Emotion Regulation and Organizational Skills in Children With ADHD Symptoms Are Associated With Behavioral Parent Training Adherence.

OBJECTIVE: Behavioral parent training (BPT) is a well-established treatment for ADHD; however, treatment response is variable. Consistency in parent skill use during BPT is known to influence child outcomes post-treatment, while less research has focused on specific child factors that may be impacting parent skill utilization during treatment. The current study examined associations between child organizational skills and emotion dysregulation (ED) with parent treatment adherence during BPT and post-treatment child impairment. METHOD: Parents of 72 children (Mage = 8.31) with ADHD symptoms and impairment participated in BPT which was embedded in a 12-week, multicomponent, school-based intervention for children delivered by school mental health clinicians. Outcomes included parent treatment adherence and child improvements in global impairment post-treatment. RESULTS: Greater pre-treatment child organizational problems were associated with less parent treatment adherence regardless of ADHD symptom severity. Worse pre-treatment child ED was associated with more impairment post-treatment regardless of ADHD symptom severity whereas the effects of child ED on parent treatment adherence were moderated by child ADHD symptom severity. CONCLUSION: The current study suggests that pre-treatment child ED and organizational difficulties impact parent treatment adherence to behavioral interventions targeting ADHD symptoms, potentially in unique ways, and should be considered in future BPT treatment studies.

Parental Cognitions, Treatment Engagement, and Child Outcomes of ADHD Behavioral Treatment among Asian American Families.

Asian American (AA) families remain critically underrepresented in clinical trials for ADHD interventions. Little is known about AA families' engagement in and outcomes of behavioral treatment (BT). Comparing AA families to other minoritized (OM) families and White families, this study examined parental cognitions, treatment engagement, and child outcomes of BT for ADHD inattentive type (ADHD-I). Path analyses were conducted utilizing data from a randomized controlled trial of BT for ADHD-I (N = 199 children, ages 7-11). Racial/ethnic differences in pretreatment parental self-competence and treatment expectations were examined for AA (n = 29) compared to OM (n = 35) and White (n = 135) parents. Two additional path models were conducted to examine the relations among race/ethnicity, pretreatment parental cognitions, treatment engagement, and posttreatment child outcomes. Direct effects of race/ethnicity and parental cognitions on posttreatment child outcomes as well as their indirect effects via treatment engagement were estimated. At pretreatment, AA parents endorsed lower parental self-competence and treatment expectations compared to OM and White parents. At posttreatment, AA parents reported fewer improvements in ADHD symptoms than White parents and lower global psychosocial improvement than OM parents. For all parents, treatment expectations positively predicted parent- and observer-rated treatment engagement, which in turn predicted child global psychosocial improvement. Path analyses indicated that the relationship between treatment expectations and posttreatment child global improvement was fully mediated by treatment engagement. These findings suggest that treatment expectations impede AA parents' engagement and success in BT. Implications for cultural adaptations of BT to improve AA families' treatment experience are discussed.

Development of a Web-Based Training Platform for School Clinicians in Evidence-Based Practices for ADHD.

Lack of training for school clinicians in evidence-based practices (EBPs) contributes to underutilization of such services for youth with attention-deficit/hyperactivity disorder (ADHD). Advances in web-based technology and videoconferencing have allowed for expanded access to and optimization of training. We describe the development and outcomes of a novel web-based platform for training school clinicians to gain skills in EBPs for school-age youth with ADHD. The training platform is adapted from an empirically supported, in-person training for a school-home behavioral intervention (Collaborative Life Skills program) and includes skill modules for working with teachers, parents, and students. Training methods include web-accessed manuals/handouts, skill example video clips, automated progress monitoring tools, and consultation/in-session coaching via videoconferencing. We gathered stakeholder qualitative and quantitative feedback during discovery and design phases of the iterative development. We then evaluated the usability, acceptability, fidelity and clinician and student outcomes of the remote training program. Focus group themes and qualitative feedback identified clinician preferences for remote training features (e.g., interactive, brief, role-plays/coaching methods), video tools (recorded samples of skills and therapy sessions), and progress monitoring tools (e.g., clear, easy to use). Clinician usability ratings of the platform were high with most components rated as moderately to very useful/easy to use. Clinician ratings of usability, fidelity implementing the treatment, and their EBP knowledge and confidence following training were favorable. Student's outcomes were similar to those achieved in prior studies of clinician in-person training. Results support the promise of remote, web-based clinician training for the dissemination of evidence-based practices.

Improving Adherence to Behavioral Parent Training for ADHD Using Digital Health Tools.

Behavioral Parent Training (BPT) is a well-established treatment for school-age children with ADHD but lack of parent adherence to prescribed parenting strategies limits treatment gains. Digital Health (dHealth) tools can be leveraged to target barriers to parent adherence but existing tools for parenting interventions are limited. New efforts to develop a dHealth tool to target adherence barriers including limited skill competence, EF processes, and low motivation/negative attitudes, are presented and recommendations for future technology-enhanced treatments are provided.

