatment period and subsequent symptom severity might be attributable to a generally low utilization in this treatment period.