Influence of Risk Factors for Child Disruptive Behavior on Parent Attendance at a Preventive Intervention
Ryan, Sarah M., Boxmeyer, Caroline L., Lochman, John E., Behavioral Disorders
Although preventive interventions that include both parent and child components produce stronger effects on disruptive behavior than child-only interventions, engaging parents in behavioral parent training is a significant challenge. This study examined the effects of specific risk factors for child disruptive behavior on parent attendance in behavioral parent training. Structural equation modeling was used to test the impact of parenting characteristics, children's social goals, and contextual characteristics on parent attendance in the parent component of the Coping Power preventive intervention, as well as interrelations among these latent variables. The sample included 121 aggressive at-risk fifth-grade children and their parents who were randomly assigned to the intervention condition in a controlled trial. Parenting characteristics were the strongest predictor of parent intervention attendance and were found to mediate the relationship between contextual factors and parent attendance and children's social goals. These analyses support and expand previous findings that parent attendance in behavioral parent training is systematically associated with risk factors for child disruptive behavior and highlight the role of parenting characteristics. Innovative strategies are needed for teaching positive parenting skills to the parents of children at greatest risk.
* Disruptive behavior is the most frequent referral problem to youth mental health clinics (Kazdin, Siegel, & Bass, 1990) and can exact a heavy toll on individuals, families, and communities. A number of programs have been developed to prevent (Creenberg, Domitrovich, & Bumbarger, 2000) and treat (Brestan & Eyberg, 1998) disruptive behavior disorders. Given the critical role parents play in shaping children's behavior, it is important to involve parents in intervention. This is particularly important for parents of children with disruptive behavior problems because they tend to be less effective in managing their children's behavior and tend to use less positive parenting practices (Hawkins et al., 1998).
Many studies have established the efficacy of behavioral parent training in reducing disruptive behavior in children (e.g., Brestan & Eyberg, 1998). Multicomponent programs that combine parent and child interventions have proven to be most effective in treating (Kazdin & Weisz, 2003) and preventing (Greenberg et al., 2000) disruptive behavior problems. For example, children who participated in a cognitive behavioral skills training program and whose parents were offered a simultaneous behavioral parent training program showed greater reductions in disruptive behavior and lower rates of substance use 1 year following intervention than children who received the child-only intervention (Lochman & Wells, 2004).
Despite the improved outcomes of programs that include parent intervention components, engaging parents in such programs is often a significant challenge. Many programs experience low parent participation and attendance rates (e.g., Barkley et al., 2000; Haggerty et al., 2002; Lee, August, Bloomquist, Mathy, & Realmuto, 2006). Engaging parents is particularly difficult for prevention programs that seek to work with children and families before the child's disruptive behavior problems escalate to the point of causing significant legal, academic, or family problems (Coie et al., 1993; Haggerty et al., 2002). Parents typically do not seek out preventive services themselves and may not yet recognize the need for change. Consequently, parent attendance at preventive intervention sessions is often very low (e.g., in the 30% range; Garvey, iulion, Fogg, Kratovil, & Gross, 2006).
Although overall parent attendance at preventive interventions is often quite low, many outcome studies include a subset of parents who attend most or all of the intervention sessions offered. This is an important source of variability to examine, as parent attendance (Lochman, Boxmeyer, Powell, Roth, & Windle, 2006) and engagement (Garvey et al. …