Parent-Child Conflict Profiles in Chinese American Immigrant Families: Links to Sociocultural Factors and School-Age Children's Psychological Adjustment.

Research suggests that parent-child conflict is a salient family process in Asian immigrant families and often a stressful experience for Asian American youth due to value discrepancies between Asian and Western cultures. The present study examined ratings of parent-child conflict across conflict topics from parents' and children's perspectives in a sample of Chinese American immigrant families with school-age children (N = 239; age = 7.5-11 years). Latent profile analyses identified three parent-rated conflict profiles and four child-rated conflict profiles. Parent and child conflict profiles were unrelated to each other and differentially related to family sociocultural factors and children's psychological adjustment. Parents' moderate conflict profile scored highest on parent-rated child behavior problems and had the highest household density and lower parent Chinese orientation. Children's moderate-specific and high conflict profiles scored higher on child-reported behavior problems than the low conflict profile. These results highlight the need to assess family conflict from both parents' and children's perspectives and target parent-child conflict communication as a pathway to prevent or reduce behavioral problems in Chinese American children of immigrant families.

Las investigaciones sugieren que el conflicto entre padres e hijos es un proceso familiar destacado en las familias de inmigrantes asiáticos, y generalmente una experiencia estresante para los jóvenes estadounidenses de origen asiático debido a las discrepancias de valores entre las culturas asiáticas y occidentales. El presente estudio analizó las evaluaciones del conflicto entre padres e hijos entre varios temas de conflicto desde las perspectivas de los padres y los hijos en un muestra de familias de inmigrantes sinoestadounidenses con niños en edad escolar (N = 239; edad = 7.5 a 11 años). Los análisis de perfiles latentes identificaron tres perfiles de conflicto evaluados por los padres y cuatro perfiles de conflicto evaluados por los niños. Los perfiles de conflicto de los padres y los hijos no se relacionaron entre sí, y estuvieron asociados diferencialmente con los factores socioculturales familiares y con los resultados de la adaptación de los niños. El perfil de conflicto moderado de los padres tuvo el puntaje más alto en los problemas de comportamiento de los niños evaluados por los padres, tuvo la densidad familiar más alta y una menor orientación china de los padres. Los perfiles de conflicto alto y moderado-específico de los niños tuvieron un mayor puntaje en los problemas de comportamiento informados por los niños que el perfil de conflicto bajo. Estos resultados destacan la necesidad de evaluar el conflicto familiar tanto desde las perspectivas de los padres como desde las de los niños y se centran en la comunicación de conflictos entre padres e hijos como vía para evitar o reducir los problemas de comportamiento en los niños sinoestadounidenses de familias inmigrantes.

Language Proficiency, Parenting Styles, and Socioemotional Adjustment of Young Dual Language Learners.

Dual language learners (DLLs) make up 32% of all children in the U.S. Past research showed that proficiency in a heritage language (HL) was associated with better psychological adjustment in school-aged children and adolescents, but the associations of HL and English (EL) proficiency to preschool-aged DLLs' socioemotional adjustment remain understudied. This study included a sample of low-income Mexican and Chinese immigrant families with preschool-aged DLLs (N = 90). Children's HL and EL proficiencies were assessed using language tests. Parents rated their own cultural orientations, parenting styles, and children's socioemotional adjustment. Children's expressed anger/frustration and sadness were observed from an emotion-evoking task. Path analyses were conducted to test: 1) the unique relations of children's HL and EL proficiency and parents' American and heritage cultural orientations to parenting styles, and 2) the relations of parenting styles to children's adjustment. Results showed that children's expressive HL proficiency and parents' American and heritage cultural orientations were positively associated with authoritative parenting, which in turn, was associated with children's lower externalizing problems and higher prosocial behaviors. Children's expressive EL was negatively associated with parents' use of authoritarian parenting, and both expressive and receptive HL were negatively associated with children's expressed sadness. These results indicate that children's HL development and parents' host and heritage cultural orientations are associated with socioemotional benefits for young DLLs growing up in low-income immigrant families.

Intrusive Parenting in Chinese American Immigrant Families: Relations with Cultural Orientations and Children's Adjustment.

This multi-method study examined associations between observed and parent- and child-reported intrusive parenting, parent and child cultural orientations, and children's adjustment in a socioeconomically diverse sample of Chinese American immigrant families. Participants were 239 Chinese American school-aged children (M age = 9.19 years, range = 7.49 to 10.96 years) and their parents from first- and second-generation immigrant families. Parents and children reported on parents' intrusive parenting, their own cultural orientations, and parents and teachers reported on children's internalizing and externalizing problems. Observed intrusive parenting behaviors were coded from videotaped parent-child conflict discussions. Findings from path analysis indicated that there was a unique positive association between child Chinese orientation and child-reported intrusive parenting, a unique negative association between parents' American orientation and child reported intrusive parenting, and a unique positive association between child American orientation and observed intrusive parenting. Intrusive parenting was negatively associated with child adjustment, but associations varied depending on measurement. Findings suggest that different measures of intrusive parenting are differentially associated with children's adjustment in Chinese American immigrant families.