Effects of Parent 1
Running Head: EFFECTS OF PARENT COGNITIONS
Effects of Parent Cognitions on Treatment Engagement
Subject Term: 8.3 child clinical/pediatric
Division 53: Society of Clinical Child and Adolescent Psychology
Sarah Gray, BA
saogray@gmail.com
Not an APA member; sponsored by co-author Abbey Eisenhower
3 Tremont Place
Somerville, MA 02143
(337) 852-4889
University of Massachusetts Boston
Graduate Student, Clinical Psychology
Boston, MA
Sarah Schwartz, BA, MEd
Graduate Student, Clinical Psychology
University of Massachusetts Boston
Abbey Eisenhower, PhD
Assistant Professor, Clinical Psychology
University of Massachusetts Boston
APA Membership Status: Early Career Member
Poster Session Preference
Permission to forward to a more appropriate division granted.
Suggested alternate division: 37: Society for Child and Family Policy and Practice
*
Introduction
A wealth of research suggests that poor treatment attendance significantly limits the
effectiveness of mental health services (Wierzbicki & Pekarik, 1993); these services
include those targeting children, with 40-60% of youth terminating therapy early
(Kazdin, 1996). When considering the treatment of children, parents’ participation
is particularly relevant, since parents are primarily responsible for treatment
attendance and adherence (Nock & Ferriter, 2005). Researchers have suggested that
parental cognitions, including locus of control and attributions about child behavior,
may be a determining variable in parental engagement in treatment (Miller, 1995;
Morrissey-Kane & Prinz, 1999). On the other hand, still more research suggests that
non-cognitive variables such as time, transportation, and scheduling barriers
supersede the effects of parental beliefs and cognitions in determining parental
engagement (Nordstrom, 2004). Our study is unique in its consideration of several
dimensions of parental engagement in treatment; in addition to simply measuring
session attendance - a common proxy for treatment engagement - we also examine
aspects of parents’ behavior during program sessions, including attitude and
openness, comprehension of principles, homework completion, and verbal
participation.
In this study, we will explore the role of cognitive and non-cognitive variables in
predicting treatment engagement in a school-based parent training program. This
manualized program, called Strong Start, provides a 10-week parent group and
teacher group intervention targeting kindergarten children with disruptive
behavior problems. Strong Start has been found to improve children’s behavioral
and social adjustment and promote parent-school relationships during the
transition to kindergarten. We explore the effects of three aspects of parental beliefs
– 1) locus of control; 2) attributions about the causes of their child’s problems, and
3) sense of adverse consequences of their child’s behavior – on parental engagement
in the program. In addition to these cognitive variables, we examine the effects of
other variables such as demographics, parent mental health, and severity of
problem behaviors in children. Finally, we examine how these factors contribute to
treatment response, including child behavior change, parent-teacher relationship
quality, and parental school involvement at post-treatment.
Methods
Participants are 88 parents whose children were enrolled in a randomized,
controlled trial of Strong Start. Children were from 33 kindergarten classes in seven
urban public schools; schools were block-randomized to receive the 10-week
intervention either in September-December (n=40) or in February-April (n=48) of
the children’s kindergarten year. All participating parents had enrolled in the
program due to child behavioral difficulties during the transition to kindergarten.
Parent- and teacher-report assessments were completed before and after each
round of the intervention. Parental attributions about the causes of their children’s
behavior problems were measured via parent report on a modified version of the
Beliefs About Causes questionnaire (Yeh et al., 2005). Scores along four dimensions
of parent attribution style were calculated, including parent-related, child-related,
biological, and external attributions. Parents’ locus of control (internal versus
external) and beliefs about adverse consequences of their children’s behavior were
measured using the Parental Belief Systems Questionnaire (PBSQ; Rooke,
Thompson, & Day, 2004), and parents’ general distress and parenting-related stress
were measured with the Parenting Stress Index (PSI; Abidin, 1995). Behavioral
observers coded parent behavioral engagement during each program session along
the following dimensions: attendance, homework completion, attitude/openness,
comprehension of principles, and verbal participation. A composite engagement
variable was created, combining parents’ mean scores on attitude/openness,
comprehension, and verbal participation, weighted by the number of sessions
attended.
Key measures of parent- and teacher-reported child adjustment, assessed at preand post-treatment, included the Child Behavior Checklist and the CaregiverTeacher Report Form (Achenbach & Rescorla, 2000). The family-school relationship,
measured as parent-teacher relationship quality and parental school involvement,
was assessed via parent- and teacher-report on the Parent and Teacher Involvement
Scale (NICHD Early Child Care Research Network, 2005).
In our sample, 91% of primary participating parents were female and 71% of
children were male. Thirty-seven percent of parents had immigrated to the United
States and were non-native English speakers. Children were largely white in racial
make-up (63%), but the sample includes children identified as Latino (16%), Middle
Eastern (9%), Asian-American (6%), African-American (2%), and other (4%).
Results and Discussion
We identified demographic differences in parental cognitions and engagement;
white parents were more likely to endorse child-related attributions than other
parents and showed higher overall engagement than other parents. Meanwhile,
parents with lower education or lower family income were more likely to endorse
external attributions for their child’s behavior problems. No other demographic
differences were identified. Child race was covaried in all relevant analyses.
Parent attendance compared favorably to that of similar interventions; on average,
parents attended 7.3 of 10 sessions, and attrition was 11.6% with 10 parents
dropping out after 2 or fewer sessions. In preliminary analyses, correlations
between parental attributions (including parent-related, child-related, biological,
and external attributions) and parental engagement were non-significant. Likewise,
parents’ locus control did not significantly predict engagement. Meanwhile, parents’
perceptions of adverse consequences on the PBSQ (specifically, perceptions of
negative effect of the behavior problems on the child) and parental distress on the
PSI each significantly contributed to parental engagement. Regression analyses
revealed that parental distress and perceptions of adverse consequences together
accounted for 11.5% of the variance in parental engagement [F(2,69) = 4.49, p =
.015]; parents experiencing more distress and perceiving higher negative effects of
the child’s behavior problems were less engaged in the program. In turn, parental
engagement factors significantly predicted treatment-related improvement in both
parent-teacher relationship quality and parental school involvement (r = .33 to .41).
Subsequent analyses will examine specific attributions about the causes of child
behavior problems as possible predictors of treatment engagement. We will also
consider socio-economic resources and behavior problem severity as predictors of
engagement. Findings suggest that parental cognitions make a small but significant
contribution to predicting parental engagement, and imply that perceived severity
of parent and child distress is a barrier to program engagement. Results also
underscore the potential importance of social and economic resources in
determining program engagement. Findings will be discussed in light of existing
literature on recruitment and retention efforts in parent-focused interventions.